Quality Measure Implementation Guide (STU3)
3.0.0 - STU 3 US

This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v3.0.0: STU3) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: EXM130 - Colorectal Cancer Screening Measure - TTL Representation

Active as of 2022-02-22

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <http://loinc.org/rdf#> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Measure;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "measure-exm130-FHIR"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm>     ], [
       fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm";
       fhir:index 1;
       fhir:link <http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n        <tr>\n            <th scope=\"row\"><b>Id: </b></th>\n            <td style=\"padding-left: 4px;\">measure-exm130-FHIR</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Url: </b></th>\n            <td style=\"padding-left: 4px;\">http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm130-FHIR</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Version: </b></th>\n            <td style=\"padding-left: 4px;\">8.0.000</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Identifier: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                <p style=\"margin-bottom: 5px;\">\n                    <b>value: </b> <span>130</span>\n                </p>\n                \n            </td>\n        </tr>\n        \n        <tr>\n            <th scope=\"row\"><b>Identifier: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                <p style=\"margin-bottom: 5px;\">\n                    <b>value: </b> <span>0034</span>\n                </p>\n                \n            </td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Name: </b></th>\n            <td style=\"padding-left: 4px;\">EXM130</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Title: </b></th>\n            <td style=\"padding-left: 4px;\">EXM130 - Colorectal Cancer Screening Measure</td>\n        </tr>\n        \n        \n        \n        <tr>\n            <th scope=\"row\"><b>Status: </b></th>\n            <td style=\"padding-left: 4px;\">active</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Experimental: </b></th>\n            <td style=\"padding-left: 4px;\">true</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Scoring: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                    \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>system: </b> <span>http://terminology.hl7.org/CodeSystem/measure-scoring</span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>code: </b> <span>proportion</span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>display: </b> <span>Proportion</span>\n                        </p>\n                        \n                    \n                \n                \n            </td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Improvement Notation: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                    \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>system: </b> <span>http://terminology.hl7.org/CodeSystem/measure-improvement-notation</span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>code: </b> <span>increase</span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>display: </b> <span>Increased score indicates improvement</span>\n                        </p>\n                        \n                    \n                \n                \n            </td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Type: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                    \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>system: </b> <span>http://terminology.hl7.org/CodeSystem/measure-type</span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>code: </b> <span>process</span>\n                        </p>\n                        \n                        \n                    \n                \n                \n            </td>\n        </tr>\n        \n        \n        \n        <tr>\n            <th scope=\"row\"><b>Date: </b></th>\n            <td style=\"padding-left: 4px;\">2022-02-22</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Publisher: </b></th>\n            <td style=\"padding-left: 4px;\">Clinical Quality Information WG</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Description: </b></th>\n            <td style=\"padding-left: 4px;\">Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer</td>\n        </tr>\n        \n        \n        \n        \n        \n        \n        \n            <tr>\n                <th scope=\"row\"><b>Supplemental Data: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        <tr><th><b>expression</b></th><th><b>system</b></th></tr>\n                        \n                        <tr>\n                            <td>SDE Ethnicity</td>\n                            <td>http://terminology.hl7.org/CodeSystem/measure-data-usage</td>\n                        </tr>\n                        \n                        <tr>\n                            <td>SDE Payer</td>\n                            <td>http://terminology.hl7.org/CodeSystem/measure-data-usage</td>\n                        </tr>\n                        \n                        <tr>\n                            <td>SDE Race</td>\n                            <td>http://terminology.hl7.org/CodeSystem/measure-data-usage</td>\n                        </tr>\n                        \n                        <tr>\n                            <td>SDE Sex</td>\n                            <td>http://terminology.hl7.org/CodeSystem/measure-data-usage</td>\n                        </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Use Context: </b></th>\n            <td style=\"padding-left: 4px;\">\n                <table class=\"grid-dict\">\n                    <tr><th><b>code</b></th><th><b>value</b></th></tr>\n                    \n                      <tr>\n                        <td>program</td>\n                        <td></td>\n                      </tr>\n                    \n                </table>\n            </td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Jurisdiction: </b></th>\n            <td style=\"padding-left: 25px;\">US</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Topic: </b></th>\n            <td style=\"padding-left: 25px;\">57024-2</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Purpose: </b></th>\n            <td style=\"padding-left: 4px;\">Patients 50-75 years of age with a visit during the measurement period</td>\n        </tr>\n        \n        \n        \n        <tr>\n            <th scope=\"row\"><b>Copyright: </b></th>\n            <td style=\"padding-left: 25px;\">This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (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 or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (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 third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Disclaimer: </b></th>\n            <td style=\"padding-left: 25px;\">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. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Approval Date: </b></th>\n            <td style=\"padding-left: 4px;\">2016-01-01</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Last Review Date: </b></th>\n            <td style=\"padding-left: 4px;\">2016-09-01</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Effective Period: </b></th>\n            <td style=\"padding-left: 4px;\">2018-01-01..2018-12-31</td>\n        </tr>\n        \n        \n        \n        \n        \n        \n    </table>\n</div>"
  ];
  fhir:DomainResource.contained [
     a fhir:Library;
     fhir:index 0;
     fhir:Resource.id [ fhir:value "effective-data-requirements" ];
     fhir:DomainResource.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode" ];
       fhir:Extension.valueCoding [
         a sct:428361000124107;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
         fhir:Coding.version [ fhir:value "http://snomed.info/sct/731000124108/version/201709" ];
         fhir:Coding.code [ fhir:value "428361000124107" ];
         fhir:Coding.display [ fhir:value "Discharge to home for hospice care (procedure)" ]       ]     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode" ];
       fhir:Extension.valueCoding [
         a sct:428371000124100;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
         fhir:Coding.version [ fhir:value "http://snomed.info/sct/731000124108/version/201709" ];
         fhir:Coding.code [ fhir:value "428371000124100" ];
         fhir:Coding.display [ fhir:value "Discharge to healthcare facility for hospice care (procedure)" ]       ]     ], [
       fhir:index 2;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "SupplementalDataElements" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "SDE Sex" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "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" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "0"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 3;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "SDE Sex" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"SDE Sex\":\n  SDE.\"SDE Sex\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "1"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 4;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Colonoscopy Performed" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Colonoscopy Performed\":\n	[Procedure: \"Colonoscopy\"] Colonoscopy\n		where Colonoscopy.status = 'completed'\n		  and Global.\"Normalize Interval\"(Colonoscopy.performed) ends 10 years or less on or before end of \"Measurement Period\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "2"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 5;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Fecal Occult Blood Test Performed" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Fecal Occult Blood Test Performed\":\n	[Observation: \"Fecal Occult Blood Test (FOBT)\"] FecalOccultResult\n		where FecalOccultResult.status in {'final', 'amended', 'corrected', 'preliminary'}\n			and FecalOccultResult.value is not null\n			and Global.\"Normalize Interval\"(FecalOccultResult.effective) during day of \"Measurement Period\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "3"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 6;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Flexible Sigmoidoscopy Performed" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Flexible Sigmoidoscopy Performed\":\n	[Procedure: \"Flexible Sigmoidoscopy\"] FlexibleSigmoidoscopy\n		where FlexibleSigmoidoscopy.status = 'completed'\n			and Global.\"Normalize Interval\"(FlexibleSigmoidoscopy.performed) ends 5 years or less on or before end of \"Measurement Period\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "4"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 7;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Fecal Immunochemical Test DNA" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Fecal Immunochemical Test DNA\":\n	[Observation: \"FIT DNA\"] FitDNA\n		where FitDNA.status in {'final', 'amended', 'corrected', 'preliminary'}\n			and FitDNA.value is not null\n			and Global.\"Normalize Interval\"(FitDNA.effective) occurs 3 years or less on or before day of end of \"Measurement Period\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "5"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 8;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "CT Colonography Performed" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"CT Colonography Performed\":\n	[Procedure: \"CT Colonography\"] Colonography\n		where Colonography.status = 'completed'\n			and Global.\"Normalize Interval\"(Colonography.performed) ends 5 years or less on or before end of \"Measurement Period\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "6"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 9;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Numerator" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Numerator\":\n	exists \"Colonoscopy Performed\"\n		or exists \"Fecal Occult Blood Test Performed\"\n		or exists \"Flexible Sigmoidoscopy Performed\"\n		or exists \"Fecal Immunochemical Test DNA\"\n		or exists \"CT Colonography Performed\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "7"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 10;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Denominator" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Denominator\":\n	true" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "8"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 11;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "SupplementalDataElements" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "SDE Payer" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"SDE Payer\":\n  [Coverage: type in \"Payer\"] Payer\n        return {\n          code: Payer.type,\n          period: Payer.period\n        }" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "9"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 12;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "SDE Payer" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"SDE Payer\":\n  SDE.\"SDE Payer\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "10"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 13;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "AdultOutpatientEncounters" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Qualifying Encounters" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Qualifying Encounters\":\n	(\n    [Encounter: \"Office Visit\"]\n  		union [Encounter: \"Annual Wellness Visit\"]\n  		union [Encounter: \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n  		union [Encounter: \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n  		union [Encounter: \"Home Healthcare Services\"]\n  ) ValidEncounter\n		where ValidEncounter.period during \"Measurement Period\"\n  		and ValidEncounter.status  = 'finished'" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "11"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 14;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Initial Population" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Initial Population\":\n	Global.\"CalendarAgeInYearsAt\"(FHIRHelpers.ToDate(Patient.birthDate), start of \"Measurement Period\") in Interval[50, 75]\n			and exists AdultOutpatientEncounters.\"Qualifying Encounters\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "12"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 15;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "SupplementalDataElements" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "SDE Ethnicity" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "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" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "13"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 16;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "SDE Ethnicity" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "14"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 17;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "Hospice" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Has Hospice" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Has Hospice\":\n	exists (\n    [Encounter: \"Encounter Inpatient\"] DischargeHospice\n			where DischargeHospice.status = 'finished'\n		    and (\n	        DischargeHospice.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n				    or DischargeHospice.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n	    	)\n				and DischargeHospice.period ends during \"Measurement Period\"\n	)\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    )" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "15"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 18;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Malignant Neoplasm Ever" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Malignant Neoplasm Ever\":\n	[Condition: \"Malignant Neoplasm of Colon\"] ColorectalCancer\n		where Global.\"Normalize Interval\"(ColorectalCancer.onset) starts on or before end of \"Measurement Period\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "16"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 19;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Total Colectomy Performed" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Total Colectomy Performed\":\n	[Procedure: \"Total Colectomy\"] Colectomy\n		where Colectomy.status = 'completed'\n			and Global.\"Normalize Interval\"(Colectomy.performed) starts on or before end of \"Measurement Period\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "17"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 20;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "Denominator Exclusion" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"Denominator Exclusion\":\n	Hospice.\"Has Hospice\"\n		or exists \"Malignant Neoplasm Ever\"\n		or exists \"Total Colectomy Performed\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "18"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 21;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "SupplementalDataElements" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "SDE Race" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "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" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "19"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ], [
       fhir:index 22;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "libraryName" ];
         fhir:Extension.valueString [ fhir:value "EXM130" ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "name" ];
         fhir:Extension.valueString [ fhir:value "SDE Race" ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "statement" ];
         fhir:Extension.valueString [ fhir:value "define \"SDE Race\":\n  SDE.\"SDE Race\"" ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "displaySequence" ];
         fhir:Extension.valueInteger [ fhir:value "20"^^xsd:integer ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition" ]     ];
     fhir:Library.name [ fhir:value "EffectiveDataRequirements" ];
     fhir:Library.status [ fhir:value "active" ];
     fhir:Library.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/library-type" ];
         fhir:Coding.code [ fhir:value "module-definition" ]       ]     ];
     fhir:Library.date [ fhir:value "2022-02-22T10:37:03-07:00"^^xsd:dateTime ];
     fhir:Library.relatedArtifact [
       fhir:index 0;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Library SDE" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://hl7.org/fhir/us/cqfmeasures/Library/SupplementalDataElements|2.0.000";
         fhir:link <http://hl7.org/fhir/us/cqfmeasures/Library/SupplementalDataElements|2.0.000>       ]     ], [
       fhir:index 1;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Library FHIRHelpers" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1";
         fhir:link <http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1>       ]     ], [
       fhir:index 2;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Library Global" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000";
         fhir:link <http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000>       ]     ], [
       fhir:index 3;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Library AdultOutpatientEncounters" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://hl7.org/fhir/us/cqfmeasures/Library/AdultOutpatientEncounters|2.0.000";
         fhir:link <http://hl7.org/fhir/us/cqfmeasures/Library/AdultOutpatientEncounters|2.0.000>       ]     ], [
       fhir:index 4;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Library Hospice" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://hl7.org/fhir/us/cqfmeasures/Library/Hospice|2.0.000";
         fhir:link <http://hl7.org/fhir/us/cqfmeasures/Library/Hospice|2.0.000>       ]     ], [
       fhir:index 5;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Code system SNOMEDCT:2017-09" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709";
         fhir:link <http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709>       ]     ], [
       fhir:index 6;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Colonoscopy" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020>       ]     ], [
       fhir:index 7;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Fecal Occult Blood Test (FOBT)" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011>       ]     ], [
       fhir:index 8;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Flexible Sigmoidoscopy" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010>       ]     ], [
       fhir:index 9;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set FIT DNA" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039>       ]     ], [
       fhir:index 10;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set CT Colonography" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038>       ]     ], [
       fhir:index 11;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Payer" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591>       ]     ], [
       fhir:index 12;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Office Visit" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001>       ]     ], [
       fhir:index 13;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Annual Wellness Visit" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240>       ]     ], [
       fhir:index 14;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Preventive Care Services - Established Office Visit, 18 and Up" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025>       ]     ], [
       fhir:index 15;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Preventive Care Services-Initial Office Visit, 18 and Up" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023>       ]     ], [
       fhir:index 16;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Home Healthcare Services" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016>       ]     ], [
       fhir:index 17;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Encounter Inpatient" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307>       ]     ], [
       fhir:index 18;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Hospice care ambulatory" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15>       ]     ], [
       fhir:index 19;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Malignant Neoplasm of Colon" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001>       ]     ], [
       fhir:index 20;
       fhir:RelatedArtifact.type [ fhir:value "depends-on" ];
       fhir:RelatedArtifact.display [ fhir:value "Value set Total Colectomy" ];
       fhir:RelatedArtifact.resource [
         fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019";
         fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019>       ]     ];
     fhir:Library.parameter [
       fhir:index 0;
       fhir:ParameterDefinition.name [ fhir:value "Measurement Period" ];
       fhir:ParameterDefinition.use [ fhir:value "in" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "1" ];
       fhir:ParameterDefinition.type [ fhir:value "Period" ]     ], [
       fhir:index 1;
       fhir:ParameterDefinition.name [ fhir:value "SDE Sex" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "1" ];
       fhir:ParameterDefinition.type [ fhir:value "Coding" ]     ], [
       fhir:index 2;
       fhir:ParameterDefinition.name [ fhir:value "Numerator" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "1" ];
       fhir:ParameterDefinition.type [ fhir:value "boolean" ]     ], [
       fhir:index 3;
       fhir:ParameterDefinition.name [ fhir:value "Denominator" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "1" ];
       fhir:ParameterDefinition.type [ fhir:value "boolean" ]     ], [
       fhir:index 4;
       fhir:ParameterDefinition.name [ fhir:value "SDE Payer" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "*" ];
       fhir:ParameterDefinition.type [ fhir:value "Any" ]     ], [
       fhir:index 5;
       fhir:ParameterDefinition.name [ fhir:value "Initial Population" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "1" ];
       fhir:ParameterDefinition.type [ fhir:value "boolean" ]     ], [
       fhir:index 6;
       fhir:ParameterDefinition.name [ fhir:value "SDE Ethnicity" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "*" ];
       fhir:ParameterDefinition.type [ fhir:value "Coding" ]     ], [
       fhir:index 7;
       fhir:ParameterDefinition.name [ fhir:value "Denominator Exclusion" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "1" ];
       fhir:ParameterDefinition.type [ fhir:value "boolean" ]     ], [
       fhir:index 8;
       fhir:ParameterDefinition.name [ fhir:value "SDE Race" ];
       fhir:ParameterDefinition.use [ fhir:value "out" ];
       fhir:ParameterDefinition.min [ fhir:value "0"^^xsd:integer ];
       fhir:ParameterDefinition.max [ fhir:value "*" ];
       fhir:ParameterDefinition.type [ fhir:value "Coding" ]     ];
     fhir:Library.dataRequirement [
       fhir:index 0;
       fhir:DataRequirement.type [ fhir:value "Coverage" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Coverage";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Coverage>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "period";
         fhir:index 0       ], [
         fhir:value "type";
         fhir:index 1       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "type" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591>         ]       ]     ], [
       fhir:index 1;
       fhir:DataRequirement.type [ fhir:value "Patient" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Patient";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Patient>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "extension";
         fhir:index 0       ], [
         fhir:value "value";
         fhir:index 1       ], [
         fhir:value "url";
         fhir:index 2       ]     ], [
       fhir:index 2;
       fhir:DataRequirement.type [ fhir:value "Encounter" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Encounter";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Encounter>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "type";
         fhir:index 0       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "type" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001>         ]       ]     ], [
       fhir:index 3;
       fhir:DataRequirement.type [ fhir:value "Encounter" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Encounter";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Encounter>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "type";
         fhir:index 0       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "type" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240>         ]       ]     ], [
       fhir:index 4;
       fhir:DataRequirement.type [ fhir:value "Encounter" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Encounter";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Encounter>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "type";
         fhir:index 0       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "type" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025>         ]       ]     ], [
       fhir:index 5;
       fhir:DataRequirement.type [ fhir:value "Encounter" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Encounter";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Encounter>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "type";
         fhir:index 0       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "type" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023>         ]       ]     ], [
       fhir:index 6;
       fhir:DataRequirement.type [ fhir:value "Encounter" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Encounter";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Encounter>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "type";
         fhir:index 0       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "type" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016>         ]       ]     ], [
       fhir:index 7;
       fhir:DataRequirement.type [ fhir:value "Encounter" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Encounter";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Encounter>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "period";
         fhir:index 0       ], [
         fhir:value "hospitalization";
         fhir:index 1       ], [
         fhir:value "hospitalization.dischargeDisposition";
         fhir:index 2       ], [
         fhir:value "type";
         fhir:index 3       ], [
         fhir:value "status";
         fhir:index 4       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "type" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307>         ]       ]     ], [
       fhir:index 8;
       fhir:DataRequirement.type [ fhir:value "Condition" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Condition";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Condition>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "code";
         fhir:index 0       ], [
         fhir:value "onset";
         fhir:index 1       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "code" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001>         ]       ]     ], [
       fhir:index 9;
       fhir:DataRequirement.type [ fhir:value "Observation" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Observation";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Observation>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "effective";
         fhir:index 0       ], [
         fhir:value "code";
         fhir:index 1       ], [
         fhir:value "value";
         fhir:index 2       ], [
         fhir:value "status";
         fhir:index 3       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "code" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039>         ]       ]     ], [
       fhir:index 10;
       fhir:DataRequirement.type [ fhir:value "Observation" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Observation";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Observation>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "effective";
         fhir:index 0       ], [
         fhir:value "code";
         fhir:index 1       ], [
         fhir:value "value";
         fhir:index 2       ], [
         fhir:value "status";
         fhir:index 3       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "code" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011>         ]       ]     ], [
       fhir:index 11;
       fhir:DataRequirement.type [ fhir:value "Procedure" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Procedure";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Procedure>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "code";
         fhir:index 0       ], [
         fhir:value "performed";
         fhir:index 1       ], [
         fhir:value "status";
         fhir:index 2       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "code" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020>         ]       ]     ], [
       fhir:index 12;
       fhir:DataRequirement.type [ fhir:value "Procedure" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Procedure";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Procedure>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "code";
         fhir:index 0       ], [
         fhir:value "performed";
         fhir:index 1       ], [
         fhir:value "status";
         fhir:index 2       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "code" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019>         ]       ]     ], [
       fhir:index 13;
       fhir:DataRequirement.type [ fhir:value "Procedure" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Procedure";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Procedure>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "code";
         fhir:index 0       ], [
         fhir:value "performed";
         fhir:index 1       ], [
         fhir:value "status";
         fhir:index 2       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "code" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038>         ]       ]     ], [
       fhir:index 14;
       fhir:DataRequirement.type [ fhir:value "Procedure" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Procedure";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Procedure>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "code";
         fhir:index 0       ], [
         fhir:value "performed";
         fhir:index 1       ], [
         fhir:value "status";
         fhir:index 2       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "code" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15>         ]       ]     ], [
       fhir:index 15;
       fhir:DataRequirement.type [ fhir:value "Procedure" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/Procedure";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/Procedure>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "code";
         fhir:index 0       ], [
         fhir:value "performed";
         fhir:index 1       ], [
         fhir:value "status";
         fhir:index 2       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "code" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010>         ]       ]     ], [
       fhir:index 16;
       fhir:DataRequirement.type [ fhir:value "ServiceRequest" ];
       fhir:DataRequirement.profile [
         fhir:value "http://hl7.org/fhir/StructureDefinition/ServiceRequest";
         fhir:index 0;
         fhir:link <http://hl7.org/fhir/StructureDefinition/ServiceRequest>       ];
       fhir:DataRequirement.mustSupport [
         fhir:value "code";
         fhir:index 0       ], [
         fhir:value "authoredOn";
         fhir:index 1       ], [
         fhir:value "intent";
         fhir:index 2       ];
       fhir:DataRequirement.codeFilter [
         fhir:index 0;
         fhir:DataRequirement.codeFilter.path [ fhir:value "code" ];
         fhir:DataRequirement.codeFilter.valueSet [
           fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15";
           fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15>         ]       ]     ]
  ];
  fhir:DomainResource.extension [
     fhir:index 0;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis" ];
     fhir:Extension.valueCode [ fhir:value "boolean" ]
  ], [
     fhir:index 1;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem" ];
     fhir:Extension.valueReference [
       fhir:Reference.reference [ fhir:value "Device/software-system-example" ]     ]
  ], [
     fhir:index 2;
     fhir:Element.id [ fhir:value "effective-data-requirements" ];
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements" ];
     fhir:Extension.valueReference [
       fhir:Reference.reference [ fhir:value "#effective-data-requirements" ]     ]
  ];
  fhir:Measure.url [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm130-FHIR"];
  fhir:Measure.identifier [
     fhir:index 0;
     fhir:Identifier.use [ fhir:value "official" ];
     fhir:Identifier.system [ fhir:value "http://example.org/fhir/cqi/ecqm/Measure/Identifier/cms" ];
     fhir:Identifier.value [ fhir:value "130" ]
  ], [
     fhir:index 1;
     fhir:Identifier.use [ fhir:value "official" ];
     fhir:Identifier.system [ fhir:value "http://example.org/fhir/cqi/ecqm/Measure/Identifier/nqf" ];
     fhir:Identifier.value [ fhir:value "0034" ]
  ];
  fhir:Measure.version [ fhir:value "8.0.000"];
  fhir:Measure.name [ fhir:value "EXM130"];
  fhir:Measure.title [ fhir:value "EXM130 - Colorectal Cancer Screening Measure"];
  fhir:Measure.status [ fhir:value "active"];
  fhir:Measure.experimental [ fhir:value "true"^^xsd:boolean];
  fhir:Measure.date [ fhir:value "2022-02-22"^^xsd:date];
  fhir:Measure.publisher [ fhir:value "Clinical Quality Information WG"];
  fhir:Measure.contact [
     fhir:index 0;
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "url" ];
       fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/cqi" ]     ]
  ];
  fhir:Measure.description [ fhir:value "Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer"];
  fhir:Measure.useContext [
     fhir:index 0;
     fhir:UsageContext.code [
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/usage-context-type" ];
       fhir:Coding.code [ fhir:value "program" ]     ];
     fhir:UsageContext.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs" ];
         fhir:Coding.code [ fhir:value "ep-ec" ];
         fhir:Coding.display [ fhir:value "EP/EC" ]       ]     ]
  ];
  fhir:Measure.jurisdiction [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ];
       fhir:Coding.code [ fhir:value "US" ]     ]
  ];
  fhir:Measure.purpose [ fhir:value "Patients 50-75 years of age with a visit during the measurement period"];
  fhir:Measure.copyright [ fhir:value "This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (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 or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (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 third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved."];
  fhir:Measure.approvalDate [ fhir:value "2016-01-01"^^xsd:date];
  fhir:Measure.lastReviewDate [ fhir:value "2016-09-01"^^xsd:date];
  fhir:Measure.effectivePeriod [
     fhir:Period.start [ fhir:value "2018-01-01"^^xsd:date ];
     fhir:Period.end [ fhir:value "2018-12-31"^^xsd:date ]
  ];
  fhir:Measure.topic [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       a loinc:57024-2;
       fhir:Coding.system [ fhir:value "http://loinc.org" ];
       fhir:Coding.code [ fhir:value "57024-2" ];
       fhir:Coding.display [ fhir:value "Health Quality Measure Document" ]     ]
  ];
  fhir:Measure.library [
     fhir:value "http://hl7.org/fhir/us/cqfmeasures/Library/EXM130";
     fhir:index 0;
     fhir:link <http://hl7.org/fhir/us/cqfmeasures/Library/EXM130>
  ];
  fhir:Measure.disclaimer [ fhir:value "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. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."];
  fhir:Measure.scoring [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-scoring" ];
       fhir:Coding.code [ fhir:value "proportion" ];
       fhir:Coding.display [ fhir:value "Proportion" ]     ]
  ];
  fhir:Measure.type [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-type" ];
       fhir:Coding.code [ fhir:value "process" ]     ]
  ];
  fhir:Measure.rationale [ fhir:value "Colorectal cancer represents 8 percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. In 2017, there were an estimated 135,430 new cases of colorectal cancer and an estimated 50,260 deaths attributed to it. According to the National Cancer Institute, about 4.3 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al. 2017). Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society 2017)."];
  fhir:Measure.clinicalRecommendationStatement [ fhir:value "The U. S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force 2016). Screening tests: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years)"];
  fhir:Measure.improvementNotation [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-improvement-notation" ];
       fhir:Coding.code [ fhir:value "increase" ];
       fhir:Coding.display [ fhir:value "Increased score indicates improvement" ]     ]
  ];
  fhir:Measure.guidance [ fhir:value "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. Do not count DRE, FOBT tests performed in an office setting or performed on a sample collected via DRE."];
  fhir:Measure.group [
     fhir:index 0;
     fhir:Measure.group.population [
       fhir:index 0;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "initial-population" ];
           fhir:Coding.display [ fhir:value "Initial Population" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql-identifier" ];
         fhir:Expression.expression [ fhir:value "Initial Population" ]       ]     ], [
       fhir:index 1;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "numerator" ];
           fhir:Coding.display [ fhir:value "Numerator" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql-identifier" ];
         fhir:Expression.expression [ fhir:value "Numerator" ]       ]     ], [
       fhir:index 2;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "denominator" ];
           fhir:Coding.display [ fhir:value "Denominator" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql-identifier" ];
         fhir:Expression.expression [ fhir:value "Denominator" ]       ]     ], [
       fhir:index 3;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "denominator-exclusion" ];
           fhir:Coding.display [ fhir:value "Denominator Exclusion" ]         ]       ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.language [ fhir:value "text/cql-identifier" ];
         fhir:Expression.expression [ fhir:value "Denominator Exclusion" ]       ]     ]
  ];
  fhir:Measure.supplementalData [
     fhir:index 0;
     fhir:Measure.supplementalData.usage [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-data-usage" ];
         fhir:Coding.code [ fhir:value "supplemental-data" ]       ]     ];
     fhir:Measure.supplementalData.criteria [
       fhir:Expression.language [ fhir:value "text/cql-identifier" ];
       fhir:Expression.expression [ fhir:value "SDE Ethnicity" ]     ]
  ], [
     fhir:index 1;
     fhir:Measure.supplementalData.usage [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-data-usage" ];
         fhir:Coding.code [ fhir:value "supplemental-data" ]       ]     ];
     fhir:Measure.supplementalData.criteria [
       fhir:Expression.language [ fhir:value "text/cql-identifier" ];
       fhir:Expression.expression [ fhir:value "SDE Payer" ]     ]
  ], [
     fhir:index 2;
     fhir:Measure.supplementalData.usage [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-data-usage" ];
         fhir:Coding.code [ fhir:value "supplemental-data" ]       ]     ];
     fhir:Measure.supplementalData.criteria [
       fhir:Expression.language [ fhir:value "text/cql-identifier" ];
       fhir:Expression.expression [ fhir:value "SDE Race" ]     ]
  ], [
     fhir:index 3;
     fhir:Measure.supplementalData.usage [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-data-usage" ];
         fhir:Coding.code [ fhir:value "supplemental-data" ]       ]     ];
     fhir:Measure.supplementalData.criteria [
       fhir:Expression.language [ fhir:value "text/cql-identifier" ];
       fhir:Expression.expression [ fhir:value "SDE Sex" ]     ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.