FHIR © HL7.org  |  Server Home  |  XIG Home  |  XIG Stats  |  Server Source  |  FHIR  

FHIR IG Statistics: Measure/EXM125-FHIR

Packagehl7.fhir.uv.cqm
Resource TypeMeasure
IdEXM125-FHIR
FHIR VersionR4
Sourcehttp://hl7.org/fhir/uv/cqm/https://build.fhir.org/ig/HL7/fhir-cqm/Measure-EXM125-FHIR.html
URLhttp://hl7.org/fhir/uv/cqm/Measure/EXM125-FHIR
Version8.0.000
Statusactive
Date2022-02-22
NameEXM125
TitleEXM125 - Breast Cancer Screening
Realmuv
Authorityhl7
DescriptionPercentage of women 50-74 years of age who had a mammogram to screen for breast cancer
PurposeThis measure has been developed to support improvement in clinical care.
CopyrightThis Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measure is copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2016 American Medical Association. LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2016 International Health Terminology Standards Development Organisation. ICD-10 copyright 2016 World Health Organization. All Rights Reserved. The American Hospital Association holds a copyright to the National Uniform Billing Committee (NUBC) codes contained in the measure specifications. The NUBC codes in the specifications are included with the permission of the AHA. The NUBC codes contained in the specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting Measure results or using Measure results for their internal quality improvement purposes. All other uses of the NUBC codes require a license from the AHA. Anyone desiring to use the NUBC codes in a commercial product to generate Measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@healthforum.com.

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

Metadata
Title EXM125 - Breast Cancer Screening
Version 8.0.000
Identifier 125
Identifier 112
Effective Period 2018-01-01 through 2018-12-31
Approval Date 2016-01-01
Last Review Date 2016-09-01
Experimental true
Use Context Clinical Venue = EC
Jurisdiction Global (Whole world)
Topic Health Quality Measure Document
Steward (Publisher) HL7 International / Clinical Quality Information
Description

Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer
Purpose

This measure has been developed to support improvement in clinical care.
Copyright

This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measure is copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2016 American Medical Association. LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2016 International Health Terminology Standards Development Organisation. ICD-10 copyright 2016 World Health Organization. All Rights Reserved. The American Hospital Association holds a copyright to the National Uniform Billing Committee (NUBC) codes contained in the measure specifications. The NUBC codes in the specifications are included with the permission of the AHA. The NUBC codes contained in the specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting Measure results or using Measure results for their internal quality improvement purposes. All other uses of the NUBC codes require a license from the AHA. Anyone desiring to use the NUBC codes in a commercial product to generate Measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@healthforum.com.
Disclaimer

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
Measure Scoring Proportion
Measure Type Process
Rationale

Breast cancer is one of the most common types of cancers, accounting for a quarter of all new cancer diagnoses for women in the U.S. (BreastCancer.Org, 2011). It ranks as the second leading cause of cancer-related mortality in women, accounting for nearly 40,000 estimated deaths in 2013 (American Cancer Society, 2011). According to the National Cancer Institute's Surveillance Epidemiology and End Results program, the chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 30, it is one in 2,212. By age 40, the chances increase to one in 235, by age 50, it becomes one in 54, and, by age 60, it is one in 25. From 2004 to 2008, the median age at the time of breast cancer diagnosis was 61 years among adult women (Tangka et al, 2010). In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits, and varying procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (Lavigne et al, 2008; Boykoff et al, 2009).
Clinical Recommendation Statement

The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (C recommendation). The Task Force concludes the evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years and older (I statement). U.S. Preventive Services Task Force (2009) Grade: B recommendation. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. Grade: C recommendation. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. Grade: D recommendation. The USPSTF recommends against teaching breast self-examination (BSE). Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
Improvement Notation Increased score indicates improvement
Measure Group (Rate)
Initial Population Description: No description provided Logic Definition: Initial Population
Numerator Description: No description provided Logic Definition: Numerator
Denominator Description: No description provided Logic Definition: Denominator
Denominator Exclusion Description: No description provided Logic Definition: Denominator Exclusion
Supplemental Data Elements
Supplemental Data Element Usage Code: Supplemental Data
Description: No description provided
Logic Definition: SDE Ethnicity
Supplemental Data Element Usage Code: Supplemental Data
Description: No description provided
Logic Definition: SDE Payer
Supplemental Data Element Usage Code: Supplemental Data
Description: No description provided
Logic Definition: SDE Race
Supplemental Data Element Usage Code: Supplemental Data
Description: No description provided
Logic Definition: SDE Sex
Measure Logic
Primary Library EXM125 - Breast Cancer Screening Library
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Population Criteria
Measure Group (Rate)
Initial Population 
define "Initial Population":
		Patient.gender = 'female'
				and Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[51, 74]
				and exists AdultOutpatientEncounters."Qualifying Encounters"
Numerator 
define "Numerator":
		exists (
				[DiagnosticReport: "Mammography"] Mammogram
						where ( Global."Normalize Interval"(Mammogram.effective) ends 27 months or less before day of end of "Measurement Period" )
								and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' }
		)
Denominator 
define "Denominator":
		"Initial Population"
Denominator Exclusion 
define "Denominator Exclusion":
		Hospice."Has Hospice"
				or ( Count("Unilateral Mastectomy Procedure") = 2 )
				or ( exists "Right Mastectomy" and exists "Left Mastectomy" )
				or exists "History Bilateral Mastectomy"
				or exists "Bilateral Mastectomy Procedure"
Logic Definitions
Logic Definition Library Name: AdultOutpatientEncounters 
define "Qualifying Encounters":
	(
    [Encounter: "Office Visit"]
  		union [Encounter: "Annual Wellness Visit"]
  		union [Encounter: "Preventive Care Services - Established Office Visit, 18 and Up"]
  		union [Encounter: "Preventive Care Services-Initial Office Visit, 18 and Up"]
  		union [Encounter: "Home Healthcare Services"]
  ) ValidEncounter
		where ValidEncounter.period during "Measurement Period"
  		and ValidEncounter.status  = 'finished'
Logic Definition Library Name: Hospice 
define "Has Hospice":
	exists (
    [Encounter: "Encounter Inpatient"] DischargeHospice
			where DischargeHospice.status = 'finished'
		    and (
	        DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
				    or DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
	    	)
				and DischargeHospice.period ends during "Measurement Period"
	)
    or exists (
      [ServiceRequest: "Hospice care ambulatory"] HospiceOrder
        where HospiceOrder.intent = 'order'
            and HospiceOrder.authoredOn in "Measurement Period"
    )
    or exists (
      [Procedure: "Hospice care ambulatory"] HospicePerformed
        where HospicePerformed.status = 'completed'
          and Global."Normalize Interval"(HospicePerformed.performed) overlaps "Measurement Period"
    )
Logic Definition Library Name: SupplementalDataElements 
define "SDE Sex":
  case
      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
      else null
    end
Logic Definition Library Name: SupplementalDataElements 
define "SDE Payer":
  [Coverage: type in "Payer"] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Ethnicity":
  (flatten (
      Patient.extension Extension
        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'
          return Extension.extension
    )) E
      where E.url = 'ombCategory'
        or E.url = 'detailed'
      return E.value as Coding
Logic Definition Library Name: SupplementalDataElements 
define "SDE Race":
  (flatten (
      Patient.extension Extension
        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'
          return Extension.extension
    )) E
      where E.url = 'ombCategory'
        or E.url = 'detailed'
      return E.value as Coding
Logic Definition Library Name: EXM125-FHIR 
define "SDE Sex":
  SDE."SDE Sex"
Logic Definition Library Name: EXM125-FHIR 
define "Numerator":
		exists (
				[DiagnosticReport: "Mammography"] Mammogram
						where ( Global."Normalize Interval"(Mammogram.effective) ends 27 months or less before day of end of "Measurement Period" )
								and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' }
		)
Logic Definition Library Name: EXM125-FHIR 
define "Initial Population":
		Patient.gender = 'female'
				and Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[51, 74]
				and exists AdultOutpatientEncounters."Qualifying Encounters"
Logic Definition Library Name: EXM125-FHIR 
define "Denominator":
		"Initial Population"
Logic Definition Library Name: EXM125-FHIR 
define "SDE Payer":
  SDE."SDE Payer"
Logic Definition Library Name: EXM125-FHIR 
define "SDE Ethnicity":
  SDE."SDE Ethnicity"
Logic Definition Library Name: EXM125-FHIR 
define "Unilateral Mastectomy Procedure":
		[Procedure: "Unilateral Mastectomy"] UnilateralMastectomyProcedure
				where Global."Normalize Interval"(UnilateralMastectomyProcedure.performed) ends before day of end of "Measurement Period"
						and UnilateralMastectomyProcedure.status = 'completed'
Logic Definition Library Name: EXM125-FHIR 
define "Right Mastectomy":
		(
				( [Condition: "Status Post Right Mastectomy"] C
          where C.clinicalStatus ~ ToConcept(Global."active")
        )
				union (
						[Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis
								where UnilateralMastectomyDiagnosis.bodySite in "Right"
                  and UnilateralMastectomyDiagnosis.clinicalStatus ~ ToConcept(Global."active")
				)
		) RightMastectomy
				where Global."Normalize Interval"(RightMastectomy.onset) starts before day of end of "Measurement Period"
Logic Definition Library Name: EXM125-FHIR 
define "Left Mastectomy":
		(
		    ( [Condition: "Status Post Left Mastectomy"] C
          where C.clinicalStatus ~ ToConcept(Global."active")
        )
				union (
						[Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis
								where UnilateralMastectomyDiagnosis.bodySite in "Left"
                  and UnilateralMastectomyDiagnosis.clinicalStatus ~ ToConcept(Global."active")
				)
		) LeftMastectomy
				where Global."Normalize Interval"(LeftMastectomy.onset) starts before day of end of "Measurement Period"
Logic Definition Library Name: EXM125-FHIR 
define "History Bilateral Mastectomy":
		[Condition: "History of bilateral mastectomy"] BilateralMastectomyHistory
				where Global."Normalize Interval"(BilateralMastectomyHistory.onset) starts before day of end of "Measurement Period"
          and BilateralMastectomyHistory.clinicalStatus ~ ToConcept(Global."active")
Logic Definition Library Name: EXM125-FHIR 
define "Bilateral Mastectomy Procedure":
		[Procedure: "Bilateral Mastectomy"] BilateralMastectomyPerformed
				where Global."Normalize Interval"(BilateralMastectomyPerformed.performed) ends before day of end of "Measurement Period"
						and BilateralMastectomyPerformed.status = 'completed'
Logic Definition Library Name: EXM125-FHIR 
define "Denominator Exclusion":
		Hospice."Has Hospice"
				or ( Count("Unilateral Mastectomy Procedure") = 2 )
				or ( exists "Right Mastectomy" and exists "Left Mastectomy" )
				or exists "History Bilateral Mastectomy"
				or exists "Bilateral Mastectomy Procedure"
Logic Definition Library Name: EXM125-FHIR 
define "SDE Race":
  SDE."SDE Race"
Terminology
Code System Description: Code system SNOMEDCT:2017-09
Resource: http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709
Canonical URL: http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709
Code System Description: Code system ConditionClinicalStatusCodes
Resource: Condition Clinical Status Codes
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-clinical
Value Set Description: Value set Mammography
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018
Value Set Description: Value set Office Visit
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Value Set Description: Value set Annual Wellness Visit
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
Value Set Description: Value set Preventive Care Services - Established Office Visit, 18 and Up
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
Value Set Description: Value set Preventive Care Services-Initial Office Visit, 18 and Up
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
Value Set Description: Value set Home Healthcare Services
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
Value Set Description: Value set Payer
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Value Set Description: Value set Encounter Inpatient
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Value Set Description: Value set Hospice care ambulatory
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
Value Set Description: Value set Unilateral Mastectomy
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1020
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1020
Value Set Description: Value set Status Post Right Mastectomy
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070
Value Set Description: Value set Unilateral Mastectomy, Unspecified Laterality
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071
Value Set Description: Value set Right
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1035
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1035
Value Set Description: Value set Status Post Left Mastectomy
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069
Value Set Description: Value set Left
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1036
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1036
Value Set Description: Value set History of bilateral mastectomy
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068
Value Set Description: Value set Bilateral Mastectomy
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005
Direct Reference Code Display: Discharge to home for hospice care (procedure)
Code: 428361000124107
System: http://snomed.info/sct
Direct Reference Code Display: Discharge to healthcare facility for hospice care (procedure)
Code: 428371000124100
System: http://snomed.info/sct
Direct Reference Code Code: active
System: http://terminology.hl7.org/CodeSystem/condition-clinical
Dependencies
Dependency Description: Library SDE
Resource: Supplemental Data Elements Libraryversion: null2.0.0)
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements|2.0.000
Dependency Description: Library FHIRHelpers
Resource: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.0.1
Canonical URL: http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.0.1
Dependency Description: Library Global
Resource: MAT Global Common Functions FHIR Libraryversion: null5.0.000)
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000
Dependency Description: Library AdultOutpatientEncounters
Resource: Adult Outpatient Encounters Common Libraryversion: null2.0.000)
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/AdultOutpatientEncounters|2.0.000
Dependency Description: Library Hospice
Resource: Hospice FHIR Libraryversion: null2.0.000)
Canonical URL: http://hl7.org/fhir/uv/cqm/Library/Hospice|2.0.000
Data Requirements
Data Requirement Type: Coverage
Profile(s): Coverage
Must Support Elements: period, type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Data Requirement Type: Patient
Profile(s): Patient
Must Support Elements: extension, value, url
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code, clinicalStatus
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code, clinicalStatus
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: bodySite, code, clinicalStatus
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071
Data Requirement Type: Condition
Profile(s): Condition
Must Support Elements: code, clinicalStatus, onset
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068
Data Requirement Type: Procedure
Profile(s): Procedure
Must Support Elements: code, performed, status
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005
Data Requirement Type: Procedure
Profile(s): Procedure
Must Support Elements: code, performed, status
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1020
Data Requirement Type: Procedure
Profile(s): Procedure
Must Support Elements: code, performed, status
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: period, hospitalization, hospitalization.dischargeDisposition, type, status
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Data Requirement Type: ServiceRequest
Profile(s): ServiceRequest
Must Support Elements: code, authoredOn, intent
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
Data Requirement Type: DiagnosticReport
Profile(s): DiagnosticReport
Must Support Elements: effective, code, status
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018
Generated using version 0.4.8 of the sample-content-ig Liquid templates

Source

{
  "resourceType": "Measure",
  "id": "EXM125-FHIR",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-proportionmeasure",
      "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure",
      "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cqlmeasure"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements-exm125",
      "meta": {
        "profile": [
          "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-moduledefinitionlibrary"
        ]
      },
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "version": "http://snomed.info/sct/731000124108/version/201709",
            "code": "428361000124107",
            "display": "Discharge to home for hospice care (procedure)"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "version": "http://snomed.info/sct/731000124108/version/201709",
            "code": "428371000124100",
            "display": "Discharge to healthcare facility for hospice care (procedure)"
          }
        },
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "active"
          }
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  case\n      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }\n      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }\n      else null\n    end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 1
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "Numerator"
            },
            {
              "url": "statement",
              "valueString": "define \"Numerator\":\n\t\texists (\n\t\t\t\t[DiagnosticReport: \"Mammography\"] Mammogram\n\t\t\t\t\t\twhere ( Global.\"Normalize Interval\"(Mammogram.effective) ends 27 months or less before day of end of \"Measurement Period\" )\n\t\t\t\t\t\t\t\tand Mammogram.status in { 'final', 'amended', 'corrected', 'appended' }\n\t\t)"
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "AdultOutpatientEncounters"
            },
            {
              "url": "name",
              "valueString": "Qualifying Encounters"
            },
            {
              "url": "statement",
              "valueString": "define \"Qualifying Encounters\":\n\t(\n    [Encounter: \"Office Visit\"]\n  \t\tunion [Encounter: \"Annual Wellness Visit\"]\n  \t\tunion [Encounter: \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  \t\tunion [Encounter: \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  \t\tunion [Encounter: \"Home Healthcare Services\"]\n  ) ValidEncounter\n\t\twhere ValidEncounter.period during \"Measurement Period\"\n  \t\tand ValidEncounter.status  = 'finished'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n\t\tPatient.gender = 'female'\n\t\t\t\tand Global.\"CalendarAgeInYearsAt\"(FHIRHelpers.ToDate(Patient.birthDate), start of \"Measurement Period\") in Interval[51, 74]\n\t\t\t\tand exists AdultOutpatientEncounters.\"Qualifying Encounters\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "Denominator"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator\":\n\t\t\"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  [Coverage: type in \"Payer\"] Payer\n        return {\n          code: Payer.type,\n          period: Payer.period\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  (flatten (\n      Patient.extension Extension\n        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'\n          return Extension.extension\n    )) E\n      where E.url = 'ombCategory'\n        or E.url = 'detailed'\n      return E.value as Coding"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "Hospice"
            },
            {
              "url": "name",
              "valueString": "Has Hospice"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Hospice\":\n\texists (\n    [Encounter: \"Encounter Inpatient\"] DischargeHospice\n\t\t\twhere DischargeHospice.status = 'finished'\n\t\t    and (\n\t        DischargeHospice.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n\t\t\t\t    or DischargeHospice.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n\t    \t)\n\t\t\t\tand DischargeHospice.period ends during \"Measurement Period\"\n\t)\n    or exists (\n      [ServiceRequest: \"Hospice care ambulatory\"] HospiceOrder\n        where HospiceOrder.intent = 'order'\n            and HospiceOrder.authoredOn in \"Measurement Period\"\n    )\n    or exists (\n      [Procedure: \"Hospice care ambulatory\"] HospicePerformed\n        where HospicePerformed.status = 'completed'\n          and Global.\"Normalize Interval\"(HospicePerformed.performed) overlaps \"Measurement Period\"\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "Unilateral Mastectomy Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"Unilateral Mastectomy Procedure\":\n\t\t[Procedure: \"Unilateral Mastectomy\"] UnilateralMastectomyProcedure\n\t\t\t\twhere Global.\"Normalize Interval\"(UnilateralMastectomyProcedure.performed) ends before day of end of \"Measurement Period\"\n\t\t\t\t\t\tand UnilateralMastectomyProcedure.status = 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "Right Mastectomy"
            },
            {
              "url": "statement",
              "valueString": "define \"Right Mastectomy\":\n\t\t(\n\t\t\t\t( [Condition: \"Status Post Right Mastectomy\"] C\n          where C.clinicalStatus ~ ToConcept(Global.\"active\")\n        )\n\t\t\t\tunion (\n\t\t\t\t\t\t[Condition: \"Unilateral Mastectomy, Unspecified Laterality\"] UnilateralMastectomyDiagnosis\n\t\t\t\t\t\t\t\twhere UnilateralMastectomyDiagnosis.bodySite in \"Right\"\n                  and UnilateralMastectomyDiagnosis.clinicalStatus ~ ToConcept(Global.\"active\")\n\t\t\t\t)\n\t\t) RightMastectomy\n\t\t\t\twhere Global.\"Normalize Interval\"(RightMastectomy.onset) starts before day of end of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "Left Mastectomy"
            },
            {
              "url": "statement",
              "valueString": "define \"Left Mastectomy\":\n\t\t(\n\t\t    ( [Condition: \"Status Post Left Mastectomy\"] C\n          where C.clinicalStatus ~ ToConcept(Global.\"active\")\n        )\n\t\t\t\tunion (\n\t\t\t\t\t\t[Condition: \"Unilateral Mastectomy, Unspecified Laterality\"] UnilateralMastectomyDiagnosis\n\t\t\t\t\t\t\t\twhere UnilateralMastectomyDiagnosis.bodySite in \"Left\"\n                  and UnilateralMastectomyDiagnosis.clinicalStatus ~ ToConcept(Global.\"active\")\n\t\t\t\t)\n\t\t) LeftMastectomy\n\t\t\t\twhere Global.\"Normalize Interval\"(LeftMastectomy.onset) starts before day of end of \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "History Bilateral Mastectomy"
            },
            {
              "url": "statement",
              "valueString": "define \"History Bilateral Mastectomy\":\n\t\t[Condition: \"History of bilateral mastectomy\"] BilateralMastectomyHistory\n\t\t\t\twhere Global.\"Normalize Interval\"(BilateralMastectomyHistory.onset) starts before day of end of \"Measurement Period\"\n          and BilateralMastectomyHistory.clinicalStatus ~ ToConcept(Global.\"active\")"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "Bilateral Mastectomy Procedure"
            },
            {
              "url": "statement",
              "valueString": "define \"Bilateral Mastectomy Procedure\":\n\t\t[Procedure: \"Bilateral Mastectomy\"] BilateralMastectomyPerformed\n\t\t\t\twhere Global.\"Normalize Interval\"(BilateralMastectomyPerformed.performed) ends before day of end of \"Measurement Period\"\n\t\t\t\t\t\tand BilateralMastectomyPerformed.status = 'completed'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "Denominator Exclusion"
            },
            {
              "url": "statement",
              "valueString": "define \"Denominator Exclusion\":\n\t\tHospice.\"Has Hospice\"\n\t\t\t\tor ( Count(\"Unilateral Mastectomy Procedure\") = 2 )\n\t\t\t\tor ( exists \"Right Mastectomy\" and exists \"Left Mastectomy\" )\n\t\t\t\tor exists \"History Bilateral Mastectomy\"\n\t\t\t\tor exists \"Bilateral Mastectomy Procedure\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  (flatten (\n      Patient.extension Extension\n        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'\n          return Extension.extension\n    )) E\n      where E.url = 'ombCategory'\n        or E.url = 'detailed'\n      return E.value as Coding"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "EXM125-FHIR"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
        }
      ],
      "url": "http://hl7.org/fhir/uv/cqm/Library/effective-data-requirements-exm125",
      "version": "1.0.0",
      "name": "EffectiveDataRequirements",
      "title": "Module Definition Library - EXM125",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "date": "2022-02-22T10:37:03-07:00",
      "description": "This library is used as an example module definition in the FHIR Quality Measure Implementation Guide",
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements|2.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "http://ecqi.healthit.gov/ecqms/Library/FHIRHelpers|4.0.1"
        },
        {
          "type": "depends-on",
          "display": "Library Global",
          "resource": "http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library AdultOutpatientEncounters",
          "resource": "http://hl7.org/fhir/uv/cqm/Library/AdultOutpatientEncounters|2.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library Hospice",
          "resource": "http://hl7.org/fhir/uv/cqm/Library/Hospice|2.0.000"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT:2017-09",
          "resource": "http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionClinicalStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-clinical"
        },
        {
          "type": "depends-on",
          "display": "Value set Mammography",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018"
        },
        {
          "type": "depends-on",
          "display": "Value set Office Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
        },
        {
          "type": "depends-on",
          "display": "Value set Annual Wellness Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
        },
        {
          "type": "depends-on",
          "display": "Value set Preventive Care Services - Established Office Visit, 18 and Up",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
        },
        {
          "type": "depends-on",
          "display": "Value set Preventive Care Services-Initial Office Visit, 18 and Up",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
        },
        {
          "type": "depends-on",
          "display": "Value set Home Healthcare Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
        },
        {
          "type": "depends-on",
          "display": "Value set Payer",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
        },
        {
          "type": "depends-on",
          "display": "Value set Encounter Inpatient",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice care ambulatory",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"
        },
        {
          "type": "depends-on",
          "display": "Value set Unilateral Mastectomy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1020"
        },
        {
          "type": "depends-on",
          "display": "Value set Status Post Right Mastectomy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070"
        },
        {
          "type": "depends-on",
          "display": "Value set Unilateral Mastectomy, Unspecified Laterality",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071"
        },
        {
          "type": "depends-on",
          "display": "Value set Right",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1035"
        },
        {
          "type": "depends-on",
          "display": "Value set Status Post Left Mastectomy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069"
        },
        {
          "type": "depends-on",
          "display": "Value set Left",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1036"
        },
        {
          "type": "depends-on",
          "display": "Value set History of bilateral mastectomy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068"
        },
        {
          "type": "depends-on",
          "display": "Value set Bilateral Mastectomy",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005"
        }
      ],
      "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": "1",
          "type": "boolean"
        },
        {
          "name": "Denominator",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Payer",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Ethnicity",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Coding"
        },
        {
          "name": "Denominator Exclusion",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Coding"
        }
      ],
      "dataRequirement": [
        {
          "type": "Coverage",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Coverage"
          ],
          "mustSupport": [
            "period",
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Patient"
          ],
          "mustSupport": [
            "extension",
            "value",
            "url"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "code",
            "clinicalStatus"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "code",
            "clinicalStatus"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "bodySite",
            "code",
            "clinicalStatus"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "code",
            "clinicalStatus",
            "onset"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Procedure"
          ],
          "mustSupport": [
            "code",
            "performed",
            "status"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Procedure"
          ],
          "mustSupport": [
            "code",
            "performed",
            "status"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1020"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Procedure"
          ],
          "mustSupport": [
            "code",
            "performed",
            "status"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "period",
            "hospitalization",
            "hospitalization.dischargeDisposition",
            "type",
            "status"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
            }
          ]
        },
        {
          "type": "ServiceRequest",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/ServiceRequest"
          ],
          "mustSupport": [
            "code",
            "authoredOn",
            "intent"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"
            }
          ]
        },
        {
          "type": "DiagnosticReport",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/DiagnosticReport"
          ],
          "mustSupport": [
            "effective",
            "code",
            "status"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018"
            }
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis",
      "valueCode": "boolean"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical": "#effective-data-requirements-exm125"
    }
  ],
  "url": "http://hl7.org/fhir/uv/cqm/Measure/EXM125-FHIR",
  "identifier": [
    {
      "use": "official",
      "system": "http://example.org/fhir/cqi/ecqm/Measure/Identifier/cms",
      "value": "125"
    },
    {
      "use": "official",
      "system": "http://example.org/fhir/cqi/ecqm/Measure/Identifier/mips",
      "value": "112"
    }
  ],
  "version": "8.0.000",
  "name": "EXM125",
  "title": "EXM125 - Breast Cancer Screening",
  "status": "active",
  "experimental": true,
  "date": "2022-02-22",
  "publisher": "HL7 International / Clinical Quality Information",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/cqi"
        }
      ]
    }
  ],
  "description": "Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "venue",
        "display": "Clinical Venue"
      },
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes",
            "code": "ec",
            "display": "EC"
          }
        ]
      }
    }
  ],
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code": "001"
        }
      ]
    }
  ],
  "purpose": "This measure has been developed to support improvement in clinical care.",
  "copyright": "This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measure is copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. \n  Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. \n CPT(R) contained in the Measure specifications is copyright 2004-2016 American Medical Association. LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2016 International Health Terminology Standards Development Organisation. ICD-10 copyright 2016 World Health Organization. All Rights Reserved. \n The American Hospital Association holds a copyright to the National Uniform Billing Committee (NUBC) codes contained in the measure specifications. The NUBC codes in the specifications are included with the permission of the AHA. The NUBC codes contained in the specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting Measure results or using Measure results for their internal quality improvement purposes. All other uses of the NUBC codes require a license from the AHA. Anyone desiring to use the NUBC codes in a commercial product to generate Measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@healthforum.com.",
  "approvalDate": "2016-01-01",
  "lastReviewDate": "2016-09-01",
  "effectivePeriod": {
    "start": "2018-01-01",
    "end": "2018-12-31"
  },
  "topic": [
    {
      "coding": [
        {
          "system": "http://loinc.org",
          "code": "57024-2",
          "display": "Health Quality Measure Document"
        }
      ]
    }
  ],
  "library": [
    "http://hl7.org/fhir/uv/cqm/Library/EXM125-FHIR"
  ],
  "disclaimer": "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.",
  "scoring": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code": "proportion",
        "display": "Proportion"
      }
    ]
  },
  "type": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/measure-type",
          "code": "process"
        }
      ]
    }
  ],
  "rationale": "Breast cancer is one of the most common types of cancers, accounting for a quarter of all new cancer diagnoses for women in the U.S. (BreastCancer.Org, 2011). It ranks as the second leading cause of cancer-related mortality in women, accounting for nearly 40,000 estimated deaths in 2013 (American Cancer Society, 2011). \n According to the National Cancer Institute's Surveillance Epidemiology and End Results program, the chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 30, it is one in 2,212. By age 40, the chances increase to one in 235, by age 50, it becomes one in 54, and, by age 60, it is one in 25. From 2004 to 2008, the median age at the time of breast cancer diagnosis was 61 years among adult women (Tangka et al, 2010). \n In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits, and varying procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (Lavigne et al, 2008; Boykoff et al, 2009).",
  "clinicalRecommendationStatement": "The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (C recommendation). The Task Force concludes the evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years and older (I statement). \n U.S. Preventive Services Task Force (2009) \n Grade: B recommendation. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. \n Grade: C recommendation. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. \n Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. \n Grade: D recommendation. The USPSTF recommends against teaching breast self-examination (BSE). \n Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. \n Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.",
  "improvementNotation": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
        "code": "increase",
        "display": "Increased score indicates improvement"
      }
    ]
  },
  "guidance": "Patient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1. Patient self-report is not allowed for laboratory tests. \n This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, MRIs or tomosynthesis (3D mammography), because they are not appropriate methods for primary breast cancer screening.",
  "group": [
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId",
          "valueString": "primary"
        }
      ],
      "population": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
              "valueString": "primary-exm125-initial-population"
            }
          ],
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
              "valueString": "primary-exm125-numerator"
            }
          ],
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "numerator",
                "display": "Numerator"
              }
            ]
          },
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Numerator"
          }
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
              "valueString": "primary-exm125-denominator"
            }
          ],
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator",
                "display": "Denominator"
              }
            ]
          },
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator"
          }
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
              "valueString": "primary-exm125-denominator-exclusion"
            }
          ],
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "denominator-exclusion",
                "display": "Denominator Exclusion"
              }
            ]
          },
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Denominator Exclusion"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
          "valueString": "primary-sde-ethnicity"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
          "valueString": "primary-sde-payer"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer"
      }
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
          "valueString": "primary-sde-race"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Race"
      }
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
          "valueString": "primary-sde-sex"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    }
  ]
}