FHIR IG analytics

Resources that use this resource

No resources found

Resources that this resource uses

No resources found

Narrative

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

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 "Has HbA1c Lab Test":
  (AC.LaboratoryObservation([Observation: "HbA1c Laboratory Test"]))

define "Most Recent HbA1c Lab Test":
  AC.MostRecent("Has HbA1c Lab Test" HbA1cTest
    where FC.ToInterval(HbA1cTest.effective) during "Measurement Period")

define "Has Most Recent HbA1c Without Result":
  ("Most Recent HbA1c Lab Test" is not null)
    and ("Most Recent HbA1c Lab Test".value is null)

define "Has Most Recent Elevated HbA1c":
  "Most Recent HbA1c Lab Test".value >= 9 '%'

define "Has No Record Of HbA1c":
  not exists("Has HbA1c Lab Test")

define "Numerator":
  "Has Most Recent HbA1c Without Result"
    or "Has Most Recent Elevated HbA1c"
    or "Has No Record Of HbA1c"

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: "Nutrition Services"]
      union [Encounter: "Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes"]
      union [Encounter: "Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes"]
      union [Encounter: "Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes"]
      union [Encounter: "Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes"]
      union [Encounter: "Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes"]
      union [Encounter: "Telephone Visits"]
  ) ValidEncounters
    where ValidEncounters.period during "Measurement Period"
	  and ValidEncounters.status ~ 'finished'

define "Initial Population":
  AgeInYearsAt(end of "Measurement Period") in Interval[18, 75]
    and exists("Qualifying Encounters")
    and exists( (AC.QualifiedConditions([Condition: "Diabetes"])) Diabetes
      where FC.ToPrevalenceInterval(Diabetes) overlaps "Measurement Period" )

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 "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 "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 or Older with Advanced Illness and Frailty":
  AgeInYearsAt(date from end of "Measurement Period") >= 66
    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")
    )

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 Exclusions":
  Hospice."Has Hospice"
    or Frailty."Is Age 66 or Older Living Long Term in a Nursing Home"
    or Frailty."Is Age 66 or Older with Advanced Illness and Frailty"
    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 MostRecent(observations List<Observation>):
  Last(
    observations O
      sort by start of FC.ToInterval(effective)
  )

define function LaboratoryObservation(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'
      and exists(Observation.category ObservationCategory
        where ( ObservationCategory ) ~ "laboratory" or (ObservationCategory) is null)
		)

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
        }

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 EncounterStatus): 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 ToDateTime(value dateTime): value.value

define function ToDate(value date): 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'
    )

/*
@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 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 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": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR",
  "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://terminology.hl7.org/CodeSystem/observation-category",
            "code": "laboratory",
            "display": "laboratory"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://www.ama-assn.org/go/cpt",
            "code": "97802",
            "display": "Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://www.ama-assn.org/go/cpt",
            "code": "97803",
            "display": "Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://www.ama-assn.org/go/cpt",
            "code": "97804",
            "display": "Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
            "code": "G0270",
            "display": "Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
            "code": "G0271",
            "display": "Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "active"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "confirmed"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "recurrence"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "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": "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": "98181-1",
            "display": "Medical equipment used"
          }
        },
        {
          "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": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "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": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "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": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "Has HbA1c Lab Test"
            },
            {
              "url": "statement",
              "valueString": "define \"Has HbA1c Lab Test\":\n  (AC.LaboratoryObservation([Observation: \"HbA1c Laboratory Test\"]))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "Most Recent HbA1c Lab Test"
            },
            {
              "url": "statement",
              "valueString": "define \"Most Recent HbA1c Lab Test\":\n  AC.MostRecent(\"Has HbA1c Lab Test\" HbA1cTest\n    where FC.ToInterval(HbA1cTest.effective) during \"Measurement Period\")"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "Has Most Recent HbA1c Without Result"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Most Recent HbA1c Without Result\":\n  (\"Most Recent HbA1c Lab Test\" is not null)\n    and (\"Most Recent HbA1c Lab Test\".value is null)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "Has Most Recent Elevated HbA1c"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Most Recent Elevated HbA1c\":\n  \"Most Recent HbA1c Lab Test\".value >= 9 '%'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "Has No Record Of HbA1c"
            },
            {
              "url": "statement",
              "valueString": "define \"Has No Record Of HbA1c\":\n  not exists(\"Has HbA1c Lab Test\")"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Has Most Recent HbA1c Without Result\"\n    or \"Has Most Recent Elevated HbA1c\"\n    or \"Has No Record Of HbA1c\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "Qualifying Encounters"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Encounters\":\n  (\n    [Encounter: \"Office Visit\"]\n\t    union [Encounter: \"Annual Wellness Visit\"]\n\t    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: \"Nutrition Services\"]\n      union [Encounter: \"Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes\"]\n      union [Encounter: \"Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes\"]\n      union [Encounter: \"Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes\"]\n      union [Encounter: \"Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes\"]\n      union [Encounter: \"Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes\"]\n      union [Encounter: \"Telephone Visits\"]\n  ) ValidEncounters\n    where ValidEncounters.period during \"Measurement Period\"\n\t  and ValidEncounters.status ~ 'finished'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  AgeInYearsAt(end of \"Measurement Period\") in Interval[18, 75]\n    and exists(\"Qualifying Encounters\")\n    and exists( (AC.QualifiedConditions([Condition: \"Diabetes\"])) Diabetes\n      where FC.ToPrevalenceInterval(Diabetes) overlaps \"Measurement Period\" )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "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": 14
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "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": 16
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "SDE State of Residence"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE State of Residence\":\n  SurveillanceDataElements.\"State of Residence\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "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": 18
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "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": 19
            }
          ],
          "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": 20
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "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": 22
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Age"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Age\":\n  SurveillanceDataElements.\"Age\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "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": 24
            }
          ],
          "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": 25
            }
          ],
          "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": 26
            }
          ],
          "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": 27
            }
          ],
          "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": 28
            }
          ],
          "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": 29
            }
          ],
          "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": 30
            }
          ],
          "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": 31
            }
          ],
          "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": 32
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdvancedIllnessandFrailtyExclusionECQMFHIR4"
            },
            {
              "url": "name",
              "valueString": "Is Age 66 or Older with Advanced Illness and Frailty"
            },
            {
              "url": "statement",
              "valueString": "define \"Is Age 66 or Older with Advanced Illness and Frailty\":\n  AgeInYearsAt(date from end of \"Measurement Period\") >= 66\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    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "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": 34
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  Hospice.\"Has Hospice\"\n    or Frailty.\"Is Age 66 or Older Living Long Term in a Nursing Home\"\n    or Frailty.\"Is Age 66 or Older with Advanced Illness and Frailty\"\n    or PalliativeCare.\"Palliative Care in the Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "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": 36
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "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": 38
            }
          ],
          "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": 39
            }
          ],
          "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": 40
            }
          ],
          "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": 41
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlphoraCommon"
            },
            {
              "url": "name",
              "valueString": "MostRecent"
            },
            {
              "url": "statement",
              "valueString": "define function MostRecent(observations List<Observation>):\n  Last(\n    observations O\n      sort by start of FC.ToInterval(effective)\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 42
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AlphoraCommon"
            },
            {
              "url": "name",
              "valueString": "LaboratoryObservation"
            },
            {
              "url": "statement",
              "valueString": "define function LaboratoryObservation(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      and exists(Observation.category ObservationCategory\n        where ( ObservationCategory ) ~ \"laboratory\" or (ObservationCategory) is null)\n\t\t)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 43
            }
          ],
          "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": 44
            }
          ],
          "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": 45
            }
          ],
          "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": 46
            }
          ],
          "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": 47
            }
          ],
          "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": 48
            }
          ],
          "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": 49
            }
          ],
          "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": 50
            }
          ],
          "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": 51
            }
          ],
          "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": 52
            }
          ],
          "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": 53
            }
          ],
          "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": 54
            }
          ],
          "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": 55
            }
          ],
          "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": 56
            }
          ],
          "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": 57
            }
          ],
          "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": 58
            }
          ],
          "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": 59
            }
          ],
          "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": 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 ServiceRequestStatus): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 61
            }
          ],
          "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": 62
            }
          ],
          "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": 63
            }
          ],
          "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": 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 ProcedureStatus): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 65
            }
          ],
          "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": 66
            }
          ],
          "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": 67
            }
          ],
          "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": 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 string): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 69
            }
          ],
          "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": 70
            }
          ],
          "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": 71
            }
          ],
          "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": 72
            }
          ],
          "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": 73
            }
          ],
          "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": 74
            }
          ],
          "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": 75
            }
          ],
          "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"
        },
        {
          "type": "depends-on",
          "display": "Library SurveillanceDataElements",
          "resource": "http://fhir.org/guides/cqf/aphl/chronic-ds/Library/SurveillanceDataElementsFHIR4|1.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library AC",
          "resource": "http://fhir.org/guides/cqf/aphl/chronic-ds/Library/AlphoraCommon"
        },
        {
          "type": "depends-on",
          "display": "Library FC",
          "resource": "http://fhir.org/guides/cqf/aphl/chronic-ds/Library/FHIRCommon|1.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library Common",
          "resource": "http://fhir.org/guides/cqf/aphl/chronic-ds/Library/MATGlobalCommonFunctionsFHIR4|6.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library Hospice",
          "resource": "http://fhir.org/guides/cqf/aphl/chronic-ds/Library/HospiceFHIR4|2.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library Frailty",
          "resource": "http://fhir.org/guides/cqf/aphl/chronic-ds/Library/AdvancedIllnessandFrailtyExclusionECQMFHIR4|5.12.000"
        },
        {
          "type": "depends-on",
          "display": "Library PalliativeCare",
          "resource": "http://fhir.org/guides/cqf/aphl/chronic-ds/Library/PalliativeCareFHIR"
        },
        {
          "type": "depends-on",
          "display": "Code system ObservationCategoryCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/observation-category"
        },
        {
          "type": "depends-on",
          "display": "Code system CPT",
          "resource": "http://www.ama-assn.org/go/cpt"
        },
        {
          "type": "depends-on",
          "display": "Code system HCPCS",
          "resource": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionClinicalStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-clinical"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionVerificationStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-ver-status"
        },
        {
          "type": "depends-on",
          "display": "Code system LOINC",
          "resource": "http://loinc.org"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Value set HbA1c Laboratory Test",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1013"
        },
        {
          "type": "depends-on",
          "display": "Value set Office Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
        },
        {
          "type": "depends-on",
          "display": "Value set Annual Wellness Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
        },
        {
          "type": "depends-on",
          "display": "Value set Preventive Care Services - Established Office Visit, 18 and Up",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
        },
        {
          "type": "depends-on",
          "display": "Value set Preventive Care Services - Initial Office Visit, 18 and Up",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
        },
        {
          "type": "depends-on",
          "display": "Value set Home Healthcare Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
        },
        {
          "type": "depends-on",
          "display": "Value set Nutrition Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1006"
        },
        {
          "type": "depends-on",
          "display": "Value set Telephone Visits",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"
        },
        {
          "type": "depends-on",
          "display": "Value set Diabetes",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.103.12.1001"
        },
        {
          "type": "depends-on",
          "display": "Value set Payer",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
        },
        {
          "type": "depends-on",
          "display": "Value set Encounter Inpatient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice Encounter",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice Care Ambulatory",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice Diagnosis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"
        },
        {
          "type": "depends-on",
          "display": "Value set Frailty Device",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300"
        },
        {
          "type": "depends-on",
          "display": "Value set Frailty Diagnosis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074"
        },
        {
          "type": "depends-on",
          "display": "Value set Frailty Encounter",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088"
        },
        {
          "type": "depends-on",
          "display": "Value set Frailty Symptom",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075"
        },
        {
          "type": "depends-on",
          "display": "Value set Outpatient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087"
        },
        {
          "type": "depends-on",
          "display": "Value set Observation",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1086"
        },
        {
          "type": "depends-on",
          "display": "Value set Emergency Department Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"
        },
        {
          "type": "depends-on",
          "display": "Value set Nonacute Inpatient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1084"
        },
        {
          "type": "depends-on",
          "display": "Value set Advanced Illness",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082"
        },
        {
          "type": "depends-on",
          "display": "Value set Acute Inpatient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1083"
        },
        {
          "type": "depends-on",
          "display": "Value set Dementia Medications",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510"
        },
        {
          "type": "depends-on",
          "display": "Value set Palliative Care Diagnosis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167"
        },
        {
          "type": "depends-on",
          "display": "Value set Palliative Care Encounter",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090"
        },
        {
          "type": "depends-on",
          "display": "Value set Palliative Care Intervention",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135"
        }
      ],
      "parameter": [
        {
          "name": "Measurement Period",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "Period"
        },
        {
          "name": "SDE Sex",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Coding"
        },
        {
          "name": "SDE Postal Code of Residence",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "string"
        },
        {
          "name": "Numerator",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "Denominator",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Payer",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE State of Residence",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "string"
        },
        {
          "name": "SDE Food Insecurity Risk Status",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "CodeableConcept"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Ethnicity",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Coding"
        },
        {
          "name": "SDE Age",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "integer"
        },
        {
          "name": "Denominator Exclusions",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Coding"
        }
      ],
      "dataRequirement": [
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Patient"
          ],
          "mustSupport": [
            "use",
            "type",
            "url",
            "extension",
            "value"
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport": [
            "code",
            "value",
            "effective",
            "status",
            "category"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "45755-6",
                  "display": "Hospice care [Minimum Data Set]"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport": [
            "code",
            "effective",
            "value",
            "status",
            "category"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "71802-3",
                  "display": "Housing status"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport": [
            "code",
            "value",
            "effective",
            "status",
            "category"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "98181-1",
                  "display": "Medical equipment used"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport": [
            "code",
            "effective",
            "status",
            "category"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport": [
            "code",
            "effective",
            "status",
            "category"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "71007-9",
                  "display": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport": [
            "code",
            "status",
            "category",
            "effective"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1013"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport": [
            "code",
            "status",
            "category"
          ],
          "codeFilter": [
            {
              "path": "code",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "88124-3",
                  "display": "Food insecurity risk [HVS]"
                }
              ]
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1006"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "code": [
                {
                  "system": "http://www.ama-assn.org/go/cpt",
                  "code": "97802",
                  "display": "Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes"
                }
              ]
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "code": [
                {
                  "system": "http://www.ama-assn.org/go/cpt",
                  "code": "97803",
                  "display": "Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes"
                }
              ]
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "code": [
                {
                  "system": "http://www.ama-assn.org/go/cpt",
                  "code": "97804",
                  "display": "Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes"
                }
              ]
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "code": [
                {
                  "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                  "code": "G0270",
                  "display": "Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes"
                }
              ]
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "code": [
                {
                  "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                  "code": "G0271",
                  "display": "Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes"
                }
              ]
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "hospitalization",
            "hospitalization.dischargeDisposition",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1086"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1084"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1083"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "code",
            "clinicalStatus",
            "verificationStatus"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.103.12.1001"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "code",
            "clinicalStatus",
            "verificationStatus"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "code",
            "clinicalStatus",
            "verificationStatus"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "code",
            "clinicalStatus",
            "verificationStatus"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "code",
            "clinicalStatus",
            "verificationStatus"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167"
            }
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "ServiceRequest",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/ServiceRequest"
          ],
          "mustSupport": [
            "code",
            "authoredOn",
            "status",
            "intent",
            "doNotPerform"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Procedure"
          ],
          "mustSupport": [
            "code",
            "performed",
            "status"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Procedure"
          ],
          "mustSupport": [
            "code",
            "performed",
            "status"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135"
            }
          ]
        },
        {
          "type": "DeviceRequest",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/DeviceRequest"
          ],
          "mustSupport": [
            "code",
            "status",
            "intent",
            "authoredOn"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/MedicationRequest"
          ],
          "mustSupport": [
            "medication",
            "status",
            "doNotPerform",
            "intent",
            "dosageInstruction"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/MedicationRequest"
          ],
          "mustSupport": [
            "medication.reference",
            "status",
            "doNotPerform",
            "intent",
            "dosageInstruction"
          ]
        },
        {
          "type": "Medication",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Medication"
          ],
          "mustSupport": [
            "id",
            "code"
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "id": "cqf-tooling",
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
      "valueReference": {
        "reference": "Device/cqf-tooling"
      }
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical": "#effective-data-requirements"
    }
  ],
  "url": "http://fhir.org/guides/cqf/aphl/chronic-ds/Measure/DiabetesHemoglobinA1cHbA1cPoorControl9FHIR",
  "identifier": [
    {
      "use": "usual",
      "system": "short-name",
      "value": "CMS122v11"
    },
    {
      "use": "official",
      "system": "publisher",
      "value": "001"
    },
    {
      "use": "official",
      "system": "http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/guid",
      "value": "f04ee808-8ece-4936-8b26-fafa462e1594"
    }
  ],
  "version": "0.1.0",
  "name": "DiabetesHemoglobinA1cHbA1cPoorControl9FHIR",
  "title": "Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)FHIR",
  "status": "draft",
  "experimental": false,
  "date": "2025-09-25T07:40:03-06:00",
  "publisher": "Clinical Quality Framework",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://cqframework.org"
        }
      ]
    }
  ],
  "description": "Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% 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) 2012-2020 National Committee for Quality Assurance. All Rights Reserved. \n\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.\n\nCPT(R) contained in the Measure specifications is copyright 2004-2020 American Medical Association. LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. ICD-10 copyright 2020 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/DiabetesHemoglobinA1cHbA1cPoorControl9FHIR"
  ],
  "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.\n \nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
  "scoring": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code": "proportion",
        "display": "Proportion"
      }
    ]
  },
  "type": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/measure-type",
          "code": "outcome",
          "display": "intermediateOutcome"
        }
      ]
    }
  ],
  "rationale": "Diabetes is the seventh leading cause of death in the United States. In 2017, diabetes affected approximately 34 million Americans (10.5 percent of the U.S. population) and killed approximately 84,000 people (Centers for Disease Control and Prevention [CDC], 2020a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2020a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, and amputation of feet or legs (CDC, 2018). \n\nIn 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (American Diabetes Association [ADA], 2018).  \n\nControlling A1c blood levels helps reduce the risk of microvascular complications (eye, kidney and nerve diseases) (ADA, 2020).",
  "clinicalRecommendationStatement": "American Diabetes Association (2020):\n\n- An A1C goal for many nonpregnant adults of <7% (53 mmol/mol) is appropriate. (Level of evidence: A)\n\n- On the basis of provider judgement and patient preference, achievement of lower A1C goals (such as <6.5%) may be acceptable if this can be achieved safely without significant hypoglycemia or other adverse effects of treatment. (Level of evidence: C)\n\n- Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the goal is difficult to achieve despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin. (Level of evidence: B)",
  "improvementNotation": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
        "code": "decrease",
        "display": "Lower score indicates better quality"
      }
    ]
  },
  "guidance": "If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance.\n\nOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.\n\nThis eCQM is a patient-based measure.\n\nThis version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.",
  "group": [
    {
      "population": [
        {
          "id": "F09F8D18-F787-46EA-8791-3D3EF50A4C72",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Seen patients between 18 and 75 years of age with an active diabetes diagnosis",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "66505C6C-AAB0-4232-B0CA-15FB438090F4",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Seen patients between 18 and 75 years of age with an active diabetes diagnosis",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "95BCB9D4-86A8-43C1-BE29-7440A2ECE294",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Patients whose most recent HbA1c > 9%",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "6AD9B271-BBB4-4BB6-95B1-D1A7E50D812F",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exclusion",
                "display": "Denominator Exclusions"
              }
            ]
          },
          "description": "Patients in hospice or long term care, or with advanced illness or frailty",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusions"
          }
        }
      ],
      "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",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code": "plan",
                "display": "SDE Payer"
              }
            ]
          },
          "description": "Payer",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "SDE Payer"
          }
        },
        {
          "id": "stratifier-race",
          "code": {
            "coding": [
              {
                "system": "http://loinc.org",
                "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"
      }
    }
  ]
}