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Packagegov.healthit.ecqi.ecqms
Resource TypeMeasure
IdMeasure-CMS104FHIRSTKDCAntithrombotic.json
FHIR VersionR4
Sourcehttps://build.fhir.org/ig/cqframework/ecqm-content-qicore-2024/Measure-CMS104FHIRSTKDCAntithrombotic.html
URLhttps://madie.cms.gov/Measure/CMS104FHIRSTKDCAntithrombotic
Version0.9.002
Statusactive
Date2026-03-13T01:50:40+00:00
NameCMS104FHIRSTKDCAntithrombotic
TitleDischarged on Antithrombotic TherapyFHIR
DescriptionIschemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge
PurposeUNKNOWN
CopyrightMeasure specifications are in the Public Domain LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.

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Narrative

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

Title: Discharged on Antithrombotic TherapyFHIR
Id: CMS104FHIRSTKDCAntithrombotic
Version: 0.9.002
Url: Discharged on Antithrombotic TherapyFHIR
Short Name Identifier:

CMS104FHIR

Version Independent Identifier:

urn:uuid:4f57e4a2-097b-45f8-9c85-91b35ea92dc1

Version Specific Identifier:

urn:uuid:9b88e8fc-1b6d-4414-af85-de255e1f81d6

Publisher (CMS) Identifier:

104FHIR

Effective Period: 2026-01-01..2026-12-31
Publisher: The Joint Commission
Author: The Joint Commission
Description:

Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge
Purpose:

UNKNOWN
Copyright:

Measure specifications are in the Public Domain

LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.
Disclaimer:

These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.
Rationale:

The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity if no contraindications exist.

For patients with a stroke due to a cardioembolic source (e.g., atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke

Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA).
Clinical recommendation statement:

Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity if no contraindications exist
Guidance (Usage): The "Nonelective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions. The "Medication, Discharge" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use. The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS104v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).
Population Criteria:
675704e146b6174510cfedb3
Initial Population: Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, ending during the measurement period
Denominator: Equals Initial Population
Denominator Exclusion: - Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. - Inpatient hospitalizations for patients discharged to another hospital - Inpatient hospitalizations for patients who left against medical advice - Inpatient hospitalizations for patients who expired - Inpatient hospitalizations for patients discharged to home for hospice care - Inpatient hospitalizations for patients discharged to a health care facility for hospice care - Inpatient hospitalizations for patients with comfort measures documented
Numerator: Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge
Denominator Exception: - Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge - Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge
Supplemental Data Elements:

SDE Ethnicity

SDE Payer

SDE Race

SDE Sex
Supplemental Data Guidance : For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity: Hispanic or Latino Not Hispanic or Latino SDE Payer-Patient's Payer: Categories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system SDE Race-Patient's Race: Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Other Race White Black or African American SDE Sex-Patient's Sex: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
Libraries:
CMS104FHIRSTKDCAntithrombotic
Terminology and Other Dependencies:
  • Library/SupplementalDataElements|3.5.000
  • Library/TJCOverall|8.15.000
  • Library/FHIRHelpers|4.4.000
  • Library/CQMCommon|2.2.000
  • Library/QICoreCommon|2.1.000
  • AdministrativeGender
  • Diagnosis Role
  • MedicationRequest Category Codes
  • Non-Elective Inpatient Encounter
  • Ischemic Stroke
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62
  • Payer
  • Discharge To Acute Care Facility
  • Left Against Medical Advice
  • Patient Expired
  • Discharged to Home for Hospice Care
  • Discharged to Health Care Facility for Hospice Care
  • Comfort Measures
  • Observation Services
  • Emergency Department Visit
  • Medical Reason
  • Patient Refusal
  • Pharmacological Contraindications For Antithrombotic Therapy
    		•
    Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    SDE Sex Out 0 1 Coding
    Numerator Out 0 * Resource
    Denominator Out 0 * Resource
    SDE Payer Out 0 * Resource
    Initial Population Out 0 * Resource
    SDE Ethnicity Out 0 1 Resource
    Denominator Exclusions Out 0 * Resource
    SDE Race Out 0 1 Resource
    Denominator Exceptions Out 0 * Resource
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Patient(QICorePatient) ethnicity race
    Encounter(QICoreEncounter) type status status.value period rank rank.value use condition condition.reference condition.reference.value Observation Services Observation Services
    Encounter(QICoreEncounter) type status status.value period rank rank.value use condition condition.reference condition.reference.value Emergency Department Visit Emergency Department Visit
    Encounter(QICoreEncounter) type period rank rank.value use condition condition.reference condition.reference.value Nonelective Inpatient Encounter Non-Elective Inpatient Encounter
    Encounter(QICoreEncounter) type period rank rank.value use condition condition.reference condition.reference.value hospitalization hospitalization.dischargeDisposition Nonelective Inpatient Encounter Non-Elective Inpatient Encounter
    Condition(QICoreCondition) id id.value
    MedicationRequest(QICoreMedicationRequest) medication authoredOn authoredOn.value Antithrombotic Therapy for Ischemic Stroke http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62
    MedicationRequest(QICoreMedicationRequest) medication status status.value intent intent.value Pharmacological Contraindications For Antithrombotic Therapy Pharmacological Contraindications For Antithrombotic Therapy
    MedicationRequest(QICoreMedicationRequest) medication status status.value intent intent.value authoredOn authoredOn.value Pharmacological Contraindications For Antithrombotic Therapy Pharmacological Contraindications For Antithrombotic Therapy
    Coverage(QICoreCoverage) type period Payer Type Payer
    ServiceRequest(QICoreServiceRequest) code status status.value intent intent.value doNotPerform doNotPerform.value Comfort Measures Comfort Measures
    Procedure(QICoreProcedure) code status status.value Comfort Measures Comfort Measures
    MedicationRequest(QICoreMedicationNotRequested) medication reasonCode authoredOn authoredOn.value Antithrombotic Therapy for Ischemic Stroke http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62
    MedicationRequest(QICoreMedicationNotRequested) medication reasonCode authoredOn authoredOn.value Antithrombotic Therapy for Ischemic Stroke http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62
    Direct Reference Codes:
    display code system
    Male M http://hl7.org/fhir/administrative-gender
    Female F http://hl7.org/fhir/administrative-gender
    Billing billing http://terminology.hl7.org/CodeSystem/diagnosis-role
    Community community http://terminology.hl7.org/CodeSystem/medicationrequest-category
    Discharge discharge http://terminology.hl7.org/CodeSystem/medicationrequest-category
    Logic Definitions:
    Group Scoring Population Criteria Expression
    675704e146b6174510cfedb3 Group scoring: proportion
    Type:

    Process

    Rate Aggregation: None
    Improvement Notation:

    Increased score indicates improvement

    Initial Population 
    define "Initial Population":
  TJC."Ischemic Stroke Encounter"
    Denominator 
    define "Denominator":
  "Initial Population"
    Denominator Exclusion 
    define "Denominator Exclusions":
  TJC."Ischemic Stroke Encounters With Discharge Disposition"
    union "Encounter With Comfort Measures During Hospitalization For Patients With Documented Ischemic Stroke"
    Numerator 
    define "Numerator":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationRequest": medication in "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic
      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
    Denominator Exception 
    define "Denominator Exceptions":
  "Encounter With Documented Reason For No Antithrombotic At Discharge"
    union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge"
    Library Name Name
    SupplementalDataElements SDE Sex 
    define "SDE Sex":
  case
    when Patient.gender = 'male' then "M"
    when Patient.gender = 'female' then "F"
    else null
  end
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic SDE Sex 
    define "SDE Sex":
  SDE."SDE Sex"
    Library Name Name
    TJCOverall Non Elective Inpatient Encounter With Age 
    define "Non Elective Inpatient Encounter With Age":
  ["Encounter": "Nonelective Inpatient Encounter"] NonElectiveEncounter
        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18
         and NonElectiveEncounter.period ends during day of "Measurement Period"
    Library Name Name
    TJCOverall Ischemic Stroke Encounter 
    define "Ischemic Stroke Encounter":
  "Non Elective Inpatient Encounter With Age" NonElectiveEncounterWithAge
    where NonElectiveEncounterWithAge.principalDiagnosis().code in "Ischemic Stroke"
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic Numerator 
    define "Numerator":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationRequest": medication in "Antithrombotic Therapy for Ischemic Stroke"] DischargeAntithrombotic
      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic Initial Population 
    define "Initial Population":
  TJC."Ischemic Stroke Encounter"
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic Denominator 
    define "Denominator":
  "Initial Population"
    Library Name Name
    SupplementalDataElements SDE Payer 
    define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic SDE Payer 
    define "SDE Payer":
  SDE."SDE Payer"
    Library Name Name
    SupplementalDataElements SDE Ethnicity 
    define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    Library Name Name
    TJCOverall Ischemic Stroke Encounters With Discharge Disposition 
    define "Ischemic Stroke Encounters With Discharge Disposition":
  "Ischemic Stroke Encounter" IschemicStrokeEncounter
  let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition
  	where  DischDisp in "Discharge To Acute Care Facility"
		or DischDisp in "Left Against Medical Advice"
		or DischDisp in "Patient Expired"
		or DischDisp in "Discharged to Home for Hospice Care"
		or DischDisp in "Discharged to Health Care Facility for Hospice Care"
    Library Name Name
    TJCOverall Intervention Comfort Measures 
    define "Intervention Comfort Measures":
  ( ["ServiceRequest": code in "Comfort Measures"] SR
    where SR.status in { 'active', 'completed', 'on-hold' }
      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      and SR.doNotPerform is not true
  )  
  union ( ["Procedure": "Comfort Measures"] InterventionPerformed
        where InterventionPerformed.status in { 'completed', 'in-progress' }
  )
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic Encounter With Comfort Measures During Hospitalization For Patients With Documented Ischemic Stroke 
    define "Encounter With Comfort Measures During Hospitalization For Patients With Documented Ischemic Stroke":
  "Denominator" Encounter
    with TJC."Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic Denominator Exclusions 
    define "Denominator Exclusions":
  TJC."Ischemic Stroke Encounters With Discharge Disposition"
    union "Encounter With Comfort Measures During Hospitalization For Patients With Documented Ischemic Stroke"
    Library Name Name
    SupplementalDataElements SDE Race 
    define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic Reason For Not Giving Antithrombotic At Discharge 
    define "Reason For Not Giving Antithrombotic At Discharge":
  ["MedicationNotRequested": "Antithrombotic Therapy for Ischemic Stroke"] NoAntithromboticDischarge
    where ( NoAntithromboticDischarge.reasonCode in "Medical Reason For Not Providing Treatment"
        or NoAntithromboticDischarge.reasonCode in "Patient Refusal"
    )
      and ( NoAntithromboticDischarge.isCommunity ( )
          or NoAntithromboticDischarge.isDischarge ( )
      )
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic Encounter With Documented Reason For No Antithrombotic At Discharge 
    define "Encounter With Documented Reason For No Antithrombotic At Discharge":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Reason For Not Giving Antithrombotic At Discharge" NoDischargeAntithrombotic
      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic Pharmacological Contraindications For Antithrombotic Therapy At Discharge 
    define "Pharmacological Contraindications For Antithrombotic Therapy At Discharge":
  ["MedicationRequest": medication in "Pharmacological Contraindications For Antithrombotic Therapy"] PharmacologicalContraindications
    where ( PharmacologicalContraindications.isCommunity ( )
        or PharmacologicalContraindications.isDischarge ( )
    )
      and PharmacologicalContraindications.status in { 'active', 'completed' }
      and PharmacologicalContraindications.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge 
    //BONNIEMAT-1617-Since there is an anticipated resolution for STU 5 for Medication.Discharge which leaves one blockers on coverage, will leave the assertion logic as is and update the test cases for coverage.


define "Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Pharmacological Contraindications For Antithrombotic Therapy At Discharge" DischargePharmacological
      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period
    Library Name Name
    CMS104FHIRSTKDCAntithrombotic Denominator Exceptions 
    define "Denominator Exceptions":
  "Encounter With Documented Reason For No Antithrombotic At Discharge"
    union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge"
    Library Name Name
    FHIRHelpers ToInterval 
    /*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
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]
    Library Name Name
    CQMCommon principalDiagnosis 
    /*
@description: Returns the condition that is specified as the principal diagnosis for the encounter
*/
define fluent function principalDiagnosis(Encounter Encounter ):
	singleton from ((Encounter.diagnosis D where D.rank = 1 and D.use ~ "Billing") PD
      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())
	)
    Library Name Name
    QICoreCommon getId 
    /*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
  Last(Split(uri, '/'))
    Library Name Name
    FHIRHelpers ToString 
    define function ToString(value uri): value.value
    Library Name Name
    FHIRHelpers ToCode 
    /*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }
    Library Name Name
    CQMCommon hospitalizationWithObservation 
    /*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
*/
define fluent function hospitalizationWithObservation(TheEncounter Encounter ):
  TheEncounter Visit
  		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
  				where LastObs.status = 'finished'
            and LastObs.period ends 1 hour or less on or before start of Visit.period
  				sort by end of period
  			),
  			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
  			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
  				where LastED.status = 'finished'
            and LastED.period ends 1 hour or less on or before VisitStart
  				sort by end of period
  			)
  		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]
    Library Name Name
    FHIRHelpers ToConcept 
    /*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }
    Library Name Name
    QICoreCommon isCommunity 
    /*
@description: Returns true if the given MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest MedicationNotRequested):
  exists (medicationRequest.category C
    where C ~ Community
  )
    Library Name Name
    QICoreCommon isDischarge 
    /*
@description: Returns true if the given MedicationRequest has a category of Discharge
*/
define fluent function isDischarge(medicationRequest MedicationNotRequested):
  exists (medicationRequest.category C
    where C ~ Discharge
  )
    Library Name Name
    QICoreCommon isCommunity 
    /*
@description: Returns true if the given MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest MedicationRequest):
  exists (medicationRequest.category C
    where C ~ Community
  )
    Library Name Name
    QICoreCommon isDischarge 
    /*
@description: Returns true if the given MedicationRequest has a category of Discharge
*/
define fluent function isDischarge(medicationRequest MedicationRequest):
  exists (medicationRequest.category C
    where C ~ Discharge
  )

    Source1

    {
  "resourceType": "Measure",
  "id": "CMS104FHIRSTKDCAntithrombotic",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://hl7.org/fhir/administrative-gender",
            "code": "M",
            "display": "Male"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://hl7.org/fhir/administrative-gender",
            "code": "F",
            "display": "Female"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
            "code": "billing",
            "display": "Billing"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
            "code": "community",
            "display": "Community"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/medicationrequest-category",
            "code": "discharge",
            "display": "Discharge"
          }
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  case\n    when Patient.gender = 'male' then \"M\"\n    when Patient.gender = 'female' then \"F\"\n    else null\n  end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Non Elective Inpatient Encounter With Age"
            },
            {
              "url": "statement",
              "valueString": "define \"Non Elective Inpatient Encounter With Age\":\n  [\"Encounter\": \"Nonelective Inpatient Encounter\"] NonElectiveEncounter\n        where AgeInYearsAt(date from start of NonElectiveEncounter.period ) >= 18\n         and NonElectiveEncounter.period ends during day of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Ischemic Stroke Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Ischemic Stroke Encounter\":\n  \"Non Elective Inpatient Encounter With Age\" NonElectiveEncounterWithAge\n    where NonElectiveEncounterWithAge.principalDiagnosis().code in \"Ischemic Stroke\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with [\"MedicationRequest\": medication in \"Antithrombotic Therapy for Ischemic Stroke\"] DischargeAntithrombotic\n      such that DischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  TJC.\"Ischemic Stroke Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  [Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Ischemic Stroke Encounters With Discharge Disposition"
            },
            {
              "url": "statement",
              "valueString": "define \"Ischemic Stroke Encounters With Discharge Disposition\":\n  \"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n  let DischDisp: IschemicStrokeEncounter.hospitalization.dischargeDisposition\n  \twhere  DischDisp in \"Discharge To Acute Care Facility\"\n\t\tor DischDisp in \"Left Against Medical Advice\"\n\t\tor DischDisp in \"Patient Expired\"\n\t\tor DischDisp in \"Discharged to Home for Hospice Care\"\n\t\tor DischDisp in \"Discharged to Health Care Facility for Hospice Care\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "Intervention Comfort Measures"
            },
            {
              "url": "statement",
              "valueString": "define \"Intervention Comfort Measures\":\n  ( [\"ServiceRequest\": code in \"Comfort Measures\"] SR\n    where SR.status in { 'active', 'completed', 'on-hold' }\n      and SR.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n      and SR.doNotPerform is not true\n  )  \n  union ( [\"Procedure\": \"Comfort Measures\"] InterventionPerformed\n        where InterventionPerformed.status in { 'completed', 'in-progress' }\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Encounter With Comfort Measures During Hospitalization For Patients With Documented Ischemic Stroke"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Comfort Measures During Hospitalization For Patients With Documented Ischemic Stroke\":\n  \"Denominator\" Encounter\n    with TJC.\"Intervention Comfort Measures\" ComfortMeasure\n      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during Encounter.hospitalizationWithObservation ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  TJC.\"Ischemic Stroke Encounters With Discharge Disposition\"\n    union \"Encounter With Comfort Measures During Hospitalization For Patients With Documented Ischemic Stroke\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Reason For Not Giving Antithrombotic At Discharge"
            },
            {
              "url": "statement",
              "valueString": "define \"Reason For Not Giving Antithrombotic At Discharge\":\n  [\"MedicationNotRequested\": \"Antithrombotic Therapy for Ischemic Stroke\"] NoAntithromboticDischarge\n    where ( NoAntithromboticDischarge.reasonCode in \"Medical Reason For Not Providing Treatment\"\n        or NoAntithromboticDischarge.reasonCode in \"Patient Refusal\"\n    )\n      and ( NoAntithromboticDischarge.isCommunity ( )\n          or NoAntithromboticDischarge.isDischarge ( )\n      )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Encounter With Documented Reason For No Antithrombotic At Discharge"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Documented Reason For No Antithrombotic At Discharge\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Reason For Not Giving Antithrombotic At Discharge\" NoDischargeAntithrombotic\n      such that NoDischargeAntithrombotic.authoredOn during IschemicStrokeEncounter.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Pharmacological Contraindications For Antithrombotic Therapy At Discharge"
            },
            {
              "url": "statement",
              "valueString": "define \"Pharmacological Contraindications For Antithrombotic Therapy At Discharge\":\n  [\"MedicationRequest\": medication in \"Pharmacological Contraindications For Antithrombotic Therapy\"] PharmacologicalContraindications\n    where ( PharmacologicalContraindications.isCommunity ( )\n        or PharmacologicalContraindications.isDischarge ( )\n    )\n      and PharmacologicalContraindications.status in { 'active', 'completed' }\n      and PharmacologicalContraindications.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge"
            },
            {
              "url": "statement",
              "valueString": "//BONNIEMAT-1617-Since there is an anticipated resolution for STU 5 for Medication.Discharge which leaves one blockers on coverage, will leave the assertion logic as is and update the test cases for coverage.\n\n\ndefine \"Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Pharmacological Contraindications For Antithrombotic Therapy At Discharge\" DischargePharmacological\n      such that DischargePharmacological.authoredOn during IschemicStrokeEncounter.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS104FHIRSTKDCAntithrombotic"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions\":\n  \"Encounter With Documented Reason For No Antithrombotic At Discharge\"\n    union \"Encounter With Pharmacological Contraindications For Antithrombotic Therapy At Discharge\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine 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": 22
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "principalDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the condition that is specified as the principal diagnosis for the encounter\n*/\ndefine fluent function principalDiagnosis(Encounter Encounter ):\n\tsingleton from ((Encounter.diagnosis D where D.rank = 1 and D.use ~ \"Billing\") PD\n      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())\n\t)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "getId"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).\n@comment: This function can be used to determine the logical id of a given resource. It can be used in\na single-server environment to trace references. However, this function does not attempt to resolve\nor distinguish the base of the given url, and so cannot be used safely in multi-server environments.\n*/\ndefine fluent function getId(uri String):\n  Last(Split(uri, '/'))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value uri): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToCode"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "hospitalizationWithObservation"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n  TheEncounter Visit\n  \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n  \t\t\t\twhere LastObs.status = 'finished'\n            and LastObs.period ends 1 hour or less on or before start of Visit.period\n  \t\t\t\tsort by end of period\n  \t\t\t),\n  \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n  \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n  \t\t\t\twhere LastED.status = 'finished'\n            and LastED.period ends 1 hour or less on or before VisitStart\n  \t\t\t\tsort by end of period\n  \t\t\t)\n  \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToConcept"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isCommunity"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given MedicationRequest has a category of Community\n*/\ndefine fluent function isCommunity(medicationRequest MedicationNotRequested):\n  exists (medicationRequest.category C\n    where C ~ Community\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isDischarge"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given MedicationRequest has a category of Discharge\n*/\ndefine fluent function isDischarge(medicationRequest MedicationNotRequested):\n  exists (medicationRequest.category C\n    where C ~ Discharge\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isCommunity"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given MedicationRequest has a category of Community\n*/\ndefine fluent function isCommunity(medicationRequest MedicationRequest):\n  exists (medicationRequest.category C\n    where C ~ Community\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isDischarge"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given MedicationRequest has a category of Discharge\n*/\ndefine fluent function isDischarge(medicationRequest MedicationRequest):\n  exists (medicationRequest.category C\n    where C ~ Discharge\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        }
      ],
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "Library/SupplementalDataElements|3.5.000"
        },
        {
          "type": "depends-on",
          "display": "Library TJC",
          "resource": "Library/TJCOverall|8.15.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library CQMCommon",
          "resource": "Library/CQMCommon|2.2.000"
        },
        {
          "type": "depends-on",
          "display": "Library QICoreCommon",
          "resource": "Library/QICoreCommon|2.1.000"
        },
        {
          "type": "depends-on",
          "display": "Code system AdministrativeGender",
          "resource": "http://hl7.org/fhir/administrative-gender"
        },
        {
          "type": "depends-on",
          "display": "Code system DiagnosisRole",
          "resource": "http://terminology.hl7.org/CodeSystem/diagnosis-role"
        },
        {
          "type": "depends-on",
          "display": "Code system MedicationRequestCategory",
          "resource": "http://terminology.hl7.org/CodeSystem/medicationrequest-category"
        },
        {
          "type": "depends-on",
          "display": "Value set Nonelective Inpatient Encounter",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
        },
        {
          "type": "depends-on",
          "display": "Value set Ischemic Stroke",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247"
        },
        {
          "type": "depends-on",
          "display": "Value set Antithrombotic Therapy for Ischemic Stroke",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
        },
        {
          "type": "depends-on",
          "display": "Value set Payer Type",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
        },
        {
          "type": "depends-on",
          "display": "Value set Discharge To Acute Care Facility",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87"
        },
        {
          "type": "depends-on",
          "display": "Value set Left Against Medical Advice",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308"
        },
        {
          "type": "depends-on",
          "display": "Value set Patient Expired",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309"
        },
        {
          "type": "depends-on",
          "display": "Value set Discharged to Home for Hospice Care",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209"
        },
        {
          "type": "depends-on",
          "display": "Value set Discharged to Health Care Facility for Hospice Care",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207"
        },
        {
          "type": "depends-on",
          "display": "Value set Comfort Measures",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
        },
        {
          "type": "depends-on",
          "display": "Value set Observation Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
        },
        {
          "type": "depends-on",
          "display": "Value set Emergency Department Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
        },
        {
          "type": "depends-on",
          "display": "Value set Medical Reason For Not Providing Treatment",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473"
        },
        {
          "type": "depends-on",
          "display": "Value set Patient Refusal",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93"
        },
        {
          "type": "depends-on",
          "display": "Value set Pharmacological Contraindications For Antithrombotic Therapy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"
        }
      ],
      "parameter": [
        {
          "name": "Measurement Period",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "Period"
        },
        {
          "name": "SDE Sex",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Coding"
        },
        {
          "name": "Numerator",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Denominator",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Payer",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Ethnicity",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "Denominator Exclusions",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "Denominator Exceptions",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        }
      ],
      "dataRequirement": [
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "ethnicity",
            "race"
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "status",
            "status.value",
            "period",
            "rank",
            "rank.value",
            "use",
            "condition",
            "condition.reference",
            "condition.reference.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
            },
            {
              "path": "status.value",
              "code": [
                {
                  "code": "finished"
                }
              ]
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "status",
            "status.value",
            "period",
            "rank",
            "rank.value",
            "use",
            "condition",
            "condition.reference",
            "condition.reference.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
            },
            {
              "path": "status.value",
              "code": [
                {
                  "code": "finished"
                }
              ]
            }
          ],
          "dateFilter": [
            {
              "path": "period",
              "valuePeriod": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/uv/crmi-analysisException",
                    "valueString": "Error attempting to determine filter value: toFhirValue not implemented for Subtract"
                  }
                ]
              }
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
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            "rank",
            "rank.value",
            "use",
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            "condition.reference",
            "condition.reference.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ],
          "dateFilter": [
            {
              "path": "period",
              "valuePeriod": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                    "valueExpression": {
                      "language": "text/cql-identifier",
                      "expression": "Measurement Period"
                    }
                  }
                ]
              }
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "rank",
            "rank.value",
            "use",
            "condition",
            "condition.reference",
            "condition.reference.value",
            "hospitalization",
            "hospitalization.dischargeDisposition"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ],
          "dateFilter": [
            {
              "path": "period",
              "valuePeriod": {
                "extension": [
                  {
                    "url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                    "valueExpression": {
                      "language": "text/cql-identifier",
                      "expression": "Measurement Period"
                    }
                  }
                ]
              }
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
          ],
          "mustSupport": [
            "id",
            "id.value"
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport": [
            "medication",
            "authoredOn",
            "authoredOn.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport": [
            "medication",
            "status",
            "status.value",
            "intent",
            "intent.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest"
          ],
          "mustSupport": [
            "medication",
            "status",
            "status.value",
            "intent",
            "intent.value",
            "authoredOn",
            "authoredOn.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.52"
            }
          ]
        },
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "ServiceRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "intent",
            "intent.value",
            "doNotPerform",
            "doNotPerform.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested"
          ],
          "mustSupport": [
            "medication",
            "reasonCode",
            "authoredOn",
            "authoredOn.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested"
          ],
          "mustSupport": [
            "medication",
            "reasonCode",
            "authoredOn",
            "authoredOn.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "id": "supplementalDataGuidance",
      "extension": [
        {
          "url": "guidance",
          "valueString": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex; SDE Ethnicity-Patient's Ethnicity:\nHispanic or Latino\nNot Hispanic or Latino\n \n SDE Payer-Patient's Payer:\nCategories of types of health care payer entities as defined by the US Public Health Data Consortium SOP code system\n \n SDE Race-Patient's Race:\nNative Hawaiian or Other Pacific Islander\nAsian\nAmerican Indian or Alaska Native\nOther Race\nWhite\nBlack or African American\n \n SDE Sex-Patient's Sex:\nGender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.\n \n "
        },
        {
          "url": "usage",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                "code": "supplemental-data",
                "display": "Supplemental Data"
              }
            ],
            "text": "Supplemental Data Guidance"
          }
        }
      ],
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-supplementalDataGuidance"
    },
    {
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
      "valueReference": {
        "reference": "Device/cqf-tooling"
      }
    },
    {
      "id": "effective-data-requirements",
      "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
      "valueReference": {
        "reference": "#effective-data-requirements"
      }
    }
  ],
  "url": "https://madie.cms.gov/Measure/CMS104FHIRSTKDCAntithrombotic",
  "identifier": [
    {
      "use": "usual",
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code": "short-name",
            "display": "Short Name"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/shortName",
      "value": "CMS104FHIR"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code": "version-independent",
            "display": "Version Independent"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:4f57e4a2-097b-45f8-9c85-91b35ea92dc1"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code": "version-specific",
            "display": "Version Specific"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:9b88e8fc-1b6d-4414-af85-de255e1f81d6"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code": "publisher",
            "display": "Publisher"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "104FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.9.002",
  "name": "CMS104FHIRSTKDCAntithrombotic",
  "title": "Discharged on Antithrombotic TherapyFHIR",
  "status": "active",
  "experimental": false,
  "date": "2026-03-13T01:50:40+00:00",
  "publisher": "The Joint Commission",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.jointcommission.org/"
        }
      ]
    }
  ],
  "description": "Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
  "purpose": "UNKNOWN",
  "usage": "The \"Nonelective Inpatient Encounter\" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the \"Inpatient encounter\" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.\n\nThe \"Medication, Discharge\" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.\n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.\n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS104v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
  "copyright": "Measure specifications are in the Public Domain\n\nLOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.",
  "effectivePeriod": {
    "start": "2026-01-01",
    "end": "2026-12-31"
  },
  "author": [
    {
      "name": "The Joint Commission",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.jointcommission.org/"
        }
      ]
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS104FHIRSTKDCAntithrombotic"
  ],
  "disclaimer": "These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.",
  "rationale": "The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity if no contraindications exist.\n\n\nFor patients with a stroke due to a cardioembolic source (e.g., atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke\n\n\nAnticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA).",
  "clinicalRecommendationStatement": "Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity if no contraindications exist",
  "guidance": "The \"Nonelective Inpatient Encounter\" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the \"Inpatient encounter\" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.\n\nThe \"Medication, Discharge\" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.\n\nThe denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.\n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS104v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
  "group": [
    {
      "id": "675704e146b6174510cfedb3",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code": "proportion",
                "display": "Proportion"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode": "Encounter"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-type",
                "code": "process",
                "display": "Process"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "None"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
      "population": [
        {
          "id": "937BAF2A-D36A-4EE5-B2B2-762A0FE04502",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, ending during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "302C1DCC-7FE6-41EF-A94E-FDAE24B7BB1B",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "description": "Equals Initial Population",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "id": "4B649804-9C55-4949-8CE0-01B462CAA74C",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exclusion",
                "display": "Denominator Exclusion"
              }
            ]
          },
          "description": "- Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.\n- Inpatient hospitalizations for patients discharged to another hospital\n- Inpatient hospitalizations for patients who left against medical advice\n- Inpatient hospitalizations for patients who expired\n- Inpatient hospitalizations for patients discharged to home for hospice care\n- Inpatient hospitalizations for patients discharged to a health care facility for hospice care\n- Inpatient hospitalizations for patients with comfort measures documented",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusions"
          }
        },
        {
          "id": "99961E3A-EFC4-4858-A3EE-F7F1D5B222FB",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "516A3DD0-69B0-49EF-BBD3-12809CDC843E",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exception",
                "display": "Denominator Exception"
              }
            ]
          },
          "description": "- Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge\n- Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exceptions"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "id": "sde-payer",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Payer",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer"
      }
    },
    {
      "id": "sde-race",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Race",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Race"
      }
    },
    {
      "id": "sde-sex",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    }
  ]
}