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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-ProstateCaAvoidanceBoneScanOveruseFHIR.html
Url https://madie.cms.gov/Measure/ProstateCaAvoidanceBoneScanOveruseFHIR
Version 0.3.000
Status draft
Date 2024-12-16T18:17:11+00:00
Name ProstateCaAvoidanceBoneScanOveruseFHIR
Title Prostate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsFHIR
Experimental False
Description Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy who did not have a bone scan performed at any time since diagnosis of prostate cancer
Purpose UNKNOWN
Copyright Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. The PCPI’s and American Medical Association's (AMA) significant past efforts and contributions to the development and updating of the Measure is acknowledged. CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is 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 is copyright 2023 World Health Organization. All Rights Reserved.

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Narrative

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

Title: Prostate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsFHIR
Id: ProstateCaAvoidanceBoneScanOveruseFHIR
Version: 0.3.000
Url: Prostate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsFHIR
short-name identifier:

CMS129FHIR

version-independent identifier:

urn:uuid:a9fa2b95-f5f7-4ff4-931c-b47df9d6371f

version-specific identifier:

urn:uuid:571966b9-0a41-46ee-9e75-b9a8d3b4f3b4

publisher (CMS) identifier:

129FHIR

Effective Period: 2025-01-01..2025-12-31
Status: draft
Publisher: Centers for Medicare & Medicaid Services (CMS)
Author: Mathematica, American Medical Association (AMA)
Description:

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy who did not have a bone scan performed at any time since diagnosis of prostate cancer
Purpose:

UNKNOWN
Copyright:

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. The PCPI’s and American Medical Association's (AMA) significant past efforts and contributions to the development and updating of the Measure is acknowledged. CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is 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 is copyright 2023 World Health Organization. All Rights Reserved.
Disclaimer:

The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R].
Scoring:

Proportion

Rationale:

Multiple studies have indicated that a bone scan is not clinically necessary for staging prostate cancer in men with a low (or very low) risk of recurrence and receiving primary therapy. For patients who are categorized as low risk, bone scans are unlikely to identify their disease. Furthermore, bone scans are not necessary for low risk patients who have no history of bony involvement or if the clinical examination suggests no bony involvement. Less than 1% of low risk patients are at risk of metastatic disease. While clinical practice guidelines do not recommend bone scans in low risk prostate cancer patients, overuse is still common. An analysis of prostate cancer patients in the Surveillance, Epidemiology and End Results Medicare database diagnosed from 2004-2007 found that 43% of patients for whom a bone scan was not recommended received it (Falchook, Hendrix, & Chen, 2015). The analysis also found that the use of bone scans in low risk patients leads to an annual cost of $4 million dollars to Medicare. The overuse of bone scan imaging for low risk prostate cancer patients is a concept included on the American Urological Association's (AUA) list in the Choosing Wisely Initiative as a means to promote adherence to evidence-based imaging practices and to reduce health care dollars wasted (AUA, 2019). This measure is intended to promote adherence to evidence-based imaging practices, lessen the financial burden of unnecessary imaging, and ultimately to improve the quality of care for prostate cancer patients in the United States.
Clinical recommendation statement:

For symptomatic patients and/or those with a life expectancy of greater than 5 years, bone imaging is appropriate for patients with unfavorable intermediate-risk prostate cancer, high-risk and very-high-risk prostate cancer (National Comprehensive Cancer Network, 2022) (Evidence Level: Category 2A). Clinicians should not perform routine bone scans in the staging of asymptomatic very low- or low-risk localized prostate cancer patients (AUA, American Society for Radiation Oncology, & Society of Urologic Oncology, 2017) (Strong Recommendation; Evidence Level: Grade C). Very low-risk or low-risk patients are unlikely to have disease identified by bone scan. Accordingly, bone scans are generally unnecessary in patients with newly diagnosed prostate cancer who have a PSA <10.0 ng/mL and a Gleason score less than 7 unless the patient’s history or clinical examination suggests bony involvement. Progression to the bone is much more common in advanced local disease or in high-grade disease that is characterized by fast and aggressive growth into surrounding areas such as bones or lymph nodes (AUA, 2019).
Guidance (Usage): A higher score indicates appropriate treatment of patients with prostate cancer at low (or very low) risk of recurrence. Only patients with prostate cancer with low (or very low) risk of recurrence will be counted in the performance denominator of this measure. In 2022, the American Urological Association published guidance recommending that clinicians not perform bone scan in asymptomatic patients with low or favorable intermediate risk prostate cancer. However, this quality measure remains focused on patients with low (or very low) risk of recurrence. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes. This FHIR-based measure has been derived from the QDM-based measure: CMS 129v14. 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:
65674cb70f81f93fca7d75f2
Initial Population: All patients, regardless of age, with a diagnosis of prostate cancer
Denominator: Equals Initial Population at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy
Numerator: Patients who did not have a bone scan performed after diagnosis of prostate cancer and before the end of the measurement period
Denominator Exception: Documentation of reason(s) for performing a bone scan (including documented pain, salvage therapy, or other medical reasons)
Supplemental Data Elements:

SDE Ethnicity

SDE Payer

SDE Race

SDE Sex
Supplemental Data Guidance : For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity SDE Payer SDE Race SDE Sex
Libraries:
ProstateCaAvoidanceBoneScanOveruseFHIR
Terminology and Other Dependencies:
  • Library/SupplementalDataElements|3.5.000
  • Library/QICoreCommon|2.1.000
  • Library/FHIRHelpers|4.4.000
  • AdministrativeGender
  • Condition Category Codes
  • US Core Condition Category Extension Codes
  • SNOMED CT (all versions)
  • Logical Observation Identifiers, Names and Codes (LOINC)
  • Bone Scan
  • Prostate Cancer
  • Prostate Cancer Treatment
  • Prostate Specific Antigen Test
  • Payer
  • Pain Related to Prostate Cancer
  • Salvage Therapy
    		•
    Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    SDE Sex Out 0 1 Coding
    Numerator 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
    SDE Race Out 0 1 Resource
    Denominator Exceptions Out 0 1 boolean
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Patient(QICorePatient) ethnicity race
    Condition(QICoreCondition) code Pain Warranting Further Investigation for Prostate Cancer Pain Related to Prostate Cancer
    Condition(QICoreCondition) code Prostate Cancer Prostate Cancer
    Observation(QICoreObservation) code effective value Bone Scan Bone Scan
    Observation(QICoreObservation) code effective status status.value value
    Observation(QICoreObservation) code status status.value value effective Prostate Specific Antigen Test Prostate Specific Antigen Test
    Observation(QICoreObservation) code effective status status.value value
    Procedure(QICoreProcedure) code performed status status.value Prostate Cancer Treatment Prostate Cancer Treatment
    Procedure(QICoreProcedure) code performed status status.value Prostate Cancer Treatment Prostate Cancer Treatment
    Procedure(QICoreProcedure) code performed status status.value Prostate Cancer Treatment Prostate Cancer Treatment
    Procedure(QICoreProcedure) code performed status status.value Salvage Therapy Salvage Therapy
    Coverage(QICoreCoverage) type period Payer Type Payer
    Direct Reference Codes:
    display code system
    Male M http://hl7.org/fhir/administrative-gender
    Female F http://hl7.org/fhir/administrative-gender
    Problem List Item problem-list-item http://terminology.hl7.org/CodeSystem/condition-category
    Health Concern health-concern http://hl7.org/fhir/us/core/CodeSystem/condition-category
    Tumor staging (tumor staging) 254292007 http://snomed.info/sct
    T1a: Prostate tumor incidental histologic finding in 5 percent or less of tissue resected (finding) 369833007 http://snomed.info/sct
    T1b: Prostate tumor incidental histologic finding in greater than 5 percent of tissue resected (finding) 369834001 http://snomed.info/sct
    Neoplasm of prostate primary tumor staging category T1c: Tumor identified by needle biopsy (finding) 433351000124101 http://snomed.info/sct
    Neoplasm of prostate primary tumor staging category T2a: Involves one-half of one lobe or less (finding) 433361000124104 http://snomed.info/sct
    Gleason score in Specimen Qualitative 35266-6 http://loinc.org
    Procedure reason record (record artifact) 433611000124109 http://snomed.info/sct
    Logic Definitions:
    Group Scoring Population Criteria Expression
    65674cb70f81f93fca7d75f2 Group scoring: proportion Measure scoring:

    Proportion

    Type:

    Process

    Rate Aggregation: None
    Improvement Notation:

    increase

    Initial Population 
    define "Initial Population":
  exists "Prostate Cancer Diagnosis"
    Denominator 
    define "Denominator":
  "Initial Population"
    and "First Prostate Cancer Treatment during day of Measurement Period" is not null
    and "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a" is not null
    and "Most Recent PSA Test Result is Low"
    and "Most Recent Gleason Score is Low"
    Numerator 
    define "Numerator":
  not exists "Bone Scan Study Performed"
    Denominator Exception 
    define "Denominator Exceptions":
  "Has Diagnosis of Pain related to Prostate Cancer"
    or "Has Salvage Therapy Performed after Prostate Cancer Diagnosis"
    or "Has Bone Scan Study Performed with Documented Reason"
    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
    ProstateCaAvoidanceBoneScanOveruseFHIR SDE Sex 
    define "SDE Sex":
  SDE."SDE Sex"
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Prostate Cancer Diagnosis 
    define "Prostate Cancer Diagnosis":
  [Condition: "Prostate Cancer"] ProstateCancer
    where ProstateCancer.prevalenceInterval ( ) overlaps day of "Measurement Period"
      and ( ProstateCancer.isProblemListItem ( )
          or ProstateCancer.isHealthConcern ( )
      )
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Bone Scan Study Performed 
    define "Bone Scan Study Performed":
  [Observation: "Bone Scan"] BoneScan
    with "Prostate Cancer Diagnosis" ActiveProstateCancer
      such that BoneScan.effective.toInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )
    where BoneScan.effective.toInterval ( ) ends during day of "Measurement Period"
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Numerator 
    define "Numerator":
  not exists "Bone Scan Study Performed"
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Initial Population 
    define "Initial Population":
  exists "Prostate Cancer Diagnosis"
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR First Prostate Cancer Treatment during day of Measurement Period 
    define "First Prostate Cancer Treatment during day of Measurement Period":
  First([Procedure: "Prostate Cancer Treatment"] ProstateCancerTreatment
      where ProstateCancerTreatment.performed.toInterval() ends during day of "Measurement Period"
        and ProstateCancerTreatment.status = 'completed'
      sort by start of performed.toInterval()
  )
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Most Recent Prostate Cancer Staging Tumor Size T1a to T2a 
    define "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a":
  ( Last([Observation: "Tumor staging (tumor staging)"] ProstateCancerStaging
      with "First Prostate Cancer Treatment during day of Measurement Period" FirstProstateCancerTreatment
        such that ProstateCancerStaging.effective.toInterval() starts before start of FirstProstateCancerTreatment.performed.toInterval()
          and ProstateCancerStaging.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ) ) LastProstateCancerStaging
    where ( LastProstateCancerStaging.value ~ "T1a: Prostate tumor incidental histologic finding in 5 percent or less of tissue resected (finding)"
        or LastProstateCancerStaging.value ~ "T1b: Prostate tumor incidental histologic finding in greater than 5 percent of tissue resected (finding)"
        or LastProstateCancerStaging.value ~ "Neoplasm of prostate primary tumor staging category T1c: Tumor identified by needle biopsy (finding)"
        or LastProstateCancerStaging.value ~ "Neoplasm of prostate primary tumor staging category T2a: Involves one-half of one lobe or less (finding)"
    )
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Most Recent PSA Test Result is Low 
    define "Most Recent PSA Test Result is Low":
  ( Last([Observation: "Prostate Specific Antigen Test"] PSATest
      with "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a" MostRecentProstateCancerStaging
        such that PSATest.effective.toInterval() starts before MostRecentProstateCancerStaging.effective.toInterval()
          and PSATest.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ) ) LastPSATest
    return LastPSATest.value as Quantity < 10 'ng/mL'
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Most Recent Gleason Score is Low 
    define "Most Recent Gleason Score is Low":
  ( Last([Observation: "Gleason score in Specimen Qualitative"] GleasonScore
      with "First Prostate Cancer Treatment during day of Measurement Period" FirstProstateCancerTreatment
        such that GleasonScore.effective.toInterval() starts before start of FirstProstateCancerTreatment.performed.toInterval()
          and GleasonScore.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ) ) LastGleasonScore
    return LastGleasonScore.value as Integer <= 6
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Denominator 
    define "Denominator":
  "Initial Population"
    and "First Prostate Cancer Treatment during day of Measurement Period" is not null
    and "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a" is not null
    and "Most Recent PSA Test Result is Low"
    and "Most Recent Gleason Score is Low"
    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
    ProstateCaAvoidanceBoneScanOveruseFHIR 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
    ProstateCaAvoidanceBoneScanOveruseFHIR SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    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
    ProstateCaAvoidanceBoneScanOveruseFHIR SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Has Diagnosis of Pain related to Prostate Cancer 
    define "Has Diagnosis of Pain related to Prostate Cancer":
  exists ( [Condition: "Pain Warranting Further Investigation for Prostate Cancer"] ProstateCancerPain
      with "Prostate Cancer Diagnosis" ActiveProstateCancer
        such that ProstateCancerPain.prevalenceInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )
          and ( ProstateCancerPain.isProblemListItem ( )
              or ProstateCancerPain.isHealthConcern ( )
          )
  )
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Has Salvage Therapy Performed after Prostate Cancer Diagnosis 
    define "Has Salvage Therapy Performed after Prostate Cancer Diagnosis":
  exists ( [Procedure: "Salvage Therapy"] SalvageTherapy
      with "Prostate Cancer Diagnosis" ActiveProstateCancer
        such that SalvageTherapy.performed.toInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )
          and SalvageTherapy.status = 'completed'
  )
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Has Bone Scan Study Performed with Documented Reason 
    define "Has Bone Scan Study Performed with Documented Reason":
  exists "Bone Scan Study Performed" BoneScanAfterDiagnosis
    where BoneScanAfterDiagnosis.value ~ "Procedure reason record (record artifact)"
    Library Name Name
    ProstateCaAvoidanceBoneScanOveruseFHIR Denominator Exceptions 
    define "Denominator Exceptions":
  "Has Diagnosis of Pain related to Prostate Cancer"
    or "Has Salvage Therapy Performed after Prostate Cancer Diagnosis"
    or "Has Bone Scan Study Performed with Documented Reason"
    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
    QICoreCommon isProblemListItem 
    /*
@description: Returns true if the given condition is a problem list item.
*/
define fluent function isProblemListItem(condition Condition):
  exists (condition.category C
    where C ~ "problem-list-item"
  )
    Library Name Name
    FHIRHelpers ToConcept 
    /*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }
    Library Name Name
    QICoreCommon isHealthConcern 
    /*
@description: Returns true if the given condition is a health concern
*/
define fluent function isHealthConcern(condition Condition):
  exists (condition.category C
    where C ~ "health-concern"
  )
    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
        }

    Source

    {
      "resourceType" : "Measure",
      "id" : "ProstateCaAvoidanceBoneScanOveruseFHIR",
      "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;\">Prostate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsFHIR</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">0.3.000</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Url: </b></th>\n                <td style=\"padding-left: 4px;\"><a href=\"Measure-ProstateCaAvoidanceBoneScanOveruseFHIR.html\">Prostate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsFHIR</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>CMS129FHIR</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:a9fa2b95-f5f7-4ff4-931c-b47df9d6371f</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:571966b9-0a41-46ee-9e75-b9a8d3b4f3b4</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>129FHIR</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;\">Centers for Medicare &amp; Medicaid Services (CMS)</td>\n            </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Author: </b></th>\n            <td style=\"padding-left: 4px;\">Mathematica, American Medical Association (AMA)</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, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy who did not have a bone scan performed at any time since diagnosis of prostate cancer</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 user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.   The PCPI’s and American Medical Association's (AMA) significant past efforts and contributions to the development and updating of the Measure is acknowledged.  CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is 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 is 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 Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.   THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.  Due to technical limitations, registered trademarks are indicated by (R) or [R].</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>Multiple studies have indicated that a bone scan is not clinically necessary for staging prostate cancer in men with a low (or very low) risk of recurrence and receiving primary therapy. For patients who are categorized as low risk, bone scans are unlikely to identify their disease. Furthermore, bone scans are not necessary for low risk patients who have no history of bony involvement or if the clinical examination suggests no bony involvement. Less than 1% of low risk patients are at risk of metastatic disease.  While clinical practice guidelines do not recommend bone scans in low risk prostate cancer patients, overuse is still common. An analysis of prostate cancer patients in the Surveillance, Epidemiology and End Results Medicare database diagnosed from 2004-2007 found that 43% of patients for whom a bone scan was not recommended received it (Falchook, Hendrix, &amp; Chen, 2015). The analysis also found that the use of bone scans in low risk patients leads to an annual cost of $4 million dollars to Medicare. The overuse of bone scan imaging for low risk prostate cancer patients is a concept included on the American Urological Association's (AUA) list in the Choosing Wisely Initiative as a means to promote adherence to evidence-based imaging practices and to reduce health care dollars wasted (AUA, 2019). This measure is intended to promote adherence to evidence-based imaging practices, lessen the financial burden of unnecessary imaging, and ultimately to improve the quality of care for prostate cancer patients in the United States.</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>For symptomatic patients and/or those with a life expectancy of greater than 5 years, bone imaging is appropriate for patients with unfavorable intermediate-risk prostate cancer, high-risk and very-high-risk prostate cancer (National Comprehensive Cancer Network, 2022) (Evidence Level: Category 2A).  Clinicians should not perform routine bone scans in the staging of asymptomatic very low- or low-risk localized prostate cancer patients (AUA, American Society for Radiation Oncology, &amp; Society of Urologic Oncology, 2017) (Strong Recommendation; Evidence Level: Grade C).  Very low-risk or low-risk patients are unlikely to have disease identified by bone scan. Accordingly, bone scans are generally unnecessary in patients with newly diagnosed prostate cancer who have a PSA &lt;10.0 ng/mL and a Gleason score less than 7 unless the patient’s history or clinical examination suggests bony involvement. Progression to the bone is much more common in advanced local disease or in high-grade disease that is characterized by fast and aggressive growth into surrounding areas such as bones or lymph nodes (AUA, 2019).</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;\">A higher score indicates appropriate treatment of patients with prostate cancer at low (or very low) risk of recurrence. Only patients with prostate cancer with low (or very low) risk of recurrence will be counted in the performance denominator of this measure.  In 2022, the American Urological Association published guidance recommending that clinicians not perform bone scan in asymptomatic patients with low or favorable intermediate risk prostate cancer. However, this quality measure remains focused on patients with low (or very low) risk of recurrence.   This eCQM is a patient-based measure.  Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes.   This FHIR-based measure has been derived from the QDM-based measure: CMS 129v14.  Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>\n            </tr>\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Population Criteria: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <table class=\"grid-dict\">\n                                \n                                    <tr>\n                                        <th><b>65674cb70f81f93fca7d75f2</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n\n                                        \n                                            \n                                                <td>All patients, regardless of age, with a diagnosis of prostate cancer</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator:</td>\n\n                                        \n                                            \n                                                <td>Equals Initial Population at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator:</td>\n\n                                        \n                                            \n                                                <td>Patients who did not have a bone scan performed after diagnosis of prostate cancer and before the end of the measurement period</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exception:</td>\n\n                                        \n                                            \n                                                <td>Documentation of reason(s) for performing a bone scan (including documented pain, salvage therapy, or other medical reasons)</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                \n                            </table>\n                        \n                    </td>\n                </tr>\n            \n        \n\n        \n            <tr>\n                <th scope=\"row\"><b> Supplemental Data Elements: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            \n                                <p>SDE Ethnicity</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Payer</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Race</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Sex</p>\n                            \n                        \n                    \n                </td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b> Supplemental Data Guidance\n                        : </b></th>\n                <td style=\"padding-left: 4px;\"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity   SDE Payer   SDE Race   SDE 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-ProstateCaAvoidanceBoneScanOveruseFHIR.html\">ProstateCaAvoidanceBoneScanOveruseFHIR</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://terminology.hl7.org/5.5.0/CodeSystem-condition-category.html\">Condition Category Codes</a></li>\n                        \n                            <li><a href=\"http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-condition-category.html\">US Core Condition Category Extension Codes</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-v3-loinc.html\">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.320/expansion\">Bone Scan</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.319/expansion\">Prostate Cancer</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.398/expansion\">Prostate Cancer Treatment</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.401/expansion\">Prostate Specific Antigen Test</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.451/expansion\">Pain Related to Prostate Cancer</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.399/expansion\">Salvage Therapy</a></li>\n                        \n                    </td>\n                </tr>\n                <tr>\n                    <th scope=\"row\"><b>Parameters:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>name</b></th>\n                                <th><b>use</b></th>\n                                <th><b>min</b></th>\n                                <th><b>max</b></th>\n                                <th><b>type</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Measurement Period</td>\n                                    <td>In</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Period</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Sex</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Coding</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Numerator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>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>SDE Race</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator Exceptions</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</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                                                 Pain Warranting Further Investigation for Prostate Cancer\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.451/expansion\">Pain Related to Prostate Cancer</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                                                 Prostate Cancer\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.319/expansion\">Prostate Cancer</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Bone Scan\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.320/expansion\">Bone Scan</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                            effective\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Prostate Specific Antigen Test\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.401/expansion\">Prostate Specific Antigen Test</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Prostate Cancer Treatment\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.398/expansion\">Prostate Cancer Treatment</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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Prostate Cancer Treatment\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.398/expansion\">Prostate Cancer Treatment</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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Prostate Cancer Treatment\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.398/expansion\">Prostate Cancer Treatment</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                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Salvage Therapy\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.399/expansion\">Salvage Therapy</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Coverage(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html\">QICoreCoverage</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Payer Type\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></td>\n                                </tr>\n                            \n                        </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>Problem List Item</td>\n                                        <td>problem-list-item</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-category.html\">http://terminology.hl7.org/CodeSystem/condition-category</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Health Concern</td>\n                                        <td>health-concern</td>\n                                        <td><a href=\"http://hl7.org/fhir/us/core/STU3.1.1/CodeSystem-condition-category.html\">http://hl7.org/fhir/us/core/CodeSystem/condition-category</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>T1a: Prostate tumor incidental histologic finding in 5 percent or less of tissue resected (finding)</td>\n                                        <td>369833007</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>T1b: Prostate tumor incidental histologic finding in greater than 5 percent of tissue resected (finding)</td>\n                                        <td>369834001</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Neoplasm of prostate primary tumor staging category T1c: Tumor identified by needle biopsy (finding)</td>\n                                        <td>433351000124101</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Neoplasm of prostate primary tumor staging category T2a: Involves one-half of one lobe or less (finding)</td>\n                                        <td>433361000124104</td>\n                                        <td><a href=\"https://browser.ihtsdotools.org/\">http://snomed.info/sct</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Gleason score in Specimen Qualitative</td>\n                                        <td>35266-6</td>\n                                        <td><a href=\"https://loinc.org/\">http://loinc.org</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Procedure reason record (record artifact)</td>\n                                        <td>433611000124109</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> 65674cb70f81f93fca7d75f2 </td>\n                                <td colspan=\"3\" style=\"padding-left: 4px;\">\n                                    \n                                        <b>Group scoring:</b>\n                                        \n                                            <span>  proportion </span>\n                                        \n                                    \n\n                                    \n\n                                    \n                                        <b>Measure scoring:</b>\n                                        \n                                            <p style=\"margin-bottom: 5px;\">\n                                                <span>Proportion</span>\n                                            </p>\n                                        \n                                    \n\n                                    \n\n                                    \n                                        <tr>\n                                        \n                                            <th scope=\"row\"><b>Type: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>Process </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            </td>\n                                        \n                                        </tr>\n                                    \n\n                                    \n\n                                    \n                                    <tr>\n                                        <th scope=\"row\"><b>Rate Aggregation: </b></th>\n                                        <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n                                    </tr>\n                                    \n\n                                    \n                                        <tr>\n                                            <th scope=\"row\"><b>Improvement Notation: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                            \n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>increase </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            \n                                            </td>\n                                        </tr>\n                                    \n\n                                    \n\n                                </td>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Initial Population</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  exists &quot;Prostate Cancer Diagnosis&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;\n    and &quot;First Prostate Cancer Treatment during day of Measurement Period&quot; is not null\n    and &quot;Most Recent Prostate Cancer Staging Tumor Size T1a to T2a&quot; is not null\n    and &quot;Most Recent PSA Test Result is Low&quot;\n    and &quot;Most Recent Gleason Score is Low&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  not exists &quot;Bone Scan Study Performed&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exception</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator Exceptions&quot;:\n  &quot;Has Diagnosis of Pain related to Prostate Cancer&quot;\n    or &quot;Has Salvage Therapy Performed after Prostate Cancer Diagnosis&quot;\n    or &quot;Has Bone Scan Study Performed with Documented Reason&quot;</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>ProstateCaAvoidanceBoneScanOveruseFHIR</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>ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n                            \n                            \n                                <td>Prostate 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;Prostate Cancer Diagnosis&quot;:\n  [Condition: &quot;Prostate Cancer&quot;] ProstateCancer\n    where ProstateCancer.prevalenceInterval ( ) overlaps day of &quot;Measurement Period&quot;\n      and ( ProstateCancer.isProblemListItem ( )\n          or ProstateCancer.isHealthConcern ( )\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>ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n                            \n                            \n                                <td>Bone Scan Study Performed</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Bone Scan Study Performed&quot;:\n  [Observation: &quot;Bone Scan&quot;] BoneScan\n    with &quot;Prostate Cancer Diagnosis&quot; ActiveProstateCancer\n      such that BoneScan.effective.toInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )\n    where BoneScan.effective.toInterval ( ) ends during day of &quot;Measurement Period&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>ProstateCaAvoidanceBoneScanOveruseFHIR</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  not exists &quot;Bone Scan Study Performed&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>ProstateCaAvoidanceBoneScanOveruseFHIR</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  exists &quot;Prostate Cancer Diagnosis&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>ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n                            \n                            \n                                <td>First Prostate Cancer Treatment during day 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 Prostate Cancer Treatment during day of Measurement Period&quot;:\n  First([Procedure: &quot;Prostate Cancer Treatment&quot;] ProstateCancerTreatment\n      where ProstateCancerTreatment.performed.toInterval() ends during day of &quot;Measurement Period&quot;\n        and ProstateCancerTreatment.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>ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n                            \n                            \n                                <td>Most Recent Prostate Cancer Staging Tumor Size T1a to T2a</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Most Recent Prostate Cancer Staging Tumor Size T1a to T2a&quot;:\n  ( Last([Observation: &quot;Tumor staging (tumor staging)&quot;] ProstateCancerStaging\n      with &quot;First Prostate Cancer Treatment during day of Measurement Period&quot; FirstProstateCancerTreatment\n        such that ProstateCancerStaging.effective.toInterval() starts before start of FirstProstateCancerTreatment.performed.toInterval()\n          and ProstateCancerStaging.status in { 'final', 'amended', 'corrected' }\n      sort by start of effective.toInterval()\n  ) ) LastProstateCancerStaging\n    where ( LastProstateCancerStaging.value ~ &quot;T1a: Prostate tumor incidental histologic finding in 5 percent or less of tissue resected (finding)&quot;\n        or LastProstateCancerStaging.value ~ &quot;T1b: Prostate tumor incidental histologic finding in greater than 5 percent of tissue resected (finding)&quot;\n        or LastProstateCancerStaging.value ~ &quot;Neoplasm of prostate primary tumor staging category T1c: Tumor identified by needle biopsy (finding)&quot;\n        or LastProstateCancerStaging.value ~ &quot;Neoplasm of prostate primary tumor staging category T2a: Involves one-half of one lobe or less (finding)&quot;\n    )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n                            \n                            \n                                <td>Most Recent PSA Test Result is Low</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Most Recent PSA Test Result is Low&quot;:\n  ( Last([Observation: &quot;Prostate Specific Antigen Test&quot;] PSATest\n      with &quot;Most Recent Prostate Cancer Staging Tumor Size T1a to T2a&quot; MostRecentProstateCancerStaging\n        such that PSATest.effective.toInterval() starts before MostRecentProstateCancerStaging.effective.toInterval()\n          and PSATest.status in { 'final', 'amended', 'corrected' }\n      sort by start of effective.toInterval()\n  ) ) LastPSATest\n    return LastPSATest.value as Quantity &lt; 10 'ng/mL'</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>ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n                            \n                            \n                                <td>Most Recent Gleason Score is Low</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Most Recent Gleason Score is Low&quot;:\n  ( Last([Observation: &quot;Gleason score in Specimen Qualitative&quot;] GleasonScore\n      with &quot;First Prostate Cancer Treatment during day of Measurement Period&quot; FirstProstateCancerTreatment\n        such that GleasonScore.effective.toInterval() starts before start of FirstProstateCancerTreatment.performed.toInterval()\n          and GleasonScore.status in { 'final', 'amended', 'corrected' }\n      sort by start of effective.toInterval()\n  ) ) LastGleasonScore\n    return LastGleasonScore.value as Integer &lt;= 6</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>ProstateCaAvoidanceBoneScanOveruseFHIR</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;\n    and &quot;First Prostate Cancer Treatment during day of Measurement Period&quot; is not null\n    and &quot;Most Recent Prostate Cancer Staging Tumor Size T1a to T2a&quot; is not null\n    and &quot;Most Recent PSA Test Result is Low&quot;\n    and &quot;Most Recent Gleason Score is Low&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>ProstateCaAvoidanceBoneScanOveruseFHIR</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>ProstateCaAvoidanceBoneScanOveruseFHIR</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>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>ProstateCaAvoidanceBoneScanOveruseFHIR</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>ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n                            \n                            \n                                <td>Has Diagnosis of Pain related to Prostate Cancer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Diagnosis of Pain related to Prostate Cancer&quot;:\n  exists ( [Condition: &quot;Pain Warranting Further Investigation for Prostate Cancer&quot;] ProstateCancerPain\n      with &quot;Prostate Cancer Diagnosis&quot; ActiveProstateCancer\n        such that ProstateCancerPain.prevalenceInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )\n          and ( ProstateCancerPain.isProblemListItem ( )\n              or ProstateCancerPain.isHealthConcern ( )\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>ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n                            \n                            \n                                <td>Has Salvage Therapy Performed after Prostate 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;Has Salvage Therapy Performed after Prostate Cancer Diagnosis&quot;:\n  exists ( [Procedure: &quot;Salvage Therapy&quot;] SalvageTherapy\n      with &quot;Prostate Cancer Diagnosis&quot; ActiveProstateCancer\n        such that SalvageTherapy.performed.toInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )\n          and SalvageTherapy.status = 'completed'\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>ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n                            \n                            \n                                <td>Has Bone Scan Study Performed with Documented Reason</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Bone Scan Study Performed with Documented Reason&quot;:\n  exists &quot;Bone Scan Study Performed&quot; BoneScanAfterDiagnosis\n    where BoneScanAfterDiagnosis.value ~ &quot;Procedure reason record (record artifact)&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>ProstateCaAvoidanceBoneScanOveruseFHIR</td>\n                            \n                            \n                                <td>Denominator Exceptions</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator Exceptions&quot;:\n  &quot;Has Diagnosis of Pain related to Prostate Cancer&quot;\n    or &quot;Has Salvage Therapy Performed after Prostate Cancer Diagnosis&quot;\n    or &quot;Has Bone Scan Study Performed with Documented Reason&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>QICoreCommon</td>\n                            \n                            \n                                <td>isProblemListItem</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns true if the given condition is a problem list item.\n*/\ndefine fluent function isProblemListItem(condition Condition):\n  exists (condition.category C\n    where C ~ &quot;problem-list-item&quot;\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToConcept</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>isHealthConcern</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n@description: Returns true if the given condition is a health concern\n*/\ndefine fluent function isHealthConcern(condition Condition):\n  exists (condition.category C\n    where C ~ &quot;health-concern&quot;\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>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                    </table>\n                </td>\n            </tr>\n            \n        \n    \n\n    </table>\n</div>"
      },
      "contained" : [
        {
          "resourceType" : "Library",
          "id" : "effective-data-requirements",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/administrative-gender",
                "code" : "M",
                "display" : "Male"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/administrative-gender",
                "code" : "F",
                "display" : "Female"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-category",
                "code" : "problem-list-item",
                "display" : "Problem List Item"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/us/core/CodeSystem/condition-category",
                "code" : "health-concern",
                "display" : "Health Concern"
              }
            },
            {
              "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://snomed.info/sct",
                "code" : "369833007",
                "display" : "T1a: Prostate tumor incidental histologic finding in 5 percent or less of tissue resected (finding)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "369834001",
                "display" : "T1b: Prostate tumor incidental histologic finding in greater than 5 percent of tissue resected (finding)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "433351000124101",
                "display" : "Neoplasm of prostate primary tumor staging category T1c: Tumor identified by needle biopsy (finding)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "433361000124104",
                "display" : "Neoplasm of prostate primary tumor staging category T2a: Involves one-half of one lobe or less (finding)"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "35266-6",
                "display" : "Gleason score in Specimen Qualitative"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "433611000124109",
                "display" : "Procedure reason record (record artifact)"
              }
            },
            {
              "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" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "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" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Prostate Cancer Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Prostate Cancer Diagnosis\":\n  [Condition: \"Prostate Cancer\"] ProstateCancer\n    where ProstateCancer.prevalenceInterval ( ) overlaps day of \"Measurement Period\"\n      and ( ProstateCancer.isProblemListItem ( )\n          or ProstateCancer.isHealthConcern ( )\n      )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 2
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Bone Scan Study Performed"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Bone Scan Study Performed\":\n  [Observation: \"Bone Scan\"] BoneScan\n    with \"Prostate Cancer Diagnosis\" ActiveProstateCancer\n      such that BoneScan.effective.toInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )\n    where BoneScan.effective.toInterval ( ) ends during day of \"Measurement Period\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 3
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Numerator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Numerator\":\n  not exists \"Bone Scan Study Performed\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 4
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial Population"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial Population\":\n  exists \"Prostate Cancer Diagnosis\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 5
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "First Prostate Cancer Treatment during day of Measurement Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"First Prostate Cancer Treatment during day of Measurement Period\":\n  First([Procedure: \"Prostate Cancer Treatment\"] ProstateCancerTreatment\n      where ProstateCancerTreatment.performed.toInterval() ends during day of \"Measurement Period\"\n        and ProstateCancerTreatment.status = 'completed'\n      sort by start of performed.toInterval()\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 6
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Most Recent Prostate Cancer Staging Tumor Size T1a to T2a\":\n  ( Last([Observation: \"Tumor staging (tumor staging)\"] ProstateCancerStaging\n      with \"First Prostate Cancer Treatment during day of Measurement Period\" FirstProstateCancerTreatment\n        such that ProstateCancerStaging.effective.toInterval() starts before start of FirstProstateCancerTreatment.performed.toInterval()\n          and ProstateCancerStaging.status in { 'final', 'amended', 'corrected' }\n      sort by start of effective.toInterval()\n  ) ) LastProstateCancerStaging\n    where ( LastProstateCancerStaging.value ~ \"T1a: Prostate tumor incidental histologic finding in 5 percent or less of tissue resected (finding)\"\n        or LastProstateCancerStaging.value ~ \"T1b: Prostate tumor incidental histologic finding in greater than 5 percent of tissue resected (finding)\"\n        or LastProstateCancerStaging.value ~ \"Neoplasm of prostate primary tumor staging category T1c: Tumor identified by needle biopsy (finding)\"\n        or LastProstateCancerStaging.value ~ \"Neoplasm of prostate primary tumor staging category T2a: Involves one-half of one lobe or less (finding)\"\n    )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 7
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Most Recent PSA Test Result is Low"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Most Recent PSA Test Result is Low\":\n  ( Last([Observation: \"Prostate Specific Antigen Test\"] PSATest\n      with \"Most Recent Prostate Cancer Staging Tumor Size T1a to T2a\" MostRecentProstateCancerStaging\n        such that PSATest.effective.toInterval() starts before MostRecentProstateCancerStaging.effective.toInterval()\n          and PSATest.status in { 'final', 'amended', 'corrected' }\n      sort by start of effective.toInterval()\n  ) ) LastPSATest\n    return LastPSATest.value as Quantity < 10 'ng/mL'"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 8
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Most Recent Gleason Score is Low"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Most Recent Gleason Score is Low\":\n  ( Last([Observation: \"Gleason score in Specimen Qualitative\"] GleasonScore\n      with \"First Prostate Cancer Treatment during day of Measurement Period\" FirstProstateCancerTreatment\n        such that GleasonScore.effective.toInterval() starts before start of FirstProstateCancerTreatment.performed.toInterval()\n          and GleasonScore.status in { 'final', 'amended', 'corrected' }\n      sort by start of effective.toInterval()\n  ) ) LastGleasonScore\n    return LastGleasonScore.value as Integer <= 6"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 9
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator\":\n  \"Initial Population\"\n    and \"First Prostate Cancer Treatment during day of Measurement Period\" is not null\n    and \"Most Recent Prostate Cancer Staging Tumor Size T1a to T2a\" is not null\n    and \"Most Recent PSA Test Result is Low\"\n    and \"Most Recent Gleason Score is Low\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 10
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  [Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 11
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 12
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "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" : 13
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 14
                }
              ],
              "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" : 15
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 16
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Diagnosis of Pain related to Prostate Cancer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Diagnosis of Pain related to Prostate Cancer\":\n  exists ( [Condition: \"Pain Warranting Further Investigation for Prostate Cancer\"] ProstateCancerPain\n      with \"Prostate Cancer Diagnosis\" ActiveProstateCancer\n        such that ProstateCancerPain.prevalenceInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )\n          and ( ProstateCancerPain.isProblemListItem ( )\n              or ProstateCancerPain.isHealthConcern ( )\n          )\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 17
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Salvage Therapy Performed after Prostate Cancer Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Salvage Therapy Performed after Prostate Cancer Diagnosis\":\n  exists ( [Procedure: \"Salvage Therapy\"] SalvageTherapy\n      with \"Prostate Cancer Diagnosis\" ActiveProstateCancer\n        such that SalvageTherapy.performed.toInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )\n          and SalvageTherapy.status = 'completed'\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 18
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Bone Scan Study Performed with Documented Reason"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Bone Scan Study Performed with Documented Reason\":\n  exists \"Bone Scan Study Performed\" BoneScanAfterDiagnosis\n    where BoneScanAfterDiagnosis.value ~ \"Procedure reason record (record artifact)\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 19
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "ProstateCaAvoidanceBoneScanOveruseFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator Exceptions"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator Exceptions\":\n  \"Has Diagnosis of Pain related to Prostate Cancer\"\n    or \"Has Salvage Therapy Performed after Prostate Cancer Diagnosis\"\n    or \"Has Bone Scan Study Performed with Documented Reason\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 20
                }
              ],
              "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" : 21
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "isProblemListItem"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns true if the given condition is a problem list item.\n*/\ndefine fluent function isProblemListItem(condition Condition):\n  exists (condition.category C\n    where C ~ \"problem-list-item\"\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 22
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
                  "url" : "name",
                  "valueString" : "ToConcept"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 23
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "isHealthConcern"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n@description: Returns true if the given condition is a health concern\n*/\ndefine fluent function isHealthConcern(condition Condition):\n  exists (condition.category C\n    where C ~ \"health-concern\"\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 24
                }
              ],
              "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" : 25
                }
              ],
              "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" : 26
                }
              ],
              "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 ConditionCategory",
              "resource" : "http://terminology.hl7.org/CodeSystem/condition-category"
            },
            {
              "type" : "depends-on",
              "display" : "Code system USCoreConditionCategoryExtensionCodes",
              "resource" : "http://hl7.org/fhir/us/core/CodeSystem/condition-category"
            },
            {
              "type" : "depends-on",
              "display" : "Code system SNOMEDCT",
              "resource" : "http://snomed.info/sct"
            },
            {
              "type" : "depends-on",
              "display" : "Code system LOINC",
              "resource" : "http://loinc.org"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Bone Scan",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.320"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Prostate Cancer",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.319"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Prostate Cancer Treatment",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.398"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Prostate Specific Antigen Test",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.401"
            },
            {
              "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 Pain Warranting Further Investigation for Prostate Cancer",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.451"
            },
            {
              "type" : "depends-on",
              "display" : "Value set Salvage Therapy",
              "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.399"
            }
          ],
          "parameter" : [
            {
              "name" : "Measurement Period",
              "use" : "in",
              "min" : 0,
              "max" : "1",
              "type" : "Period"
            },
            {
              "name" : "SDE Sex",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "Coding"
            },
            {
              "name" : "Numerator",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "boolean"
            },
            {
              "name" : "Denominator",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "boolean"
            },
            {
              "name" : "SDE Payer",
              "use" : "out",
              "min" : 0,
              "max" : "*",
              "type" : "Resource"
            },
            {
              "name" : "Initial Population",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "boolean"
            },
            {
              "name" : "SDE Ethnicity",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "Resource"
            },
            {
              "name" : "SDE Race",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "Resource"
            },
            {
              "name" : "Denominator Exceptions",
              "use" : "out",
              "min" : 0,
              "max" : "1",
              "type" : "boolean"
            }
          ],
          "dataRequirement" : [
            {
              "type" : "Patient",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
              ],
              "mustSupport" : [
                "ethnicity",
                "race"
              ]
            },
            {
              "type" : "Condition",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
              ],
              "mustSupport" : [
                "code"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.451"
                }
              ]
            },
            {
              "type" : "Condition",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
              ],
              "mustSupport" : [
                "code"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.319"
                }
              ]
            },
            {
              "type" : "Observation",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
              ],
              "mustSupport" : [
                "code",
                "effective",
                "value"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.320"
                }
              ],
              "dateFilter" : [
                {
                  "path" : "effective",
                  "valuePeriod" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                        "valueExpression" : {
                          "language" : "text/cql-identifier",
                          "expression" : "Measurement Period"
                        }
                      }
                    ]
                  }
                }
              ]
            },
            {
              "id" : "352",
              "type" : "Observation",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
              ],
              "mustSupport" : [
                "code",
                "effective",
                "status",
                "status.value",
                "value"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "code" : [
                    {
                      "system" : "http://snomed.info/sct",
                      "code" : "254292007",
                      "display" : "Tumor staging (tumor staging)"
                    }
                  ]
                }
              ]
            },
            {
              "type" : "Observation",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
              ],
              "mustSupport" : [
                "code",
                "status",
                "status.value",
                "value",
                "effective"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.401"
                }
              ]
            },
            {
              "id" : "531",
              "type" : "Observation",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
              ],
              "mustSupport" : [
                "code",
                "effective",
                "status",
                "status.value",
                "value"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "code" : [
                    {
                      "system" : "http://loinc.org",
                      "code" : "35266-6",
                      "display" : "Gleason score in Specimen Qualitative"
                    }
                  ]
                }
              ]
            },
            {
              "type" : "Procedure",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
              ],
              "mustSupport" : [
                "code",
                "performed",
                "status",
                "status.value"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.398"
                },
                {
                  "path" : "status.value",
                  "code" : [
                    {
                      "code" : "completed"
                    }
                  ]
                }
              ],
              "dateFilter" : [
                {
                  "path" : "performed",
                  "valuePeriod" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                        "valueExpression" : {
                          "language" : "text/cql-identifier",
                          "expression" : "Measurement Period"
                        }
                      }
                    ]
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "extension" : [
                    {
                      "url" : "targetId",
                      "valueString" : "352"
                    },
                    {
                      "url" : "targetProperty",
                      "valueString" : "effective"
                    }
                  ],
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-relatedRequirement"
                }
              ],
              "type" : "Procedure",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
              ],
              "mustSupport" : [
                "code",
                "performed",
                "status",
                "status.value"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.398"
                },
                {
                  "path" : "status.value",
                  "code" : [
                    {
                      "code" : "completed"
                    }
                  ]
                }
              ],
              "dateFilter" : [
                {
                  "path" : "performed",
                  "valuePeriod" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                        "valueExpression" : {
                          "language" : "text/cql-identifier",
                          "expression" : "Measurement Period"
                        }
                      }
                    ]
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "extension" : [
                    {
                      "url" : "targetId",
                      "valueString" : "531"
                    },
                    {
                      "url" : "targetProperty",
                      "valueString" : "effective"
                    }
                  ],
                  "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-relatedRequirement"
                }
              ],
              "type" : "Procedure",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
              ],
              "mustSupport" : [
                "code",
                "performed",
                "status",
                "status.value"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.398"
                },
                {
                  "path" : "status.value",
                  "code" : [
                    {
                      "code" : "completed"
                    }
                  ]
                }
              ],
              "dateFilter" : [
                {
                  "path" : "performed",
                  "valuePeriod" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                        "valueExpression" : {
                          "language" : "text/cql-identifier",
                          "expression" : "Measurement Period"
                        }
                      }
                    ]
                  }
                }
              ]
            },
            {
              "type" : "Procedure",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
              ],
              "mustSupport" : [
                "code",
                "performed",
                "status",
                "status.value"
              ],
              "codeFilter" : [
                {
                  "path" : "code",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.399"
                },
                {
                  "path" : "status.value",
                  "code" : [
                    {
                      "code" : "completed"
                    }
                  ]
                }
              ]
            },
            {
              "type" : "Coverage",
              "profile" : [
                "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
              ],
              "mustSupport" : [
                "type",
                "period"
              ],
              "codeFilter" : [
                {
                  "path" : "type",
                  "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
                }
              ]
            }
          ]
        }
      ],
      "extension" : [
        {
          "id" : "supplementalDataGuidance",
          "extension" : [
            {
              "url" : "guidance",
              "valueString" : "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity   SDE Payer   SDE Race   SDE Sex   "
            },
            {
              "url" : "usage",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                    "code" : "supplemental-data",
                    "display" : "Supplemental Data"
                  }
                ],
                "text" : "Supplemental Data Guidance"
              }
            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
          "valueReference" : {
            "reference" : "Device/cqf-tooling"
          }
        },
        {
          "id" : "effective-data-requirements",
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
          "valueReference" : {
            "reference" : "#effective-data-requirements"
          }
        }
      ],
      "url" : "https://madie.cms.gov/Measure/ProstateCaAvoidanceBoneScanOveruseFHIR",
      "identifier" : [
        {
          "use" : "usual",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "short-name"
              }
            ]
          },
          "system" : "https://madie.cms.gov/measure/shortName",
          "value" : "CMS129FHIR"
        },
        {
          "use" : "official",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "version-independent"
              }
            ]
          },
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:uuid:a9fa2b95-f5f7-4ff4-931c-b47df9d6371f"
        },
        {
          "use" : "official",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "version-specific"
              }
            ]
          },
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:uuid:571966b9-0a41-46ee-9e75-b9a8d3b4f3b4"
        },
        {
          "use" : "official",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
                "code" : "publisher"
              }
            ]
          },
          "system" : "https://madie.cms.gov/measure/cmsId",
          "value" : "129FHIR",
          "assigner" : {
            "display" : "CMS"
          }
        }
      ],
      "version" : "0.3.000",
      "name" : "ProstateCaAvoidanceBoneScanOveruseFHIR",
      "title" : "Prostate Cancer Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsFHIR",
      "status" : "draft",
      "experimental" : false,
      "date" : "2024-12-16T18:17:11+00:00",
      "publisher" : "Centers for Medicare & Medicaid Services (CMS)",
      "contact" : [
        {
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.cms.gov/"
            }
          ]
        }
      ],
      "description" : "Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy who did not have a bone scan performed at any time since diagnosis of prostate cancer",
      "purpose" : "UNKNOWN",
      "usage" : "A higher score indicates appropriate treatment of patients with prostate cancer at low (or very low) risk of recurrence. Only patients with prostate cancer with low (or very low) risk of recurrence will be counted in the performance denominator of this measure.  In 2022, the American Urological Association published guidance recommending that clinicians not perform bone scan in asymptomatic patients with low or favorable intermediate risk prostate cancer. However, this quality measure remains focused on patients with low (or very low) risk of recurrence.   This eCQM is a patient-based measure.  Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes.   This FHIR-based measure has been derived from the QDM-based measure: CMS 129v14.  Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
      "copyright" : "Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.   The PCPI’s and American Medical Association's (AMA) significant past efforts and contributions to the development and updating of the Measure is acknowledged.  CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is 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 is copyright 2023 World Health Organization. All Rights Reserved.",
      "effectivePeriod" : {
        "start" : "2025-01-01",
        "end" : "2025-12-31"
      },
      "author" : [
        {
          "name" : "Mathematica",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.mathematica.org/"
            }
          ]
        },
        {
          "name" : "American Medical Association (AMA)",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.ama-assn.org/"
            }
          ]
        }
      ],
      "library" : [
        "https://madie.cms.gov/Library/ProstateCaAvoidanceBoneScanOveruseFHIR"
      ],
      "disclaimer" : "The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.   THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.  Due to technical limitations, registered trademarks are indicated by (R) or [R].",
      "scoring" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
            "code" : "proportion",
            "display" : "Proportion"
          }
        ]
      },
      "rationale" : "Multiple studies have indicated that a bone scan is not clinically necessary for staging prostate cancer in men with a low (or very low) risk of recurrence and receiving primary therapy. For patients who are categorized as low risk, bone scans are unlikely to identify their disease. Furthermore, bone scans are not necessary for low risk patients who have no history of bony involvement or if the clinical examination suggests no bony involvement. Less than 1% of low risk patients are at risk of metastatic disease.  While clinical practice guidelines do not recommend bone scans in low risk prostate cancer patients, overuse is still common. An analysis of prostate cancer patients in the Surveillance, Epidemiology and End Results Medicare database diagnosed from 2004-2007 found that 43% of patients for whom a bone scan was not recommended received it (Falchook, Hendrix, & Chen, 2015). The analysis also found that the use of bone scans in low risk patients leads to an annual cost of $4 million dollars to Medicare. The overuse of bone scan imaging for low risk prostate cancer patients is a concept included on the American Urological Association's (AUA) list in the Choosing Wisely Initiative as a means to promote adherence to evidence-based imaging practices and to reduce health care dollars wasted (AUA, 2019). This measure is intended to promote adherence to evidence-based imaging practices, lessen the financial burden of unnecessary imaging, and ultimately to improve the quality of care for prostate cancer patients in the United States.",
      "clinicalRecommendationStatement" : "For symptomatic patients and/or those with a life expectancy of greater than 5 years, bone imaging is appropriate for patients with unfavorable intermediate-risk prostate cancer, high-risk and very-high-risk prostate cancer (National Comprehensive Cancer Network, 2022) (Evidence Level: Category 2A).  Clinicians should not perform routine bone scans in the staging of asymptomatic very low- or low-risk localized prostate cancer patients (AUA, American Society for Radiation Oncology, & Society of Urologic Oncology, 2017) (Strong Recommendation; Evidence Level: Grade C).  Very low-risk or low-risk patients are unlikely to have disease identified by bone scan. Accordingly, bone scans are generally unnecessary in patients with newly diagnosed prostate cancer who have a PSA <10.0 ng/mL and a Gleason score less than 7 unless the patient’s history or clinical examination suggests bony involvement. Progression to the bone is much more common in advanced local disease or in high-grade disease that is characterized by fast and aggressive growth into surrounding areas such as bones or lymph nodes (AUA, 2019).",
      "group" : [
        {
          "id" : "65674cb70f81f93fca7d75f2",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                    "code" : "proportion",
                    "display" : "Proportion"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
              "valueCode" : "boolean"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
                    "code" : "process",
                    "display" : "Process"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
              "valueCode" : "None"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                    "code" : "decrease",
                    "display" : "increase"
                  }
                ]
              }
            }
          ],
          "description" : "Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy who did not have a bone scan performed at any time since diagnosis of prostate cancer",
          "population" : [
            {
              "id" : "39BB4399-7C7D-48B6-A49A-3A73DB83F10F",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              },
              "description" : "All patients, regardless of age, with a diagnosis of prostate cancer",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Initial Population"
              }
            },
            {
              "id" : "BEBCB6B6-6EFC-43CA-ABAC-9B6097BBC2AB",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator",
                    "display" : "Denominator"
                  }
                ]
              },
              "description" : "Equals Initial Population at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator"
              }
            },
            {
              "id" : "E712FB6E-F76B-46C1-BB4E-5E0FEF5C2390",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "numerator",
                    "display" : "Numerator"
                  }
                ]
              },
              "description" : "Patients who did not have a bone scan performed after diagnosis of prostate cancer and before the end of the measurement period",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Numerator"
              }
            },
            {
              "id" : "F352B1F3-5574-4F4D-8E53-6181E6BBC0A5",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator-exception",
                    "display" : "Denominator Exception"
                  }
                ]
              },
              "description" : "Documentation of reason(s) for performing a bone scan (including documented pain, salvage therapy, or other medical reasons)",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator Exceptions"
              }
            }
          ]
        }
      ],
      "supplementalData" : [
        {
          "id" : "sde-ethnicity",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Ethnicity",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Ethnicity"
          }
        },
        {
          "id" : "sde-payer",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Payer",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Payer"
          }
        },
        {
          "id" : "sde-race",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Race",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Race"
          }
        },
        {
          "id" : "sde-sex",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Sex",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Sex"
          }
        }
      ]
    }

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