Quality Measure Implementation Guide
5.0.0 - STU5
Quality Measure Implementation Guide
5.0.0 - STU5
This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v5.0.0: STU5 (v5.0.0)) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
| Active as of 2022-02-22 |
<Measure xmlns="http://hl7.org/fhir">
<id value="EXM108-FHIR"/>
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<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<div>
<table class="grid dict">
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">EXM108 - Venous Thromboembolism Prophylaxis</td>
</tr>
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">EXM108-FHIR</td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">8.2.000</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="Measure-EXM108-FHIR.html">EXM108 - Venous Thromboembolism Prophylaxis</a></td>
</tr>
<tr>
<th scope="row">
<b>
Official
</b>
</th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>108</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Effective Period: </b></th>
<td style="padding-left: 4px;">2018-01-01..2018-12-31</td>
</tr>
<tr>
<th scope="row"><b>Experimental: </b></th>
<td style="padding-left: 4px;">true</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">HL7 International / Clinical Quality Information</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;"><div><p>This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Use Context: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>code</b></th>
<th><b>value</b></th>
</tr>
<tr>
<td>venue</td>
<td/>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Jurisdiction: </b></th>
<td style="padding-left: 4px;">US</td>
</tr>
<tr>
<th scope="row"><b>Topic: </b></th>
<td style="padding-left: 4px;">57024-2</td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>Measure specifications are in the Public Domain.</p>
<p>LOINC(R) is a registered trademark of the Regenstrief Institute.</p>
<p>This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2017 International Health Terminology Standards Development Organization. All rights reserved.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Disclaimer: </b></th>
<td style="padding-left: 4px;"><div><p>These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Basis: </b></th>
<td style="padding-left: 4px;">
Encounter
</td>
</tr>
<tr>
<th scope="row"><b>Scoring: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Proportion </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>process </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Rationale: </b></th>
<td style="padding-left: 4px;"><div><p>Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008).</p>
<p>The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the 2001 report by The Agency for Healthcare Research and Quality (AHRQ). AHRQ indicates that "the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety by reducing the incidence of venous thromboembolism" (Shojania, 2001).</p>
<p>Despite its proven effectiveness, rates of appropriate thromboprophylaxis remain low in both medical and surgical patients. A recent analysis from the ENDORSE survey, which evaluated prophylaxis rates in 17,084 major surgery patients, found that more than one third of patients at risk for VTE (38%) did not receive prophylaxis and that rates varied by surgery type (Cohen, et al., 2008).</p>
<p>In a review of evidence-based patient safety practices, the Agency for Healthcare Research and Quality defined thromboprophylaxis against VTE as the "number one patient safety practice" for hospitalized patients (Shojania, 2001). Updated "safe practices" published by the National Quality Forum (NQF) recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis (National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism, 2006).</p>
<p>As noted by the ACCP, a vast number of randomized clinical trials provide irrefutable evidence that thromboprophylaxis reduces VTE events, and there are studies that have also shown that fatal PE is prevented by thromboprophylaxis (Geerts, et al. 2008).</p>
<p>Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Clinical recommendation statement: </b></th>
<td style="padding-left: 4px;"><div><p>Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for acutely ill hospitalized patients at high risk for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease. All hospitalized patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Improvement Notation: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<span>Increased score indicates improvement </span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Population Criteria: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td>Initial Population:</td>
<td>Patients age 18 and older discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period</td>
</tr>
<tr>
<td>Numerator:</td>
<td>Patients who received VTE prophylaxis:
- the day of or the day after hospital admission
- the day of or the day after surgery end date for surgeries that end the day of or the day after hospital admission
Patients who have documentation of a reason why no VTE prophylaxis was given:
- between arrival and hospital admission
- the day of or the day after hospital admission
- the day of or the day after surgery end date (for surgeries that end the day of or the day after hospital admission)</td>
</tr>
<tr>
<td>Denominator:</td>
<td>All patients in the initial population</td>
</tr>
<tr>
<td>Denominator Exclusion:</td>
<td>* Patients who have a length of stay less than 2 days
* Patients with comfort measures documented anytime between arrival and the day after hospital admission
* Patients with comfort measures documented by the day after surgery end date for surgeries that start the day of or the day after hospital admission
* Patients who are direct admits to intensive care unit (ICU), or transferred to ICU the day of or the day after hospital admission with ICU length of stay greater than or equal to one day
* Patients with a principal diagnosis of mental disorders or stroke
* Patients with a principal procedure of Surgical Care Improvement Project (SCIP) VTE selected surgeries</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b> Supplemental Data Elements: </b></th>
<td style="padding-left: 4px;">
<p>SDE Ethnicity</p>
<p>SDE Payer</p>
<p>SDE Race</p>
<p>SDE Sex</p>
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td><a href="Library-EXM108-FHIR.html">EXM108 - Venous Thromboembolism Prophylaxis Library</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Terminology and Other Dependencies: </b></th>
<td style="padding-left: 4px;">
<li><a href="Library-SupplementalDataElements.html">Supplemental Data Elements Libraryversion: null2.0.0)</a></li>
<li><code>http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1</code></li>
<li><a href="Library-MATGlobalCommonFunctions.html">MAT Global Common Functions FHIR Libraryversion: null5.0.000)</a></li>
<li><a href="Library-TJCOverall.html">TJC Overall Libraryversion: null4.0.000)</a></li>
<li><a href="Library-VTEICU.html">VTE ICU Libraryversion: null5.0.000)</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html">Condition Clinical Status Codes</a></li>
<li><a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.263</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.279</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.264</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.223</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.134</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.400</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.218</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.222</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.205</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.41</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.23</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1004</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272</code></li>
<li><code>http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45</code></li>
</td>
</tr>
<tr>
<th scope="row"><b>Parameters:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>name</b></th>
<th><b>use</b></th>
<th><b>min</b></th>
<th><b>max</b></th>
<th><b>type</b></th>
</tr>
<tr>
<td>Measurement Period</td>
<td>In</td>
<td>0</td>
<td>1</td>
<td>Period</td>
</tr>
<tr>
<td>SDE Sex</td>
<td>Out</td>
<td>0</td>
<td>1</td>
<td>Coding</td>
</tr>
<tr>
<td>Numerator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Encounter</td>
</tr>
<tr>
<td>Denominator</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Encounter</td>
</tr>
<tr>
<td>SDE Payer</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>Initial Population</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Encounter</td>
</tr>
<tr>
<td>SDE Ethnicity</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Coding</td>
</tr>
<tr>
<td>Denominator Exclusion</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Resource</td>
</tr>
<tr>
<td>SDE Race</td>
<td>Out</td>
<td>0</td>
<td>*</td>
<td>Coding</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>DataRequirements:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Resource Type</b></th>
<th><b>Resource Elements</b></th>
<th><b>Valueset Name</b></th>
<th><b>Valueset</b></th>
</tr>
<tr>
<td>Patient(<a href="http://hl7.org/fhir/R4/patient.html">Patient</a>)</td>
<td>
extension
value
birthDate
url
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/R4/encounter.html">Encounter</a>)</td>
<td>
period
type
</td>
<td>
Emergency Department Visit
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292</code></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/R4/encounter.html">Encounter</a>)</td>
<td>
period
type
</td>
<td>
Observation Services
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143</code></td>
</tr>
<tr>
<td>Encounter(<a href="http://hl7.org/fhir/R4/encounter.html">Encounter</a>)</td>
<td>
period
type
status
</td>
<td>
Encounter Inpatient
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307</code></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/R4/medicationadministration.html">MedicationAdministration</a>)</td>
<td>
dosage.route
dosage
medication
</td>
<td>
Unfractionated Heparin
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.218</code></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/R4/medicationadministration.html">MedicationAdministration</a>)</td>
<td>
medication
</td>
<td>
Direct Thrombin Inhibitor
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.205</code></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/R4/medicationadministration.html">MedicationAdministration</a>)</td>
<td>
medication
</td>
<td>
Glycoprotein IIb/IIIa Inhibitors
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.41</code></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/R4/medicationadministration.html">MedicationAdministration</a>)</td>
<td>
dosage.route
dosage
medication
status
</td>
<td>
Low Dose Unfractionated Heparin for VTE Prophylaxis
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39</code></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/R4/medicationadministration.html">MedicationAdministration</a>)</td>
<td>
medication
status
</td>
<td>
Low Molecular Weight Heparin for VTE Prophylaxis
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219</code></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/R4/medicationadministration.html">MedicationAdministration</a>)</td>
<td>
medication
status
</td>
<td>
Injectable Factor Xa Inhibitor for VTE Prophylaxis
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211</code></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/R4/medicationadministration.html">MedicationAdministration</a>)</td>
<td>
medication
status
</td>
<td>
Warfarin
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232</code></td>
</tr>
<tr>
<td>MedicationAdministration(<a href="http://hl7.org/fhir/R4/medicationadministration.html">MedicationAdministration</a>)</td>
<td>
effective
medication
status
</td>
<td>
Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.134</code></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/R4/medicationrequest.html">MedicationRequest</a>)</td>
<td>
medication
</td>
<td>
Low Dose Unfractionated Heparin for VTE Prophylaxis
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39</code></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/R4/medicationrequest.html">MedicationRequest</a>)</td>
<td>
medication
</td>
<td>
Low Molecular Weight Heparin for VTE Prophylaxis
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219</code></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/R4/medicationrequest.html">MedicationRequest</a>)</td>
<td>
medication
</td>
<td>
Injectable Factor Xa Inhibitor for VTE Prophylaxis
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211</code></td>
</tr>
<tr>
<td>MedicationRequest(<a href="http://hl7.org/fhir/R4/medicationrequest.html">MedicationRequest</a>)</td>
<td>
medication
</td>
<td>
Warfarin
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232</code></td>
</tr>
<tr>
<td>ServiceRequest(<a href="http://hl7.org/fhir/R4/servicerequest.html">ServiceRequest</a>)</td>
<td>
code
</td>
<td>
Venous foot pumps (VFP)
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230</code></td>
</tr>
<tr>
<td>ServiceRequest(<a href="http://hl7.org/fhir/R4/servicerequest.html">ServiceRequest</a>)</td>
<td>
code
</td>
<td>
Intermittent pneumatic compression devices (IPC)
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214</code></td>
</tr>
<tr>
<td>ServiceRequest(<a href="http://hl7.org/fhir/R4/servicerequest.html">ServiceRequest</a>)</td>
<td>
code
</td>
<td>
Graduated compression stockings (GCS)
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256</code></td>
</tr>
<tr>
<td>ServiceRequest(<a href="http://hl7.org/fhir/R4/servicerequest.html">ServiceRequest</a>)</td>
<td>
code
intent
</td>
<td>
Comfort Measures
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45</code></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/R4/procedure.html">Procedure</a>)</td>
<td>
code
</td>
<td>
General Surgery
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255</code></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/R4/procedure.html">Procedure</a>)</td>
<td>
code
</td>
<td>
Gynecological Surgery
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257</code></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/R4/procedure.html">Procedure</a>)</td>
<td>
code
</td>
<td>
Hip Fracture Surgery
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258</code></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/R4/procedure.html">Procedure</a>)</td>
<td>
code
</td>
<td>
Intracranial Neurosurgery
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260</code></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/R4/procedure.html">Procedure</a>)</td>
<td>
code
</td>
<td>
Urological Surgery
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272</code></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/R4/procedure.html">Procedure</a>)</td>
<td>
code
status
</td>
<td>
Comfort Measures
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45</code></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/R4/procedure.html">Procedure</a>)</td>
<td>
code
</td>
<td>
Hip Replacement Surgery
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259</code></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/R4/procedure.html">Procedure</a>)</td>
<td>
code
</td>
<td>
Knee Replacement Surgery
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261</code></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/R4/procedure.html">Procedure</a>)</td>
<td>
code
statusReason
usedCode
id
status
</td>
<td>
Device Application
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48</code></td>
</tr>
<tr>
<td>Procedure(<a href="http://hl7.org/fhir/R4/procedure.html">Procedure</a>)</td>
<td>
code
performed
status
</td>
<td>
General or Neuraxial Anesthesia
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743</code></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/R4/condition.html">Condition</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/R4/condition.html">Condition</a>)</td>
<td>
code
clinicalStatus
onset
</td>
<td>
Atrial Fibrillation/Flutter
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202</code></td>
</tr>
<tr>
<td>Condition(<a href="http://hl7.org/fhir/R4/condition.html">Condition</a>)</td>
<td>
code
clinicalStatus
onset
</td>
<td>
Venous Thromboembolism
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.279</code></td>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/R4/observation.html">Observation</a>)</td>
<td>
code
value
status
</td>
<td>
</td>
<td/>
</tr>
<tr>
<td>Observation(<a href="http://hl7.org/fhir/R4/observation.html">Observation</a>)</td>
<td>
code
id
issued
value
status
</td>
<td>
INR
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213</code></td>
</tr>
<tr>
<td>Coverage(<a href="http://hl7.org/fhir/R4/coverage.html">Coverage</a>)</td>
<td>
period
type
</td>
<td>
Payer
</td>
<td><code>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591</code></td>
</tr>
<tr>
<td>Location(<a href="http://hl7.org/fhir/R4/location.html">Location</a>)</td>
<td>
id
</td>
<td>
</td>
<td/>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Direct Reference Codes:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>display</b></th>
<th><b>code</b></th>
<th><b>system</b></th>
</tr>
<tr>
<td/>
<td>active</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td/>
<td>recurrence</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td/>
<td>relapse</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td/>
<td>inactive</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td/>
<td>remission</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td/>
<td>resolved</td>
<td><a href="http://hl7.org/fhir/R4/codesystem-condition-clinical.html">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>
</tr>
<tr>
<td>Risk for venous thromboembolism</td>
<td>72136-5</td>
<td><a href="http://terminology.hl7.org/6.0.2/CodeSystem-v3-loinc.html">http://loinc.org</a></td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Logic Definitions:</b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<th><b>Group</b></th>
<th><b>Scoring</b></th>
<th><b>Population Criteria</b></th>
<th><b>Expression</b></th>
</tr>
<tr>
<td> </td>
<td colspan="3" style="padding-left: 4px;">
<b>Measure scoring:</b>
<p style="margin-bottom: 5px;">
<span>Proportion</span>
</p>
</td>
<tr>
<td/>
<td/>
<td>Initial Population</td>
<td>
<pre><code class="language-cql">define "Initial Population":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Numerator</td>
<td>
<pre><code class="language-cql">define "Numerator":
"Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure"
union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"
intersect ( "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE"
union "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery"
)
)
union "Encounter With Low Risk for VTE or Anticoagulant Administered"
union "Encounter With No VTE Prophylaxis Due to Medical Reason"
union "Encounter With No VTE Prophylaxis Due to Patient Refusal"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator</td>
<td>
<pre><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<td/>
<td/>
<td>Denominator Exclusion</td>
<td>
<pre><code class="language-cql">define "Denominator Exclusion":
"Encounter Less Than 2 Days"
union "Encounter With ICU Location Stay 1 Day or More"
union "Encounter With Principal Diagnosis of Mental Disorder or Stroke"
union "Encounter With Principal Procedure of SCIP VTE Selected Surgery"
union "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission"
union "Encounter With Intervention Comfort Measures on Day of or Day After Procedure"</code></pre>
</td>
</tr>
</tr>
</table>
<table class="grid-dict">
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>SDE Sex</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Sex":
SDE."SDE Sex"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>MATGlobalCommonFunctions</td>
<td>Inpatient Encounter</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Inpatient Encounter":
[Encounter: "Encounter Inpatient"] EncounterInpatient
where EncounterInpatient.status = 'finished'
and "LengthInDays"(EncounterInpatient.period) <= 120
and EncounterInpatient.period ends during "Measurement Period"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Admission Without VTE or Obstetrical Conditions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Admission Without VTE or Obstetrical Conditions":
Global."Inpatient Encounter" InpatientEncounter
where not (exists (Global.EncounterDiagnosis(InpatientEncounter)) EncounterDiagnosis
where (EncounterDiagnosis.code in "Obstetrics"
or EncounterDiagnosis.code in "Venous Thromboembolism"
or EncounterDiagnosis.code in "Obstetrics VTE"
)
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">// Note: added FHIRHelpers.ToDate() in R4
define "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions":
( Global."Inpatient Encounter" InpatientEncounter
with ["Patient"] BirthDate
such that Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(BirthDate.birthDate), start of InpatientEncounter.period) >= 18
)
intersect "Admission Without VTE or Obstetrical Conditions"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108</td>
<td>VTE Prophylaxis by Medication Administered or Device Applied</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">// 10/29: Replaced DeviceUseStatement with Procedure with a new value set and procedure.usdCode for specifying devices
define "VTE Prophylaxis by Medication Administered or Device Applied":
( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
where VTEMedication.status ='completed'
and VTEMedication.dosage.route in "Subcutaneous route"
)
union (["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] LMWH where LMWH.status = 'completed')
union (["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] FactorXa where FactorXa.status = 'completed')
union (["MedicationAdministration": medication in "Warfarin"] Warfarin where Warfarin.status = 'completed')
union (
["Procedure": "Device Application"] DeviceApplied
where DeviceApplied.status = 'complete'
and (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)"
or DeviceApplied.usedCode in"Venous foot pumps (VFP)"
or DeviceApplied.usedCode in "Graduated compression stockings (GCS)"
)
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure":
( from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
"VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis
where Coalesce(Global."Normalize Interval"(VTEProphylaxis.effective), Global."Normalize Interval"(VTEProphylaxis.performed)) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
return QualifyingEncounter
)
union (
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis
where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(Global."Normalize Interval"(VTEProphylaxis.effective), Global."Normalize Interval"(VTEProphylaxis.performed)) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure":
( from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
where FactorXaMedication.status = 'completed'
and Global."Normalize Interval"(FactorXaMedication.effective) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
return QualifyingEncounter
)
union ( from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
where FactorXaMedication.status = 'completed'
and AnesthesiaProcedure.status = 'completed'
and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Global."Normalize Interval"(FactorXaMedication.effective) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/*NOTE: Feedback at Digitial Quality Summit 2019 indicates verificationStatus may be difficult for implementers to retrieve
both condition.clinicalStatus and condition.verificationStatus = 'confirmed'
*/
define "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE":
( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with ["Condition": code in "Atrial Fibrillation/Flutter"] AtrialFibrillation
such that FHIRHelpers.ToConcept(AtrialFibrillation.clinicalStatus) in { Global."active", Global."recurrence", Global."relapse" }
and Global."Normalize Interval"(AtrialFibrillation.onset) starts on or before end of QualifyingEncounter.period
)
union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where Global.EncounterDiagnosis(QualifyingEncounter).code in "Atrial Fibrillation/Flutter"
)
union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with ["Condition": code in "Venous Thromboembolism"] VTEDiagnosis
such that FHIRHelpers.ToConcept(VTEDiagnosis.clinicalStatus) in { Global."inactive", Global."remission", Global."resolved" }
//and VTEDiagnosis.verificationStatus = 'confirmed'
and Global."Normalize Interval"(VTEDiagnosis.onset) before start of QualifyingEncounter.period
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with ( ["Procedure": "Hip Replacement Surgery"]
union ["Procedure": "Knee Replacement Surgery"] ) HipKneeProcedure
such that HipKneeProcedure.status = 'completed'
and Global."Normalize Interval"(HipKneeProcedure.performed) starts on or before end of QualifyingEncounter.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Is In Low Risk for VTE or On Anticoagulant</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Is In Low Risk for VTE or On Anticoagulant":
( ["Observation": "Risk for venous thromboembolism"] VTERiskAssessment
where VTERiskAssessment.value in "Low Risk"
and VTERiskAssessment.status in {'final','amended', 'corrected'}
)
union ( ["Observation": "INR"] INRLabTest
where INRLabTest.value as Quantity > 3.0
and INRLabTest.status in {'final','amended', 'corrected'}
return "Observation" { id: INRLabTest.id, effective: INRLabTest.issued }
)
union ((( ["MedicationAdministration": "Unfractionated Heparin"] UnfractionatedHeparin
where UnfractionatedHeparin.dosage.route in "Intravenous route"
)
union ["MedicationAdministration": "Direct Thrombin Inhibitor"]
union ["MedicationAdministration": "Glycoprotein IIb/IIIa Inhibitors"] ) AnticoagulantMedication
where AnticoagulantMedication.status = 'complete'
return "Observation" { id: AnticoagulantMedication.id, effective: AnticoagulantMedication.effective }
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment
such that Global."Normalize Interval"(VTERiskAssessment.effective) starts during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment
where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Global."Normalize Interval"(VTERiskAssessment.effective) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With Low Risk for VTE or Anticoagulant Administered</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter With Low Risk for VTE or Anticoagulant Administered":
"Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission"
union "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>No VTE Prophylaxis Medication Administered or Ordered</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "No VTE Prophylaxis Medication Administered or Ordered":
(( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
union
["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"]
union
["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
union
["MedicationAdministration": medication in "Warfarin"]
) MedicationAdm
where MedicationAdm.status = 'not-done'
)
union
(( ["MedicationRequest": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
union
["MedicationRequest": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"]
union
["MedicationRequest": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
union
["MedicationRequest": medication in "Warfarin"]
) MedicationOrder
where MedicationOrder.doNotPerform is true
and MedicationOrder.status in {'completed', 'cancelled'}
//11/5 discussion: all expressions for QI-Core must include a status.
//Therefore, we need ServiceRequest.status = completed; and MedicationRequest.status = cancelled (or completed, since cancelled indicates it was once ordered but intentionally never filled).
//So the not done issue is handled by ServiceRequest.doNotPerform = True Or MedicationRequest.doNotPerform = True
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
such that Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason"
and Coalesce(NoVTEMedication.authoredOn, start of Global."Normalize Interval"(NoVTEMedication.effective)) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>No VTE Prophylaxis Device Applied or Ordered</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "No VTE Prophylaxis Device Applied or Ordered":
((
["ServiceRequest": "Venous foot pumps (VFP)"]
union ["ServiceRequest": "Intermittent pneumatic compression devices (IPC)"]
union ["ServiceRequest": "Graduated compression stockings (GCS)"]
) DeviceOrder
where DeviceOrder.status = 'completed'
//11/5 discussion: all expressions for QI-Core must include a status
//ServiceRequest.status - draft | active | suspended | completed | entered-in-error | cancelled
and DeviceOrder.doNotPerform is true
return {id: DeviceOrder.id, requestStatusReason: GetStatusReason(DeviceOrder), authoredOn: DeviceOrder.authoredOn}
)
union
(
["Procedure": "Device Application"] DeviceApplied
let DeviceNotDoneTiming: Global.GetExtension(DeviceApplied, 'qicore-recorded').value
where (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)"
or DeviceApplied.usedCode in "Venous foot pumps (VFP)"
or DeviceApplied.usedCode in "Graduated compression stockings (GCS)"
)
and DeviceApplied.status = 'not-done'
return {id: DeviceApplied.id, requestStatusReason: DeviceApplied.statusReason, authoredOn: DeviceNotDoneTiming}
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
such that NoVTEDevice.requestStatusReason in "Medical Reason"
and NoVTEDevice.authoredOn during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason"
and AnesthesiaProcedure.status = 'completed'
and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(NoVTEMedication.authoredOn, start of Global."Normalize Interval"(NoVTEMedication.effective)) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
where NoVTEDevice.requestStatusReason in "Medical Reason"
and AnesthesiaProcedure.status = 'completed'
and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and NoVTEDevice.authoredOn during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With No VTE Prophylaxis Due to Medical Reason</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter With No VTE Prophylaxis Due to Medical Reason":
( "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
intersect "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
)
union ( "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure"
intersect "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>No VTE Prophylaxis Medication or Device Due to Patient Refusal</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "No VTE Prophylaxis Medication or Device Due to Patient Refusal":
( "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Patient Refusal"
)
union ("No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
where NoVTEDevice.requestStatusReason in "Patient Refusal"
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
such that Coalesce(start of Global."Normalize Interval"(PatientRefusal.effective), PatientRefusal.authoredOn)
during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(start of Global."Normalize Interval"(PatientRefusal.effective), PatientRefusal.authoredOn)
during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With No VTE Prophylaxis Due to Patient Refusal</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter With No VTE Prophylaxis Due to Patient Refusal":
"No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission"
union "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Numerator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Numerator":
"Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure"
union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"
intersect ( "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE"
union "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery"
)
)
union "Encounter With Low Risk for VTE or Anticoagulant Administered"
union "Encounter With No VTE Prophylaxis Due to Medical Reason"
union "Encounter With No VTE Prophylaxis Due to Patient Refusal"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Initial Population</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Initial Population":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Denominator</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator":
"Initial Population"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
[Coverage: type in "Payer"] Payer
return {
code: Payer.type,
period: Payer.period
}</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>SDE Payer</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Payer":
SDE."SDE Payer"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>SDE Ethnicity</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Ethnicity":
SDE."SDE Ethnicity"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter Less Than 2 Days</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter Less Than 2 Days":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where Global."LengthInDays"(QualifyingEncounter.period)< 2</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With ICU Location Stay 1 Day or More</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter With ICU Location Stay 1 Day or More":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where exists ( QualifyingEncounter.location Location
where Global.GetLocation(Location.location).type in "Intensive Care Unit"
and Global."LengthInDays"(Location.period)>= 1
and Location.period starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With Principal Diagnosis of Mental Disorder or Stroke</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter With Principal Diagnosis of Mental Disorder or Stroke":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Mental Health Diagnoses"
or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Hemorrhagic Stroke"
or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Ischemic Stroke"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>SCIP VTE Selected Surgery</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SCIP VTE Selected Surgery":
( ["Procedure": "General Surgery"]
union ["Procedure": "Gynecological Surgery"]
union ["Procedure": "Hip Fracture Surgery"]
union ["Procedure": "Hip Replacement Surgery"]
union ["Procedure": "Intracranial Neurosurgery"]
union ["Procedure": "Knee Replacement Surgery"]
union ["Procedure": "Urological Surgery"] ) Procedure
where Procedure.status = 'completed'</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With Principal Procedure of SCIP VTE Selected Surgery</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">/* NOTE: 2 options to express Principal Procedure to retrive "encounter Procedure as an url" and proedure "rank as extension" in R4
VTE-1 uses Option 1 - generic extension funtion
VTE-2 uses Option 2 - Specific extension functions
TODO: Mapping Table needs revision on using "Encounter.procedure.code", "Encounter.procedure.sequence"
*/
define "Encounter With Principal Procedure of SCIP VTE Selected Surgery":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
"SCIP VTE Selected Surgery" SelectedProcedure
let EncounterProcedure: Global.GetExtension(QualifyingEncounter, 'qicore-encounter-procedure')
where FHIRHelpers.ToInteger(Global.GetExtension(EncounterProcedure, 'rank').value as FHIR.positiveInt) = 1
and Global.GetId(FHIRHelpers.ToString((Global.GetExtension(EncounterProcedure, 'procedure').value as FHIR.Reference).reference)) = SelectedProcedure.id
and Global."Normalize Interval"(SelectedProcedure.performed) during QualifyingEncounter.period</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Intervention Comfort Measures</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Intervention Comfort Measures":
(["ServiceRequest": "Comfort Measures"] P
where P.intent = 'order'
)
union
(["Procedure": "Comfort Measures"] InterventionPerformed
where InterventionPerformed.status in {'completed', 'in-progress'})</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "Intervention Comfort Measures" ComfortMeasure
such that Coalesce(start of Global."Normalize Interval"(ComfortMeasure.performed), ComfortMeasure.authoredOn) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Encounter With Intervention Comfort Measures on Day of or Day After Procedure</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Encounter With Intervention Comfort Measures on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"Intervention Comfort Measures" ComfortMeasure
where AnesthesiaProcedure.status = 'completed'
and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(start of Global."Normalize Interval"(ComfortMeasure.performed), ComfortMeasure.authoredOn) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>Denominator Exclusion</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "Denominator Exclusion":
"Encounter Less Than 2 Days"
union "Encounter With ICU Location Stay 1 Day or More"
union "Encounter With Principal Diagnosis of Mental Disorder or Stroke"
union "Encounter With Principal Procedure of SCIP VTE Selected Surgery"
union "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission"
union "Encounter With Intervention Comfort Measures on Day of or Day After Procedure"</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>SupplementalDataElements</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">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</code></pre>
</td>
</tr>
<tr>
<th><b>Library Name</b></th>
<th><b>Name</b></th>
</tr>
<tr>
<td>EXM108-FHIR</td>
<td>SDE Race</td>
</tr>
<tr>
<td/>
<td>
<pre class="highlight language-cql"><code class="language-cql">define "SDE Race":
SDE."SDE Race"</code></pre>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements-exm108"/>
<meta>
<profile
value="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-moduledefinitionlibrary"/>
</meta>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="active"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="recurrence"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="relapse"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="inactive"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="remission"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="resolved"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
<valueCoding>
<system value="http://loinc.org"/>
<code value="72136-5"/>
<display value="Risk for venous thromboembolism"/>
</valueCoding>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="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"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Sex"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Sex":
SDE."SDE Sex""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="MATGlobalCommonFunctions"/>
</extension>
<extension url="name">
<valueString value="Inpatient Encounter"/>
</extension>
<extension url="statement">
<valueString
value="define "Inpatient Encounter":
[Encounter: "Encounter Inpatient"] EncounterInpatient
where EncounterInpatient.status = 'finished'
and "LengthInDays"(EncounterInpatient.period) <= 120
and EncounterInpatient.period ends during "Measurement Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Admission Without VTE or Obstetrical Conditions"/>
</extension>
<extension url="statement">
<valueString
value="define "Admission Without VTE or Obstetrical Conditions":
Global."Inpatient Encounter" InpatientEncounter
where not (exists (Global.EncounterDiagnosis(InpatientEncounter)) EncounterDiagnosis
where (EncounterDiagnosis.code in "Obstetrics"
or EncounterDiagnosis.code in "Venous Thromboembolism"
or EncounterDiagnosis.code in "Obstetrics VTE"
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"/>
</extension>
<extension url="statement">
<valueString
value="// Note: added FHIRHelpers.ToDate() in R4
define "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions":
( Global."Inpatient Encounter" InpatientEncounter
with ["Patient"] BirthDate
such that Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(BirthDate.birthDate), start of InpatientEncounter.period) >= 18
)
intersect "Admission Without VTE or Obstetrical Conditions""/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108"/>
</extension>
<extension url="name">
<valueString
value="VTE Prophylaxis by Medication Administered or Device Applied"/>
</extension>
<extension url="statement">
<valueString
value="// 10/29: Replaced DeviceUseStatement with Procedure with a new value set and procedure.usdCode for specifying devices
define "VTE Prophylaxis by Medication Administered or Device Applied":
( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
where VTEMedication.status ='completed'
and VTEMedication.dosage.route in "Subcutaneous route"
)
union (["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] LMWH where LMWH.status = 'completed')
union (["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] FactorXa where FactorXa.status = 'completed')
union (["MedicationAdministration": medication in "Warfarin"] Warfarin where Warfarin.status = 'completed')
union (
["Procedure": "Device Application"] DeviceApplied
where DeviceApplied.status = 'complete'
and (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)"
or DeviceApplied.usedCode in"Venous foot pumps (VFP)"
or DeviceApplied.usedCode in "Graduated compression stockings (GCS)"
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure":
( from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
"VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis
where Coalesce(Global."Normalize Interval"(VTEProphylaxis.effective), Global."Normalize Interval"(VTEProphylaxis.performed)) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
return QualifyingEncounter
)
union (
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis
where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(Global."Normalize Interval"(VTEProphylaxis.effective), Global."Normalize Interval"(VTEProphylaxis.performed)) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure":
( from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
where FactorXaMedication.status = 'completed'
and Global."Normalize Interval"(FactorXaMedication.effective) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
return QualifyingEncounter
)
union ( from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
where FactorXaMedication.status = 'completed'
and AnesthesiaProcedure.status = 'completed'
and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Global."Normalize Interval"(FactorXaMedication.effective) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE"/>
</extension>
<extension url="statement">
<valueString
value="/*NOTE: Feedback at Digitial Quality Summit 2019 indicates verificationStatus may be difficult for implementers to retrieve
both condition.clinicalStatus and condition.verificationStatus = 'confirmed'
*/
define "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE":
( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with ["Condition": code in "Atrial Fibrillation/Flutter"] AtrialFibrillation
such that FHIRHelpers.ToConcept(AtrialFibrillation.clinicalStatus) in { Global."active", Global."recurrence", Global."relapse" }
and Global."Normalize Interval"(AtrialFibrillation.onset) starts on or before end of QualifyingEncounter.period
)
union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where Global.EncounterDiagnosis(QualifyingEncounter).code in "Atrial Fibrillation/Flutter"
)
union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with ["Condition": code in "Venous Thromboembolism"] VTEDiagnosis
such that FHIRHelpers.ToConcept(VTEDiagnosis.clinicalStatus) in { Global."inactive", Global."remission", Global."resolved" }
//and VTEDiagnosis.verificationStatus = 'confirmed'
and Global."Normalize Interval"(VTEDiagnosis.onset) before start of QualifyingEncounter.period
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with ( ["Procedure": "Hip Replacement Surgery"]
union ["Procedure": "Knee Replacement Surgery"] ) HipKneeProcedure
such that HipKneeProcedure.status = 'completed'
and Global."Normalize Interval"(HipKneeProcedure.performed) starts on or before end of QualifyingEncounter.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="Is In Low Risk for VTE or On Anticoagulant"/>
</extension>
<extension url="statement">
<valueString
value="define "Is In Low Risk for VTE or On Anticoagulant":
( ["Observation": "Risk for venous thromboembolism"] VTERiskAssessment
where VTERiskAssessment.value in "Low Risk"
and VTERiskAssessment.status in {'final','amended', 'corrected'}
)
union ( ["Observation": "INR"] INRLabTest
where INRLabTest.value as Quantity > 3.0
and INRLabTest.status in {'final','amended', 'corrected'}
return "Observation" { id: INRLabTest.id, effective: INRLabTest.issued }
)
union ((( ["MedicationAdministration": "Unfractionated Heparin"] UnfractionatedHeparin
where UnfractionatedHeparin.dosage.route in "Intravenous route"
)
union ["MedicationAdministration": "Direct Thrombin Inhibitor"]
union ["MedicationAdministration": "Glycoprotein IIb/IIIa Inhibitors"] ) AnticoagulantMedication
where AnticoagulantMedication.status = 'complete'
return "Observation" { id: AnticoagulantMedication.id, effective: AnticoagulantMedication.effective }
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission"/>
</extension>
<extension url="statement">
<valueString
value="define "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment
such that Global."Normalize Interval"(VTERiskAssessment.effective) starts during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure"/>
</extension>
<extension url="statement">
<valueString
value="define "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment
where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Global."Normalize Interval"(VTERiskAssessment.effective) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter"/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With Low Risk for VTE or Anticoagulant Administered"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter With Low Risk for VTE or Anticoagulant Administered":
"Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission"
union "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure""/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="No VTE Prophylaxis Medication Administered or Ordered"/>
</extension>
<extension url="statement">
<valueString
value="define "No VTE Prophylaxis Medication Administered or Ordered":
(( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
union
["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"]
union
["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
union
["MedicationAdministration": medication in "Warfarin"]
) MedicationAdm
where MedicationAdm.status = 'not-done'
)
union
(( ["MedicationRequest": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
union
["MedicationRequest": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"]
union
["MedicationRequest": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
union
["MedicationRequest": medication in "Warfarin"]
) MedicationOrder
where MedicationOrder.doNotPerform is true
and MedicationOrder.status in {'completed', 'cancelled'}
//11/5 discussion: all expressions for QI-Core must include a status.
//Therefore, we need ServiceRequest.status = completed; and MedicationRequest.status = cancelled (or completed, since cancelled indicates it was once ordered but intentionally never filled).
//So the not done issue is handled by ServiceRequest.doNotPerform = True Or MedicationRequest.doNotPerform = True
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"/>
</extension>
<extension url="statement">
<valueString
value="define "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
such that Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason"
and Coalesce(NoVTEMedication.authoredOn, start of Global."Normalize Interval"(NoVTEMedication.effective)) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="No VTE Prophylaxis Device Applied or Ordered"/>
</extension>
<extension url="statement">
<valueString
value="define "No VTE Prophylaxis Device Applied or Ordered":
((
["ServiceRequest": "Venous foot pumps (VFP)"]
union ["ServiceRequest": "Intermittent pneumatic compression devices (IPC)"]
union ["ServiceRequest": "Graduated compression stockings (GCS)"]
) DeviceOrder
where DeviceOrder.status = 'completed'
//11/5 discussion: all expressions for QI-Core must include a status
//ServiceRequest.status - draft | active | suspended | completed | entered-in-error | cancelled
and DeviceOrder.doNotPerform is true
return {id: DeviceOrder.id, requestStatusReason: GetStatusReason(DeviceOrder), authoredOn: DeviceOrder.authoredOn}
)
union
(
["Procedure": "Device Application"] DeviceApplied
let DeviceNotDoneTiming: Global.GetExtension(DeviceApplied, 'qicore-recorded').value
where (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)"
or DeviceApplied.usedCode in "Venous foot pumps (VFP)"
or DeviceApplied.usedCode in "Graduated compression stockings (GCS)"
)
and DeviceApplied.status = 'not-done'
return {id: DeviceApplied.id, requestStatusReason: DeviceApplied.statusReason, authoredOn: DeviceNotDoneTiming}
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"/>
</extension>
<extension url="statement">
<valueString
value="define "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
such that NoVTEDevice.requestStatusReason in "Medical Reason"
and NoVTEDevice.authoredOn during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure"/>
</extension>
<extension url="statement">
<valueString
value="define "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason"
and AnesthesiaProcedure.status = 'completed'
and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(NoVTEMedication.authoredOn, start of Global."Normalize Interval"(NoVTEMedication.effective)) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure"/>
</extension>
<extension url="statement">
<valueString
value="define "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
where NoVTEDevice.requestStatusReason in "Medical Reason"
and AnesthesiaProcedure.status = 'completed'
and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and NoVTEDevice.authoredOn during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With No VTE Prophylaxis Due to Medical Reason"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter With No VTE Prophylaxis Due to Medical Reason":
( "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
intersect "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
)
union ( "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure"
intersect "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="No VTE Prophylaxis Medication or Device Due to Patient Refusal"/>
</extension>
<extension url="statement">
<valueString
value="define "No VTE Prophylaxis Medication or Device Due to Patient Refusal":
( "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Patient Refusal"
)
union ("No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
where NoVTEDevice.requestStatusReason in "Patient Refusal"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission"/>
</extension>
<extension url="statement">
<valueString
value="define "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
such that Coalesce(start of Global."Normalize Interval"(PatientRefusal.effective), PatientRefusal.authoredOn)
during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure"/>
</extension>
<extension url="statement">
<valueString
value="define "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(start of Global."Normalize Interval"(PatientRefusal.effective), PatientRefusal.authoredOn)
during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With No VTE Prophylaxis Due to Patient Refusal"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter With No VTE Prophylaxis Due to Patient Refusal":
"No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission"
union "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure""/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="Numerator"/>
</extension>
<extension url="statement">
<valueString
value="define "Numerator":
"Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure"
union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"
intersect ( "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE"
union "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery"
)
)
union "Encounter With Low Risk for VTE or Anticoagulant Administered"
union "Encounter With No VTE Prophylaxis Due to Medical Reason"
union "Encounter With No VTE Prophylaxis Due to Patient Refusal""/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="Initial Population"/>
</extension>
<extension url="statement">
<valueString
value="define "Initial Population":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions""/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator":
"Initial Population""/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
[Coverage: type in "Payer"] Payer
return {
code: Payer.type,
period: Payer.period
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Payer"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Payer":
SDE."SDE Payer""/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="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"/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Ethnicity"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Ethnicity":
SDE."SDE Ethnicity""/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="Encounter Less Than 2 Days"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter Less Than 2 Days":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where Global."LengthInDays"(QualifyingEncounter.period)< 2"/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With ICU Location Stay 1 Day or More"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter With ICU Location Stay 1 Day or More":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where exists ( QualifyingEncounter.location Location
where Global.GetLocation(Location.location).type in "Intensive Care Unit"
and Global."LengthInDays"(Location.period)>= 1
and Location.period starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With Principal Diagnosis of Mental Disorder or Stroke"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter With Principal Diagnosis of Mental Disorder or Stroke":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Mental Health Diagnoses"
or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Hemorrhagic Stroke"
or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Ischemic Stroke""/>
</extension>
<extension url="displaySequence">
<valueInteger value="34"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="SCIP VTE Selected Surgery"/>
</extension>
<extension url="statement">
<valueString
value="define "SCIP VTE Selected Surgery":
( ["Procedure": "General Surgery"]
union ["Procedure": "Gynecological Surgery"]
union ["Procedure": "Hip Fracture Surgery"]
union ["Procedure": "Hip Replacement Surgery"]
union ["Procedure": "Intracranial Neurosurgery"]
union ["Procedure": "Knee Replacement Surgery"]
union ["Procedure": "Urological Surgery"] ) Procedure
where Procedure.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="35"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With Principal Procedure of SCIP VTE Selected Surgery"/>
</extension>
<extension url="statement">
<valueString
value="/* NOTE: 2 options to express Principal Procedure to retrive "encounter Procedure as an url" and proedure "rank as extension" in R4
VTE-1 uses Option 1 - generic extension funtion
VTE-2 uses Option 2 - Specific extension functions
TODO: Mapping Table needs revision on using "Encounter.procedure.code", "Encounter.procedure.sequence"
*/
define "Encounter With Principal Procedure of SCIP VTE Selected Surgery":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
"SCIP VTE Selected Surgery" SelectedProcedure
let EncounterProcedure: Global.GetExtension(QualifyingEncounter, 'qicore-encounter-procedure')
where FHIRHelpers.ToInteger(Global.GetExtension(EncounterProcedure, 'rank').value as FHIR.positiveInt) = 1
and Global.GetId(FHIRHelpers.ToString((Global.GetExtension(EncounterProcedure, 'procedure').value as FHIR.Reference).reference)) = SelectedProcedure.id
and Global."Normalize Interval"(SelectedProcedure.performed) during QualifyingEncounter.period"/>
</extension>
<extension url="displaySequence">
<valueInteger value="36"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="Intervention Comfort Measures"/>
</extension>
<extension url="statement">
<valueString
value="define "Intervention Comfort Measures":
(["ServiceRequest": "Comfort Measures"] P
where P.intent = 'order'
)
union
(["Procedure": "Comfort Measures"] InterventionPerformed
where InterventionPerformed.status in {'completed', 'in-progress'})"/>
</extension>
<extension url="displaySequence">
<valueInteger value="37"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "Intervention Comfort Measures" ComfortMeasure
such that Coalesce(start of Global."Normalize Interval"(ComfortMeasure.performed), ComfortMeasure.authoredOn) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="38"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString
value="Encounter With Intervention Comfort Measures on Day of or Day After Procedure"/>
</extension>
<extension url="statement">
<valueString
value="define "Encounter With Intervention Comfort Measures on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"Intervention Comfort Measures" ComfortMeasure
where AnesthesiaProcedure.status = 'completed'
and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(start of Global."Normalize Interval"(ComfortMeasure.performed), ComfortMeasure.authoredOn) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
return QualifyingEncounter"/>
</extension>
<extension url="displaySequence">
<valueInteger value="39"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="Denominator Exclusion"/>
</extension>
<extension url="statement">
<valueString
value="define "Denominator Exclusion":
"Encounter Less Than 2 Days"
union "Encounter With ICU Location Stay 1 Day or More"
union "Encounter With Principal Diagnosis of Mental Disorder or Stroke"
union "Encounter With Principal Procedure of SCIP VTE Selected Surgery"
union "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission"
union "Encounter With Intervention Comfort Measures on Day of or Day After Procedure""/>
</extension>
<extension url="displaySequence">
<valueInteger value="40"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="SupplementalDataElements"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="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"/>
</extension>
<extension url="displaySequence">
<valueInteger value="41"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="EXM108-FHIR"/>
</extension>
<extension url="name">
<valueString value="SDE Race"/>
</extension>
<extension url="statement">
<valueString
value="define "SDE Race":
SDE."SDE Race""/>
</extension>
<extension url="displaySequence">
<valueInteger value="42"/>
</extension>
</extension>
<url
value="http://hl7.org/fhir/us/cqfmeasures/Library/effective-data-requirements-exm108"/>
<version value="1.0.0"/>
<name value="EffectiveDataRequirements"/>
<title value="Module Definition Library - EXM108"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<date value="2022-02-22T10:37:04-07:00"/>
<description
value="This library is used as an example module definition in the FHIR Quality Measure Implementation Guide"/>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library SDE"/>
<resource
value="http://hl7.org/fhir/us/cqfmeasures/Library/SupplementalDataElements|2.0.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource
value="http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Global"/>
<resource
value="http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library TJC"/>
<resource
value="http://hl7.org/fhir/us/cqfmeasures/Library/TJCOverall|4.0.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library VTEICU"/>
<resource
value="http://hl7.org/fhir/us/cqfmeasures/Library/VTEICU|5.0.000"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system ConditionClinicalStatusCodes"/>
<resource
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Code system LOINC"/>
<resource value="http://loinc.org"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Encounter Inpatient"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Obstetrics"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.263"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Venous Thromboembolism"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.279"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Obstetrics VTE"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.264"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Low Dose Unfractionated Heparin for VTE Prophylaxis"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Subcutaneous route"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.223"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Low Molecular Weight Heparin for VTE Prophylaxis"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Injectable Factor Xa Inhibitor for VTE Prophylaxis"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Warfarin"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Device Application"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Intermittent pneumatic compression devices (IPC)"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Venous foot pumps (VFP)"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Graduated compression stockings (GCS)"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set General or Neuraxial Anesthesia"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.134"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Atrial Fibrillation/Flutter"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hip Replacement Surgery"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Knee Replacement Surgery"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Low Risk"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.400"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set INR"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Unfractionated Heparin"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.218"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Intravenous route"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.222"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Direct Thrombin Inhibitor"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.205"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Glycoprotein IIb/IIIa Inhibitors"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.41"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Observation Services"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Emergency Department Visit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Medical Reason"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Patient Refusal"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Payer"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Intensive Care Unit"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.23"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Mental Health Diagnoses"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1004"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hemorrhagic Stroke"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Ischemic Stroke"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set General Surgery"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Gynecological Surgery"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hip Fracture Surgery"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Intracranial Neurosurgery"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Urological Surgery"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Comfort Measures"/>
<resource
value="http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"/>
</relatedArtifact>
<parameter>
<name value="Measurement Period"/>
<use value="in"/>
<min value="0"/>
<max value="1"/>
<type value="Period"/>
</parameter>
<parameter>
<name value="SDE Sex"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="Coding"/>
</parameter>
<parameter>
<name value="Numerator"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Encounter"/>
</parameter>
<parameter>
<name value="Denominator"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Encounter"/>
</parameter>
<parameter>
<name value="SDE Payer"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="Initial Population"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Encounter"/>
</parameter>
<parameter>
<name value="SDE Ethnicity"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Coding"/>
</parameter>
<parameter>
<name value="Denominator Exclusion"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Resource"/>
</parameter>
<parameter>
<name value="SDE Race"/>
<use value="out"/>
<min value="0"/>
<max value="*"/>
<type value="Coding"/>
</parameter>
<dataRequirement>
<type value="Patient"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
<mustSupport value="extension"/>
<mustSupport value="value"/>
<mustSupport value="birthDate"/>
<mustSupport value="url"/>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="period"/>
<mustSupport value="type"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="period"/>
<mustSupport value="type"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="period"/>
<mustSupport value="type"/>
<mustSupport value="status"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
<mustSupport value="dosage.route"/>
<mustSupport value="dosage"/>
<mustSupport value="medication"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.218"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
<mustSupport value="medication"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.205"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
<mustSupport value="medication"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.41"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
<mustSupport value="dosage.route"/>
<mustSupport value="dosage"/>
<mustSupport value="medication"/>
<mustSupport value="status"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
<mustSupport value="medication"/>
<mustSupport value="status"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
<mustSupport value="medication"/>
<mustSupport value="status"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
<mustSupport value="medication"/>
<mustSupport value="status"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationAdministration"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationAdministration"/>
<mustSupport value="effective"/>
<mustSupport value="medication"/>
<mustSupport value="status"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.134"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<mustSupport value="medication"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<mustSupport value="medication"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<mustSupport value="medication"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<mustSupport value="medication"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="ServiceRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="ServiceRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="ServiceRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="ServiceRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
<mustSupport value="code"/>
<mustSupport value="intent"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<mustSupport value="statusReason"/>
<mustSupport value="usedCode"/>
<mustSupport value="id"/>
<mustSupport value="status"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<mustSupport value="performed"/>
<mustSupport value="status"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="code"/>
<mustSupport value="clinicalStatus"/>
<mustSupport value="onset"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="code"/>
<mustSupport value="clinicalStatus"/>
<mustSupport value="onset"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.279"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<codeFilter>
<path value="code"/>
<code>
<system value="http://loinc.org"/>
<code value="72136-5"/>
<display value="Risk for venous thromboembolism"/>
</code>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Observation"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
<mustSupport value="code"/>
<mustSupport value="id"/>
<mustSupport value="issued"/>
<mustSupport value="value"/>
<mustSupport value="status"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Coverage"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Coverage"/>
<mustSupport value="period"/>
<mustSupport value="type"/>
<codeFilter>
<path value="type"/>
<valueSet
value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Location"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Location"/>
<mustSupport value="id"/>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
<valueCode value="Encounter"/>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements">
<valueCanonical value="#effective-data-requirements-exm108"/>
</extension>
<url value="http://hl7.org/fhir/us/cqfmeasures/Measure/EXM108-FHIR"/>
<identifier>
<use value="official"/>
<system value="http://example.org/fhir/cqi/ecqm/Measure/Identifier/cms"/>
<value value="108"/>
</identifier>
<version value="8.2.000"/>
<name value="EXM108"/>
<title value="EXM108 - Venous Thromboembolism Prophylaxis"/>
<status value="active"/>
<experimental value="true"/>
<date value="2022-02-22"/>
<publisher value="HL7 International / Clinical Quality Information"/>
<contact>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/cqi"/>
</telecom>
</contact>
<description
value="This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission"/>
<useContext>
<code>
<system
value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="venue"/>
<display value="Venue"/>
</code>
<valueCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/intended-venue-codes"/>
<code value="eh"/>
<display value="EH"/>
</coding>
</valueCodeableConcept>
</useContext>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
</coding>
</jurisdiction>
<copyright
value="Measure specifications are in the Public Domain.
LOINC(R) is a registered trademark of the Regenstrief Institute.
This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2017 International Health Terminology Standards Development Organization. All rights reserved."/>
<approvalDate value="2019-03-08"/>
<lastReviewDate value="2019-03-08"/>
<effectivePeriod>
<start value="2018-01-01"/>
<end value="2018-12-31"/>
</effectivePeriod>
<topic>
<coding>
<system value="http://loinc.org"/>
<code value="57024-2"/>
<display value="Health Quality Measure Document"/>
</coding>
</topic>
<library value="http://hl7.org/fhir/us/cqfmeasures/Library/EXM108-FHIR"/>
<disclaimer
value="These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty"/>
<scoring>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
<code value="proportion"/>
<display value="Proportion"/>
</coding>
</scoring>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
<code value="process"/>
</coding>
</type>
<rationale
value="Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008).
The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the 2001 report by The Agency for Healthcare Research and Quality (AHRQ). AHRQ indicates that "the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety by reducing the incidence of venous thromboembolism" (Shojania, 2001).
Despite its proven effectiveness, rates of appropriate thromboprophylaxis remain low in both medical and surgical patients. A recent analysis from the ENDORSE survey, which evaluated prophylaxis rates in 17,084 major surgery patients, found that more than one third of patients at risk for VTE (38%) did not receive prophylaxis and that rates varied by surgery type (Cohen, et al., 2008).
In a review of evidence-based patient safety practices, the Agency for Healthcare Research and Quality defined thromboprophylaxis against VTE as the "number one patient safety practice" for hospitalized patients (Shojania, 2001). Updated "safe practices" published by the National Quality Forum (NQF) recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis (National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism, 2006).
As noted by the ACCP, a vast number of randomized clinical trials provide irrefutable evidence that thromboprophylaxis reduces VTE events, and there are studies that have also shown that fatal PE is prevented by thromboprophylaxis (Geerts, et al. 2008).
Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure."/>
<clinicalRecommendationStatement
value="Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for acutely ill hospitalized patients at high risk for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease. All hospitalized patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated."/>
<improvementNotation>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
<code value="increase"/>
<display value="Increased score indicates improvement"/>
</coding>
</improvementNotation>
<guidance
value="When low dose unfractionated heparin is administered for VTE Prophylaxis, the intended administration route for low dose unfractionated heparin is subcutaneous.
Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed.""/>
<group>
<population>
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="initial-population"/>
<display value="Initial Population"/>
</coding>
</code>
<description
value="Patients age 18 and older discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Initial Population"/>
</criteria>
</population>
<population>
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="numerator"/>
<display value="Numerator"/>
</coding>
</code>
<description
value="Patients who received VTE prophylaxis:
- the day of or the day after hospital admission
- the day of or the day after surgery end date for surgeries that end the day of or the day after hospital admission
Patients who have documentation of a reason why no VTE prophylaxis was given:
- between arrival and hospital admission
- the day of or the day after hospital admission
- the day of or the day after surgery end date (for surgeries that end the day of or the day after hospital admission)"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Numerator"/>
</criteria>
</population>
<population>
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator"/>
<display value="Denominator"/>
</coding>
</code>
<description value="All patients in the initial population"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator"/>
</criteria>
</population>
<population>
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-population"/>
<code value="denominator-exclusion"/>
<display value="Denominator Exclusion"/>
</coding>
</code>
<description
value="* Patients who have a length of stay less than 2 days
* Patients with comfort measures documented anytime between arrival and the day after hospital admission
* Patients with comfort measures documented by the day after surgery end date for surgeries that start the day of or the day after hospital admission
* Patients who are direct admits to intensive care unit (ICU), or transferred to ICU the day of or the day after hospital admission with ICU length of stay greater than or equal to one day
* Patients with a principal diagnosis of mental disorders or stroke
* Patients with a principal procedure of Surgical Care Improvement Project (SCIP) VTE selected surgeries"/>
<criteria>
<language value="text/cql-identifier"/>
<expression value="Denominator Exclusion"/>
</criteria>
</population>
</group>
<supplementalData>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="summary"/>
</extension>
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Ethnicity"/>
</criteria>
</supplementalData>
<supplementalData>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="summary"/>
</extension>
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Payer"/>
</criteria>
</supplementalData>
<supplementalData>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="summary"/>
</extension>
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Race"/>
</criteria>
</supplementalData>
<supplementalData>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
<valueCode value="summary"/>
</extension>
<usage>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
<code value="supplemental-data"/>
</coding>
</usage>
<criteria>
<language value="text/cql-identifier"/>
<expression value="SDE Sex"/>
</criteria>
</supplementalData>
</Measure>
IG © 2019+ HL7 International / Clinical Quality Information. Package hl7.fhir.us.cqfmeasures#5.0.0 based on FHIR 4.0.1. Generated 2024-11-04
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