FHIR © HL7.org  |  FHIRsmith 4.0.1  |  Server Home  |  XIG Home  |  XIG Stats  | 

FHIR IG analytics

Packagegov.healthit.ecqi.ecqms
Resource TypeMeasure
IdMeasure-CMS72FHIRSTKAntithromboticDay2.json
FHIR VersionR4
Sourcehttps://build.fhir.org/ig/cqframework/ecqm-content-qicore-2024/Measure-CMS72FHIRSTKAntithromboticDay2.html
URLhttps://madie.cms.gov/Measure/CMS72FHIRSTKAntithromboticDay2
Version0.7.001
Statusactive
Date2026-03-13T01:50:40+00:00
NameCMS72FHIRSTKAntithromboticDay2
TitleAntithrombotic Therapy By End of Hospital Day 2FHIR
DescriptionIschemic stroke patients administered antithrombotic therapy by the end of hospital day 2
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.

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

Title: Antithrombotic Therapy By End of Hospital Day 2FHIR
Id: CMS72FHIRSTKAntithromboticDay2
Version: 0.7.001
Url: Antithrombotic Therapy By End of Hospital Day 2FHIR
Short Name Identifier:

CMS72FHIR

Version Independent Identifier:

urn:uuid:b6ae4357-9baa-4195-a9cd-50391b7d0dab

Version Specific Identifier:

urn:uuid:e74bdff8-3857-471e-a0c5-b9307889bda6

Publisher (CMS) Identifier:

72FHIR

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

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2
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 (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.

Aspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.

Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.
Clinical recommendation statement:

Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as 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 Inpatient Encounters include emergency, urgent, and unplanned admissions. NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous). In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including Emergency Department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits. 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: CMS72v14. 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:
64f0d9e456d636294b157dec
Initial Population: Inpatient hospitalization (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke that ends during the measurement period
Denominator: Equals Initial Population
Denominator Exclusion: - Inpatient hospitalization for patients who have a duration of stay less than 2 days. - Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival. - Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization.
Numerator: Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival
Denominator Exception: - Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival - Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival - Inpatient hospitalization for patients with an international normalised ratio (INR) greater than 3.5
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:
CMS72FHIRSTKAntithromboticDay2
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
  • Condition Clinical Status Codes
  • ConditionVerificationStatus
  • Non-Elective Inpatient Encounter
  • Ischemic Stroke
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62
  • Observation Services
  • Emergency Department Visit
  • Payer
  • Comfort Measures
  • Thrombolytic (t-PA) Therapy
  • Intravenous or Intra-arterial Thrombolytic (t-PA) Therapy
  • Intravenous or Intra arterial Thrombolytic (tPA) Therapy Prior to Arrival
  • Medical Reason
  • Patient Refusal
  • Pharmacological Contraindications For Antithrombotic Therapy
  • INR
    		•
    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
    Condition(QICoreCondition) id id.value code
    Condition(QICoreCondition) code recordedDate recordedDate.value verificationStatus Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival Intravenous or Intra arterial Thrombolytic (tPA) Therapy Prior to Arrival
    MedicationAdministration(QICoreMedicationAdministration) medication status status.value effective Antithrombotic Therapy for Ischemic Stroke http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62
    MedicationAdministration(QICoreMedicationAdministration) medication status status.value id id.value effective Thrombolytic tPA Therapy Thrombolytic (t-PA) Therapy
    MedicationAdministration(QICoreMedicationAdministration) medication status status.value effective 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
    Procedure(QICoreProcedure) code status status.value id id.value performed Intravenous or Intraarterial Thrombolytic tPA Therapy Intravenous or Intra-arterial Thrombolytic (t-PA) Therapy
    MedicationRequest(QICoreMedicationNotRequested) medication status status.value intent intent.value reasonCode id id.value authoredOn authoredOn.value Antithrombotic Therapy for Ischemic Stroke http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62
    MedicationAdministration(QICoreMedicationAdministrationNotDone) medication statusReason id id.value extension Antithrombotic Therapy for Ischemic Stroke http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62
    Observation(QICoreObservation) code value status status.value issued issued.value INR INR
    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
    Active active http://terminology.hl7.org/CodeSystem/condition-clinical
    Recurrence recurrence http://terminology.hl7.org/CodeSystem/condition-clinical
    Relapse relapse http://terminology.hl7.org/CodeSystem/condition-clinical
    Confirmed confirmed http://terminology.hl7.org/CodeSystem/condition-ver-status
    Logic Definitions:
    Group Scoring Population Criteria Expression
    64f0d9e456d636294b157dec 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":
  "Encounter Less Than Two Days"
    union "Encounter With Comfort Measures During Day Of Or Day After Arrival"
    union "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"
    Numerator 
    define "Numerator":
  "Encounter With Antithrombotic Therapy"
    Denominator Exception 
    define "Denominator Exceptions":
  "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival"
    union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival"
    union "Encounter With An INR Greater Than 3.5"
    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
    CMS72FHIRSTKAntithromboticDay2 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
    CMS72FHIRSTKAntithromboticDay2 Encounter With Antithrombotic Therapy 
    define "Encounter With Antithrombotic Therapy":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationAdministration": medication in "Antithrombotic Therapy for Ischemic Stroke"] Antithrombotic
      such that Antithrombotic.status in { 'in-progress', 'completed' }
        and Antithrombotic.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Numerator 
    define "Numerator":
  "Encounter With Antithrombotic Therapy"
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Initial Population 
    define "Initial Population":
  TJC."Ischemic Stroke Encounter"
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 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
    CMS72FHIRSTKAntithromboticDay2 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
    CMS72FHIRSTKAntithromboticDay2 SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Encounter Less Than Two Days 
    define "Encounter Less Than Two Days":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    where IschemicStrokeEncounter.hospitalizationWithObservation ( ).lengthInDays ( ) < 2
    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
    CMS72FHIRSTKAntithromboticDay2 Encounter With Comfort Measures During Day Of Or Day After Arrival 
    define "Encounter With Comfort Measures During Day Of Or Day After Arrival":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with TJC."Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Thrombolytic Therapy Medication Or Procedures 
    define "Thrombolytic Therapy Medication Or Procedures":
  ( ["MedicationAdministration": medication in "Thrombolytic tPA Therapy"] ThrombolyticMedication
      where ThrombolyticMedication.status in { 'in-progress', 'completed' }
      return {
        id: ThrombolyticMedication.id,
        effective: ThrombolyticMedication.effective
      }
  )
    union ( ["Procedure": "Intravenous or Intraarterial Thrombolytic tPA Therapy"] ThrombolyticProcedure
        where ThrombolyticProcedure.status = 'completed'
        return {
          id: ThrombolyticProcedure.id,
          effective: ThrombolyticProcedure.performed
        }
    )
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Encounter With Thrombolytic Therapy Medication Or Procedures 
    define "Encounter With Thrombolytic Therapy Medication Or Procedures":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Thrombolytic Therapy Medication Or Procedures" ThrombolyticTherapy
      such that ThrombolyticTherapy.effective.toInterval ( ) starts during Interval[start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) - 24 hours, end of IschemicStrokeEncounter.hospitalizationWithObservation ( ) )
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Encounter With Thrombolytic Therapy Prior To Arrival 
    define "Encounter With Thrombolytic Therapy Prior To Arrival":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
        where ( EncounterDiagnosis.code in "Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival" )
    )
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Encounter With Thrombolytic Therapy Documented As Already Given 
    define "Encounter With Thrombolytic Therapy Documented As Already Given":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with [Condition: "Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival"] PriorTPA
      such that PriorTPA.recordedDate during CQMCommon."HospitalizationWithObservation" ( IschemicStrokeEncounter )
        and PriorTPA.isActive ( )
        and PriorTPA.verificationStatus is not null
        and PriorTPA.verificationStatus ~ QICoreCommon."confirmed"
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization 
    define "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization":
  "Encounter With Thrombolytic Therapy Medication Or Procedures"
    union "Encounter With Thrombolytic Therapy Prior To Arrival"
    union "Encounter With Thrombolytic Therapy Documented As Already Given"
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Denominator Exclusions 
    define "Denominator Exclusions":
  "Encounter Less Than Two Days"
    union "Encounter With Comfort Measures During Day Of Or Day After Arrival"
    union "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"
    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
    CMS72FHIRSTKAntithromboticDay2 SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Reason For Not Ordering Antithrombotic 
    define "Reason For Not Ordering Antithrombotic":
  ["MedicationNotRequested": medication in "Antithrombotic Therapy for Ischemic Stroke"] NoAntithromboticOrder
    where NoAntithromboticOrder.status = 'completed'
      and NoAntithromboticOrder.intent = 'order'
      and ( NoAntithromboticOrder.reasonCode in "Medical Reason for Not Providing Treatment"
          or NoAntithromboticOrder.reasonCode in "Patient Refusal"
      )
    return {
      id: NoAntithromboticOrder.id,
      authoredOn: NoAntithromboticOrder.authoredOn
    }
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Reason For Not Administering Antithrombotic 
    define "Reason For Not Administering Antithrombotic":
  ["MedicationAdministrationNotDone": medication in "Antithrombotic Therapy for Ischemic Stroke"] MedicationAdm
    where ( MedicationAdm.statusReason in "Medical Reason for Not Providing Treatment"
        or MedicationAdm.statusReason in "Patient Refusal"
    )
    return {
      id: MedicationAdm.id,
      authoredOn: MedicationAdm.recorded
    }
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Documented Reason For No Antithrombotic Ordered Or Administered 
    define "Documented Reason For No Antithrombotic Ordered Or Administered":
  "Reason For Not Ordering Antithrombotic"
    union "Reason For Not Administering Antithrombotic"
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival 
    define "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with "Documented Reason For No Antithrombotic Ordered Or Administered" NoAntithrombotic
      such that NoAntithrombotic.authoredOn during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival 
    define "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["MedicationAdministration": medication in "Pharmacological Contraindications For Antithrombotic Therapy"] PharmacologicalContraindications
      such that PharmacologicalContraindications.status in { 'in-progress', 'completed' }
        and PharmacologicalContraindications.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Encounter With An INR Greater Than 3.5 
    define "Encounter With An INR Greater Than 3.5":
  TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter
    with ["Observation": "INR"] INR
      such that INR.value as Quantity > 3.5
        and INR.status in { 'final', 'amended', 'corrected' }
        and INR.issued during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )
    Library Name Name
    CMS72FHIRSTKAntithromboticDay2 Denominator Exceptions 
    define "Denominator Exceptions":
  "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival"
    union "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival"
    union "Encounter With An INR Greater Than 3.5"
    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
    TJCOverall CalendarDayOfOrDayAfter 
    define fluent function CalendarDayOfOrDayAfter(StartValue DateTime):
  Interval [date from (StartValue), date from (StartValue) + 1 day]
    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 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 lengthInDays 
    /*
@description: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
  difference in days between start of Value and end of Value
    Library Name Name
    CQMCommon encounterDiagnosis 
    /*
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.diagnosis D
    return singleton from ([Condition] C where C.id = D.condition.reference.getId())
    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
@deprecated: This function is deprecated. Use the fluent function `hospitalizationWithObservation()` instead.
*/
define 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
    QICoreCommon isActive 
    /* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
  condition.clinicalStatus ~ "active"
    or condition.clinicalStatus ~ "recurrence"
    or condition.clinicalStatus ~ "relapse"
    Library Name Name
    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
        }

    Source1

    {
  "resourceType": "Measure",
  "id": "CMS72FHIRSTKAntithromboticDay2",
  "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/condition-clinical",
            "code": "active",
            "display": "Active"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "recurrence",
            "display": "Recurrence"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "relapse",
            "display": "Relapse"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
            "code": "confirmed",
            "display": "Confirmed"
          }
        },
        {
          "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": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "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": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Encounter With Antithrombotic Therapy"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Antithrombotic Therapy\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with [\"MedicationAdministration\": medication in \"Antithrombotic Therapy for Ischemic Stroke\"] Antithrombotic\n      such that Antithrombotic.status in { 'in-progress', 'completed' }\n        and Antithrombotic.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n  \"Encounter With Antithrombotic Therapy\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  TJC.\"Ischemic Stroke Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n  \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "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": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "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": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Encounter Less Than Two Days"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter Less Than Two Days\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    where IschemicStrokeEncounter.hospitalizationWithObservation ( ).lengthInDays ( ) < 2"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "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": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Encounter With Comfort Measures During Day Of Or Day After Arrival"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Comfort Measures During Day Of Or Day After Arrival\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with TJC.\"Intervention Comfort Measures\" ComfortMeasure\n      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Thrombolytic Therapy Medication Or Procedures"
            },
            {
              "url": "statement",
              "valueString": "define \"Thrombolytic Therapy Medication Or Procedures\":\n  ( [\"MedicationAdministration\": medication in \"Thrombolytic tPA Therapy\"] ThrombolyticMedication\n      where ThrombolyticMedication.status in { 'in-progress', 'completed' }\n      return {\n        id: ThrombolyticMedication.id,\n        effective: ThrombolyticMedication.effective\n      }\n  )\n    union ( [\"Procedure\": \"Intravenous or Intraarterial Thrombolytic tPA Therapy\"] ThrombolyticProcedure\n        where ThrombolyticProcedure.status = 'completed'\n        return {\n          id: ThrombolyticProcedure.id,\n          effective: ThrombolyticProcedure.performed\n        }\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Encounter With Thrombolytic Therapy Medication Or Procedures"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Thrombolytic Therapy Medication Or Procedures\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Thrombolytic Therapy Medication Or Procedures\" ThrombolyticTherapy\n      such that ThrombolyticTherapy.effective.toInterval ( ) starts during Interval[start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) - 24 hours, end of IschemicStrokeEncounter.hospitalizationWithObservation ( ) )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Encounter With Thrombolytic Therapy Prior To Arrival"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Thrombolytic Therapy Prior To Arrival\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    where exists ( ( IschemicStrokeEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis\n        where ( EncounterDiagnosis.code in \"Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\" )\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Encounter With Thrombolytic Therapy Documented As Already Given"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Thrombolytic Therapy Documented As Already Given\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with [Condition: \"Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival\"] PriorTPA\n      such that PriorTPA.recordedDate during CQMCommon.\"HospitalizationWithObservation\" ( IschemicStrokeEncounter )\n        and PriorTPA.isActive ( )\n        and PriorTPA.verificationStatus is not null\n        and PriorTPA.verificationStatus ~ QICoreCommon.\"confirmed\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization\":\n  \"Encounter With Thrombolytic Therapy Medication Or Procedures\"\n    union \"Encounter With Thrombolytic Therapy Prior To Arrival\"\n    union \"Encounter With Thrombolytic Therapy Documented As Already Given\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusions\":\n  \"Encounter Less Than Two Days\"\n    union \"Encounter With Comfort Measures During Day Of Or Day After Arrival\"\n    union \"Encounter With Thrombolytic Therapy Given Prior To Arrival Or During Hospitalization\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "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": 21
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Reason For Not Ordering Antithrombotic"
            },
            {
              "url": "statement",
              "valueString": "define \"Reason For Not Ordering Antithrombotic\":\n  [\"MedicationNotRequested\": medication in \"Antithrombotic Therapy for Ischemic Stroke\"] NoAntithromboticOrder\n    where NoAntithromboticOrder.status = 'completed'\n      and NoAntithromboticOrder.intent = 'order'\n      and ( NoAntithromboticOrder.reasonCode in \"Medical Reason for Not Providing Treatment\"\n          or NoAntithromboticOrder.reasonCode in \"Patient Refusal\"\n      )\n    return {\n      id: NoAntithromboticOrder.id,\n      authoredOn: NoAntithromboticOrder.authoredOn\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Reason For Not Administering Antithrombotic"
            },
            {
              "url": "statement",
              "valueString": "define \"Reason For Not Administering Antithrombotic\":\n  [\"MedicationAdministrationNotDone\": medication in \"Antithrombotic Therapy for Ischemic Stroke\"] MedicationAdm\n    where ( MedicationAdm.statusReason in \"Medical Reason for Not Providing Treatment\"\n        or MedicationAdm.statusReason in \"Patient Refusal\"\n    )\n    return {\n      id: MedicationAdm.id,\n      authoredOn: MedicationAdm.recorded\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Documented Reason For No Antithrombotic Ordered Or Administered"
            },
            {
              "url": "statement",
              "valueString": "define \"Documented Reason For No Antithrombotic Ordered Or Administered\":\n  \"Reason For Not Ordering Antithrombotic\"\n    union \"Reason For Not Administering Antithrombotic\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with \"Documented Reason For No Antithrombotic Ordered Or Administered\" NoAntithrombotic\n      such that NoAntithrombotic.authoredOn during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with [\"MedicationAdministration\": medication in \"Pharmacological Contraindications For Antithrombotic Therapy\"] PharmacologicalContraindications\n      such that PharmacologicalContraindications.status in { 'in-progress', 'completed' }\n        and PharmacologicalContraindications.effective.toInterval ( ) starts during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Encounter With An INR Greater Than 3.5"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With An INR Greater Than 3.5\":\n  TJC.\"Ischemic Stroke Encounter\" IschemicStrokeEncounter\n    with [\"Observation\": \"INR\"] INR\n      such that INR.value as Quantity > 3.5\n        and INR.status in { 'final', 'amended', 'corrected' }\n        and INR.issued during day of ( start of IschemicStrokeEncounter.hospitalizationWithObservation ( ) ).CalendarDayOfOrDayAfter ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS72FHIRSTKAntithromboticDay2"
            },
            {
              "url": "name",
              "valueString": "Denominator Exceptions"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exceptions\":\n  \"Encounter With Documented Reason For No Antithrombotic Ordered Or Administered Day Of Or Day After Hospital Arrival\"\n    union \"Encounter With Pharmacological Contraindications For Antithrombotic Therapy Given Day Of Or Day After Hospital Arrival\"\n    union \"Encounter With An INR Greater Than 3.5\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "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": 30
            }
          ],
          "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": 31
            }
          ],
          "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": 32
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "TJCOverall"
            },
            {
              "url": "name",
              "valueString": "CalendarDayOfOrDayAfter"
            },
            {
              "url": "statement",
              "valueString": "define fluent function CalendarDayOfOrDayAfter(StartValue DateTime):\n  Interval [date from (StartValue), date from (StartValue) + 1 day]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "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": 34
            }
          ],
          "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": 35
            }
          ],
          "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": 36
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "lengthInDays"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Calculates the difference in calendar days between the start and end of the given interval.\n*/\ndefine fluent function lengthInDays(Value Interval<DateTime> ):\n  difference in days between start of Value and end of Value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "encounterDiagnosis"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns the Condition resources referenced by the diagnosis element of the Encounter\n*/\ndefine fluent function encounterDiagnosis(Encounter Encounter ):\n  Encounter.diagnosis D\n    return singleton from ([Condition] C where C.id = D.condition.reference.getId())"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "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@deprecated: This function is deprecated. Use the fluent function `hospitalizationWithObservation()` instead.\n*/\ndefine 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": 39
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "isActive"
            },
            {
              "url": "statement",
              "valueString": "/* Candidates for FHIRCommon */\n\n/*\n@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse\n*/\ndefine fluent function isActive(condition Condition):\n  condition.clinicalStatus ~ \"active\"\n    or condition.clinicalStatus ~ \"recurrence\"\n    or condition.clinicalStatus ~ \"relapse\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 40
            }
          ],
          "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": 41
            }
          ],
          "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 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": "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 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 Payer Type",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
        },
        {
          "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 Thrombolytic tPA Therapy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.226"
        },
        {
          "type": "depends-on",
          "display": "Value set Intravenous or Intraarterial Thrombolytic tPA Therapy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.21"
        },
        {
          "type": "depends-on",
          "display": "Value set Intravenous or Intraarterial Thrombolytic tPA Therapy Prior to Arrival",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.21"
        },
        {
          "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"
        },
        {
          "type": "depends-on",
          "display": "Value set INR",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213"
        }
      ],
      "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",
            "period",
            "rank",
            "rank.value",
            "use",
            "condition",
            "condition.reference",
            "condition.reference.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.424"
            }
          ],
          "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",
            "code"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
          ],
          "mustSupport": [
            "code",
            "recordedDate",
            "recordedDate.value",
            "verificationStatus"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.21"
            },
            {
              "path": "verificationStatus"
            }
          ]
        },
        {
          "type": "MedicationAdministration",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration"
          ],
          "mustSupport": [
            "medication",
            "status",
            "status.value",
            "effective"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        },
        {
          "type": "MedicationAdministration",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration"
          ],
          "mustSupport": [
            "medication",
            "status",
            "status.value",
            "id",
            "id.value",
            "effective"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.226"
            }
          ]
        },
        {
          "type": "MedicationAdministration",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration"
          ],
          "mustSupport": [
            "medication",
            "status",
            "status.value",
            "effective"
          ],
          "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": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "id",
            "id.value",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.21"
            },
            {
              "path": "status.value",
              "code": [
                {
                  "code": "completed"
                }
              ]
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotrequested"
          ],
          "mustSupport": [
            "medication",
            "status",
            "status.value",
            "intent",
            "intent.value",
            "reasonCode",
            "id",
            "id.value",
            "authoredOn",
            "authoredOn.value"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        },
        {
          "type": "MedicationAdministration",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-mednotadministered"
          ],
          "mustSupport": [
            "medication",
            "statusReason",
            "id",
            "id.value",
            "extension"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.62"
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
          ],
          "mustSupport": [
            "code",
            "value",
            "status",
            "status.value",
            "issued",
            "issued.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213"
            }
          ]
        }
      ]
    }
  ],
  "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 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 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 "
        },
        {
          "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/CMS72FHIRSTKAntithromboticDay2",
  "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": "CMS72FHIR"
    },
    {
      "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:b6ae4357-9baa-4195-a9cd-50391b7d0dab"
    },
    {
      "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:e74bdff8-3857-471e-a0c5-b9307889bda6"
    },
    {
      "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": "72FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.7.001",
  "name": "CMS72FHIRSTKAntithromboticDay2",
  "title": "Antithrombotic Therapy By End of Hospital Day 2FHIR",
  "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 administered antithrombotic therapy by the end of hospital day 2",
  "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 Inpatient Encounters include emergency, urgent, and unplanned admissions. \n\nNPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous).  \n\nIn the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including Emergency Department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.\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: CMS72v14.  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/CMS72FHIRSTKAntithromboticDay2"
  ],
  "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 (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.\n\nAspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy.\n\nAnticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.",
  "clinicalRecommendationStatement": "Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as 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 Inpatient Encounters include emergency, urgent, and unplanned admissions. \n\nNPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous).  \n\nIn the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including Emergency Department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits.\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: CMS72v14.  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": "64f0d9e456d636294b157dec",
      "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 administered antithrombotic therapy by the end of hospital day 2",
      "population": [
        {
          "id": "671415E2-A9AB-4A88-8D9F-E13567DB60DE",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Inpatient hospitalization (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke that ends during the measurement period",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "66E700CD-3526-4907-B48F-20A3C99FF470",
          "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": "0B767BB2-1D05-4020-B629-548946B64CBD",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exclusion",
                "display": "Denominator Exclusion"
              }
            ]
          },
          "description": "- Inpatient hospitalization for patients who have a duration of stay less than 2 days.\n- Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival.\n- Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization.",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusions"
          }
        },
        {
          "id": "DADB9060-BF4C-4032-94D5-8D981DDFDD1B",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "description": "Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "id": "998D63FA-104C-4FFB-9641-37E14045AF9D",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exception",
                "display": "Denominator Exception"
              }
            ]
          },
          "description": "- Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival\n- Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival\n- Inpatient hospitalization for patients with an international normalised ratio (INR) greater than 3.5",
          "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"
      }
    }
  ]
}