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define "SDE Sex":
  case
      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
      else null
    end

define "SDE Sex":
  SDE."SDE Sex"

// Jurisdiction of residence (jurisdiction of the patient)
define "Most recent physical home address":
  First(
    Patient.address A
      where A.use = 'home'
        and A.type = 'physical'
      sort by end of period desc
  )

define "Postal Code of Residence":
  "Most recent physical home address".postalCode

define "SDE Postal Code of Residence":
  SurveillanceDataElements."Postal Code of Residence"

define "Qualifying Diastolic Blood Pressure Reading":
	[Observation: "Blood pressure"] BloodPressure
    without ([Encounter: "Encounter Inpatient"]
      union [Encounter: "Emergency Department Evaluation and Management Visit"]) DisqualifyingEncounter
      such that Common.Latest(BloodPressure.effective) during day of DisqualifyingEncounter.period
    where BloodPressure.status in {'final', 'amended'}
      and Common.Latest(BloodPressure.effective) during "Measurement Period"
      and exists (
        BloodPressure.component DiastolicBP
          where DiastolicBP.code ~ "Diastolic blood pressure"
            and (DiastolicBP.value as Quantity).code.value = 'mm[Hg]'
      )

define "Qualifying Systolic Blood Pressure Reading":
	[Observation: "Blood pressure"] BloodPressure
    without ([Encounter: "Encounter Inpatient"]
      union [Encounter: "Emergency Department Evaluation and Management Visit"]) DisqualifyingEncounter
      such that Common.Latest(BloodPressure.effective) during day of DisqualifyingEncounter.period
    where BloodPressure.status in {'final', 'amended'}
      and Common.Latest(BloodPressure.effective) during "Measurement Period"
      and exists (
        BloodPressure.component SystolicBP
          where SystolicBP.code ~ "Systolic blood pressure"
            and (SystolicBP.value as Quantity).code.value = 'mm[Hg]'
      )

define "Blood Pressure Days":
	("Qualifying Diastolic Blood Pressure Reading" DBPExam 
        return Common.Latest(DBPExam.effective)
    ) 
        intersect ("Qualifying Systolic Blood Pressure Reading" SBPExam 
            return Common.Latest(SBPExam.effective)
        )

define "Most Recent Blood Pressure Day":
	Max("Blood Pressure Days")

define "Lowest Diastolic Reading on Most Recent Blood Pressure Day":
	First(
        "Qualifying Diastolic Blood Pressure Reading" DBPReading
		    where Common.Earliest(DBPReading.effective) same day as "Most Recent Blood Pressure Day"
        return singleton from (
            DBPReading.component C
                where C.code ~ "Diastolic blood pressure"
                return C.value as FHIR.Quantity
        ) sort ascending
	)

define "Has Diastolic Blood Pressure Less Than 90":
    "Lowest Diastolic Reading on Most Recent Blood Pressure Day" < 90 'mm[Hg]'

define "Lowest Systolic Reading on Most Recent Blood Pressure Day":
	First(
        "Qualifying Systolic Blood Pressure Reading" SBPReading
		    where Common.Latest(SBPReading.effective) same day as "Most Recent Blood Pressure Day"
        return singleton from (
            SBPReading.component C
                where C.code ~ "Systolic blood pressure"
                return C.value as FHIR.Quantity
        ) sort ascending
    )

define "Has Systolic Blood Pressure Less Than 140":
	"Lowest Systolic Reading on Most Recent Blood Pressure Day" < 140 'mm[Hg]'

define "Numerator":
	"Has Diastolic Blood Pressure Less Than 90"
	    and "Has Systolic Blood Pressure Less Than 140"

define "Essential Hypertension Diagnosis":
	[Condition: "Essential Hypertension"] Hypertension
    where Hypertension.verificationStatus ~ Common."confirmed"
      and Common."Prevalence Period"(Hypertension) overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months]

define "Qualifying Encounters":
  (
	[Encounter: "Office Visit"]
      union [Encounter: "Annual Wellness Visit"]
      union [Encounter: "Preventive Care Services - Established Office Visit, 18 and Up"]
      union [Encounter: "Preventive Care Services - Initial Office Visit, 18 and Up"]
      union [Encounter: "Home Healthcare Services"]
      union [Encounter: "Online Assessments"]
      union [Encounter: "Telephone Visits"]
  ) ValidEncounters
    where FC.ToInterval(ValidEncounters.period) during "Measurement Period"
	  and ValidEncounters.status ~ 'finished' or ValidEncounters.status ~ 'in-progress'

define "Initial Population":
  AgeInYearsAt(date from end of "Measurement Period") in Interval[18, 85]
		and exists "Essential Hypertension Diagnosis"
		and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":
	"Initial Population"

define "SDE Payer":
  [Coverage: type in "Payer"] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }

define "SDE Payer":
  SDE."SDE Payer"

define "State of Residence":
  "Most recent physical home address".state

define "SDE State of Residence":
  SurveillanceDataElements."State of Residence"

// Jurisdiction of care (jurisdiction of the most recent encounter)
// TODO:
//define "Most recent address of care":

// NOTE: Included in eICR
// Occupational Data for Health - Past or Present Job
// http://hl7.org/fhir/us/odh/StructureDefinition-odh-PastOrPresentJob.html
// Observation: LOINC#11341-5, valueCodeableConcept in https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7186

// Social Determinants of Health (SDOH)
// http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/StructureDefinition-SDOHCC-ObservationScreeningResponse.html
// Food insecurity risk: http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/Observation-SDOHCC-ObservationResponseHungerVitalSignQuestion3Example.html
// Observation: LOINC#88124-3, valueCodeableConcept in https://loinc.org/LL2510-7/ (At risk, No risk)
define "Food Insecurity Risk Status":
  First(
    [Observation: "Food insecurity risk [HVS]"] O
      sort by issued desc
  ).value as CodeableConcept

define "SDE Food Insecurity Risk Status":
  SurveillanceDataElements."Food Insecurity Risk Status"

define "SDE Ethnicity":
  (flatten (
      Patient.extension Extension
        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'
          return Extension.extension
    )) E
      where E.url = 'ombCategory'
        or E.url = 'detailed'
      return E.value as Coding

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

// Age
define "Age":
  AgeInYearsAt(end of "Measurement Period")

define "SDE Age":
  SurveillanceDataElements."Age"

define "Has Hospice":
  exists(
    (AC.QualifiedEncounters([Encounter: "Encounter Inpatient"])) HospiceInp
      where (HospiceInp.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
        or HospiceInp.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)")
      and FC.ToInterval(HospiceInp.period) ends during "Measurement Period"
  ) or exists(
    (AC.QualifiedEncounters([Encounter: "Hospice Encounter"])) HospiceEnc
      where FC.ToInterval(HospiceEnc.period) overlaps "Measurement Period"
  ) or exists(
    (AC.QualifiedObservations([Observation: "Hospice care [Minimum Data Set]"])) HospiceObs
      where HospiceObs.value ~ ToConcept("Yes (qualifier value)")
        and FC.ToInterval(HospiceObs.effective) overlaps "Measurement Period"
  ) or exists(
    (AC.QualifiedServiceRequests([ServiceRequest: "Hospice Care Ambulatory"])) HospiceSR
      where FC.ToInterval(HospiceSR.authoredOn) during "Measurement Period"
  ) or exists(
    (AC.QualifiedProcedures([Procedure: "Hospice Care Ambulatory"])) HospiceProc
      where FC.ToInterval(HospiceProc.performed) overlaps "Measurement Period"
  ) or exists(
    (AC.QualifiedConditions([Condition: "Hospice Diagnosis"])) HospiceCareDiagnosis
      where FC.ToPrevalenceInterval(HospiceCareDiagnosis) overlaps "Measurement Period"
  )

define "Pregnancy Or Renal Diagnosis":
	( [Condition: "Pregnancy"]
		union [Condition: "End Stage Renal Disease"]
		union [Condition: "Kidney Transplant Recipient"]
		union [Condition: "Chronic Kidney Disease, Stage 5"] ) PregnancyESRDDiagnosis
      where PregnancyESRDDiagnosis.verificationStatus ~ Common."confirmed"
        and PregnancyESRDDiagnosis.recordedDate during "Measurement Period"

define "End Stage Renal Disease Procedures":
	([Procedure: "Kidney Transplant"]
		union [Procedure: "Dialysis Services"]) ESRDProcedure
		    where ESRDProcedure.status = 'completed'
                and end of Common."Normalize Interval"(ESRDProcedure.performed) on or before end of "Measurement Period"

define "End Stage Renal Disease Encounter":
	[Encounter: "ESRD Monthly Outpatient Services"] ESRDEncounter
		where ESRDEncounter.status in { 'arrived', 'triaged', 'in-progress', 'onleave', 'finished' }
		  and ESRDEncounter.period starts on or before end of "Measurement Period"

define "Has Criteria Indicating Frailty":
  exists(
    (AC.QualifiedDeviceRequests([DeviceRequest: "Frailty Device"])) FrailtyDeviceOrder
      where FrailtyDeviceOrder.authoredOn during day of "Measurement Period"
    ) 
    or exists(
        (AC.QualifiedObservations([Observation: "Medical Equipment Used"])) EquipmentUsed
          where EquipmentUsed.value in "Frailty Device"
            and FC.ToInterval(EquipmentUsed.effective) ends during day of "Measurement Period"
    )
    or exists(
      (AC.QualifiedConditions([Condition: "Frailty Diagnosis"])) FrailtyDiagnosis
        where FC.ToPrevalenceInterval(FrailtyDiagnosis) overlaps "Measurement Period"
    )
    or exists(
      (AC.QualifiedEncounters([Encounter: "Frailty Encounter"])) FrailtyEnc
        where FC.ToInterval(FrailtyEnc.period) overlaps "Measurement Period"
    )
    or exists(
      (AC.QualifiedObservations([Observation: "Frailty Symptom"])) FrailtySymptom
        where FC.ToInterval(FrailtySymptom.effective) overlaps "Measurement Period"
    )

define "Up To One Year Prior Including Measurement Period":
  Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"]

define "Outpatient Encounters With Advanced Illness":
  ((AC.QualifiedEncounters([Encounter: "Outpatient"]))
    union (AC.QualifiedEncounters([Encounter: "Observation"]))
    union (AC.QualifiedEncounters([Encounter: "Emergency Department Visit"]))
    union (AC.QualifiedEncounters([Encounter: "Nonacute Inpatient"]))) OutpatientEnc
      with (AC.QualifiedConditions([Condition: "Advanced Illness"])) AdvanIll
        such that FC.ToPrevalenceInterval(AdvanIll) overlaps "Measurement Period"
      and FC.ToInterval(OutpatientEnc.period) overlaps "Up To One Year Prior Including Measurement Period"

define "Has Two Outpatient Encounters With Advanced Illness on Different Dates of Service":
  from
    "Outpatient Encounters With Advanced Illness" OutpatientEncounter1,
    "Outpatient Encounters With Advanced Illness" OutpatientEncounter2
  where OutpatientEncounter2.period ends 1 day or more after day of end of OutpatientEncounter1.period
  return OutpatientEncounter1

define "Has Inpatient Encounter With Advanced Illness":  
  (AC.QualifiedEncounters([Encounter: "Acute Inpatient"])) InpatientEnc
    with (AC.QualifiedConditions([Condition: "Advanced Illness"])) AdvanIll
      such that FC.ToPrevalenceInterval(AdvanIll) overlaps InpatientEnc.period
        and FC.ToInterval(InpatientEnc.period) overlaps "Up To One Year Prior Including Measurement Period"

define "Has Dementia Medications In Year Before or During Measurement Period":
  (AC.QualifiedMedicationRequests([MedicationRequest: "Dementia Medications"])) DementiaMed
    where exists(
      DementiaMed.dosageInstruction dosage
      where exists(
        FC.ToTimingInterval(dosage.timing)) timing
        where timing overlaps "Up To One Year Prior Including Measurement Period")

define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty":
  (
    AgeInYearsAt(date from end of "Measurement Period") in Interval[66, 80]
      and "Has Criteria Indicating Frailty"
      and (
        exists("Has Two Outpatient Encounters With Advanced Illness on Different Dates of Service")
        or exists("Has Inpatient Encounter With Advanced Illness")
        or exists("Has Dementia Medications In Year Before or During Measurement Period")
      )
  ) 
  or (
    AgeInYearsAt(date from end of "Measurement Period") >= 81
      and "Has Criteria Indicating Frailty"
  )

define "Lives In A Nursing Home":
  Last(
    (AC.QualifiedObservations([Observation: "Housing Status"])) HousingStatus
      where FC.ToInterval(HousingStatus.effective) ends on or before end of "Measurement Period"
        and HousingStatus.value ~ ToConcept("Lives In A Nursing Home (finding)")
    sort by issued ascending
  ) is not null

define "Is Age 66 or Older Living Long Term in a Nursing Home":
  AgeInYearsAt(date from end of "Measurement Period") >= 66
    and "Lives In A Nursing Home"

define "Palliative Care in the Measurement Period":
  exists(
    (AC.QualifiedObservations([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"])) PalliativeObservation
      where FC.ToInterval(PalliativeObservation.effective) overlaps "Measurement Period"
  ) or exists(
    (AC.QualifiedConditions([Condition: "Palliative Care Diagnosis"])) PalliativeDiagnosis
      where FC.ToPrevalenceInterval(PalliativeDiagnosis) overlaps "Measurement Period"
  ) or exists(
    (AC.QualifiedEncounters([Encounter: "Palliative Care Encounter"])) PalliativeEncounter
      where FC.ToInterval(PalliativeEncounter.period) overlaps "Measurement Period"
  ) or exists(
    (AC.QualifiedProcedures([Procedure: "Palliative Care Intervention"])) PalliativeProcedure
      where FC.ToInterval(PalliativeProcedure.performed) overlaps "Measurement Period"
  )

define "Denominator Exclusion":
  Hospice."Has Hospice"
    or exists ("Pregnancy Or Renal Diagnosis")
    or exists ("End Stage Renal Disease Procedures")
    or exists ("End Stage Renal Disease Encounter")
    or FrailtyLTI."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty"
    or FrailtyLTI."Is Age 66 or Older Living Long Term in a Nursing Home"
    or PalliativeCare."Palliative Care in the Measurement Period"

define "SDE Race":
  (flatten (
      Patient.extension Extension
        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'
          return Extension.extension
    )) E
      where E.url = 'ombCategory'
        or E.url = 'detailed'
      return E.value as Coding

define "SDE Race":
  SDE."SDE Race"

define function ToString(value AdministrativeGender): value.value

define function ToString(value AddressUse): value.value

define function ToString(value AddressType): value.value

define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

define function ToQuantity(quantity FHIR.Quantity):
    case
        when quantity is null then null
        when quantity.value is null then null
        when quantity.comparator is not null then
            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')
        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'
              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then
            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }
        else
            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')
    end

define function ToCalendarUnit(unit System.String):
    case unit
        when 'ms' then 'millisecond'
        when 's' then 'second'
        when 'min' then 'minute'
        when 'h' then 'hour'
        when 'd' then 'day'
        when 'wk' then 'week'
        when 'mo' then 'month'
        when 'a' then 'year'
        else unit
    end

define function ToString(value ObservationStatus): value.value

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
        }

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
        }

/*
Returns an interval representing the period during which the condition was prevalent (i.e. onset to abatement)
If the condition is "active", then abatement being unknown
would indicate the condition is ongoing, and the ending boundary of the prevalence
period is inclusive, otherwise, the abatement is considered unknown and the ending boundary
of the prevalence period is exclusive.
Note that when using this function it should be noted that many clinical systems
do not actually capture abatement, so care should be taken when using this function
to meet clinical intent.
*/
define function "Prevalence Period"(condition Condition ):
  if condition.clinicalStatus ~ "active"
    or condition.clinicalStatus ~ "recurrence"
    or condition.clinicalStatus ~ "relapse" then
    Interval[start of "Normalize Interval"(condition.onset), end of "Normalize Abatement"(condition)]
  else
    Interval[start of "Normalize Interval"(condition.onset), end of "Normalize Abatement"(condition))

/**
* Returns an interval representing the abatement of the given condition, if an
abatement element is present, null otherwise.
This function uses the semantics of Normalize Interval to interpret the abatement
element.
*/
define function "Normalize Abatement"(condition Condition ):
  if condition.abatement is FHIR.dateTime then
	  Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]
	else if condition.abatement is FHIR.Period then
	  FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)
	else if condition.abatement is FHIR.string then
  Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value')
	else if condition.abatement is FHIR.Age then
		Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),
			FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)
	else if condition.abatement is FHIR.Range then
	  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),
		  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)
	else if condition.abatement is FHIR.boolean then
	  Interval[end of "Normalize Interval"(condition.onset), condition.recordedDate)
	else null

define function ToDateTime(value dateTime): value.value

define function ToDate(value date): value.value

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in FHIR, allowing this function to be used across any resource.

The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.
If the input is a Period, the result is a DateTime Interval.
If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.
If the input is an instant, the result is a DateTime Interval beginning and ending on that instant.
If the input is a string, an error is raised indicating a single interval cannot be computed from a string.
If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,
and ending immediately prior to when the patient was the given Age plus one year.
If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given
by the low end of the Range, and ending immediately prior to when the patient was the Age given by the
high end of the Range plus one year.

NOTE: Due to the
complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used
with a Timing or String.
*/
define function ToInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):
  case
	  when choice is FHIR.dateTime then
    	Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]
		when choice is FHIR.Period then
  		FHIRHelpers.ToInterval(choice as FHIR.Period)
		when choice is FHIR.instant then
			Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]
		when choice is FHIR.Age then
		  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),
			  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)
		when choice is FHIR.Range then
		  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),
			  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)
		when choice is FHIR.Timing then
			//Interval[FHIRHelpers.ToDateTime(choice as FHIR.timing), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]
		  Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute a single interval from a Timing type')
    when choice is FHIR.string then
      Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value')
		else
			null as Interval<DateTime>
	end

define function ToDateTime(value instant): value.value

define function ToString(value EncounterStatus): value.value

define function ToString(value uri): value.value

/* Common Resource Qualifications and Negations */
define function QualifiedEncounters(value List<FHIR.Encounter>):
  value Encounter
    where (
      //planned | arrived | triaged | in-progress | onleave | finished | cancelled | entered-in-error | unknown
      Encounter.status ~ 'arrived'
      or Encounter.status ~ 'in-progress'
      or Encounter.status ~ 'finished'
      or Encounter.status ~ 'onleave'
      or Encounter.status ~ 'triaged'
    )

define function QualifiedObservations(value List<FHIR.Observation>):
  value Observation
		where (
      //registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown
      Observation.status ~ 'final'
			or Observation.status ~ 'amended'
			or Observation.status ~ 'corrected'
		)

define function QualifiedServiceRequests(value List<FHIR.ServiceRequest>):
  value ServiceRequest
    where (
      //draft | active | on-hold | revoked | completed | entered-in-error | unknown
      ServiceRequest.status ~ 'active'
      or ServiceRequest.status ~ 'completed'
      and ServiceRequest.intent ~ 'order'
    )
    and (
      ServiceRequest.doNotPerform is null
      or ServiceRequest.doNotPerform = false
    )

define function ToString(value ServiceRequestStatus): value.value

define function ToString(value ServiceRequestIntent): value.value

define function ToBoolean(value boolean): value.value

define function QualifiedProcedures(value List<FHIR.Procedure>):
  value Procedure
    where (
      //preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown
      Procedure.status ~ 'completed'
    )

define function ToString(value ProcedureStatus): value.value

define function QualifiedConditions(value List<FHIR.Condition>):
  value Condition
    where (
      FHIRHelpers.ToConcept(Condition.clinicalStatus) ~ FC."active"
    )
    and (
      FHIRHelpers.ToConcept(Condition.verificationStatus) ~ FC."confirmed"
    )

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition resource.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition.
*/
define function ToPrevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)]
else
  Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))

/*
@description: Returns an interval representing the normalized Abatement of a given Condition resource.
@comment: NOTE: Due to the complexity of determining an interval from a String, this function will throw
a run-time exception if used with a Condition instance that has a String as the abatement value.
*/
define function ToAbatementInterval(condition Condition):
	if condition.abatement is FHIR.dateTime then
	  Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]
	else if condition.abatement is FHIR.Period then
	  FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)
	else if condition.abatement is FHIR.string then
    Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value')
	else if condition.abatement is FHIR.Age then
		Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),
			FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)
	else if condition.abatement is FHIR.Range then
	  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),
		  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)
	else if condition.abatement is FHIR.boolean then
	  Interval[end of ToInterval(condition.onset), condition.recordedDate)
	else null

define function QualifiedDeviceRequests(value List<FHIR.DeviceRequest>):
  value DeviceRequest
    where (
      //draft | active | on-hold | revoked | completed | entered-in-error | unknown
      DeviceRequest.status ~ 'completed'
      or DeviceRequest.status ~ 'active'
      and DeviceRequest.intent ~ 'order'
    )

define function ToString(value DeviceRequestStatus): value.value

define function ToString(value RequestIntent): value.value

define function ToString(value string): value.value

define function QualifiedMedicationRequests(value List<FHIR.MedicationRequest>):
  value MedicationRequest
    where (
      //active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown
      (MedicationRequest.status ~ 'active'
        or MedicationRequest.status ~ 'completed'
      )
        and (
          MedicationRequest.doNotPerform is null
          or MedicationRequest.doNotPerform = false
        )
        and MedicationRequest.intent ~ 'order'
    )

define function ToString(value MedicationRequestStatus): value.value

define function ToString(value MedicationRequestIntent): value.value

define function ToTimingInterval(timing FHIR.Timing):
  convert (
    NullToEmptyInterval(ToIntervalFromList(timing.event))
    union NullToEmptyInterval({ToInterval(timing.repeat.bounds as FHIR.Period)})
  ) to List<Interval<DateTime>> except { null }

define function NullToEmptyInterval(value List<Interval<DateTime>>):
  if value is not null then value else { }

define function ToIntervalFromList(value List<FHIR.dateTime>):
  value v
    return ToInterval(v)

Source1

{
  "resourceType": "Measure",
  "id": "ControllingHighBloodPressureFHIR",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "85354-9",
            "display": "blood pressure"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "confirmed",
            "display": "confirmed"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "active",
            "display": "active"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "recurrence",
            "display": "recurrence"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "relapse",
            "display": "relapse"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "88124-3",
            "display": "Food insecurity risk [HVS]"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "428361000124107",
            "display": "Discharge to home for hospice care (procedure)"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "428371000124100",
            "display": "Discharge to healthcare facility for hospice care (procedure)"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "45755-6",
            "display": "Hospice care [Minimum Data Set]"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "373066001",
            "display": "Yes (qualifier value)"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "98181-1",
            "display": "Medical equipment used"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "71802-3",
            "display": "Housing status"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "160734000",
            "display": "Lives in a nursing home (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://loinc.org",
            "code": "71007-9",
            "display": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"
          }
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElementsFHIR4"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  case\n      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }\n      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }\n      else null\n    end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SurveillanceDataElementsFHIR4"
            },
            {
              "url": "name",
              "valueString": "Most recent physical home address"
            },
            {
              "url": "statement",
              "valueString": "// Jurisdiction of residence (jurisdiction of the patient)\ndefine \"Most recent physical home address\":\n  First(\n    Patient.address A\n      where A.use = 'home'\n        and A.type = 'physical'\n      sort by end of period desc\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SurveillanceDataElementsFHIR4"
            },
            {
              "url": "name",
              "valueString": "Postal Code of Residence"
            },
            {
              "url": "statement",
              "valueString": "define \"Postal Code of Residence\":\n  \"Most recent physical home address\".postalCode"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Postal Code of Residence"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Postal Code of Residence\":\n  SurveillanceDataElements.\"Postal Code of Residence\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Qualifying Diastolic Blood Pressure Reading"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Diastolic Blood Pressure Reading\":\n\t[Observation: \"Blood pressure\"] BloodPressure\n    without ([Encounter: \"Encounter Inpatient\"]\n      union [Encounter: \"Emergency Department Evaluation and Management Visit\"]) DisqualifyingEncounter\n      such that Common.Latest(BloodPressure.effective) during day of DisqualifyingEncounter.period\n    where BloodPressure.status in {'final', 'amended'}\n      and Common.Latest(BloodPressure.effective) during \"Measurement Period\"\n      and exists (\n        BloodPressure.component DiastolicBP\n          where DiastolicBP.code ~ \"Diastolic blood pressure\"\n            and (DiastolicBP.value as Quantity).code.value = 'mm[Hg]'\n      )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Qualifying Systolic Blood Pressure Reading"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Systolic Blood Pressure Reading\":\n\t[Observation: \"Blood pressure\"] BloodPressure\n    without ([Encounter: \"Encounter Inpatient\"]\n      union [Encounter: \"Emergency Department Evaluation and Management Visit\"]) DisqualifyingEncounter\n      such that Common.Latest(BloodPressure.effective) during day of DisqualifyingEncounter.period\n    where BloodPressure.status in {'final', 'amended'}\n      and Common.Latest(BloodPressure.effective) during \"Measurement Period\"\n      and exists (\n        BloodPressure.component SystolicBP\n          where SystolicBP.code ~ \"Systolic blood pressure\"\n            and (SystolicBP.value as Quantity).code.value = 'mm[Hg]'\n      )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Blood Pressure Days"
            },
            {
              "url": "statement",
              "valueString": "define \"Blood Pressure Days\":\n\t(\"Qualifying Diastolic Blood Pressure Reading\" DBPExam \n        return Common.Latest(DBPExam.effective)\n    ) \n        intersect (\"Qualifying Systolic Blood Pressure Reading\" SBPExam \n            return Common.Latest(SBPExam.effective)\n        )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Most Recent Blood Pressure Day"
            },
            {
              "url": "statement",
              "valueString": "define \"Most Recent Blood Pressure Day\":\n\tMax(\"Blood Pressure Days\")"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Lowest Diastolic Reading on Most Recent Blood Pressure Day"
            },
            {
              "url": "statement",
              "valueString": "define \"Lowest Diastolic Reading on Most Recent Blood Pressure Day\":\n\tFirst(\n        \"Qualifying Diastolic Blood Pressure Reading\" DBPReading\n\t\t    where Common.Earliest(DBPReading.effective) same day as \"Most Recent Blood Pressure Day\"\n        return singleton from (\n            DBPReading.component C\n                where C.code ~ \"Diastolic blood pressure\"\n                return C.value as FHIR.Quantity\n        ) sort ascending\n\t)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Has Diastolic Blood Pressure Less Than 90"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Diastolic Blood Pressure Less Than 90\":\n    \"Lowest Diastolic Reading on Most Recent Blood Pressure Day\" < 90 'mm[Hg]'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Lowest Systolic Reading on Most Recent Blood Pressure Day"
            },
            {
              "url": "statement",
              "valueString": "define \"Lowest Systolic Reading on Most Recent Blood Pressure Day\":\n\tFirst(\n        \"Qualifying Systolic Blood Pressure Reading\" SBPReading\n\t\t    where Common.Latest(SBPReading.effective) same day as \"Most Recent Blood Pressure Day\"\n        return singleton from (\n            SBPReading.component C\n                where C.code ~ \"Systolic blood pressure\"\n                return C.value as FHIR.Quantity\n        ) sort ascending\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Has Systolic Blood Pressure Less Than 140"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Systolic Blood Pressure Less Than 140\":\n\t\"Lowest Systolic Reading on Most Recent Blood Pressure Day\" < 140 'mm[Hg]'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n\t\"Has Diastolic Blood Pressure Less Than 90\"\n\t    and \"Has Systolic Blood Pressure Less Than 140\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Essential Hypertension Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Essential Hypertension Diagnosis\":\n\t[Condition: \"Essential Hypertension\"] Hypertension\n    where Hypertension.verificationStatus ~ Common.\"confirmed\"\n      and Common.\"Prevalence Period\"(Hypertension) overlaps Interval[start of \"Measurement Period\", start of \"Measurement Period\" + 6 months]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdultOutpatientEncountersFHIR4"
            },
            {
              "url": "name",
              "valueString": "Qualifying Encounters"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Encounters\":\n  (\n\t[Encounter: \"Office Visit\"]\n      union [Encounter: \"Annual Wellness Visit\"]\n      union [Encounter: \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n      union [Encounter: \"Preventive Care Services - Initial Office Visit, 18 and Up\"]\n      union [Encounter: \"Home Healthcare Services\"]\n      union [Encounter: \"Online Assessments\"]\n      union [Encounter: \"Telephone Visits\"]\n  ) ValidEncounters\n    where FC.ToInterval(ValidEncounters.period) during \"Measurement Period\"\n\t  and ValidEncounters.status ~ 'finished' or ValidEncounters.status ~ 'in-progress'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  AgeInYearsAt(date from end of \"Measurement Period\") in Interval[18, 85]\n\t\tand exists \"Essential Hypertension Diagnosis\"\n\t\tand exists AdultOutpatientEncounters.\"Qualifying Encounters\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n\t\"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElementsFHIR4"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  [Coverage: type in \"Payer\"] Payer\n        return {\n          code: Payer.type,\n          period: Payer.period\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SurveillanceDataElementsFHIR4"
            },
            {
              "url": "name",
              "valueString": "State of Residence"
            },
            {
              "url": "statement",
              "valueString": "define \"State of Residence\":\n  \"Most recent physical home address\".state"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE State of Residence"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE State of Residence\":\n  SurveillanceDataElements.\"State of Residence\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SurveillanceDataElementsFHIR4"
            },
            {
              "url": "name",
              "valueString": "Food Insecurity Risk Status"
            },
            {
              "url": "statement",
              "valueString": "// Jurisdiction of care (jurisdiction of the most recent encounter)\n// TODO:\n//define \"Most recent address of care\":\n\n// NOTE: Included in eICR\n// Occupational Data for Health - Past or Present Job\n// http://hl7.org/fhir/us/odh/StructureDefinition-odh-PastOrPresentJob.html\n// Observation: LOINC#11341-5, valueCodeableConcept in https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7186\n\n// Social Determinants of Health (SDOH)\n// http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/StructureDefinition-SDOHCC-ObservationScreeningResponse.html\n// Food insecurity risk: http://build.fhir.org/ig/HL7/fhir-sdoh-clinicalcare/Observation-SDOHCC-ObservationResponseHungerVitalSignQuestion3Example.html\n// Observation: LOINC#88124-3, valueCodeableConcept in https://loinc.org/LL2510-7/ (At risk, No risk)\ndefine \"Food Insecurity Risk Status\":\n  First(\n    [Observation: \"Food insecurity risk [HVS]\"] O\n      sort by issued desc\n  ).value as CodeableConcept"
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Food Insecurity Risk Status"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Food Insecurity Risk Status\":\n  SurveillanceDataElements.\"Food Insecurity Risk Status\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElementsFHIR4"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  (flatten (\n      Patient.extension Extension\n        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'\n          return Extension.extension\n    )) E\n      where E.url = 'ombCategory'\n        or E.url = 'detailed'\n      return E.value as Coding"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SurveillanceDataElementsFHIR4"
            },
            {
              "url": "name",
              "valueString": "Age"
            },
            {
              "url": "statement",
              "valueString": "// Age\ndefine \"Age\":\n  AgeInYearsAt(end of \"Measurement Period\")"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Age"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Age\":\n  SurveillanceDataElements.\"Age\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "HospiceFHIR4"
            },
            {
              "url": "name",
              "valueString": "Has Hospice"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Hospice\":\n  exists(\n    (AC.QualifiedEncounters([Encounter: \"Encounter Inpatient\"])) HospiceInp\n      where (HospiceInp.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n        or HospiceInp.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\")\n      and FC.ToInterval(HospiceInp.period) ends during \"Measurement Period\"\n  ) or exists(\n    (AC.QualifiedEncounters([Encounter: \"Hospice Encounter\"])) HospiceEnc\n      where FC.ToInterval(HospiceEnc.period) overlaps \"Measurement Period\"\n  ) or exists(\n    (AC.QualifiedObservations([Observation: \"Hospice care [Minimum Data Set]\"])) HospiceObs\n      where HospiceObs.value ~ ToConcept(\"Yes (qualifier value)\")\n        and FC.ToInterval(HospiceObs.effective) overlaps \"Measurement Period\"\n  ) or exists(\n    (AC.QualifiedServiceRequests([ServiceRequest: \"Hospice Care Ambulatory\"])) HospiceSR\n      where FC.ToInterval(HospiceSR.authoredOn) during \"Measurement Period\"\n  ) or exists(\n    (AC.QualifiedProcedures([Procedure: \"Hospice Care Ambulatory\"])) HospiceProc\n      where FC.ToInterval(HospiceProc.performed) overlaps \"Measurement Period\"\n  ) or exists(\n    (AC.QualifiedConditions([Condition: \"Hospice Diagnosis\"])) HospiceCareDiagnosis\n      where FC.ToPrevalenceInterval(HospiceCareDiagnosis) overlaps \"Measurement Period\"\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Pregnancy Or Renal Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Pregnancy Or Renal Diagnosis\":\n\t( [Condition: \"Pregnancy\"]\n\t\tunion [Condition: \"End Stage Renal Disease\"]\n\t\tunion [Condition: \"Kidney Transplant Recipient\"]\n\t\tunion [Condition: \"Chronic Kidney Disease, Stage 5\"] ) PregnancyESRDDiagnosis\n      where PregnancyESRDDiagnosis.verificationStatus ~ Common.\"confirmed\"\n        and PregnancyESRDDiagnosis.recordedDate during \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "End Stage Renal Disease Procedures"
            },
            {
              "url": "statement",
              "valueString": "define \"End Stage Renal Disease Procedures\":\n\t([Procedure: \"Kidney Transplant\"]\n\t\tunion [Procedure: \"Dialysis Services\"]) ESRDProcedure\n\t\t    where ESRDProcedure.status = 'completed'\n                and end of Common.\"Normalize Interval\"(ESRDProcedure.performed) on or before end of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "End Stage Renal Disease Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"End Stage Renal Disease Encounter\":\n\t[Encounter: \"ESRD Monthly Outpatient Services\"] ESRDEncounter\n\t\twhere ESRDEncounter.status in { 'arrived', 'triaged', 'in-progress', 'onleave', 'finished' }\n\t\t  and ESRDEncounter.period starts on or before end of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailtyExclusionECQMFHIR4"
            },
            {
              "url": "name",
              "valueString": "Has Criteria Indicating Frailty"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Criteria Indicating Frailty\":\n  exists(\n    (AC.QualifiedDeviceRequests([DeviceRequest: \"Frailty Device\"])) FrailtyDeviceOrder\n      where FrailtyDeviceOrder.authoredOn during day of \"Measurement Period\"\n    ) \n    or exists(\n        (AC.QualifiedObservations([Observation: \"Medical Equipment Used\"])) EquipmentUsed\n          where EquipmentUsed.value in \"Frailty Device\"\n            and FC.ToInterval(EquipmentUsed.effective) ends during day of \"Measurement Period\"\n    )\n    or exists(\n      (AC.QualifiedConditions([Condition: \"Frailty Diagnosis\"])) FrailtyDiagnosis\n        where FC.ToPrevalenceInterval(FrailtyDiagnosis) overlaps \"Measurement Period\"\n    )\n    or exists(\n      (AC.QualifiedEncounters([Encounter: \"Frailty Encounter\"])) FrailtyEnc\n        where FC.ToInterval(FrailtyEnc.period) overlaps \"Measurement Period\"\n    )\n    or exists(\n      (AC.QualifiedObservations([Observation: \"Frailty Symptom\"])) FrailtySymptom\n        where FC.ToInterval(FrailtySymptom.effective) overlaps \"Measurement Period\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailtyExclusionECQMFHIR4"
            },
            {
              "url": "name",
              "valueString": "Up To One Year Prior Including Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Up To One Year Prior Including Measurement Period\":\n  Interval[start of \"Measurement Period\" - 1 year, end of \"Measurement Period\"]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailtyExclusionECQMFHIR4"
            },
            {
              "url": "name",
              "valueString": "Outpatient Encounters With Advanced Illness"
            },
            {
              "url": "statement",
              "valueString": "define \"Outpatient Encounters With Advanced Illness\":\n  ((AC.QualifiedEncounters([Encounter: \"Outpatient\"]))\n    union (AC.QualifiedEncounters([Encounter: \"Observation\"]))\n    union (AC.QualifiedEncounters([Encounter: \"Emergency Department Visit\"]))\n    union (AC.QualifiedEncounters([Encounter: \"Nonacute Inpatient\"]))) OutpatientEnc\n      with (AC.QualifiedConditions([Condition: \"Advanced Illness\"])) AdvanIll\n        such that FC.ToPrevalenceInterval(AdvanIll) overlaps \"Measurement Period\"\n      and FC.ToInterval(OutpatientEnc.period) overlaps \"Up To One Year Prior Including Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailtyExclusionECQMFHIR4"
            },
            {
              "url": "name",
              "valueString": "Has Two Outpatient Encounters With Advanced Illness on Different Dates of Service"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Two Outpatient Encounters With Advanced Illness on Different Dates of Service\":\n  from\n    \"Outpatient Encounters With Advanced Illness\" OutpatientEncounter1,\n    \"Outpatient Encounters With Advanced Illness\" OutpatientEncounter2\n  where OutpatientEncounter2.period ends 1 day or more after day of end of OutpatientEncounter1.period\n  return OutpatientEncounter1"
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailtyExclusionECQMFHIR4"
            },
            {
              "url": "name",
              "valueString": "Has Inpatient Encounter With Advanced Illness"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Inpatient Encounter With Advanced Illness\":  \n  (AC.QualifiedEncounters([Encounter: \"Acute Inpatient\"])) InpatientEnc\n    with (AC.QualifiedConditions([Condition: \"Advanced Illness\"])) AdvanIll\n      such that FC.ToPrevalenceInterval(AdvanIll) overlaps InpatientEnc.period\n        and FC.ToInterval(InpatientEnc.period) overlaps \"Up To One Year Prior Including Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailtyExclusionECQMFHIR4"
            },
            {
              "url": "name",
              "valueString": "Has Dementia Medications In Year Before or During Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Dementia Medications In Year Before or During Measurement Period\":\n  (AC.QualifiedMedicationRequests([MedicationRequest: \"Dementia Medications\"])) DementiaMed\n    where exists(\n      DementiaMed.dosageInstruction dosage\n      where exists(\n        FC.ToTimingInterval(dosage.timing)) timing\n        where timing overlaps \"Up To One Year Prior Including Measurement Period\")"
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailtyExclusionECQMFHIR4"
            },
            {
              "url": "name",
              "valueString": "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty"
            },
            {
              "url": "statement",
              "valueString": "define \"Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty\":\n  (\n    AgeInYearsAt(date from end of \"Measurement Period\") in Interval[66, 80]\n      and \"Has Criteria Indicating Frailty\"\n      and (\n        exists(\"Has Two Outpatient Encounters With Advanced Illness on Different Dates of Service\")\n        or exists(\"Has Inpatient Encounter With Advanced Illness\")\n        or exists(\"Has Dementia Medications In Year Before or During Measurement Period\")\n      )\n  ) \n  or (\n    AgeInYearsAt(date from end of \"Measurement Period\") >= 81\n      and \"Has Criteria Indicating Frailty\"\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailtyExclusionECQMFHIR4"
            },
            {
              "url": "name",
              "valueString": "Lives In A Nursing Home"
            },
            {
              "url": "statement",
              "valueString": "define \"Lives In A Nursing Home\":\n  Last(\n    (AC.QualifiedObservations([Observation: \"Housing Status\"])) HousingStatus\n      where FC.ToInterval(HousingStatus.effective) ends on or before end of \"Measurement Period\"\n        and HousingStatus.value ~ ToConcept(\"Lives In A Nursing Home (finding)\")\n    sort by issued ascending\n  ) is not null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 39
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailtyExclusionECQMFHIR4"
            },
            {
              "url": "name",
              "valueString": "Is Age 66 or Older Living Long Term in a Nursing Home"
            },
            {
              "url": "statement",
              "valueString": "define \"Is Age 66 or Older Living Long Term in a Nursing Home\":\n  AgeInYearsAt(date from end of \"Measurement Period\") >= 66\n    and \"Lives In A Nursing Home\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 40
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "PalliativeCareFHIR"
            },
            {
              "url": "name",
              "valueString": "Palliative Care in the Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Palliative Care in the Measurement Period\":\n  exists(\n    (AC.QualifiedObservations([Observation: \"Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)\"])) PalliativeObservation\n      where FC.ToInterval(PalliativeObservation.effective) overlaps \"Measurement Period\"\n  ) or exists(\n    (AC.QualifiedConditions([Condition: \"Palliative Care Diagnosis\"])) PalliativeDiagnosis\n      where FC.ToPrevalenceInterval(PalliativeDiagnosis) overlaps \"Measurement Period\"\n  ) or exists(\n    (AC.QualifiedEncounters([Encounter: \"Palliative Care Encounter\"])) PalliativeEncounter\n      where FC.ToInterval(PalliativeEncounter.period) overlaps \"Measurement Period\"\n  ) or exists(\n    (AC.QualifiedProcedures([Procedure: \"Palliative Care Intervention\"])) PalliativeProcedure\n      where FC.ToInterval(PalliativeProcedure.performed) overlaps \"Measurement Period\"\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 41
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusion"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusion\":\n  Hospice.\"Has Hospice\"\n    or exists (\"Pregnancy Or Renal Diagnosis\")\n    or exists (\"End Stage Renal Disease Procedures\")\n    or exists (\"End Stage Renal Disease Encounter\")\n    or FrailtyLTI.\"Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty\"\n    or FrailtyLTI.\"Is Age 66 or Older Living Long Term in a Nursing Home\"\n    or PalliativeCare.\"Palliative Care in the Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 42
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElementsFHIR4"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  (flatten (\n      Patient.extension Extension\n        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'\n          return Extension.extension\n    )) E\n      where E.url = 'ombCategory'\n        or E.url = 'detailed'\n      return E.value as Coding"
            },
            {
              "url": "displaySequence",
              "valueInteger": 43
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "ControllingHighBloodPressureFHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 44
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value AdministrativeGender): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 45
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value AddressUse): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 46
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value AddressType): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 47
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToInterval"
            },
            {
              "url": "statement",
              "valueString": "define function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period.\"start\" is null then\n            Interval(period.\"start\".value, period.\"end\".value]\n        else\n            Interval[period.\"start\".value, period.\"end\".value]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 48
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToQuantity"
            },
            {
              "url": "statement",
              "valueString": "define function ToQuantity(quantity FHIR.Quantity):\n    case\n        when quantity is null then null\n        when quantity.value is null then null\n        when quantity.comparator is not null then\n            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')\n        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'\n              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then\n            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }\n        else\n            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')\n    end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 49
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToCalendarUnit"
            },
            {
              "url": "statement",
              "valueString": "define function ToCalendarUnit(unit System.String):\n    case unit\n        when 'ms' then 'millisecond'\n        when 's' then 'second'\n        when 'min' then 'minute'\n        when 'h' then 'hour'\n        when 'd' then 'day'\n        when 'wk' then 'week'\n        when 'mo' then 'month'\n        when 'a' then 'year'\n        else unit\n    end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 50
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value ObservationStatus): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 51
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToConcept"
            },
            {
              "url": "statement",
              "valueString": "define function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 52
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToCode"
            },
            {
              "url": "statement",
              "valueString": "define function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 53
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "MATGlobalCommonFunctionsFHIR4"
            },
            {
              "url": "name",
              "valueString": "Prevalence Period"
            },
            {
              "url": "statement",
              "valueString": "/*\nReturns an interval representing the period during which the condition was prevalent (i.e. onset to abatement)\nIf the condition is \"active\", then abatement being unknown\nwould indicate the condition is ongoing, and the ending boundary of the prevalence\nperiod is inclusive, otherwise, the abatement is considered unknown and the ending boundary\nof the prevalence period is exclusive.\nNote that when using this function it should be noted that many clinical systems\ndo not actually capture abatement, so care should be taken when using this function\nto meet clinical intent.\n*/\ndefine function \"Prevalence Period\"(condition Condition ):\n  if condition.clinicalStatus ~ \"active\"\n    or condition.clinicalStatus ~ \"recurrence\"\n    or condition.clinicalStatus ~ \"relapse\" then\n    Interval[start of \"Normalize Interval\"(condition.onset), end of \"Normalize Abatement\"(condition)]\n  else\n    Interval[start of \"Normalize Interval\"(condition.onset), end of \"Normalize Abatement\"(condition))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 54
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "MATGlobalCommonFunctionsFHIR4"
            },
            {
              "url": "name",
              "valueString": "Normalize Abatement"
            },
            {
              "url": "statement",
              "valueString": "/**\n* Returns an interval representing the abatement of the given condition, if an\nabatement element is present, null otherwise.\nThis function uses the semantics of Normalize Interval to interpret the abatement\nelement.\n*/\ndefine function \"Normalize Abatement\"(condition Condition ):\n  if condition.abatement is FHIR.dateTime then\n\t  Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]\n\telse if condition.abatement is FHIR.Period then\n\t  FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)\n\telse if condition.abatement is FHIR.string then\n  Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value')\n\telse if condition.abatement is FHIR.Age then\n\t\tInterval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),\n\t\t\tFHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)\n\telse if condition.abatement is FHIR.Range then\n\t  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),\n\t\t  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)\n\telse if condition.abatement is FHIR.boolean then\n\t  Interval[end of \"Normalize Interval\"(condition.onset), condition.recordedDate)\n\telse null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 55
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToDateTime"
            },
            {
              "url": "statement",
              "valueString": "define function ToDateTime(value dateTime): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 56
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToDate"
            },
            {
              "url": "statement",
              "valueString": "define function ToDate(value date): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 57
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRCommon"
            },
            {
              "url": "name",
              "valueString": "ToInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in FHIR, allowing this function to be used across any resource.\n\nThe input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.\nIf the input is a Period, the result is a DateTime Interval.\nIf the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.\nIf the input is an instant, the result is a DateTime Interval beginning and ending on that instant.\nIf the input is a string, an error is raised indicating a single interval cannot be computed from a string.\nIf the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,\nand ending immediately prior to when the patient was the given Age plus one year.\nIf the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given\nby the low end of the Range, and ending immediately prior to when the patient was the Age given by the\nhigh end of the Range plus one year.\n\nNOTE: Due to the\ncomplexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used\nwith a Timing or String.\n*/\ndefine function ToInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):\n  case\n\t  when choice is FHIR.dateTime then\n    \tInterval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n\t\twhen choice is FHIR.Period then\n  \t\tFHIRHelpers.ToInterval(choice as FHIR.Period)\n\t\twhen choice is FHIR.instant then\n\t\t\tInterval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]\n\t\twhen choice is FHIR.Age then\n\t\t  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),\n\t\t\t  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)\n\t\twhen choice is FHIR.Range then\n\t\t  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),\n\t\t\t  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)\n\t\twhen choice is FHIR.Timing then\n\t\t\t//Interval[FHIRHelpers.ToDateTime(choice as FHIR.timing), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n\t\t  Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute a single interval from a Timing type')\n    when choice is FHIR.string then\n      Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value')\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
            },
            {
              "url": "displaySequence",
              "valueInteger": 58
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToDateTime"
            },
            {
              "url": "statement",
              "valueString": "define function ToDateTime(value instant): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 59
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value EncounterStatus): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 60
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value uri): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 61
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlphoraCommon"
            },
            {
              "url": "name",
              "valueString": "QualifiedEncounters"
            },
            {
              "url": "statement",
              "valueString": "/* Common Resource Qualifications and Negations */\ndefine function QualifiedEncounters(value List<FHIR.Encounter>):\n  value Encounter\n    where (\n      //planned | arrived | triaged | in-progress | onleave | finished | cancelled | entered-in-error | unknown\n      Encounter.status ~ 'arrived'\n      or Encounter.status ~ 'in-progress'\n      or Encounter.status ~ 'finished'\n      or Encounter.status ~ 'onleave'\n      or Encounter.status ~ 'triaged'\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 62
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlphoraCommon"
            },
            {
              "url": "name",
              "valueString": "QualifiedObservations"
            },
            {
              "url": "statement",
              "valueString": "define function QualifiedObservations(value List<FHIR.Observation>):\n  value Observation\n\t\twhere (\n      //registered | preliminary | final | amended | corrected | cancelled | entered-in-error | unknown\n      Observation.status ~ 'final'\n\t\t\tor Observation.status ~ 'amended'\n\t\t\tor Observation.status ~ 'corrected'\n\t\t)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 63
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlphoraCommon"
            },
            {
              "url": "name",
              "valueString": "QualifiedServiceRequests"
            },
            {
              "url": "statement",
              "valueString": "define function QualifiedServiceRequests(value List<FHIR.ServiceRequest>):\n  value ServiceRequest\n    where (\n      //draft | active | on-hold | revoked | completed | entered-in-error | unknown\n      ServiceRequest.status ~ 'active'\n      or ServiceRequest.status ~ 'completed'\n      and ServiceRequest.intent ~ 'order'\n    )\n    and (\n      ServiceRequest.doNotPerform is null\n      or ServiceRequest.doNotPerform = false\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 64
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value ServiceRequestStatus): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 65
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value ServiceRequestIntent): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 66
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToBoolean"
            },
            {
              "url": "statement",
              "valueString": "define function ToBoolean(value boolean): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 67
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlphoraCommon"
            },
            {
              "url": "name",
              "valueString": "QualifiedProcedures"
            },
            {
              "url": "statement",
              "valueString": "define function QualifiedProcedures(value List<FHIR.Procedure>):\n  value Procedure\n    where (\n      //preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown\n      Procedure.status ~ 'completed'\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 68
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value ProcedureStatus): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 69
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlphoraCommon"
            },
            {
              "url": "name",
              "valueString": "QualifiedConditions"
            },
            {
              "url": "statement",
              "valueString": "define function QualifiedConditions(value List<FHIR.Condition>):\n  value Condition\n    where (\n      FHIRHelpers.ToConcept(Condition.clinicalStatus) ~ FC.\"active\"\n    )\n    and (\n      FHIRHelpers.ToConcept(Condition.verificationStatus) ~ FC.\"confirmed\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 70
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRCommon"
            },
            {
              "url": "name",
              "valueString": "ToPrevalenceInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition resource.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition.\n*/\ndefine function ToPrevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition)]\nelse\n  Interval[start of ToInterval(condition.onset), end of ToAbatementInterval(condition))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 71
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRCommon"
            },
            {
              "url": "name",
              "valueString": "ToAbatementInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns an interval representing the normalized Abatement of a given Condition resource.\n@comment: NOTE: Due to the complexity of determining an interval from a String, this function will throw\na run-time exception if used with a Condition instance that has a String as the abatement value.\n*/\ndefine function ToAbatementInterval(condition Condition):\n\tif condition.abatement is FHIR.dateTime then\n\t  Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]\n\telse if condition.abatement is FHIR.Period then\n\t  FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)\n\telse if condition.abatement is FHIR.string then\n    Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value')\n\telse if condition.abatement is FHIR.Age then\n\t\tInterval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),\n\t\t\tFHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)\n\telse if condition.abatement is FHIR.Range then\n\t  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),\n\t\t  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)\n\telse if condition.abatement is FHIR.boolean then\n\t  Interval[end of ToInterval(condition.onset), condition.recordedDate)\n\telse null"
            },
            {
              "url": "displaySequence",
              "valueInteger": 72
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlphoraCommon"
            },
            {
              "url": "name",
              "valueString": "QualifiedDeviceRequests"
            },
            {
              "url": "statement",
              "valueString": "define function QualifiedDeviceRequests(value List<FHIR.DeviceRequest>):\n  value DeviceRequest\n    where (\n      //draft | active | on-hold | revoked | completed | entered-in-error | unknown\n      DeviceRequest.status ~ 'completed'\n      or DeviceRequest.status ~ 'active'\n      and DeviceRequest.intent ~ 'order'\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 73
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value DeviceRequestStatus): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 74
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value RequestIntent): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 75
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value string): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 76
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlphoraCommon"
            },
            {
              "url": "name",
              "valueString": "QualifiedMedicationRequests"
            },
            {
              "url": "statement",
              "valueString": "define function QualifiedMedicationRequests(value List<FHIR.MedicationRequest>):\n  value MedicationRequest\n    where (\n      //active | on-hold | cancelled | completed | entered-in-error | stopped | draft | unknown\n      (MedicationRequest.status ~ 'active'\n        or MedicationRequest.status ~ 'completed'\n      )\n        and (\n          MedicationRequest.doNotPerform is null\n          or MedicationRequest.doNotPerform = false\n        )\n        and MedicationRequest.intent ~ 'order'\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 77
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value MedicationRequestStatus): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 78
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value MedicationRequestIntent): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 79
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRCommon"
            },
            {
              "url": "name",
              "valueString": "ToTimingInterval"
            },
            {
              "url": "statement",
              "valueString": "define function ToTimingInterval(timing FHIR.Timing):\n  convert (\n    NullToEmptyInterval(ToIntervalFromList(timing.event))\n    union NullToEmptyInterval({ToInterval(timing.repeat.bounds as FHIR.Period)})\n  ) to List<Interval<DateTime>> except { null }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 80
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRCommon"
            },
            {
              "url": "name",
              "valueString": "NullToEmptyInterval"
            },
            {
              "url": "statement",
              "valueString": "define function NullToEmptyInterval(value List<Interval<DateTime>>):\n  if value is not null then value else { }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 81
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRCommon"
            },
            {
              "url": "name",
              "valueString": "ToIntervalFromList"
            },
            {
              "url": "statement",
              "valueString": "define function ToIntervalFromList(value List<FHIR.dateTime>):\n  value v\n    return ToInterval(v)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 82
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "http://fhir.org/guides/cqf/aphl/chronic-ds/Library/SupplementalDataElementsFHIR4|2.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "http://fhir.org/guides/cqf/aphl/chronic-ds/Library/FHIRHelpers|4.1.000"
        },
        {
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      "valueCanonical": "#effective-data-requirements"
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  "url": "http://fhir.org/guides/cqf/aphl/chronic-ds/Measure/ControllingHighBloodPressureFHIR",
  "identifier": [
    {
      "use": "usual",
      "system": "short-name",
      "value": "CMS165v12"
    },
    {
      "use": "official",
      "system": "publisher",
      "value": "236"
    },
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      "system": "http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/guid",
      "value": "abdc37cc-bac6-4156-9b91-d1be2c8b7268"
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  "version": "0.1.0",
  "name": "ControllingHighBloodPressureFHIR",
  "title": "Controlling High Blood Pressure",
  "status": "draft",
  "experimental": false,
  "date": "2025-09-25T07:40:03-06:00",
  "publisher": "Clinical Quality Framework",
  "contact": [
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          "value": "http://cqframework.org"
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  ],
  "description": "Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90 mmHg) during the measurement period",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code": "001"
        }
      ]
    }
  ],
  "purpose": "Unknown",
  "copyright": "This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2022 National Committee for Quality Assurance. All Rights Reserved.\nLimited 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. NCQA disclaims all liability for use or accuracy of any third-party codes contained in the specifications.\nCPT(R) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.\nLOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. \nThis material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. \nICD-10 copyright 2022 World Health Organization. All Rights Reserved.",
  "effectivePeriod": {
    "start": "2024-01-01",
    "end": "2024-12-31"
  },
  "library": [
    "http://fhir.org/guides/cqf/aphl/chronic-ds/Library/ControllingHighBloodPressureFHIR"
  ],
  "disclaimer": "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND. \nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
  "scoring": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code": "proportion",
        "display": "Proportion"
      }
    ]
  },
  "type": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/measure-type",
          "code": "outcome",
          "display": "intermediateOutcome"
        }
      ]
    }
  ],
  "rationale": "High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2021). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.5 million US adults >= 20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent (Virani et al., 2021). In an analysis of adults with hypertension in NHANES, the estimated age-adjusted proportion with controlled BP increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018 (Tsao et al., 2022).\nHBP, known as the “silent killer,” increases risks of heart disease and stroke which are two of the leading causes of death in the US; a person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2012). The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause (CDC, 2022). Between 2009 and 2019 the number of deaths due to HBP rose by 65.3 percent (Tsao et al., 2022). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.7 percent) (Tsao et al., 2022).\nHBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014 (Kirkland et al., 2018). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures (SBP) of >= 160 mmHg could be effective and cost-saving (Moran, 2015).\nMany studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mmHg compared to a SBP goal of <140 mmHg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). \nControlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.",
  "clinicalRecommendationStatement": "U.S. Preventive Services Task Force (USPSTF) (2021):\n- The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation.  \n\nAmerican College of Cardiology/American Heart Association (2017):\n- For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10 percent or higher, a blood pressure target of less than 130/80 mmHg is recommended (Level of evidence: B-R (for systolic blood pressures), Level of evidence: C-EO (for diastolic blood pressure)) \n- For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However, observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life) (Level of evidence: B-NR (for systolic blood pressure), Level of evidence: C-EO (for diastolic blood pressure)).\n\nAmerican College of Physicians and the American Academy of Family Physicians (2017):   \n- Initiate or intensify pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mmHg (Grade: weak recommendation, Quality of evidence: low) \n- Initiate or intensify pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk of recurrent stroke (Grade: weak recommendation, Quality of evidence: moderate) \n\nAmerican Diabetes Association (2021): \n- For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk >=15 percent), a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: C)\n- For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year atherosclerotic cardiovascular disease risk <15 percent), treat to a blood pressure target of <140/90 mmHg (Level of evidence: A)",
  "improvementNotation": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
        "code": "decrease",
        "display": "Lower score indicates better quality"
      }
    ]
  },
  "guidance": "In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record.\nDo not include BP readings taken during an acute inpatient stay or an ED visit.\nIf no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed 'not controlled'.\nIf there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance.\nThis eCQM is a patient-based measure.\nThis version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",
  "group": [
    {
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        {
          "id": "F348D767-1BDE-41AB-884D-5F0E19093980",
          "code": {
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              {
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                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Patients 18-85 years of age who had a visit during the measurement period and diagnosis of essential hypertension",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
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          },
          "description": "Patients 18-85 years of age who had a visit during the measurement period and diagnosis of essential hypertension",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "24803F44-C643-45C7-A2A5-4C58BD540579",
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                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "95E1480E-8B61-4777-865D-B2A1D6525E1A",
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            "coding": [
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                "code": "denominator-exclusion",
                "display": "Denominator Exclusions"
              }
            ]
          },
          "description": "Patients with ESRD or dialysis or renal transplant or pregnancy or in hospice or 66+ in nursing care or 66-80 with frailty and advanced illness or 81+ with frailty or receiving palliative care",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusion"
          }
        }
      ],
      "stratifier": [
        {
          "id": "stratifier-ethnicity",
          "code": {
            "coding": [
              {
                "system": "http://loinc.org",
                "code": "54133-4",
                "display": "Ethnicity"
              }
            ]
          },
          "description": "Ethnicity (CDC Value Set)",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SDE Ethnicity"
          }
        },
        {
          "id": "stratifier-payer",
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                "code": "plan",
                "display": "SDE Payer"
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          },
          "description": "Payer",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SDE Payer"
          }
        },
        {
          "id": "stratifier-race",
          "code": {
            "coding": [
              {
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                "code": "32624-9",
                "display": "SDE Race"
              }
            ]
          },
          "description": "Race (CDC Value Set)",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SDE Race"
          }
        },
        {
          "id": "stratifier-sex",
          "code": {
            "coding": [
              {
                "system": "http://loinc.org",
                "code": "72143-1",
                "display": "Sex [HL7.v3]"
              }
            ]
          },
          "description": "Administrative sex",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SDE Sex"
          }
        },
        {
          "id": "stratifier-age",
          "code": {
            "coding": [
              {
                "system": "http://loinc.org",
                "code": "30525-0",
                "display": "Age"
              }
            ]
          },
          "description": "Age",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SDE Age"
          }
        },
        {
          "id": "stratifier-state-of-residence",
          "code": {
            "coding": [
              {
                "system": "http://loinc.org",
                "code": "52830-7",
                "display": "State, district or territory federal abbreviation"
              }
            ]
          },
          "description": "State of residence",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SDE State of Residence"
          }
        },
        {
          "id": "stratifier-postal-code-of-residence",
          "code": {
            "coding": [
              {
                "system": "http://loinc.org",
                "code": "45401-7",
                "display": "Postal code"
              }
            ]
          },
          "description": "Postal code of residence",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SDE Postal Code of Residence"
          }
        },
        {
          "id": "stratifier-food-insecurity-risk-status",
          "code": {
            "coding": [
              {
                "system": "http://loinc.org",
                "code": "88124-3",
                "display": "Food insecurity risk [HVS]"
              }
            ]
          },
          "description": "Food insecurity risk status",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SDE Food Insecurity Risk Status"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-ethnicity",
      "code": {
        "coding": [
          {
            "system": "http://loinc.org",
            "code": "54133-4",
            "display": "Ethnicity"
          }
        ]
      },
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "Ethnicity (CDC Value Set)",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "id": "sde-payer",
      "code": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
            "code": "plan",
            "display": "SDE Payer"
          }
        ]
      },
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "Payer",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer"
      }
    },
    {
      "id": "sde-race",
      "code": {
        "coding": [
          {
            "system": "http://loinc.org",
            "code": "32624-9",
            "display": "SDE Race"
          }
        ]
      },
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "Race (CDC Value Set)",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Race"
      }
    },
    {
      "id": "sde-sex",
      "code": {
        "coding": [
          {
            "system": "http://loinc.org",
            "code": "72143-1",
            "display": "Sex [HL7.v3]"
          }
        ]
      },
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "Administrative sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    },
    {
      "id": "sde-age",
      "code": {
        "coding": [
          {
            "system": "http://loinc.org",
            "code": "30525-0",
            "display": "Age"
          }
        ]
      },
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "Age",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Age"
      }
    },
    {
      "id": "sde-state-of-residence",
      "code": {
        "coding": [
          {
            "system": "http://loinc.org",
            "code": "52830-7",
            "display": "State, district or territory federal abbreviation"
          }
        ]
      },
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "State of residence",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE State of Residence"
      }
    },
    {
      "id": "sde-postal-code-of-residence",
      "code": {
        "coding": [
          {
            "system": "http://loinc.org",
            "code": "45401-7",
            "display": "Postal code"
          }
        ]
      },
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "Postal code of residence",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Postal Code of Residence"
      }
    },
    {
      "id": "sde-food-insecurity-risk-status",
      "code": {
        "coding": [
          {
            "system": "http://loinc.org",
            "code": "88124-3",
            "display": "Food insecurity risk [HVS]"
          }
        ]
      },
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "Food insecurity risk status",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Food Insecurity Risk Status"
      }
    }
  ]
}