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Packagegov.healthit.ecqi.ecqms
Resource TypeMeasure
IdMeasure-OncologyPainIntensityQuantifiedFHIR.json
FHIR VersionR4
Sourcehttps://build.fhir.org/ig/cqframework/ecqm-content-qicore-2024/Measure-OncologyPainIntensityQuantifiedFHIR.html
URLhttps://madie.cms.gov/Measure/OncologyPainIntensityQuantifiedFHIR
Version0.1.000
Statusdraft
Date2026-03-13T01:50:42+00:00
NameOncologyPainIntensityQuantifiedFHIR
TitleOncology: Medical and Radiation Pain Intensity QuantifiedFHIR
DescriptionPercentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified
PurposeUNKNOWN
CopyrightCopyright 2024 American Society of Clinical Oncology. All Rights Reserved.

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Narrative

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

Title: Oncology: Medical and Radiation Pain Intensity QuantifiedFHIR
Id: OncologyPainIntensityQuantifiedFHIR
Version: 0.1.000
Url: Oncology: Medical and Radiation Pain Intensity QuantifiedFHIR
short-name identifier:

CMS157FHIR

version-independent identifier:

urn:uuid:b7b487bf-bc27-48c9-994f-6d095ff84500

version-specific identifier:

urn:uuid:b64a5fbf-607d-4b2f-bf67-6a80db552b48

endorser (CMS Consensus Based Entity) identifier:

0384e

publisher (CMS) identifier:

157FHIR

Effective Period: 2025-01-01..2025-12-31
Status: draft
Publisher: American Society of Clinical Oncology
Author: American Society of Clinical Oncology
Description:

Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified
Purpose:

UNKNOWN
Copyright:

Copyright 2024 American Society of Clinical Oncology. All Rights Reserved.
Disclaimer:

The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.

The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain.

Commercial uses of the Measure require a license agreement between the user and American Society of Clinical Oncology (ASCO) and prior written approval of ASCO. Contact measurement@asco.org for licensing this measure. Neither ASCO nor its members shall be responsible for any use of the Measure.

The PCPI’s and American Medical Association’s significant past efforts and contributions to the development and updating of the Measures are acknowledged.

ASCO is solely responsible for the review and enhancement ("Maintenance") of the Measure as of June 2020.

ASCO encourages the use of the Measure by other health care professionals, where appropriate.

THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Limited proprietary coding may be contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. ASCO and its members disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R].
Scoring:

Proportion

Rationale:

Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee, Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN, 2023), undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement. Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure fulfilment of patient goals around comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). To maximize patient outcomes, pain management is an essential part of oncologic management (NCCN, 2023).

A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management.
Clinical recommendation statement:

-Screen all patients for pain at each contact.

-Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, satisfaction with pain relief, pain interference, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment. If necessary, get additional information from caregiver regarding pain and impact on function.

-Perform comprehensive pain assessment if new or worsening pain is present and regularly for persisting pain.

Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2023).
Guidance (Usage): This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face or telehealth interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face or telehealth encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face or telehealth encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). This FHIR-based measure has been derived from the QDM-based measure: CMS157v13. 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:
6511b159da013638e7b3ddda
Initial Population: All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy
Denominator: Equals Initial Population
Numerator: Patient visits in which pain intensity is quantified
6511b159da013638e7b3dddb
Initial Population: All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving radiation therapy
Denominator: Equals Initial Population
Numerator: Patient visits in which pain intensity is quantified
Libraries:
OncologyPainIntensityQuantifiedFHIR
Terminology and Other Dependencies:
  • Library/QICoreCommon|2.1.000
  • Library/FHIRHelpers|4.4.000
  • Condition Clinical Status Codes
  • Current Procedural Terminology (CPT®)
  • Radiation Treatment Management
  • Cancer
  • Office Visit
  • Chemotherapy Administration
  • Standardized Pain Assessment Tool
    		•
    Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    Denominator 2 Out 0 * Resource
    Numerator 1 Out 0 * Resource
    Numerator 2 Out 0 * Resource
    Initial Population 1 Out 0 * Resource
    Initial Population 2 Out 0 * Resource
    Denominator 1 Out 0 * Resource
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Patient(QICorePatient)
    Condition(QICoreCondition) code Cancer Cancer
    Encounter(QICoreEncounter) type period status status.value Radiation Treatment Management Radiation Treatment Management
    Encounter(QICoreEncounter) type period status status.value Office Visit Office Visit
    Procedure(QICoreProcedure) code performed status status.value Chemotherapy Administration Chemotherapy Administration
    Procedure(QICoreProcedure) code performed status status.value Chemotherapy Administration Chemotherapy Administration
    Procedure(QICoreProcedure) code performed status status.value Chemotherapy Administration Chemotherapy Administration
    Observation(QICoreObservation) code value status status.value effective Standardized Pain Assessment Tool Standardized Pain Assessment Tool
    Direct Reference Codes:
    display code system
    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
    Radiation treatment management, 5 treatments 77427 http://www.ama-assn.org/go/cpt
    Logic Definitions:
    Group Scoring Population Criteria Expression
    6511b159da013638e7b3ddda Group scoring: proportion Measure scoring:

    Proportion

    Type:

    Process

    Rate Aggregation: This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: - Population 1: Visits for patients with a diagnosis of cancer who are currently receiving chemotherapy - Population 2: Visits for patients with a diagnosis of cancer who are currently receiving radiation therapy For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ (Denominator 1 + Denominator 2)
    Improvement Notation:

    Increased score indicates improvement

    Initial Population 
    define "Initial Population 1":
  "Face to Face or Telehealth Encounter with Ongoing Chemotherapy"
    Denominator 
    define "Denominator 1":
  "Initial Population 1"
    Numerator 
    define "Numerator 1":
  "Face to Face or Telehealth Encounter with Ongoing Chemotherapy" FaceToFaceOrTelehealthEncounterWithChemo
    with "Standard Pain Assessment with Result" PainAssessed
      such that PainAssessed.effective.toInterval ( ) during FaceToFaceOrTelehealthEncounterWithChemo.period
    6511b159da013638e7b3dddb Group scoring: proportion Measure scoring:

    Proportion

    Type:

    Process

    Rate Aggregation: This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: - Population 1: Visits for patients with a diagnosis of cancer who are currently receiving chemotherapy - Population 2: Visits for patients with a diagnosis of cancer who are currently receiving radiation therapy For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ (Denominator 1 + Denominator 2)
    Improvement Notation:

    increase

    Initial Population 
    define "Initial Population 2":
  "Radiation Treatment Management During Measurement Period with Cancer Diagnosis"
    Denominator 
    define "Denominator 2":
  "Initial Population 2"
    Numerator 
    define "Numerator 2":
  "Radiation Treatment Management During Measurement Period with Cancer Diagnosis" RadiationManagementEncounter
    with "Standard Pain Assessment with Result" PainAssessed
      such that case
        when exists ( ( RadiationManagementEncounter.type ) RadiationManagement
            where RadiationManagement ~ "Radiation treatment management, 5 treatments"
        ) then PainAssessed.effective.toInterval ( ) 6 days or less on or before day of start of RadiationManagementEncounter.period 
        else PainAssessed.effective.toInterval ( ) during day of RadiationManagementEncounter.period end
    Library Name Name
    OncologyPainIntensityQuantifiedFHIR Radiation Treatment Management During Measurement Period with Cancer Diagnosis 
    define "Radiation Treatment Management During Measurement Period with Cancer Diagnosis":
  ( [Encounter: "Radiation Treatment Management"] ) RadiationTreatmentManagement
    with [Condition: "Cancer"] Cancer
      such that Cancer.isActive ( )
        and Cancer.prevalenceInterval ( ) overlaps RadiationTreatmentManagement.period
    where RadiationTreatmentManagement.period during "Measurement Period"
      and RadiationTreatmentManagement.status = 'finished'
    Library Name Name
    OncologyPainIntensityQuantifiedFHIR Initial Population 2 
    define "Initial Population 2":
  "Radiation Treatment Management During Measurement Period with Cancer Diagnosis"
    Library Name Name
    OncologyPainIntensityQuantifiedFHIR Denominator 2 
    define "Denominator 2":
  "Initial Population 2"
    Library Name Name
    OncologyPainIntensityQuantifiedFHIR Chemotherapy Within 31 Days Prior and During Measurement Period 
    define "Chemotherapy Within 31 Days Prior and During Measurement Period":
  [Procedure: "Chemotherapy Administration"] ChemoAdministration
    where ChemoAdministration.performed.toInterval ( ) during Interval[start of "Measurement Period" - 31 days, end of "Measurement Period"]
      and ChemoAdministration.status = 'completed'
    Library Name Name
    OncologyPainIntensityQuantifiedFHIR Face to Face or Telehealth Encounter with Ongoing Chemotherapy 
    define "Face to Face or Telehealth Encounter with Ongoing Chemotherapy":
  from
    [Encounter: "Office Visit"] FaceToFaceOrTelehealthEncounter,
    "Chemotherapy Within 31 Days Prior and During Measurement Period" ChemoBeforeEncounter,
    "Chemotherapy Within 31 Days Prior and During Measurement Period" ChemoAfterEncounter,
    [Condition: "Cancer"] Cancer
    where Cancer.isActive ( )
      and Cancer.prevalenceInterval ( ) overlaps FaceToFaceOrTelehealthEncounter.period
      and ChemoBeforeEncounter.performed.toInterval ( ) starts 30 days or less on or before day of end of FaceToFaceOrTelehealthEncounter.period
      and ChemoAfterEncounter.performed.toInterval ( ) starts 30 days or less on or after day of end of FaceToFaceOrTelehealthEncounter.period
      and not ( ChemoAfterEncounter.performed.toInterval ( ) same day as ChemoBeforeEncounter.performed.toInterval ( ) )
      and FaceToFaceOrTelehealthEncounter.period during "Measurement Period"
      and FaceToFaceOrTelehealthEncounter.status = 'finished'
    return FaceToFaceOrTelehealthEncounter
    Library Name Name
    OncologyPainIntensityQuantifiedFHIR Standard Pain Assessment with Result 
    define "Standard Pain Assessment with Result":
  ["Observation": "Standardized Pain Assessment Tool"] AssessedPain
    where AssessedPain.value is not null
      and AssessedPain.status = 'final'
    Library Name Name
    OncologyPainIntensityQuantifiedFHIR Numerator 1 
    define "Numerator 1":
  "Face to Face or Telehealth Encounter with Ongoing Chemotherapy" FaceToFaceOrTelehealthEncounterWithChemo
    with "Standard Pain Assessment with Result" PainAssessed
      such that PainAssessed.effective.toInterval ( ) during FaceToFaceOrTelehealthEncounterWithChemo.period
    Library Name Name
    OncologyPainIntensityQuantifiedFHIR Numerator 2 
    define "Numerator 2":
  "Radiation Treatment Management During Measurement Period with Cancer Diagnosis" RadiationManagementEncounter
    with "Standard Pain Assessment with Result" PainAssessed
      such that case
        when exists ( ( RadiationManagementEncounter.type ) RadiationManagement
            where RadiationManagement ~ "Radiation treatment management, 5 treatments"
        ) then PainAssessed.effective.toInterval ( ) 6 days or less on or before day of start of RadiationManagementEncounter.period 
        else PainAssessed.effective.toInterval ( ) during day of RadiationManagementEncounter.period end
    Library Name Name
    OncologyPainIntensityQuantifiedFHIR Initial Population 1 
    define "Initial Population 1":
  "Face to Face or Telehealth Encounter with Ongoing Chemotherapy"
    Library Name Name
    OncologyPainIntensityQuantifiedFHIR Denominator 1 
    define "Denominator 1":
  "Initial Population 1"
    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
    QICoreCommon prevalenceInterval 
    /*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]
    Library Name Name
    QICoreCommon abatementInterval 
    /*
@description: Returns an interval representing the normalized abatement of a given Condition.
@comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.
*/
define fluent function abatementInterval(condition Condition):
	if condition.abatement is DateTime then
	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
	else if condition.abatement is Quantity then
		Interval[Patient.birthDate + (condition.abatement as Quantity),
			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
	else if condition.abatement is Interval<Quantity> then
	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
	else if condition.abatement is Interval<DateTime> then
	  Interval[condition.abatement.low, condition.abatement.high)
	else null as Interval<DateTime>
    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
    FHIRHelpers ToConcept 
    /*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }
    Library Name Name
    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
        }

    Source1

    {
  "resourceType": "Measure",
  "id": "OncologyPainIntensityQuantifiedFHIR",
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      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
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      "extension": [
        {
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          "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://www.ama-assn.org/go/cpt",
            "code": "77427",
            "display": "Radiation treatment management, 5 treatments"
          }
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            {
              "url": "name",
              "valueString": "Radiation Treatment Management During Measurement Period with Cancer Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Radiation Treatment Management During Measurement Period with Cancer Diagnosis\":\n  ( [Encounter: \"Radiation Treatment Management\"] ) RadiationTreatmentManagement\n    with [Condition: \"Cancer\"] Cancer\n      such that Cancer.isActive ( )\n        and Cancer.prevalenceInterval ( ) overlaps RadiationTreatmentManagement.period\n    where RadiationTreatmentManagement.period during \"Measurement Period\"\n      and RadiationTreatmentManagement.status = 'finished'"
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            },
            {
              "url": "name",
              "valueString": "Chemotherapy Within 31 Days Prior and During Measurement Period"
            },
            {
              "url": "statement",
              "valueString": "define \"Chemotherapy Within 31 Days Prior and During Measurement Period\":\n  [Procedure: \"Chemotherapy Administration\"] ChemoAdministration\n    where ChemoAdministration.performed.toInterval ( ) during Interval[start of \"Measurement Period\" - 31 days, end of \"Measurement Period\"]\n      and ChemoAdministration.status = 'completed'"
            },
            {
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            }
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        },
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          "extension": [
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              "valueString": "OncologyPainIntensityQuantifiedFHIR"
            },
            {
              "url": "name",
              "valueString": "Face to Face or Telehealth Encounter with Ongoing Chemotherapy"
            },
            {
              "url": "statement",
              "valueString": "define \"Face to Face or Telehealth Encounter with Ongoing Chemotherapy\":\n  from\n    [Encounter: \"Office Visit\"] FaceToFaceOrTelehealthEncounter,\n    \"Chemotherapy Within 31 Days Prior and During Measurement Period\" ChemoBeforeEncounter,\n    \"Chemotherapy Within 31 Days Prior and During Measurement Period\" ChemoAfterEncounter,\n    [Condition: \"Cancer\"] Cancer\n    where Cancer.isActive ( )\n      and Cancer.prevalenceInterval ( ) overlaps FaceToFaceOrTelehealthEncounter.period\n      and ChemoBeforeEncounter.performed.toInterval ( ) starts 30 days or less on or before day of end of FaceToFaceOrTelehealthEncounter.period\n      and ChemoAfterEncounter.performed.toInterval ( ) starts 30 days or less on or after day of end of FaceToFaceOrTelehealthEncounter.period\n      and not ( ChemoAfterEncounter.performed.toInterval ( ) same day as ChemoBeforeEncounter.performed.toInterval ( ) )\n      and FaceToFaceOrTelehealthEncounter.period during \"Measurement Period\"\n      and FaceToFaceOrTelehealthEncounter.status = 'finished'\n    return FaceToFaceOrTelehealthEncounter"
            },
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            }
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            },
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            },
            {
              "url": "statement",
              "valueString": "define \"Standard Pain Assessment with Result\":\n  [\"Observation\": \"Standardized Pain Assessment Tool\"] AssessedPain\n    where AssessedPain.value is not null\n      and AssessedPain.status = 'final'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
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            {
              "url": "libraryName",
              "valueString": "OncologyPainIntensityQuantifiedFHIR"
            },
            {
              "url": "name",
              "valueString": "Numerator 1"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator 1\":\n  \"Face to Face or Telehealth Encounter with Ongoing Chemotherapy\" FaceToFaceOrTelehealthEncounterWithChemo\n    with \"Standard Pain Assessment with Result\" PainAssessed\n      such that PainAssessed.effective.toInterval ( ) during FaceToFaceOrTelehealthEncounterWithChemo.period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "OncologyPainIntensityQuantifiedFHIR"
            },
            {
              "url": "name",
              "valueString": "Numerator 2"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator 2\":\n  \"Radiation Treatment Management During Measurement Period with Cancer Diagnosis\" RadiationManagementEncounter\n    with \"Standard Pain Assessment with Result\" PainAssessed\n      such that case\n        when exists ( ( RadiationManagementEncounter.type ) RadiationManagement\n            where RadiationManagement ~ \"Radiation treatment management, 5 treatments\"\n        ) then PainAssessed.effective.toInterval ( ) 6 days or less on or before day of start of RadiationManagementEncounter.period \n        else PainAssessed.effective.toInterval ( ) during day of RadiationManagementEncounter.period end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "OncologyPainIntensityQuantifiedFHIR"
            },
            {
              "url": "name",
              "valueString": "Initial Population 1"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population 1\":\n  \"Face to Face or Telehealth Encounter with Ongoing Chemotherapy\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "OncologyPainIntensityQuantifiedFHIR"
            },
            {
              "url": "name",
              "valueString": "Denominator 1"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator 1\":\n  \"Initial Population 1\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "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": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "prevalenceInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Condition):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n    (end of condition.abatementInterval()) abatementDate\n    return if abatementDate is null then\n      Interval[start of condition.onset.toInterval(), abatementDate)\n    else\n      Interval[start of condition.onset.toInterval(), abatementDate]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "abatementInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns an interval representing the normalized abatement of a given Condition.\n@comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n*/\ndefine fluent function abatementInterval(condition Condition):\n\tif condition.abatement is DateTime then\n\t  Interval[condition.abatement as DateTime, condition.abatement as DateTime]\n\telse if condition.abatement is Quantity then\n\t\tInterval[Patient.birthDate + (condition.abatement as Quantity),\n\t\t\tPatient.birthDate + (condition.abatement as Quantity) + 1 year)\n\telse if condition.abatement is Interval<Quantity> then\n\t  Interval[Patient.birthDate + (condition.abatement.low as Quantity),\n\t\t  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)\n\telse if condition.abatement is Interval<DateTime> then\n\t  Interval[condition.abatement.low, condition.abatement.high)\n\telse null as Interval<DateTime>"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "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": 13
            }
          ],
          "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": 14
            }
          ],
          "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": 15
            }
          ],
          "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 QICoreCommon",
          "resource": "Library/QICoreCommon|2.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionClinicalStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-clinical"
        },
        {
          "type": "depends-on",
          "display": "Code system CPT",
          "resource": "http://www.ama-assn.org/go/cpt"
        },
        {
          "type": "depends-on",
          "display": "Value set Radiation Treatment Management",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1026"
        },
        {
          "type": "depends-on",
          "display": "Value set Cancer",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1010"
        },
        {
          "type": "depends-on",
          "display": "Value set Office Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
        },
        {
          "type": "depends-on",
          "display": "Value set Chemotherapy Administration",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1027"
        },
        {
          "type": "depends-on",
          "display": "Value set Standardized Pain Assessment Tool",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1028"
        }
      ],
      "parameter": [
        {
          "name": "Measurement Period",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "Period"
        },
        {
          "name": "Denominator 2",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Numerator 1",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Numerator 2",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Initial Population 1",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Initial Population 2",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Denominator 1",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        }
      ],
      "dataRequirement": [
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition"
          ],
          "mustSupport": [
            "code"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1010"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1026"
            },
            {
              "path": "status.value",
              "code": [
                {
                  "code": "finished"
                }
              ]
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
            },
            {
              "path": "status.value",
              "code": [
                {
                  "code": "finished"
                }
              ]
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "performed",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1027"
            },
            {
              "path": "status.value",
              "code": [
                {
                  "code": "completed"
                }
              ]
            }
          ]
        },
        {
          "id": "281",
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "performed",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1027"
            },
            {
              "path": "status.value",
              "code": [
                {
                  "code": "completed"
                }
              ]
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "performed",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1027"
            },
            {
              "path": "status.value",
              "code": [
                {
                  "code": "completed"
                }
              ]
            }
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation"
          ],
          "mustSupport": [
            "code",
            "value",
            "status",
            "status.value",
            "effective"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1028"
            },
            {
              "path": "status.value",
              "code": [
                {
                  "code": "final"
                }
              ]
            }
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "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/OncologyPainIntensityQuantifiedFHIR",
  "identifier": [
    {
      "use": "usual",
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code": "short-name"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/shortName",
      "value": "CMS157FHIR"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code": "version-independent"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:b7b487bf-bc27-48c9-994f-6d095ff84500"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code": "version-specific"
          }
        ]
      },
      "system": "urn:ietf:rfc:3986",
      "value": "urn:uuid:b64a5fbf-607d-4b2f-bf67-6a80db552b48"
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code": "endorser"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cbeId",
      "value": "0384e",
      "assigner": {
        "display": "CMS Consensus Based Entity"
      }
    },
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code": "publisher"
          }
        ]
      },
      "system": "https://madie.cms.gov/measure/cmsId",
      "value": "157FHIR",
      "assigner": {
        "display": "CMS"
      }
    }
  ],
  "version": "0.1.000",
  "name": "OncologyPainIntensityQuantifiedFHIR",
  "title": "Oncology: Medical and Radiation Pain Intensity QuantifiedFHIR",
  "status": "draft",
  "experimental": false,
  "date": "2026-03-13T01:50:42+00:00",
  "publisher": "American Society of Clinical Oncology",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "www.asco.org"
        }
      ]
    }
  ],
  "description": "Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified",
  "purpose": "UNKNOWN",
  "usage": "This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. \n\nFor patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face or telehealth interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face or telehealth encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face or telehealth encounter occurring on the actual billing date or within the 6 days prior to the billing date.\n\nFor patients receiving chemotherapy, pain intensity should be quantified at each face-to-face or telehealth encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients \"currently receiving chemotherapy\" refers to patients administered chemotherapy on the same day as the encounter or during the 30 days before the date of the encounter AND during the 30 days after the date of the encounter. \n\nPain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI).\n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS157v13.\n\nPlease 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": "Copyright 2024 American Society of Clinical Oncology. All Rights Reserved.",
  "effectivePeriod": {
    "start": "2025-01-01",
    "end": "2025-12-31"
  },
  "author": [
    {
      "name": "American Society of Clinical Oncology",
      "telecom": [
        {
          "system": "url",
          "value": "www.asco.org"
        }
      ]
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/OncologyPainIntensityQuantifiedFHIR"
  ],
  "disclaimer": "The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. \n\nThe Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. \n\nCommercial uses of the Measure require a license agreement between the user and American Society of Clinical Oncology (ASCO) and prior written approval of ASCO. Contact measurement@asco.org for licensing this measure. Neither ASCO nor its members shall be responsible for any use of the Measure.\n\nThe PCPI’s and American Medical Association’s significant past efforts and contributions to the development and updating of the Measures are acknowledged. \n\nASCO is solely responsible for the review and enhancement (\"Maintenance\") of the Measure as of June 2020. \n\nASCO encourages the use of the Measure by other health care professionals, where appropriate. \n\nTHE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n\nLimited proprietary coding may be contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party’s use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. ASCO and its members disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. \n\nCPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. LOINC(R) is copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved.\n\nDue to technical limitations, registered trademarks are indicated by (R) or [R].",
  "scoring": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code": "proportion",
        "display": "Proportion"
      }
    ]
  },
  "rationale": "Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee, Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN, 2023), undertreatment of pain remains a problem among a significant subset of cancer patients, survival is linked with symptom control and pain management, and pain management contributes to broad quality of life improvement. Furthermore, NCCN notes that formal pain reevaluation is required at each contact to ensure fulfilment of patient goals around comfort, function, and safety. Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). To maximize patient outcomes, pain management is an essential part of oncologic management (NCCN, 2023).  \n\nA recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management.",
  "clinicalRecommendationStatement": "-Screen all patients for pain at each contact. \n\n-Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, satisfaction with pain relief, pain interference, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment. If necessary, get additional information from caregiver regarding pain and impact on function. \n\n-Perform comprehensive pain assessment if new or worsening pain is present and regularly for persisting pain.\n\nVarious methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2023).",
  "group": [
    {
      "id": "6511b159da013638e7b3ddda",
      "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": {
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                "display": "Process"
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            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: \n- Population 1: Visits for patients with a diagnosis of cancer who are currently receiving chemotherapy \n- Population 2: Visits for patients with a diagnosis of cancer who are currently receiving radiation therapy\n\nFor the purposes of this measure, a single performance rate can be calculated as follows:\nPerformance Rate = (Numerator 1 + Numerator 2)/ (Denominator 1 + Denominator 2)"
        },
        {
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          "valueCodeableConcept": {
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                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
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      ],
      "description": "Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy in which pain intensity is quantified",
      "population": [
        {
          "id": "8DE96B96-0B2D-472D-BF59-359A760B9B50",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy ",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population 1"
          }
        },
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          "description": "Equals Initial Population",
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            "expression": "Denominator 1"
          }
        },
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          "id": "67650E41-C6EE-41A9-A7B3-88FEFCC8A688",
          "code": {
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                "code": "numerator",
                "display": "Numerator"
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          },
          "description": "Patient visits in which pain intensity is quantified",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator 1"
          }
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      ]
    },
    {
      "id": "6511b159da013638e7b3dddb",
      "extension": [
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          "valueCodeableConcept": {
            "coding": [
              {
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          "valueCode": "Encounter"
        },
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          "valueCodeableConcept": {
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        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-rateAggregation",
          "valueCode": "This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: \n- Population 1: Visits for patients with a diagnosis of cancer who are currently receiving chemotherapy \n- Population 2: Visits for patients with a diagnosis of cancer who are currently receiving radiation therapy\n\nFor the purposes of this measure, a single performance rate can be calculated as follows:\nPerformance Rate = (Numerator 1 + Numerator 2)/ (Denominator 1 + Denominator 2)"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
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                "code": "decrease",
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      ],
      "description": "Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently radiation therapy in which pain intensity is quantified",
      "population": [
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          "description": "All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving radiation therapy",
          "criteria": {
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          "description": "Equals Initial Population",
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            "expression": "Denominator 2"
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        {
          "id": "9E2F9931-FA1F-40EC-9013-8F63BD8CB53C",
          "code": {
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                "code": "numerator",
                "display": "Numerator"
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            ]
          },
          "description": "Patient visits in which pain intensity is quantified",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator 2"
          }
        }
      ]
    }
  ]
}