Quality Measure Implementation Guide
1.0.0 - STU 1

Quality Measure Implementation Guide - Downloaded Version null See the Directory of published versions

## : EXM55 - Median Emergency Department Visit Duration - XML Representation

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    <Measure xmlns="http://hl7.org/fhir">
      <id value="EXM55-FHIR"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cvmeasure"/>
        <profile
                 value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure"/>
        <profile
                 value="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure"/>
      </meta>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml">
      <table class="narrative-table">
        <tbody>
    <tr>

    <th colspan="2" scope="row" class="row-header">Metadata</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Title</th>

    <td class="content-container">EXM55 - Median Emergency Department Visit Duration</td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Version</th>

    <td class="content-container">5.0.0</td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Identifier</th>

    <td class="content-container">55</td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Identifier</th>

    <td class="content-container">urn:oid:2.16.840.1.113883.4.642.40.61.29.8</td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Effective Period</th>

    <td class="content-container">2018-01-01 through 2018-12-31</td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Approval Date</th>

    <td class="content-container">2019-03-08</td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Last Review Date</th>

    <td class="content-container">2019-03-08</td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Experimental</th>

    <td class="content-container">true</td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Use Context</th>

    <td class="content-container"><span title="{http://terminology.hl7.org/CodeSystem/usage-context-type venue}">Clinical Venue</span> = <span title="Codes:{http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes eh}">EH</span></td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Jurisdiction</th>

    <td class="content-container"><span title="Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}">Global (Whole world)</span></td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Topic</th>

    <td class="content-container"><span title="Codes:{http://loinc.org 57024-2}">Health Quality Measure Document</span></td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Steward (Publisher)</th>

    <td class="content-container">HL7 International / Clinical Quality Information</td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Description</th>

    <td class="content-container"><div><p>This example illustrates a continuous variable measure represented as a FHIR eCQM</p>
    </div></td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Measure Basis</th>

    <td class="content-container">Encounter</td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Measure Scoring</th>

    <td class="content-container"><span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}">Continuous Variable</span></td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Measure Type</th>

    <td class="content-container"><span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-type process}">Process</span></td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Improvement Notation</th>

    <td class="content-container"><span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-improvement-notation decrease}">Decreased score indicates improvement</span></td>
    </tr>

        <tr>

    <th colspan="2" scope="row" class="row-header">Measure Group (Rate) (ID: primary)</th>

    </tr>

        <tr>

    <th scope="row" class="row-header">Initial Population</th>

          <td class="content-container">

            <em>ID</em>: primary-exm55-initial-population
            <br/>

              <em>Description</em>: No description provided

                  <em>Criteria</em>: <a href="#primary-primary-exm55-initial-population">Initial Population</a>

          </td>
        </tr>

        <tr>

    <th scope="row" class="row-header">Measure Population</th>

          <td class="content-container">

            <em>ID</em>: primary-exm55-measure-population
            <br/>

              <em>Description</em>: No description provided

                  <em>Criteria</em>: <a href="#primary-primary-exm55-measure-population">Measure Population</a>

          </td>
        </tr>

        <tr>

    <th scope="row" class="row-header">Measure Population Exclusion</th>

          <td class="content-container">

            <em>ID</em>: primary-exm55-measure-population-exclusion
            <br/>

              <em>Description</em>: No description provided

                  <em>Criteria</em>: <a href="#primary-primary-exm55-measure-population-exclusion">Measure Population Exclusion</a>

          </td>
        </tr>

        <tr>

    <th scope="row" class="row-header">Measure Observation</th>

          <td class="content-container">

            <em>ID</em>: primary-exm55-measure-population-identifier
            <br/>

              <em>Description</em>: No description provided

                  <em>Criteria</em>: <a href="#primary-primary-exm55-measure-population-identifier">Measure Observation</a>

              <br/><em>Input Population</em>: measure-population-identifier

              <em>AggregateMethod</em>: median

          </td>
        </tr>

    <tr>

    <th scope="row" class="row-header">Stratifier</th>

      <td class="content-container">

            <em>Code</em>: Stratification 1

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Stratifier</th>

      <td class="content-container">

            <em>Code</em>: Stratification 2

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Stratifier</th>

      <td class="content-container">

            <em>Code</em>: Stratification 3

      </td>
    </tr>

    <tr>

    <th colspan="2" scope="row" class="row-header">Measure Logic</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Primary Library</th>

    <td class="content-container"><a href="Library-EXM55.html">EXM55 - Median Emergency Department Visit Duration Library (Example Continuous Variable Measure Library)</a></td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Contents</th>
      <td class="content-container">
        <em><a href="#population-criteria">Population Criteria</a></em>
        <br/>
        <em><a href="#definitions">Logic Definitions</a></em>
        <br/>
        <em><a href="#terminology">Terminology</a></em>
        <br/>
        <em><a href="#dependencies">Dependencies</a></em>
        <br/>
        <em><a href="#data-requirements">Data Requirements</a></em>
        <br/>
      </td>
    </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="population-criteria"> </a>Population Criteria</th>

    </tr>

        <tr>

    <th colspan="2" scope="row" class="row-header">Measure Group (Rate) (ID: primary)</th>

    </tr>

                <tr>
      <th scope="row" rowspan="2" class="row-header">

        Initial Population

      </th>
    </tr>
    <tr>

      <td>

          <a name="primary-primary-exm55-initial-population"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        with [&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED
         such that ED.status = 'finished'
           and ED.period ends 1 hour or less before start of Encounter.period</code></pre>

          <a href="#exm55-initial-population"><em>Definition</em></a>

      </td>

    </tr>

                <tr>
      <th scope="row" rowspan="2" class="row-header">

        Measure Population

      </th>
    </tr>
    <tr>

      <td>

          <a name="primary-primary-exm55-measure-population"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Measure Population&quot; :
      &quot;Initial Population&quot;</code></pre>

          <a href="#exm55-measure-population"><em>Definition</em></a>

      </td>

    </tr>

                <tr>
      <th scope="row" rowspan="2" class="row-header">

        Measure Population Exclusion

      </th>
    </tr>
    <tr>

      <td>

          <a name="primary-primary-exm55-measure-population-exclusion"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Measure Population Exclusion&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        with [&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED
          such that ED.period ends 1 hour or less before start of Encounter.period
            and ED.status = 'finished'
            and ED.hospitalization.admitSource in &quot;Hospital Settings&quot;</code></pre>

          <a href="#exm55-measure-population-exclusion"><em>Definition</em></a>

      </td>

    </tr>

                <tr>
      <th scope="row" rowspan="2" class="row-header">

        Measure Observation

      </th>
    </tr>
    <tr>

      <td>

          <a name="primary-primary-exm55-measure-population-identifier"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;Measure Observation&quot; (Encounter &quot;Encounter&quot; ) :
      duration in minutes of &quot;Related ED Visit&quot;(Encounter).period</code></pre>

          <a href="#exm55-measure-observation"><em>Definition</em></a>

      </td>

    </tr>

                <tr>
      <th scope="row" rowspan="2" class="row-header">

        Stratifier

      </th>
    </tr>
    <tr>

      <td>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratification 1&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        where not (PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;)</code></pre>

          <a href="#exm55-stratification-1"><em>Definition</em></a>

      </td>

    </tr>

                <tr>
      <th scope="row" rowspan="2" class="row-header">

        Stratifier

      </th>
    </tr>
    <tr>

      <td>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratification 2&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        where PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;</code></pre>

          <a href="#exm55-stratification-2"><em>Definition</em></a>

      </td>

    </tr>

                <tr>
      <th scope="row" rowspan="2" class="row-header">

        Stratifier

      </th>
    </tr>
    <tr>

      <td>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratification 3&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        where PrincipalDiagnosis(Encounter) is null</code></pre>

          <a href="#exm55-stratification-3"><em>Definition</em></a>

      </td>

    </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="definitions"> </a>Logic Definitions</th>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

    </tr>
    <tr>

      <td>

          <a name="fhirhelpers-tointerval"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
    @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
    value to a CQL DateTime Interval
    @comment: If the start value of the given period is unspecified, the starting
    boundary of the resulting interval will be open (meaning the start of the interval
    is unknown, as opposed to interpreted as the beginning of time).
    */
    define function ToInterval(period FHIR.Period):
        if period is null then
            null
        else
            if period.&quot;start&quot; is null then
                Interval(period.&quot;start&quot;.value, period.&quot;end&quot;.value]
            else
                Interval[period.&quot;start&quot;.value, period.&quot;end&quot;.value]</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

    </tr>
    <tr>

      <td>

          <a name="fhirhelpers-toconcept"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
    @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
    */
    define function ToConcept(concept FHIR.CodeableConcept):
        if concept is null then
            null
        else
            System.Concept {
                codes: concept.coding C return ToCode(C),
                display: concept.text.value
            }</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

    </tr>
    <tr>

      <td>

          <a name="fhirhelpers-tocode"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">/*
    @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
    */
    define function ToCode(coding FHIR.Coding):
        if coding is null then
            null
        else
            System.Code {
              code: coding.code.value,
              system: coding.system.value,
              version: coding.version.value,
              display: coding.display.value
            }</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

    </tr>
    <tr>

      <td>

          <a name="fhirhelpers-tostring"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToString(value string): value.value</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> FHIRHelpers</td>

    </tr>
    <tr>

      <td>

          <a name="fhirhelpers-tostring"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToString(value EncounterStatus): value.value</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-inpatient-encounter"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Inpatient Encounter&quot; :
      [&quot;Encounter&quot;] Encounter
        where LengthInDays(Encounter.period) &lt;= 120
          and Encounter.period ends during &quot;Measurement Period&quot;</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-stratification-3"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratification 3&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        where PrincipalDiagnosis(Encounter) is null</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-stratification-2"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratification 2&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        where PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-measure-population-exclusion"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Measure Population Exclusion&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        with [&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED
          such that ED.period ends 1 hour or less before start of Encounter.period
            and ED.status = 'finished'
            and ED.hospitalization.admitSource in &quot;Hospital Settings&quot;</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-stratification-1"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Stratification 1&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        where not (PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;)</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-initial-population"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        with [&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED
         such that ED.status = 'finished'
           and ED.period ends 1 hour or less before start of Encounter.period</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-measure-population"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Measure Population&quot; :
      &quot;Initial Population&quot;</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-lengthindays"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;LengthInDays&quot;(Value Interval&lt;DateTime&gt;):
    	difference in days between start of Value and end of Value</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-principaldiagnosis"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;PrincipalDiagnosis&quot;(Encounter Encounter):
    	(singleton from (Encounter.diagnosis D where D.use ~ ToConcept(&quot;Billing&quot;) and D.rank.value = 1)) PD
    		return singleton from ([Condition: id in &quot;GetId&quot;(PD.condition.reference)])</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-getid"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;GetId&quot;(uri String):
    	Last(Split(uri, '/'))</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-measure-observation"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;Measure Observation&quot; (Encounter &quot;Encounter&quot; ) :
      duration in minutes of &quot;Related ED Visit&quot;(Encounter).period</code></pre>
      </td>

    </tr>

    <tr>
      <th scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM55</td>

    </tr>
    <tr>

      <td>

          <a name="exm55-related-ed-visit"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">//Measure Observation
    define function &quot;Related ED Visit&quot; (Encounter &quot;Encounter&quot; ) :
      Last([&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED
        where ED.status = 'finished'
          and ED.period ends 1 hour or less before start of Encounter.period
        sort by start of period )</code></pre>
      </td>

    </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="terminology"> </a>Terminology</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Code System</th>

      <td class="content-container">

        <em>Description</em>: Code system Diagnosis Role

        <br/>

        <em>Resource</em>: <a href="http://terminology.hl7.org/6.5.0/CodeSystem-diagnosis-role.html">Diagnosis Role</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://terminology.hl7.org/CodeSystem/diagnosis-role</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Psychiatric/Mental Health Patient

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.299/expansion">Psychiatric/Mental Health Diagnosis</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.299</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Emergency Department Visit

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292</tt>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Value Set</th>

      <td class="content-container">

        <em>Description</em>: Value set Hospital Settings

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1111.126/expansion">Hospital Settings</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.126</tt>

      </td>
    </tr>

      <tr>
        <th scope="row" class="row-header">Direct Reference Code</th>
        <td class="content-container">

            <em>Display</em>: Billing
            <br/>

          <em>Code</em>: billing
          <br/>
          <em>System</em>: <tt>http://terminology.hl7.org/CodeSystem/diagnosis-role</tt>
        </td>
      </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="dependencies"> </a>Dependencies</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Dependency</th>

      <td class="content-container">

        <em>Description</em>: Library FHIRHelpers

        <br/>

        <em>Resource</em>: <a href="http://hl7.org/fhir/uv/cql/STU2/Library-FHIRHelpers.html">http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1</tt>

      </td>
    </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header"><a name="data-requirements"> </a>Data Requirements</th>

    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Encounter
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/R4/encounter.html">Encounter</a>
        <br/>

        <em>Must Support Elements</em>: period, use, rank, rank.value, condition, condition.reference
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Encounter
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/R4/encounter.html">Encounter</a>
        <br/>

        <em>Must Support Elements</em>: type, period, status, hospitalization, hospitalization.admitSource, use, rank, rank.value, condition, condition.reference
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: type</span>
        <br/>

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.292/expansion">Emergency Department Visit</a>
        <br/>

      </td>
    </tr>

    <tr>
      <th scope="row" class="row-header">Data Requirement</th>
      <td class="content-container">
        <em>Type</em>: Condition
        <br/>

        <em>Profile(s)</em>:

        <a href="http://hl7.org/fhir/R4/condition.html">Condition</a>
        <br/>

        <em>Must Support Elements</em>: id
        <br/>

        <em>Code Filter(s)</em>:
        <br/>

        <span class="tab-one"><em>Path</em>: id</span>
        <br/>

      </td>
    </tr>

    <tr>
      <th colspan="2" scope="row" class="row-header">Generated using version 0.4.9 of the sample-content-ig Liquid templates</th>
    </tr>

        </tbody>
      </table>
    </div>
      </text>
      <contained>
        <Library>
          <id value="effective-data-requirements"/>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/diagnosis-role"/>
              <code value="billing"/>
              <display value="Billing"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="Inpatient Encounter"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Inpatient Encounter&quot; :
      [&quot;Encounter&quot;] Encounter
        where LengthInDays(Encounter.period) &lt;= 120
          and Encounter.period ends during &quot;Measurement Period&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="0"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="Stratification 3"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Stratification 3&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        where PrincipalDiagnosis(Encounter) is null"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="1"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="Stratification 2"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Stratification 2&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        where PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="2"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="Measure Population Exclusion"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Measure Population Exclusion&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        with [&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED
          such that ED.period ends 1 hour or less before start of Encounter.period
            and ED.status = 'finished'
            and ED.hospitalization.admitSource in &quot;Hospital Settings&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="3"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="Stratification 1"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Stratification 1&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        where not (PrincipalDiagnosis(Encounter).code in &quot;Psychiatric/Mental Health Patient&quot;)"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="4"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="Initial Population"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Initial Population&quot; :
      &quot;Inpatient Encounter&quot; Encounter
        with [&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED
         such that ED.status = 'finished'
           and ED.period ends 1 hour or less before start of Encounter.period"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="5"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="Measure Population"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Measure Population&quot; :
      &quot;Initial Population&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="6"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="LengthInDays"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function &quot;LengthInDays&quot;(Value Interval&lt;DateTime&gt;):
    	difference in days between start of Value and end of Value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="7"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToInterval"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="/*
    @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
    value to a CQL DateTime Interval
    @comment: If the start value of the given period is unspecified, the starting
    boundary of the resulting interval will be open (meaning the start of the interval
    is unknown, as opposed to interpreted as the beginning of time).
    */
    define function ToInterval(period FHIR.Period):
        if period is null then
            null
        else
            if period.&quot;start&quot; is null then
                Interval(period.&quot;start&quot;.value, period.&quot;end&quot;.value]
            else
                Interval[period.&quot;start&quot;.value, period.&quot;end&quot;.value]"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="8"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="PrincipalDiagnosis"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function &quot;PrincipalDiagnosis&quot;(Encounter Encounter):
    	(singleton from (Encounter.diagnosis D where D.use ~ ToConcept(&quot;Billing&quot;) and D.rank.value = 1)) PD
    		return singleton from ([Condition: id in &quot;GetId&quot;(PD.condition.reference)])"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="9"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToConcept"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="/*
    @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
    */
    define function ToConcept(concept FHIR.CodeableConcept):
        if concept is null then
            null
        else
            System.Concept {
                codes: concept.coding C return ToCode(C),
                display: concept.text.value
            }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="10"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToCode"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="/*
    @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
    */
    define function ToCode(coding FHIR.Coding):
        if coding is null then
            null
        else
            System.Code {
              code: coding.code.value,
              system: coding.system.value,
              version: coding.version.value,
              display: coding.display.value
            }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="11"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="GetId"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function &quot;GetId&quot;(uri String):
    	Last(Split(uri, '/'))"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="12"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToString"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function ToString(value string): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="13"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToString"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function ToString(value EncounterStatus): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="14"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="Measure Observation"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function &quot;Measure Observation&quot; (Encounter &quot;Encounter&quot; ) :
      duration in minutes of &quot;Related ED Visit&quot;(Encounter).period"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="15"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM55"/>
            </extension>
            <extension url="name">
              <valueString value="Related ED Visit"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="//Measure Observation
    define function &quot;Related ED Visit&quot; (Encounter &quot;Encounter&quot; ) :
      Last([&quot;Encounter&quot; : &quot;Emergency Department Visit&quot;] ED
        where ED.status = 'finished'
          and ED.period ends 1 hour or less before start of Encounter.period
        sort by start of period )"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="16"/>
            </extension>
          </extension>
          <name value="EffectiveDataRequirements"/>
          <status value="active"/>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/library-type"/>
              <code value="module-definition"/>
            </coding>
          </type>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library FHIRHelpers"/>
            <resource
                      value="http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system Diagnosis Role"/>
            <resource
                      value="http://terminology.hl7.org/CodeSystem/diagnosis-role"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Psychiatric/Mental Health Patient"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.299"/>
          </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 Hospital Settings"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.126"/>
          </relatedArtifact>
          <parameter>
            <name value="Measurement Period"/>
            <use value="in"/>
            <min value="0"/>
            <max value="1"/>
            <type value="Period"/>
          </parameter>
          <parameter>
            <name value="Stratification 3"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="Encounter"/>
          </parameter>
          <parameter>
            <name value="Stratification 2"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="Encounter"/>
          </parameter>
          <parameter>
            <name value="Measure Population Exclusion"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="Encounter"/>
          </parameter>
          <parameter>
            <name value="Stratification 1"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="Encounter"/>
          </parameter>
          <parameter>
            <name value="Initial Population"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="Encounter"/>
          </parameter>
          <parameter>
            <name value="Measure Population"/>
            <use value="out"/>
            <min value="0"/>
            <max value="*"/>
            <type value="Encounter"/>
          </parameter>
          <dataRequirement>
            <type value="Encounter"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
            <mustSupport value="period"/>
            <mustSupport value="use"/>
            <mustSupport value="rank"/>
            <mustSupport value="rank.value"/>
            <mustSupport value="condition"/>
            <mustSupport value="condition.reference"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="status"/>
            <mustSupport value="hospitalization"/>
            <mustSupport value="hospitalization.admitSource"/>
            <mustSupport value="use"/>
            <mustSupport value="rank"/>
            <mustSupport value="rank.value"/>
            <mustSupport value="condition"/>
            <mustSupport value="condition.reference"/>
            <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="Condition"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
            <mustSupport value="id"/>
            <codeFilter>
              <path value="id"/>
            </codeFilter>
          </dataRequirement>
        </Library>
      </contained>
      <extension
                 url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis">
        <valueCode value="Encounter"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem">
        <valueReference>🔗
          <reference value="Device/software-system-example"/>
        </valueReference>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements" id="effective-data-requirements">
        <valueCanonical value="#effective-data-requirements"/>
      </extension>
      <url value="http://hl7.org/fhir/uv/cqm/Measure/EXM55-FHIR"/>
      <identifier>
        <use value="official"/>
        <system value="http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm"/>
        <value value="55"/>
      </identifier>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:2.16.840.1.113883.4.642.40.61.29.8"/>
      </identifier>
      <version value="5.0.0"/>
      <name value="EXM55"/>
      <title value="EXM55 - Median Emergency Department Visit Duration"/>
      <status value="active"/>
      <experimental value="true"/>
      <date value="2025-08-13"/>
      <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 example illustrates a continuous variable measure represented as a FHIR eCQM"/>
      <useContext>
        <code>
          <system
                  value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
          <code value="venue"/>
          <display value="Clinical Venue"/>
        </code>
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes"/>
            <code value="eh"/>
            <display value="EH"/>
          </coding>
        </valueCodeableConcept>
      </useContext>
      <jurisdiction>
        <coding>
          <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
          <code value="001"/>
        </coding>
      </jurisdiction>
      <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/uv/cqm/Library/EXM55"/>
      <scoring>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
          <code value="continuous-variable"/>
          <display value="Continuous Variable"/>
        </coding>
      </scoring>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
          <code value="process"/>
        </coding>
      </type>
      <improvementNotation>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
          <code value="decrease"/>
          <display value="Decreased score indicates improvement"/>
        </coding>
      </improvementNotation>
      <group id="group-1">
        <extension
                   url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId">
          <valueString value="primary"/>
        </extension>
        <population>
          <extension
                     url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId">
            <valueString value="primary-exm55-initial-population"/>
          </extension>
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="initial-population"/>
              <display value="Initial Population"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Initial Population"/>
          </criteria>
        </population>
        <population>
          <extension
                     url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId">
            <valueString value="primary-exm55-measure-population"/>
          </extension>
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="measure-population"/>
              <display value="Measure Population"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Measure Population"/>
          </criteria>
        </population>
        <population>
          <extension
                     url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId">
            <valueString value="primary-exm55-measure-population-exclusion"/>
          </extension>
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="measure-population-exclusion"/>
              <display value="Measure Population Exclusion"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Measure Population Exclusion"/>
          </criteria>
        </population>
        <population>
          <extension
                     url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId">
            <valueString value="primary-exm55-measure-population-identifier"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference">
            <valueString value="measure-population-identifier"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-aggregateMethod">
            <valueCode value="median"/>
          </extension>
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="measure-observation"/>
              <display value="Measure Observation"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Measure Observation"/>
          </criteria>
        </population>
        <stratifier>
          <extension
                     url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId">
            <valueString value="primary-exm55-stratification-1"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/measure-population"/>
                <code value="initial-population"/>
                <display value="Initial Population"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <code>
            <coding>
              <system value="http://example.org/stratification"/>
              <code value="Stratification 1"/>
              <display value="Stratification 1"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Stratification 1"/>
          </criteria>
        </stratifier>
        <stratifier>
          <extension
                     url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId">
            <valueString value="primary-exm55-stratificatio-2"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/measure-population"/>
                <code value="initial-population"/>
                <display value="Initial Population"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <code>
            <coding>
              <system value="http://example.org/stratification"/>
              <code value="Stratification 2"/>
              <display value="Stratification 2"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Stratification 2"/>
          </criteria>
        </stratifier>
        <stratifier>
          <extension
                     url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.stratifier.linkId">
            <valueString value="primary-exm55-stratification-3"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-appliesTo">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/measure-population"/>
                <code value="initial-population"/>
                <display value="Initial Population"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <code>
            <coding>
              <system value="http://example.org/stratification"/>
              <code value="Stratification 3"/>
              <display value="Stratification 3"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Stratification 3"/>
          </criteria>
        </stratifier>
      </group>
    </Measure>