Situational Awareness for Novel Epidemic Response
1.0.0 - STU Release

This page is part of the Situational Awareness for Novel Epidemic Response (v1.0.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: FEMA Laboratory Orders and Results Daily Increase Reporting - TTL Representation

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

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

 a fhir:Measure;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "FEMADailyHospitalCOVID19Reporting"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/uv/saner/StructureDefinition/PublicHealthMeasure";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/uv/saner/StructureDefinition/PublicHealthMeasure>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>Enables specification of proposed measure reporting</b>: Do Once per 1 days</p><p><b>url</b>: <code>http://hl7.org/fhir/uv/saner/Measure/FEMADailyHospitalCOVID19Reporting</code></p><p><b>version</b>: 1.0.0</p><p><b>name</b>: FEMADailyHospitalCOVID19Reporting</p><p><b>status</b>: draft</p><p><b>experimental</b>: true</p><p><b>date</b>: Sep 7, 2021 7:08:29 PM</p><p><b>publisher</b>: HL7 International Public Health Workgroup</p><p><b>contact</b>: <a href=\"http://hl7.org/Special/committees/pher\">http://hl7.org/Special/committees/pher</a>, <a href=\"mailto:pher@lists.hl7.org\">pher@lists.hl7.org</a>, Keith W. Boone: <a href=\"mailto:mailto:kboone@ainq.com\">mailto:kboone@ainq.com</a></p><p><b>jurisdiction</b>: <span title=\"Codes: {http://unstats.un.org/unsd/methods/m49/m49.htm 001}\">World</span></p><p><b>topic</b>: <span title=\"Codes: {http://snomed.info/sct 252318005}\">Immunology laboratory test (procedure)</span></p><p><b>author</b>: HL7 Public Health Workgroup: <a href=\"mailto:mailto:pher@lists.hl7.org\">mailto:pher@lists.hl7.org</a></p><p><b>library</b>: <a href=\"http://hl7.org/fhir/uv/saner/StructureDefinition/FEMAMeasureLibrary\">http://hl7.org/fhir/uv/saner/StructureDefinition/FEMAMeasureLibrary</a></p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-type outcome}\">Outcome</span></p><p><b>rateAggregation</b>: count</p><blockquote><p><b>group</b></p><blockquote><p><b>Attributes describing a group of measures</b></p><p><b>value</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}\">Continuous Variable</span></p><p><b>value</b>: <span title=\"Codes: {http://hl7.org/fhir/resource-types ServiceRequest}, {http://snomed.info/sct 252318005}\">COVID-19 Diagnostic Testing</span></p><p><b>value</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-type outcome}\">Outcome</span></p><p><b>value</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-improvement-notation decrease}\">Decreased score indicates improvement</span></p><p><b>value</b>: cumulative</p></blockquote><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasureGroupSystem positiveIncreasePercent}\"># of new positive test results released / # of total new tests released for previous date queried</span></p><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues totalOrdersIncrease}, {http://terminology.hl7.org/CodeSystem/measure-population initial-population}\">Midnight to midnight cutoff, tests ordered on previous date queried</span></p><p><b>description</b>: Enter the number of new Diagnostic Tests Ordered/Received during the reporting period.</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues totalTestResultsIncrease}, {http://terminology.hl7.org/CodeSystem/measure-population denominator}\">Midnight to midnight cutoff, test results released on previous date queried</span></p><p><b>description</b>: Enter the number of results recieved/generated during the reporting period.\n Do not include results where the test could not be completed because the specimen\n was rejected or a positive/negative result could not be established</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues positiveIncrease}, {http://terminology.hl7.org/CodeSystem/measure-population numerator}\">Midnight to midnight cutoff, positive test results released on previous date queried</span></p><p><b>description</b>: Enter the number of positive test results released during the reporting period.</p></blockquote></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>Attributes describing a group of measures</b></p><p><b>value</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}\">Continuous Variable</span></p><p><b>value</b>: <span title=\"Codes: {http://hl7.org/fhir/resource-types ServiceRequest}, {http://snomed.info/sct 252318005}\">COVID-19 Cumulative Diagnostic Testing</span></p><p><b>value</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-type outcome}\">Outcome</span></p><p><b>value</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/measure-improvement-notation decrease}\">Decreased score indicates improvement</span></p><p><b>value</b>: cumulative</p></blockquote><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasureGroupSystem positivePercent}\"># of total positive results to released date / # of total tests results released to date</span></p><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues totalOrders}, {http://terminology.hl7.org/CodeSystem/measure-population initial-population}\">All tests ordered to date.</span></p><p><b>description</b>: Enter the cumulative number of tests ordered to date.</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues rejected}, {http://terminology.hl7.org/CodeSystem/measure-population denominator-exclusion}\">All specimens rejected for testing to date</span></p><p><b>description</b>: Enter the cumulative number of specimens rejected for testing to date.</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues totalTestResults}, {http://terminology.hl7.org/CodeSystem/measure-population denominator}\">All tests with results released to date</span></p><p><b>description</b>: Enter the total number tests with results released to date. Do not include tests where a\n positive/negative result could not be determined (e.g., because the specimen was inadequate).</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues positive}, {http://terminology.hl7.org/CodeSystem/measure-population numerator}\">All positive test results released to date</span></p><p><b>description</b>: Enter the total number of positive test results release to date.</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues allReports}\">Reports to date including corrected, amended and canceled reports</span></p><p><b>description</b>: This is in intermediate population used to simplify calculations</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues latestReports}\">Latest Reports to date for each order</span></p><p><b>description</b>: This is in intermediate population used to simplify calculations</p></blockquote></blockquote></div>"
  ];
  fhir:DomainResource.extension [
     fhir:index 0;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/saner/StructureDefinition/ReportingPeriod" ];
     fhir:Extension.valueTiming [
       fhir:Timing.repeat [
         fhir:Timing.repeat.frequency [ fhir:value "1"^^xsd:positiveInteger ];
         fhir:Timing.repeat.period [ fhir:value "1"^^xsd:decimal ];
         fhir:Timing.repeat.periodUnit [ fhir:value "d" ]       ]     ]
  ];
  fhir:Measure.url [ fhir:value "http://hl7.org/fhir/uv/saner/Measure/FEMADailyHospitalCOVID19Reporting"];
  fhir:Measure.version [ fhir:value "1.0.0"];
  fhir:Measure.name [ fhir:value "FEMADailyHospitalCOVID19Reporting"];
  fhir:Measure.status [ fhir:value "draft"];
  fhir:Measure.experimental [ fhir:value "true"^^xsd:boolean];
  fhir:Measure.date [ fhir:value "2021-09-07T19:08:29+00:00"^^xsd:dateTime];
  fhir:Measure.publisher [ fhir:value "HL7 International Public Health Workgroup"];
  fhir:Measure.contact [
     fhir:index 0;
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "url" ];
       fhir:ContactPoint.value [ fhir:value "http://hl7.org/Special/committees/pher" ]     ]
  ], [
     fhir:index 1;
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "email" ];
       fhir:ContactPoint.value [ fhir:value "pher@lists.hl7.org" ]     ]
  ], [
     fhir:index 2;
     fhir:ContactDetail.name [ fhir:value "Keith W. Boone" ];
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "email" ];
       fhir:ContactPoint.value [ fhir:value "mailto:kboone@ainq.com" ]     ]
  ];
  fhir:Measure.useContext [
     fhir:index 0;
     fhir:UsageContext.code [
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/usage-context-type" ];
       fhir:Coding.code [ fhir:value "focus" ]     ];
     fhir:UsageContext.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         a sct:840539006;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
         fhir:Coding.code [ fhir:value "840539006" ];
         fhir:Coding.display [ fhir:value "COVID-19" ]       ]     ]
  ];
  fhir:Measure.jurisdiction [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://unstats.un.org/unsd/methods/m49/m49.htm" ];
       fhir:Coding.code [ fhir:value "001" ]     ]
  ];
  fhir:Measure.topic [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       a sct:252318005;
       fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
       fhir:Coding.code [ fhir:value "252318005" ];
       fhir:Coding.display [ fhir:value "Immunology laboratory test (procedure)" ]     ]
  ];
  fhir:Measure.author [
     fhir:index 0;
     fhir:ContactDetail.name [ fhir:value "HL7 Public Health Workgroup" ];
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "email" ];
       fhir:ContactPoint.value [ fhir:value "mailto:pher@lists.hl7.org" ]     ]
  ];
  fhir:Measure.relatedArtifact [
     fhir:index 0;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.label [ fhir:value "CMS Press Release" ];
     fhir:RelatedArtifact.display [ fhir:value "Trump Administration Engages America’s Hospitals in Unprecedented Data Sharing" ];
     fhir:RelatedArtifact.url [ fhir:value "https://www.cms.gov/newsroom/press-releases/trump-administration-engages-americas-hospitals-unprecedented-data-sharing" ]
  ], [
     fhir:index 1;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.label [ fhir:value "Vice President Pence Letter to Hospital Administrators" ];
     fhir:RelatedArtifact.display [ fhir:value "Text of a Letter from the Vice President to Hospital Administrators" ];
     fhir:RelatedArtifact.url [ fhir:value "https://www.whitehouse.gov/briefings-statements/text-letter-vice-president-hospital-administrators/" ]
  ], [
     fhir:index 2;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.label [ fhir:value "AHA Advisory on COVID-19 Reporting" ];
     fhir:RelatedArtifact.display [ fhir:value "Administration Requests Hospitals Report Daily on COVID-19 Testing Results, Bed and Ventilator" ];
     fhir:RelatedArtifact.url [ fhir:value "https://www.aha.org/advisory/2020-03-30-coronavirus-update-administration-requests-hospitals-report-daily-covid-19" ]
  ], [
     fhir:index 3;
     fhir:RelatedArtifact.type [ fhir:value "documentation" ];
     fhir:RelatedArtifact.label [ fhir:value "Excel Spreadsheet template for reporting to FEMA" ];
     fhir:RelatedArtifact.display [ fhir:value "Template for Daily Hospital COVID-19 Reporting.xlsx" ];
     fhir:RelatedArtifact.url [ fhir:value "https://images.magnetmail.net/images/clients/AHA_MCHF/attach/2020/March/0330/Template_for_Daily_Hospital_COVID19_Reporting.xlsx" ]
  ];
  fhir:Measure.library [
     fhir:value "http://hl7.org/fhir/uv/saner/StructureDefinition/FEMAMeasureLibrary";
     fhir:index 0;
     fhir:link <http://hl7.org/fhir/uv/saner/StructureDefinition/FEMAMeasureLibrary>
  ];
  fhir:Measure.type [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-type" ];
       fhir:Coding.code [ fhir:value "outcome" ]     ]
  ];
  fhir:Measure.rateAggregation [ fhir:value "count"];
  fhir:Measure.group [
     fhir:index 0;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "scoring" ];
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-scoring" ];
             fhir:Coding.code [ fhir:value "continuous-variable" ]           ]         ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "subject" ];
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://hl7.org/fhir/resource-types" ];
             fhir:Coding.code [ fhir:value "ServiceRequest" ]           ], [
             fhir:index 1;
             a sct:252318005;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "252318005" ];
             fhir:Coding.display [ fhir:value "Immunology laboratory test (procedure)" ]           ];
           fhir:CodeableConcept.text [ fhir:value "COVID-19 Diagnostic Testing" ]         ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "type" ];
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-type" ];
             fhir:Coding.code [ fhir:value "outcome" ]           ]         ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "improvementNotation" ];
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-improvement-notation" ];
             fhir:Coding.code [ fhir:value "decrease" ]           ]         ]       ], [
         fhir:index 4;
         fhir:Extension.url [ fhir:value "rateAggregation" ];
         fhir:Extension.valueString [ fhir:value "cumulative" ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes" ]     ];
     fhir:Measure.group.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasureGroupSystem" ];
         fhir:Coding.code [ fhir:value "positiveIncreasePercent" ];
         fhir:Coding.display [ fhir:value "Percent Positive among Newly Resulted Tests" ]       ];
       fhir:CodeableConcept.text [ fhir:value "# of new positive test results released / # of total new tests released for previous date queried" ]     ];
     fhir:Measure.group.population [
       fhir:index 0;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues" ];
           fhir:Coding.code [ fhir:value "totalOrdersIncrease" ];
           fhir:Coding.display [ fhir:value "New Diagnostic Tests Ordered/Received" ]         ], [
           fhir:index 1;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "initial-population" ]         ];
         fhir:CodeableConcept.text [ fhir:value "Midnight to midnight cutoff, tests ordered on previous date queried" ]       ];
       fhir:Measure.group.population.description [ fhir:value "Enter the number of new Diagnostic Tests Ordered/Received during the reporting period." ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.description [ fhir:value "Orders initiated during %reportingPeriod" ];
         fhir:Expression.name [ fhir:value "totalOrdersIncrease" ];
         fhir:Expression.language [ fhir:value "text/fhirpath" ];
         fhir:Expression.expression [ fhir:value "ServiceRequest.where(\n    authoredOn.toDate() = %reportingPeriod /* May need to change logic to support ranges for reportingPeriod */\n    and status in ('active', 'completed')\n    and intent in ('order', 'orginal-order', 'reflex-order', 'filler-order', 'instance-order')\n)" ]       ]     ], [
       fhir:index 1;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues" ];
           fhir:Coding.code [ fhir:value "totalTestResultsIncrease" ];
           fhir:Coding.display [ fhir:value "New Tests Resulted" ]         ], [
           fhir:index 1;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "denominator" ]         ];
         fhir:CodeableConcept.text [ fhir:value "Midnight to midnight cutoff, test results released on previous date queried" ]       ];
       fhir:Measure.group.population.description [ fhir:value "Enter the number of results recieved/generated during the reporting period.\n Do not include results where the test could not be completed because the specimen\n was rejected or a positive/negative result could not be established" ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.description [ fhir:value "Results recieved during reporting period" ];
         fhir:Expression.name [ fhir:value "totalTestResultsIncrease" ];
         fhir:Expression.language [ fhir:value "text/fhirpath" ];
         fhir:Expression.expression [ fhir:value "DiagnosticReport.where(\n    issued.toDate() = %reportingPeriod /* May need to change logic to support ranges for reportingPeriod */\n    and status in ('final, 'amended', 'corrected', 'appended')\n)" ]       ]     ], [
       fhir:index 2;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues" ];
           fhir:Coding.code [ fhir:value "positiveIncrease" ];
           fhir:Coding.display [ fhir:value "New Positive COVID-19 Tests" ]         ], [
           fhir:index 1;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "numerator" ]         ];
         fhir:CodeableConcept.text [ fhir:value "Midnight to midnight cutoff, positive test results released on previous date queried" ]       ];
       fhir:Measure.group.population.description [ fhir:value "Enter the number of positive test results released during the reporting period." ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.description [ fhir:value "Result is positive with respect to COVID-19" ];
         fhir:Expression.name [ fhir:value "positiveIncrease" ];
         fhir:Expression.language [ fhir:value "text/fhirpath" ];
         fhir:Expression.expression [ fhir:value "DiagnosticReport.where($this in %totalTestResultsIncrease and conclusionCode in %ValueSet-ConfirmedCOVID19Diagnosis)" ]       ]     ]
  ], [
     fhir:index 1;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Element.extension [
         fhir:index 0;
         fhir:Extension.url [ fhir:value "scoring" ];
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-scoring" ];
             fhir:Coding.code [ fhir:value "continuous-variable" ]           ]         ]       ], [
         fhir:index 1;
         fhir:Extension.url [ fhir:value "subject" ];
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://hl7.org/fhir/resource-types" ];
             fhir:Coding.code [ fhir:value "ServiceRequest" ]           ], [
             fhir:index 1;
             a sct:252318005;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "252318005" ];
             fhir:Coding.display [ fhir:value "Immunology laboratory test (procedure)" ]           ];
           fhir:CodeableConcept.text [ fhir:value "COVID-19 Cumulative Diagnostic Testing" ]         ]       ], [
         fhir:index 2;
         fhir:Extension.url [ fhir:value "type" ];
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-type" ];
             fhir:Coding.code [ fhir:value "outcome" ]           ]         ]       ], [
         fhir:index 3;
         fhir:Extension.url [ fhir:value "improvementNotation" ];
         fhir:Extension.valueCodeableConcept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-improvement-notation" ];
             fhir:Coding.code [ fhir:value "decrease" ]           ]         ]       ], [
         fhir:index 4;
         fhir:Extension.url [ fhir:value "rateAggregation" ];
         fhir:Extension.valueString [ fhir:value "cumulative" ]       ];
       fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/saner/StructureDefinition/MeasureGroupAttributes" ]     ];
     fhir:Measure.group.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasureGroupSystem" ];
         fhir:Coding.code [ fhir:value "positivePercent" ];
         fhir:Coding.display [ fhir:value "Cumulative Percent Positive among Resulted Tests" ]       ];
       fhir:CodeableConcept.text [ fhir:value "# of total positive results to released date / # of total tests results released to date" ]     ];
     fhir:Measure.group.population [
       fhir:index 0;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues" ];
           fhir:Coding.code [ fhir:value "totalOrders" ];
           fhir:Coding.display [ fhir:value "Cumulative Diagnostic Tests Ordered/Received" ]         ], [
           fhir:index 1;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "initial-population" ]         ];
         fhir:CodeableConcept.text [ fhir:value "All tests ordered to date." ]       ];
       fhir:Measure.group.population.description [ fhir:value "Enter the cumulative number of tests ordered to date." ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.description [ fhir:value "Report all active or completed test orders for a COVID-19 test authored during the reporting period" ];
         fhir:Expression.name [ fhir:value "totalOrders" ];
         fhir:Expression.language [ fhir:value "text/fhirpath" ];
         fhir:Expression.expression [ fhir:value "ServiceRequest.where(\n    authoredOn.toDate() <= %reportingPeriod /* May need to change logic to support ranges for reportingPeriod */\n    and status in ('active', 'completed')\n    and code in %ValueSet-COVID19DiagnosticTest\n    and intent in ('order', 'orginal-order', 'reflex-order', 'filler-order', 'instance-order')\n)" ]       ]     ], [
       fhir:index 1;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues" ];
           fhir:Coding.code [ fhir:value "rejected" ];
           fhir:Coding.display [ fhir:value "Cumulative Specimens Rejected" ]         ], [
           fhir:index 1;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "denominator-exclusion" ]         ];
         fhir:CodeableConcept.text [ fhir:value "All specimens rejected for testing to date" ]       ];
       fhir:Measure.group.population.description [ fhir:value "Enter the cumulative number of specimens rejected for testing to date." ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.description [ fhir:value "DiagnosticReport for COVID-19 where the report is unavailable because the measurement was not started or not completed." ];
         fhir:Expression.name [ fhir:value "rejected" ];
         fhir:Expression.language [ fhir:value "text/fhirpath" ];
         fhir:Expression.expression [ fhir:value "DiagnosticReport.where(status = 'cancelled' and code in %ValueSet-COVID19DiagnosticTest)" ]       ]     ], [
       fhir:index 2;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues" ];
           fhir:Coding.code [ fhir:value "totalTestResults" ];
           fhir:Coding.display [ fhir:value "Cumulative Tests Performed" ]         ], [
           fhir:index 1;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "denominator" ]         ];
         fhir:CodeableConcept.text [ fhir:value "All tests with results released to date" ]       ];
       fhir:Measure.group.population.description [ fhir:value "Enter the total number tests with results released to date. Do not include tests where a\n positive/negative result could not be determined (e.g., because the specimen was inadequate)." ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.description [ fhir:value "Report all active or completed test orders for a COVID-19 test authored during or prior to the end of the reporting period that have had results released." ];
         fhir:Expression.name [ fhir:value "totalTestResults" ];
         fhir:Expression.language [ fhir:value "text/fhirpath" ];
         fhir:Expression.expression [ fhir:value "ServiceRequest.where(\n    status in ('active', 'completed')\n    and intent in ('order', 'orginal-order', 'reflex-order', 'filler-order', 'instance-order')\n)" ]       ]     ], [
       fhir:index 3;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues" ];
           fhir:Coding.code [ fhir:value "positive" ];
           fhir:Coding.display [ fhir:value "Cumulative Positive COVID-19 Tests" ]         ], [
           fhir:index 1;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/measure-population" ];
           fhir:Coding.code [ fhir:value "numerator" ]         ];
         fhir:CodeableConcept.text [ fhir:value "All positive test results released to date" ]       ];
       fhir:Measure.group.population.description [ fhir:value "Enter the total number of positive test results release to date." ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.description [ fhir:value "The result is positive for COVID-19" ];
         fhir:Expression.name [ fhir:value "positive" ];
         fhir:Expression.language [ fhir:value "text/fhirpath" ];
         fhir:Expression.expression [ fhir:value "DiagnosticReport.where($this in %totalTestResults and conclusionCode in %ValueSet-ConfirmedCOVID19Diagnosis)" ]       ]     ], [
       fhir:index 4;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues" ];
           fhir:Coding.code [ fhir:value "allReports" ];
           fhir:Coding.display [ fhir:value "All Laboratory Reports for any Order" ]         ];
         fhir:CodeableConcept.text [ fhir:value "Reports to date including corrected, amended and canceled reports" ]       ];
       fhir:Measure.group.population.description [ fhir:value "This is in intermediate population used to simplify calculations" ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.description [ fhir:value "Diagnostic Reports provided in response to totalOrders" ];
         fhir:Expression.name [ fhir:value "allReports" ];
         fhir:Expression.language [ fhir:value "text/fhirpath" ];
         fhir:Expression.expression [ fhir:value "DiagnosticReport.where(basedOn in %totalOrders)" ]       ]     ], [
       fhir:index 5;
       fhir:Measure.group.population.code [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/saner/CodeSystem/MeasuredValues" ];
           fhir:Coding.code [ fhir:value "latestReports" ];
           fhir:Coding.display [ fhir:value "Most Recent Laboratory Reports for any Order" ]         ];
         fhir:CodeableConcept.text [ fhir:value "Latest Reports to date for each order" ]       ];
       fhir:Measure.group.population.description [ fhir:value "This is in intermediate population used to simplify calculations" ];
       fhir:Measure.group.population.criteria [
         fhir:Expression.description [ fhir:value "Most recent diagnostic reports provided in response to totalOrders" ];
         fhir:Expression.name [ fhir:value "latestReports" ];
         fhir:Expression.language [ fhir:value "text/fhirpath" ];
         fhir:Expression.expression [ fhir:value "TBD" ]       ]     ]
  ].

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

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