Bundle exm-measure-bundle of type collection

Entry 1

Resource Measure:

Generated Narrative

id: measure-exm124-FHIR

meta:

url: http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm124-FHIR

identifier: 130 (OFFICIAL), 0034 (OFFICIAL)

version: 9.0.000

name: EXM124

title: Cervical Cancer Screening

status: active

experimental: true

date: Sep 17, 2018, 12:00:00 AM

publisher: National Committee for Quality Assurance

contact: http://www.ncqa.org/

description: Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: * Women age 21-64 who had cervical cytology performed every 3 years <br.* Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years

useContext:

jurisdiction: United States of America

purpose: Women 23-64 years of age with a visit during the measurement period

copyright: 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.

approvalDate: 2016-01-01

lastReviewDate: 2016-09-01

effectivePeriod: Jan 1, 2018, 12:00:00 AM --> Dec 31, 2018, 12:00:00 AM

topic: Health Quality Measure Document

relatedArtifact: , , ,

library: http://hl7.org/fhir/us/cqfmeasures/Library/EXM124

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. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

scoring: Proportion

type: Process

rationale: Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Howlader et al, 2016). In 2013, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Howlader et al, 2016). While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Howlader et al, 2016). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 235; by age 50 it becomes 1 in 54; by age 60, it is 1 in 25 (National Business Group on Health, 2011). 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 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 (National Business Group on Health, 2011). If breast cancer is detected through mammography screening and diagnosed in its earliest stages, treatment may be less expensive (Feig, 2011).

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 screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (C recommendation). (USPSTF, 2016) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement). (USPSTF, 2016) The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I Statement). (USPSTF, 2016) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement). (USPSTF, 2016)

improvementNotation: Increased score indicates improvement

guidance: To ensure the measure is only looking for a cervical cytology test only after a woman turns 21 years of age, the youngest age in the initial population is 23. 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. Include only cytology and HPV "co-testing"; in co-testing, both cytology and HPV tests are performed (i.e., the samples are collected and both tests are ordered, regardless of the cytology result) on the same date of service. Do not include reflex testing. In addition, if the medical record indicates the HPV test was performed only after determining the cytology result, this is considered reflex testing and does not meet criteria for the measure.

group

population

code: Initial Population

criteria:

population

code: Numerator

criteria:

population

code: Denominator

criteria:

population

code: Denominator Exclusion

criteria:

supplementalData

usage: Supplemental Data

criteria:

supplementalData

usage: Supplemental Data

criteria:

supplementalData

usage: Supplemental Data

criteria:

supplementalData

usage: Supplemental Data

criteria:

Entry 2

Resource Library:

Id:	EXM124
Url:	http://hl7.org/fhir/us/cqfmeasures/Library/EXM124
Version:	9.0.000
Identifier:	value: EXM124
Name:	EXM124
Title:	Cervical Cancer Screening
Status:	active
Experimental:	true
Type:	system: http://terminology.hl7.org/CodeSystem/library-type code: logic-library
Date:	2019-09-03T00:00:00-06:00
Publisher:	Health Level 7 International - Clinical Quality Information Work Group
Description:	This library is used as an example in the FHIR Quality Measure Implementation Guide
Use Context:	code value program ep-ec
Jurisdiction:	US
Approval Date:	2019-08-03
Last Review Date:	2019-08-03
Related Artifacts:	Type Resource depends-on http://hl7.org/fhir/Library/FHIR-ModelInfo|4.0.1 depends-on http://hl7.org/fhir/Library/FHIRHelpers|4.0.1 depends-on http://hl7.org/fhir/us/cqfmeasures/Library/Hospice|2.0.000 depends-on http://hl7.org/fhir/us/cqfmeasures/Library/AdultOutpatientEncounters|2.0.000 depends-on http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000 depends-on http://hl7.org/fhir/us/cqfmeasures/Library/SupplementalDataElements|2.0.0 depends-on http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709 depends-on http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1014 depends-on http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1017 depends-on http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1059
Parameters:	Name Type Min Max In/Out Measurement Period Period 0 1 in Patient Patient 0 1 out SDE Ethnicity Coding 0 * out SDE Payer Any 0 * out SDE Race Coding 0 * out SDE Sex Coding 0 1 out Initial Population boolean 0 1 out Denominator boolean 0 1 out Absence of Cervix Any 0 * out Denominator Exclusion boolean 0 1 out Cervical Cytology Within 3 Years Observation 0 * out HPV Test Within 5 Years for Women Age 30 and Older Observation 0 * out Numerator boolean 0 1 out
Data Requirements:	Type Profile MS Code Filter Procedure http://hl7.org/fhir/StructureDefinition/Procedure code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1014 Condition http://hl7.org/fhir/StructureDefinition/Condition code filter: path: code system: http://snomed.info/sct code: 37687000 display: Congenital absence of cervix (disorder) Observation http://hl7.org/fhir/StructureDefinition/Observation code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1017 Observation http://hl7.org/fhir/StructureDefinition/Observation code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1059

Content: text/cql

library EXM124 version '9.0.000' /* Based on CMS124v9 - Cervical Cancer Screening */ /* This example is a work in progress and should not be considered a final specification or recommendation for guidance. This example will help guide and direct the process of finding conventions and usage patterns that meet the needs of the various stakeholders in the measure development community. */ using FHIR version '4.0.1' include FHIRHelpers version '4.0.1' called FHIRHelpers include Hospice version '2.0.000' called Hospice include AdultOutpatientEncounters version '2.0.000' called AdultOutpatientEncounters include MATGlobalCommonFunctions version '5.0.000' called Global include SupplementalDataElements version '2.0.0' called SDE codesystem "SNOMEDCT:2017-09": 'http://snomed.info/sct' version 'http://snomed.info/sct/731000124108/version/201709' valueset "Hysterectomy with No Residual Cervix": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1014' valueset "Pap Test": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1017' valueset "HPV Test": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1059' code "Congenital absence of cervix (disorder)": '37687000' from "SNOMEDCT:2017-09" display 'Congenital absence of cervix (disorder)' parameter "Measurement Period" Interval<DateTime> default Interval[@2019-01-01T00:00:00.0, @2020-01-01T00:00:00.0) context Patient define "SDE Ethnicity": SDE."SDE Ethnicity" define "SDE Payer": SDE."SDE Payer" define "SDE Race": SDE."SDE Race" define "SDE Sex": SDE."SDE Sex" define "Initial Population": Patient.gender = 'female' and Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[23, 64] and exists AdultOutpatientEncounters."Qualifying Encounters" define "Denominator": "Initial Population" define "Denominator Exclusion": Hospice."Has Hospice" or exists "Absence of Cervix" define "Absence of Cervix": ([Procedure: "Hysterectomy with No Residual Cervix"] NoCervixProcedure where Global."Normalize Interval"(NoCervixProcedure.performed) ends on or before end of "Measurement Period" and NoCervixProcedure.status = 'completed' ) union [Condition : "Congenital absence of cervix (disorder)"] NoCervixBirth where Global."Normalize Interval"(NoCervixBirth.onset) starts on or before end of "Measurement Period" // and NoCervixBirth.clinicalStatus ~ ToConcept(Global."active") because this is an excluion, all statuses are acceptable define "Numerator": exists "Cervical Cytology Within 3 Years" or exists "HPV Test Within 5 Years for Women Age 30 and Older" define "Cervical Cytology Within 3 Years": [Observation: "Pap Test"] CervicalCytology where CervicalCytology.value is not null and CervicalCytology.status in { 'final', 'amended', 'corrected', 'preliminary' } and Global."Normalize Interval"(CervicalCytology.effective) ends 3 years or less on or before end of "Measurement Period" define "HPV Test Within 5 Years for Women Age 30 and Older": [Observation: "HPV Test"] HPVTest where HPVTest.value is not null and HPVTest.status in { 'final', 'amended', 'corrected', 'preliminary' } and Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of Global."Normalize Interval"(HPVTest.effective))>= 30 and Global."Normalize Interval"(HPVTest.effective) ends 5 years or less on or before end of "Measurement Period"

Content: application/elm+xml
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