Quality Measure Implementation Guide
1.0.0 - STU 1

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## : EXM130 - Colorectal Cancer Screening Measure - XML Representation

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    <Measure xmlns="http://hl7.org/fhir">
      <id value="EXM130-FHIR"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-proportionmeasure"/>
        <profile
                 value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure"/>
        <profile
                 value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cqlmeasure"/>
        <profile
                 value="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure"/>
      </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">EXM130 - Colorectal Cancer Screening Measure</td>
    </tr>

    <tr>

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

    <td class="content-container">8.0.000</td>
    </tr>

    <tr>

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

    <td class="content-container">130</td>
    </tr>

    <tr>

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

    <td class="content-container">0034</td>
    </tr>

    <tr>

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

    <td class="content-container">urn:oid:2.16.840.1.113883.4.642.40.61.29.6</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">2016-01-01</td>
    </tr>

    <tr>

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

    <td class="content-container">2016-09-01</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 ec}">EC</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>Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer</p>
    </div></td>
    </tr>

    <tr>

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

    <td class="content-container"><div><p>This measure has been developed to support improvement in clinical care.</p>
    </div></td>
    </tr>

    <tr>

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

    <td class="content-container"><div><p>This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.</p>
    </div></td>
    </tr>

    <tr>

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

    <td class="content-container"><div><p>The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>
    </div></td>
    </tr>

    <tr>

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

    <td class="content-container">boolean</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 proportion}">Proportion</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">Rationale</th>

    <td class="content-container"><div><p>Colorectal cancer represents 8 percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. In 2017, there were an estimated 135,430 new cases of colorectal cancer and an estimated 50,260 deaths attributed to it. According to the National Cancer Institute, about 4.3 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al. 2017). Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society 2017).</p>
    </div></td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Clinical Recommendation Statement</th>

    <td class="content-container"><div><p>The U. S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force 2016). Screening tests: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years)</p>
    </div></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 increase}">Increased 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-exm130-initial-population
            <br/>

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

                  <em>Criteria</em>: <a href="#primary-primary-exm130-initial-population">Initial Population</a>

          </td>
        </tr>

        <tr>

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

          <td class="content-container">

            <em>ID</em>: primary-exm130-numerator
            <br/>

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

                  <em>Criteria</em>: <a href="#primary-primary-exm130-numerator">Numerator</a>

          </td>
        </tr>

        <tr>

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

          <td class="content-container">

            <em>ID</em>: primary-exm130-denominator
            <br/>

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

                  <em>Criteria</em>: <a href="#primary-primary-exm130-denominator">Denominator</a>

          </td>
        </tr>

        <tr>

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

          <td class="content-container">

            <em>ID</em>: primary-exm130-denominator-exclusion
            <br/>

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

                  <em>Criteria</em>: <a href="#primary-primary-exm130-denominator-exclusion">Denominator Exclusion</a>

          </td>
        </tr>

      <tr>

    <th colspan="2" scope="row" class="row-header">Supplemental Data Elements</th>

    </tr>

    <tr>

    <th scope="row" class="row-header">Supplemental Data Element</th>

      <td class="content-container">

              <em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>

            <br/>

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

            <br/>

              <em>Logic Definition</em>: <a href="#exm130-sde-ethnicity">SDE Ethnicity</a>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Supplemental Data Element</th>

      <td class="content-container">

              <em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>

            <br/>

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

            <br/>

              <em>Logic Definition</em>: <a href="#exm130-sde-payer">SDE Payer</a>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Supplemental Data Element</th>

      <td class="content-container">

              <em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>

            <br/>

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

            <br/>

              <em>Logic Definition</em>: <a href="#exm130-sde-race">SDE Race</a>

      </td>
    </tr>

    <tr>

    <th scope="row" class="row-header">Supplemental Data Element</th>

      <td class="content-container">

              <em>Usage Code</em>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/measure-data-usage supplemental-data}">Supplemental Data</span>

            <br/>

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

            <br/>

              <em>Logic Definition</em>: <a href="#exm130-sde-sex">SDE Sex</a>

      </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-EXM130.html">EXM130 - Colorectal Cancer Screening 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-exm130-initial-population"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
    	Global.&quot;CalendarAgeInYearsAt&quot;(FHIRHelpers.ToDate(Patient.birthDate), start of &quot;Measurement Period&quot;) in Interval[50, 75]
    			and exists AdultOutpatientEncounters.&quot;Qualifying Encounters&quot;</code></pre>

          <a href="#exm130-initial-population"><em>Definition</em></a>

      </td>

    </tr>

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

        Numerator

      </th>
    </tr>
    <tr>

      <td>

          <a name="primary-primary-exm130-numerator"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
    	exists &quot;Colonoscopy Performed&quot;
    		or exists &quot;Fecal Occult Blood Test Performed&quot;
    		or exists &quot;Flexible Sigmoidoscopy Performed&quot;
    		or exists &quot;Fecal Immunochemical Test DNA&quot;
    		or exists &quot;CT Colonography Performed&quot;</code></pre>

          <a href="#exm130-numerator"><em>Definition</em></a>

      </td>

    </tr>

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

        Denominator

      </th>
    </tr>
    <tr>

      <td>

          <a name="primary-primary-exm130-denominator"> </a>

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

          <a href="#exm130-denominator"><em>Definition</em></a>

      </td>

    </tr>

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

        Denominator Exclusion

      </th>
    </tr>
    <tr>

      <td>

          <a name="primary-primary-exm130-denominator-exclusion"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Denominator Exclusion&quot;:
    	Hospice.&quot;Has Hospice&quot;
    		or exists &quot;Malignant Neoplasm Ever&quot;
    		or exists &quot;Total Colectomy Performed&quot;</code></pre>

          <a href="#exm130-denominator-exclusion"><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> AdultOutpatientEncounters</td>

    </tr>
    <tr>

      <td>

          <a name="adultoutpatientencounters-qualifying-encounters"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Qualifying Encounters&quot;:
    	(
        [Encounter: &quot;Office Visit&quot;]
      		union [Encounter: &quot;Annual Wellness Visit&quot;]
      		union [Encounter: &quot;Preventive Care Services - Established Office Visit, 18 and Up&quot;]
      		union [Encounter: &quot;Preventive Care Services-Initial Office Visit, 18 and Up&quot;]
      		union [Encounter: &quot;Home Healthcare Services&quot;]
      ) ValidEncounter
    		where ValidEncounter.period during &quot;Measurement Period&quot;
      		and ValidEncounter.status  = 'finished'</code></pre>
      </td>

    </tr>

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

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

    </tr>
    <tr>

      <td>

          <a name="hospice-has-hospice"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Has Hospice&quot;:
    	exists (
        [Encounter: &quot;Encounter Inpatient&quot;] DischargeHospice
    			where DischargeHospice.status = 'finished'
    		    and (
    	        DischargeHospice.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;
    				    or DischargeHospice.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;
    	    	)
    				and DischargeHospice.period ends during &quot;Measurement Period&quot;
    	)
        or exists (
          [ServiceRequest: &quot;Hospice care ambulatory&quot;] HospiceOrder
            where HospiceOrder.intent = 'order'
                and HospiceOrder.authoredOn in &quot;Measurement Period&quot;
        )
        or exists (
          [Procedure: &quot;Hospice care ambulatory&quot;] HospicePerformed
            where HospicePerformed.status = 'completed'
              and Global.&quot;Normalize Interval&quot;(HospicePerformed.performed) overlaps &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> SupplementalDataElements</td>

    </tr>
    <tr>

      <td>

          <a name="supplementaldataelements-sde-sex"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
      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 scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

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

    </tr>
    <tr>

      <td>

          <a name="supplementaldataelements-sde-payer"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
      [Coverage: type in &quot;Payer&quot;] Payer
            return {
              code: Payer.type,
              period: Payer.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> SupplementalDataElements</td>

    </tr>
    <tr>

      <td>

          <a name="supplementaldataelements-sde-ethnicity"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
      (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 scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

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

    </tr>
    <tr>

      <td>

          <a name="supplementaldataelements-sde-race"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
      (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 scope="row" rowspan="2" class="row-header">
        Logic Definition
      </th>

      <td class="content-container"><em>Library Name:</em> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-sde-sex"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Sex&quot;:
      SDE.&quot;SDE Sex&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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-colonoscopy-performed"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Colonoscopy Performed&quot;:
    	[Procedure: &quot;Colonoscopy&quot;] Colonoscopy
    		where Colonoscopy.status = 'completed'
    		  and Global.&quot;Normalize Interval&quot;(Colonoscopy.performed) ends 10 years or less on or before end of &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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-fecal-occult-blood-test-performed"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Fecal Occult Blood Test Performed&quot;:
    	[Observation: &quot;Fecal Occult Blood Test (FOBT)&quot;] FecalOccultResult
    		where FecalOccultResult.status in {'final', 'amended', 'corrected', 'preliminary'}
    			and FecalOccultResult.value is not null
    			and Global.&quot;Normalize Interval&quot;(FecalOccultResult.effective) during day of &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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-flexible-sigmoidoscopy-performed"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Flexible Sigmoidoscopy Performed&quot;:
    	[Procedure: &quot;Flexible Sigmoidoscopy&quot;] FlexibleSigmoidoscopy
    		where FlexibleSigmoidoscopy.status = 'completed'
    			and Global.&quot;Normalize Interval&quot;(FlexibleSigmoidoscopy.performed) ends 5 years or less on or before end of &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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-fecal-immunochemical-test-dna"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Fecal Immunochemical Test DNA&quot;:
    	[Observation: &quot;FIT DNA&quot;] FitDNA
    		where FitDNA.status in {'final', 'amended', 'corrected', 'preliminary'}
    			and FitDNA.value is not null
    			and Global.&quot;Normalize Interval&quot;(FitDNA.effective) occurs 3 years or less on or before day of end of &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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-ct-colonography-performed"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;CT Colonography Performed&quot;:
    	[Procedure: &quot;CT Colonography&quot;] Colonography
    		where Colonography.status = 'completed'
    			and Global.&quot;Normalize Interval&quot;(Colonography.performed) ends 5 years or less on or before end of &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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-numerator"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Numerator&quot;:
    	exists &quot;Colonoscopy Performed&quot;
    		or exists &quot;Fecal Occult Blood Test Performed&quot;
    		or exists &quot;Flexible Sigmoidoscopy Performed&quot;
    		or exists &quot;Fecal Immunochemical Test DNA&quot;
    		or exists &quot;CT Colonography Performed&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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-denominator"> </a>

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

    </tr>

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

      <td class="content-container"><em>Library Name:</em> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-sde-payer"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Payer&quot;:
      SDE.&quot;SDE Payer&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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-initial-population"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Initial Population&quot;:
    	Global.&quot;CalendarAgeInYearsAt&quot;(FHIRHelpers.ToDate(Patient.birthDate), start of &quot;Measurement Period&quot;) in Interval[50, 75]
    			and exists AdultOutpatientEncounters.&quot;Qualifying Encounters&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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-sde-ethnicity"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Ethnicity&quot;:
      SDE.&quot;SDE Ethnicity&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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-malignant-neoplasm-ever"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Malignant Neoplasm Ever&quot;:
    	[Condition: &quot;Malignant Neoplasm of Colon&quot;] ColorectalCancer
    		where Global.&quot;Normalize Interval&quot;(ColorectalCancer.onset) starts on or before end of &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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-total-colectomy-performed"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Total Colectomy Performed&quot;:
    	[Procedure: &quot;Total Colectomy&quot;] Colectomy
    		where Colectomy.status = 'completed'
    			and Global.&quot;Normalize Interval&quot;(Colectomy.performed) starts on or before end of &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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-denominator-exclusion"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;Denominator Exclusion&quot;:
    	Hospice.&quot;Has Hospice&quot;
    		or exists &quot;Malignant Neoplasm Ever&quot;
    		or exists &quot;Total Colectomy Performed&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> EXM130</td>

    </tr>
    <tr>

      <td>

          <a name="exm130-sde-race"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define &quot;SDE Race&quot;:
      SDE.&quot;SDE Race&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> MATGlobalCommonFunctions</td>

    </tr>
    <tr>

      <td>

          <a name="matglobalcommonfunctions-calendarageinyearsat"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;CalendarAgeInYearsAt&quot;(BirthDateTime DateTime, AsOf DateTime):
    	years between ToDate(BirthDateTime)and ToDate(AsOf)</code></pre>
      </td>

    </tr>

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

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

    </tr>
    <tr>

      <td>

          <a name="matglobalcommonfunctions-todate"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function &quot;ToDate&quot;(Value DateTime):
    	DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from 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 AdministrativeGender): 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 ProcedureStatus): 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 ObservationStatus): 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-todate"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToDate(value date): 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-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-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> 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 uri): 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-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 ServiceRequestIntent): 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-todatetime"> </a>

        <pre style="border: none;" class="content-container highlight language-cql"><code class="language-cql">define function ToDateTime(value dateTime): value.value</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 SNOMEDCT:2017-09

        <br/>

        <em>Resource</em>: <code>http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709</code>
        <br/>
        <em>Canonical URL</em>: <tt>http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Colonoscopy

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1020/expansion">Colonoscopy</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Fecal Occult Blood Test (FOBT)

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1011/expansion">Fecal Occult Blood Test (FOBT)</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Flexible Sigmoidoscopy

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1010/expansion">Flexible Sigmoidoscopy</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set FIT DNA

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1039/expansion">sDNA FIT Test</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set CT Colonography

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1038/expansion">CT Colonography</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Payer

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion">Payer Type</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Office Visit

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Annual Wellness Visit

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion">Annual Wellness Visit</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Preventive Care Services - Established Office Visit, 18 and Up

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services Established Office Visit, 18 and Up</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Preventive Care Services-Initial Office Visit, 18 and Up

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services Initial Office Visit, 18 and Up</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Home Healthcare Services

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Encounter Inpatient

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Hospice care ambulatory

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1108.15/expansion">Hospice Care Ambulatory</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Malignant Neoplasm of Colon

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1001/expansion">Malignant Neoplasm of Colon</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Value set Total Colectomy

        <br/>

        <em>Resource</em>: <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1019/expansion">Total Colectomy</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019</tt>

      </td>
    </tr>

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

            <em>Display</em>: Discharge to home for hospice care (procedure)
            <br/>

          <em>Code</em>: 428361000124107
          <br/>
          <em>System</em>: <tt>http://snomed.info/sct</tt>
        </td>
      </tr>

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

            <em>Display</em>: Discharge to healthcare facility for hospice care (procedure)
            <br/>

          <em>Code</em>: 428371000124100
          <br/>
          <em>System</em>: <tt>http://snomed.info/sct</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 SDE

        <br/>

        <em>Resource</em>: <a href="Library-SupplementalDataElements.html">Supplemental Data Elementsversion: null2.0.000)</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements|2.0.000</tt>

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

      <td class="content-container">

        <em>Description</em>: Library Global

        <br/>

        <em>Resource</em>: <a href="Library-MATGlobalCommonFunctions.html">MAT Global Common Functions FHIR Libraryversion: null5.0.000)</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Library AdultOutpatientEncounters

        <br/>

        <em>Resource</em>: <a href="Library-AdultOutpatientEncounters.html">Adult Outpatient Encounters Common Libraryversion: null2.0.000)</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cqm/Library/AdultOutpatientEncounters|2.0.000</tt>

      </td>
    </tr>

    <tr>

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

      <td class="content-container">

        <em>Description</em>: Library Hospice

        <br/>

        <em>Resource</em>: <a href="Library-Hospice.html">Hospice FHIR Libraryversion: null2.0.000)</a>
        <br/>
        <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cqm/Library/Hospice|2.0.000</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>: Patient
        <br/>

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

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

        <em>Must Support Elements</em>: url, extension, value
        <br/>

      </td>
    </tr>

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

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

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

        <em>Must Support Elements</em>: code, status, performed
        <br/>

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

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

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1020/expansion">Colonoscopy</a>
        <br/>

      </td>
    </tr>

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

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

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

        <em>Must Support Elements</em>: code, status, performed
        <br/>

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

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

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1010/expansion">Flexible Sigmoidoscopy</a>
        <br/>

      </td>
    </tr>

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

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

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

        <em>Must Support Elements</em>: code, status, performed
        <br/>

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

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

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1038/expansion">CT Colonography</a>
        <br/>

      </td>
    </tr>

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

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

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

        <em>Must Support Elements</em>: code, status, performed
        <br/>

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

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

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1108.15/expansion">Hospice Care Ambulatory</a>
        <br/>

      </td>
    </tr>

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

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

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

        <em>Must Support Elements</em>: code, status, performed
        <br/>

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

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

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1019/expansion">Total Colectomy</a>
        <br/>

      </td>
    </tr>

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

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

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

        <em>Must Support Elements</em>: code, status, value, effective
        <br/>

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

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

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1011/expansion">Fecal Occult Blood Test (FOBT)</a>
        <br/>

      </td>
    </tr>

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

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

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

        <em>Must Support Elements</em>: code, status, value, effective
        <br/>

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

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

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1039/expansion">sDNA FIT Test</a>
        <br/>

      </td>
    </tr>

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

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

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

        <em>Must Support Elements</em>: type, period
        <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/2.16.840.1.114222.4.11.3591/expansion">Payer Type</a>
        <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
        <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/2.16.840.1.113883.3.464.1003.101.12.1001/expansion">Office Visit</a>
        <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
        <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/2.16.840.1.113883.3.526.3.1240/expansion">Annual Wellness Visit</a>
        <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
        <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/2.16.840.1.113883.3.464.1003.101.12.1025/expansion">Preventive Care Services Established Office Visit, 18 and Up</a>
        <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
        <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/2.16.840.1.113883.3.464.1003.101.12.1023/expansion">Preventive Care Services Initial Office Visit, 18 and Up</a>
        <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
        <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/2.16.840.1.113883.3.464.1003.101.12.1016/expansion">Home Healthcare Services</a>
        <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, status, hospitalization, hospitalization.dischargeDisposition, period
        <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/2.16.840.1.113883.3.666.5.307/expansion">Encounter Inpatient</a>
        <br/>

      </td>
    </tr>

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

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

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

        <em>Must Support Elements</em>: code, intent, authoredOn
        <br/>

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

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

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1108.15/expansion">Hospice Care Ambulatory</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>: code, onset
        <br/>

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

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

        <span class="tab-one"><em>ValueSet</em>:</span> <a href="https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1001/expansion">Malignant Neoplasm of Colon</a>
        <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://snomed.info/sct"/>
              <version
                       value="http://snomed.info/sct/731000124108/version/201709"/>
              <code value="428361000124107"/>
              <display value="Discharge to home for hospice care (procedure)"/>
            </valueCoding>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode">
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <version
                       value="http://snomed.info/sct/731000124108/version/201709"/>
              <code value="428371000124100"/>
              <display
                       value="Discharge to healthcare facility for hospice care (procedure)"/>
            </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 &quot;SDE Sex&quot;:
      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="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Sex"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Sex&quot;:
      SDE.&quot;SDE Sex&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="1"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="Colonoscopy Performed"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Colonoscopy Performed&quot;:
    	[Procedure: &quot;Colonoscopy&quot;] Colonoscopy
    		where Colonoscopy.status = 'completed'
    		  and Global.&quot;Normalize Interval&quot;(Colonoscopy.performed) ends 10 years or less on or before end of &quot;Measurement Period&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="2"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="Fecal Occult Blood Test Performed"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Fecal Occult Blood Test Performed&quot;:
    	[Observation: &quot;Fecal Occult Blood Test (FOBT)&quot;] FecalOccultResult
    		where FecalOccultResult.status in {'final', 'amended', 'corrected', 'preliminary'}
    			and FecalOccultResult.value is not null
    			and Global.&quot;Normalize Interval&quot;(FecalOccultResult.effective) during day of &quot;Measurement Period&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="3"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="Flexible Sigmoidoscopy Performed"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Flexible Sigmoidoscopy Performed&quot;:
    	[Procedure: &quot;Flexible Sigmoidoscopy&quot;] FlexibleSigmoidoscopy
    		where FlexibleSigmoidoscopy.status = 'completed'
    			and Global.&quot;Normalize Interval&quot;(FlexibleSigmoidoscopy.performed) ends 5 years or less on or before end of &quot;Measurement Period&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="4"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="Fecal Immunochemical Test DNA"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Fecal Immunochemical Test DNA&quot;:
    	[Observation: &quot;FIT DNA&quot;] FitDNA
    		where FitDNA.status in {'final', 'amended', 'corrected', 'preliminary'}
    			and FitDNA.value is not null
    			and Global.&quot;Normalize Interval&quot;(FitDNA.effective) occurs 3 years or less on or before day of end of &quot;Measurement Period&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="5"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="CT Colonography Performed"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;CT Colonography Performed&quot;:
    	[Procedure: &quot;CT Colonography&quot;] Colonography
    		where Colonography.status = 'completed'
    			and Global.&quot;Normalize Interval&quot;(Colonography.performed) ends 5 years or less on or before end of &quot;Measurement Period&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="6"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="Numerator"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Numerator&quot;:
    	exists &quot;Colonoscopy Performed&quot;
    		or exists &quot;Fecal Occult Blood Test Performed&quot;
    		or exists &quot;Flexible Sigmoidoscopy Performed&quot;
    		or exists &quot;Fecal Immunochemical Test DNA&quot;
    		or exists &quot;CT Colonography Performed&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="7"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="Denominator"/>
            </extension>
            <extension url="statement">
              <valueString value="define &quot;Denominator&quot;:
    	true"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="8"/>
            </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 &quot;SDE Payer&quot;:
      [Coverage: type in &quot;Payer&quot;] Payer
            return {
              code: Payer.type,
              period: Payer.period
            }"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="9"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Payer"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Payer&quot;:
      SDE.&quot;SDE Payer&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="10"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="AdultOutpatientEncounters"/>
            </extension>
            <extension url="name">
              <valueString value="Qualifying Encounters"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Qualifying Encounters&quot;:
    	(
        [Encounter: &quot;Office Visit&quot;]
      		union [Encounter: &quot;Annual Wellness Visit&quot;]
      		union [Encounter: &quot;Preventive Care Services - Established Office Visit, 18 and Up&quot;]
      		union [Encounter: &quot;Preventive Care Services-Initial Office Visit, 18 and Up&quot;]
      		union [Encounter: &quot;Home Healthcare Services&quot;]
      ) ValidEncounter
    		where ValidEncounter.period during &quot;Measurement Period&quot;
      		and ValidEncounter.status  = 'finished'"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="11"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="Initial Population"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Initial Population&quot;:
    	Global.&quot;CalendarAgeInYearsAt&quot;(FHIRHelpers.ToDate(Patient.birthDate), start of &quot;Measurement Period&quot;) in Interval[50, 75]
    			and exists AdultOutpatientEncounters.&quot;Qualifying Encounters&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="12"/>
            </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 &quot;SDE Ethnicity&quot;:
      (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="13"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Ethnicity"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Ethnicity&quot;:
      SDE.&quot;SDE Ethnicity&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="14"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="Hospice"/>
            </extension>
            <extension url="name">
              <valueString value="Has Hospice"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Has Hospice&quot;:
    	exists (
        [Encounter: &quot;Encounter Inpatient&quot;] DischargeHospice
    			where DischargeHospice.status = 'finished'
    		    and (
    	        DischargeHospice.hospitalization.dischargeDisposition ~ &quot;Discharge to home for hospice care (procedure)&quot;
    				    or DischargeHospice.hospitalization.dischargeDisposition ~ &quot;Discharge to healthcare facility for hospice care (procedure)&quot;
    	    	)
    				and DischargeHospice.period ends during &quot;Measurement Period&quot;
    	)
        or exists (
          [ServiceRequest: &quot;Hospice care ambulatory&quot;] HospiceOrder
            where HospiceOrder.intent = 'order'
                and HospiceOrder.authoredOn in &quot;Measurement Period&quot;
        )
        or exists (
          [Procedure: &quot;Hospice care ambulatory&quot;] HospicePerformed
            where HospicePerformed.status = 'completed'
              and Global.&quot;Normalize Interval&quot;(HospicePerformed.performed) overlaps &quot;Measurement Period&quot;
        )"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="15"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="Malignant Neoplasm Ever"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Malignant Neoplasm Ever&quot;:
    	[Condition: &quot;Malignant Neoplasm of Colon&quot;] ColorectalCancer
    		where Global.&quot;Normalize Interval&quot;(ColorectalCancer.onset) starts on or before end of &quot;Measurement Period&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="16"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="Total Colectomy Performed"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Total Colectomy Performed&quot;:
    	[Procedure: &quot;Total Colectomy&quot;] Colectomy
    		where Colectomy.status = 'completed'
    			and Global.&quot;Normalize Interval&quot;(Colectomy.performed) starts on or before end of &quot;Measurement Period&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="17"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="Denominator Exclusion"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;Denominator Exclusion&quot;:
    	Hospice.&quot;Has Hospice&quot;
    		or exists &quot;Malignant Neoplasm Ever&quot;
    		or exists &quot;Total Colectomy Performed&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="18"/>
            </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 &quot;SDE Race&quot;:
      (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="19"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="EXM130"/>
            </extension>
            <extension url="name">
              <valueString value="SDE Race"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define &quot;SDE Race&quot;:
      SDE.&quot;SDE Race&quot;"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="20"/>
            </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 AdministrativeGender): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="21"/>
            </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 ProcedureStatus): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="22"/>
            </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 ObservationStatus): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="23"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="MATGlobalCommonFunctions"/>
            </extension>
            <extension url="name">
              <valueString value="CalendarAgeInYearsAt"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function &quot;CalendarAgeInYearsAt&quot;(BirthDateTime DateTime, AsOf DateTime):
    	years between ToDate(BirthDateTime)and ToDate(AsOf)"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="24"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="MATGlobalCommonFunctions"/>
            </extension>
            <extension url="name">
              <valueString value="ToDate"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function &quot;ToDate&quot;(Value DateTime):
    	DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="25"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToDate"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function ToDate(value date): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="26"/>
            </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="27"/>
            </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="28"/>
            </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 uri): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="29"/>
            </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="30"/>
            </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="31"/>
            </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 ServiceRequestIntent): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="32"/>
            </extension>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
            <extension url="libraryName">
              <valueString value="FHIRHelpers"/>
            </extension>
            <extension url="name">
              <valueString value="ToDateTime"/>
            </extension>
            <extension url="statement">
              <valueString
                           value="define function ToDateTime(value dateTime): value.value"/>
            </extension>
            <extension url="displaySequence">
              <valueInteger value="33"/>
            </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 SDE"/>
            <resource
                      value="http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements|2.0.000"/>
          </relatedArtifact>
          <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="Library Global"/>
            <resource
                      value="http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library AdultOutpatientEncounters"/>
            <resource
                      value="http://hl7.org/fhir/uv/cqm/Library/AdultOutpatientEncounters|2.0.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Library Hospice"/>
            <resource value="http://hl7.org/fhir/uv/cqm/Library/Hospice|2.0.000"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Code system SNOMEDCT:2017-09"/>
            <resource
                      value="http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Colonoscopy"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Fecal Occult Blood Test (FOBT)"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Flexible Sigmoidoscopy"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set FIT DNA"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set CT Colonography"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038"/>
          </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 Office Visit"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Annual Wellness Visit"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Preventive Care Services - Established Office Visit, 18 and Up"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display
                     value="Value set Preventive Care Services-Initial Office Visit, 18 and Up"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Home Healthcare Services"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
          </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 Hospice care ambulatory"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Malignant Neoplasm of Colon"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001"/>
          </relatedArtifact>
          <relatedArtifact>
            <type value="depends-on"/>
            <display value="Value set Total Colectomy"/>
            <resource
                      value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019"/>
          </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="1"/>
            <type value="boolean"/>
          </parameter>
          <parameter>
            <name value="Denominator"/>
            <use value="out"/>
            <min value="0"/>
            <max value="1"/>
            <type value="boolean"/>
          </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="1"/>
            <type value="boolean"/>
          </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="1"/>
            <type value="boolean"/>
          </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="url"/>
            <mustSupport value="extension"/>
            <mustSupport value="value"/>
          </dataRequirement>
          <dataRequirement>
            <type value="Procedure"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
            <mustSupport value="code"/>
            <mustSupport value="status"/>
            <mustSupport value="performed"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Procedure"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
            <mustSupport value="code"/>
            <mustSupport value="status"/>
            <mustSupport value="performed"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Procedure"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
            <mustSupport value="code"/>
            <mustSupport value="status"/>
            <mustSupport value="performed"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Procedure"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
            <mustSupport value="code"/>
            <mustSupport value="status"/>
            <mustSupport value="performed"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Procedure"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
            <mustSupport value="code"/>
            <mustSupport value="status"/>
            <mustSupport value="performed"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
            <mustSupport value="code"/>
            <mustSupport value="status"/>
            <mustSupport value="value"/>
            <mustSupport value="effective"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Observation"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
            <mustSupport value="code"/>
            <mustSupport value="status"/>
            <mustSupport value="value"/>
            <mustSupport value="effective"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Coverage"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Coverage"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <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="Encounter"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="status"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="status"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="status"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="status"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="period"/>
            <mustSupport value="status"/>
            <codeFilter>
              <path value="type"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Encounter"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
            <mustSupport value="type"/>
            <mustSupport value="status"/>
            <mustSupport value="hospitalization"/>
            <mustSupport value="hospitalization.dischargeDisposition"/>
            <mustSupport value="period"/>
            <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="ServiceRequest"/>
            <profile
                     value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
            <mustSupport value="code"/>
            <mustSupport value="intent"/>
            <mustSupport value="authoredOn"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"/>
            </codeFilter>
          </dataRequirement>
          <dataRequirement>
            <type value="Condition"/>
            <profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
            <mustSupport value="code"/>
            <mustSupport value="onset"/>
            <codeFilter>
              <path value="code"/>
              <valueSet
                        value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001"/>
            </codeFilter>
          </dataRequirement>
        </Library>
      </contained>
      <extension
                 url="http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis">
        <valueCode value="boolean"/>
      </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/EXM130-FHIR"/>
      <identifier>
        <use value="official"/>
        <system value="http://example.org/fhir/cqi/ecqm/Measure/Identifier/cms"/>
        <value value="130"/>
      </identifier>
      <identifier>
        <use value="official"/>
        <system value="http://example.org/fhir/cqi/ecqm/Measure/Identifier/nqf"/>
        <value value="0034"/>
      </identifier>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:2.16.840.1.113883.4.642.40.61.29.6"/>
      </identifier>
      <version value="8.0.000"/>
      <name value="EXM130"/>
      <title value="EXM130 - Colorectal Cancer Screening Measure"/>
      <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="Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer"/>
      <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="ec"/>
            <display value="EC"/>
          </coding>
        </valueCodeableConcept>
      </useContext>
      <jurisdiction>
        <coding>
          <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
          <code value="001"/>
        </coding>
      </jurisdiction>
      <purpose
               value="This measure has been developed to support improvement in clinical care."/>
      <copyright
                 value="This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved."/>
      <approvalDate value="2016-01-01"/>
      <lastReviewDate value="2016-09-01"/>
      <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/EXM130"/>
      <disclaimer
                  value="The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."/>
      <scoring>
        <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="Colorectal cancer represents 8 percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. In 2017, there were an estimated 135,430 new cases of colorectal cancer and an estimated 50,260 deaths attributed to it. According to the National Cancer Institute, about 4.3 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Howlader et al. 2017). Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society 2017)."/>
      <clinicalRecommendationStatement
                                       value="The U. S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force 2016). Screening tests: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years)"/>
      <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="Patient self-report for procedures as well as diagnostic studies should be recorded in &quot;Procedure, Performed&quot; template or &quot;Diagnostic Study, Performed&quot; template in QRDA-1. Do not count DRE, FOBT tests performed in an office setting or performed on a sample collected via DRE."/>
      <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-exm130-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-exm130-numerator"/>
          </extension>
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="numerator"/>
              <display value="Numerator"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Numerator"/>
          </criteria>
        </population>
        <population>
          <extension
                     url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId">
            <valueString value="primary-exm130-denominator"/>
          </extension>
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="denominator"/>
              <display value="Denominator"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Denominator"/>
          </criteria>
        </population>
        <population>
          <extension
                     url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId">
            <valueString value="primary-exm130-denominator-exclusion"/>
          </extension>
          <code>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/measure-population"/>
              <code value="denominator-exclusion"/>
              <display value="Denominator Exclusion"/>
            </coding>
          </code>
          <criteria>
            <language value="text/cql-identifier"/>
            <expression value="Denominator Exclusion"/>
          </criteria>
        </population>
      </group>
      <supplementalData>
        <extension
                   url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId">
          <valueString value="primary-sde-ethnicity"/>
        </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/5.0/StructureDefinition/extension-Measure.supplementalData.linkId">
          <valueString value="primary-sde-epayer"/>
        </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/5.0/StructureDefinition/extension-Measure.supplementalData.linkId">
          <valueString value="primary-sde-race"/>
        </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/5.0/StructureDefinition/extension-Measure.supplementalData.linkId">
          <valueString value="primary-sde-sex"/>
        </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>