Quality Measure Implementation Guide (STU3 Ballot)
2.1.0 - ballot

This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v2.1.0: STU3 Ballot 1) based on FHIR R4. The current version which supercedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

: Cervical Cancer Screening - XML Representation

Raw xml | Download



<Measure xmlns="http://hl7.org/fhir">
  <id value="measure-exm124-FHIR"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/proportion-measure-cqfm"/>
    <profile
             value="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b style="color: maroon">Exception generating Narrative: Unable to read attribute on &lt;br&gt; at line 165 column 74</b></p></div>
  </text>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
    <valueCode value="boolean"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="Measurement Period"/>
      <use value="in"/>
      <min value="0"/>
      <max value="1"/>
      <type value="Period"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="SDE Sex"/>
      <use value="out"/>
      <min value="0"/>
      <max value="1"/>
      <type value="Coding"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="Numerator"/>
      <use value="out"/>
      <min value="0"/>
      <max value="1"/>
      <type value="boolean"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="Cervical Cytology Within 3 Years"/>
      <use value="out"/>
      <min value="0"/>
      <max value="*"/>
      <type value="Observation"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="HPV Test Within 5 Years for Women Age 30 and Older"/>
      <use value="out"/>
      <min value="0"/>
      <max value="*"/>
      <type value="Observation"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="Patient"/>
      <use value="out"/>
      <min value="0"/>
      <max value="1"/>
      <type value="Patient"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="Denominator"/>
      <use value="out"/>
      <min value="0"/>
      <max value="1"/>
      <type value="boolean"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="Initial Population"/>
      <use value="out"/>
      <min value="0"/>
      <max value="1"/>
      <type value="boolean"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="Qualifying Encounters"/>
      <use value="out"/>
      <min value="0"/>
      <max value="*"/>
      <type value="Encounter"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="SDE Payer"/>
      <use value="out"/>
      <min value="0"/>
      <max value="*"/>
      <type value="Any"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="SDE Ethnicity"/>
      <use value="out"/>
      <min value="0"/>
      <max value="*"/>
      <type value="Coding"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="Denominator Exclusion"/>
      <use value="out"/>
      <min value="0"/>
      <max value="1"/>
      <type value="boolean"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="Has Hospice"/>
      <use value="out"/>
      <min value="0"/>
      <max value="1"/>
      <type value="boolean"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="Absence of Cervix"/>
      <use value="out"/>
      <min value="0"/>
      <max value="*"/>
      <type value="Any"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-parameter">
    <valueParameterDefinition>
      <name value="SDE Race"/>
      <use value="out"/>
      <min value="0"/>
      <max value="*"/>
      <type value="Coding"/>
    </valueParameterDefinition>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Observation"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      <codeFilter>
        <path value="code"/>
        <valueSet
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1017"/>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Observation"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Observation"/>
      <codeFilter>
        <path value="code"/>
        <valueSet
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1059"/>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Patient"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Encounter"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
      <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>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Encounter"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
      <codeFilter>
        <path value="type"/>
        <valueSet
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"/>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Encounter"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
      <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>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Encounter"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
      <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>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Encounter"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
      <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>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Coverage"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Coverage"/>
      <codeFilter>
        <path value="type"/>
        <valueSet
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"/>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Patient"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Encounter"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
      <codeFilter>
        <path value="type"/>
        <valueSet
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"/>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="ServiceRequest"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
      <codeFilter>
        <path value="code"/>
        <valueSet
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"/>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Procedure"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
      <codeFilter>
        <path value="code"/>
        <valueSet
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"/>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Procedure"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
      <codeFilter>
        <path value="code"/>
        <valueSet
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1014"/>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Procedure"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
      <codeFilter>
        <path value="code"/>
        <valueSet
                  value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1014"/>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Condition"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
      <codeFilter>
        <path value="code"/>
        <code>
          <system value="http://snomed.info/sct"/>
          <version value="http://snomed.info/sct/731000124108/version/201709"/>
          <code value="37687000"/>
          <display value="Congenital absence of cervix (disorder)"/>
        </code>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-dataRequirement">
    <valueDataRequirement>
      <type value="Condition"/>
      <profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
      <codeFilter>
        <path value="code"/>
        <code>
          <system value="http://snomed.info/sct"/>
          <version value="http://snomed.info/sct/731000124108/version/201709"/>
          <code value="37687000"/>
          <display value="Congenital absence of cervix (disorder)"/>
        </code>
      </codeFilter>
    </valueDataRequirement>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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/us/cqfmeasures/StructureDefinition/cqfm-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/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode">
    <valueCoding>
      <system value="http://snomed.info/sct"/>
      <version value="http://snomed.info/sct/731000124108/version/201709"/>
      <code value="37687000"/>
      <display value="Congenital absence of cervix (disorder)"/>
    </valueCoding>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </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="0"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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 = &#39;male&#39; then Code { code: &#39;M&#39;, system: &#39;http://hl7.org/fhir/v3/AdministrativeGender&#39;, display: &#39;Male&#39; }
      when Patient.gender = &#39;female&#39; then Code { code: &#39;F&#39;, system: &#39;http://hl7.org/fhir/v3/AdministrativeGender&#39;, display: &#39;Female&#39; }
      else null
    end"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="1"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </extension>
    <extension url="name">
      <valueString value="Numerator"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="//    and NoCervixBirth.clinicalStatus ~ ToConcept(Global.&quot;active&quot;) because this is an excluion, all statuses are acceptabledefine &quot;Numerator&quot;:
	exists &quot;Cervical Cytology Within 3 Years&quot;
		or exists &quot;HPV Test Within 5 Years for Women Age 30 and Older&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="2"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </extension>
    <extension url="name">
      <valueString value="Cervical Cytology Within 3 Years"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define &quot;Cervical Cytology Within 3 Years&quot;:
	[Observation: &quot;Pap Test&quot;] CervicalCytology
		where CervicalCytology.value is not null
			and CervicalCytology.status in { &#39;final&#39;, &#39;amended&#39;, &#39;corrected&#39;, &#39;preliminary&#39; }
		  and Global.&quot;Normalize Interval&quot;(CervicalCytology.effective) ends 3 years or less on or before end of &quot;Measurement Period&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="3"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </extension>
    <extension url="name">
      <valueString value="HPV Test Within 5 Years for Women Age 30 and Older"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define &quot;HPV Test Within 5 Years for Women Age 30 and Older&quot;:
	[Observation: &quot;HPV Test&quot;] HPVTest
      where HPVTest.value is not null
        and HPVTest.status in { &#39;final&#39;, &#39;amended&#39;, &#39;corrected&#39;, &#39;preliminary&#39; }
        and  Global.&quot;CalendarAgeInYearsAt&quot;(FHIRHelpers.ToDate(Patient.birthDate), start of Global.&quot;Normalize Interval&quot;(HPVTest.effective))&gt;= 30
        and Global.&quot;Normalize Interval&quot;(HPVTest.effective) 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/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </extension>
    <extension url="name">
      <valueString value="Denominator"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define &quot;Denominator&quot;:
	&quot;Initial Population&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="5"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </extension>
    <extension url="name">
      <valueString value="Initial Population"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define &quot;Initial Population&quot;:
	Patient.gender = &#39;female&#39;
		and Global.&quot;CalendarAgeInYearsAt&quot;(FHIRHelpers.ToDate(Patient.birthDate), start of &quot;Measurement Period&quot;) in Interval[23, 64]
		and exists AdultOutpatientEncounters.&quot;Qualifying Encounters&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="6"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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  = &#39;finished&#39;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="7"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </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="8"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </extension>
    <extension url="name">
      <valueString value="Initial Population"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define &quot;Initial Population&quot;:
	Patient.gender = &#39;female&#39;
		and Global.&quot;CalendarAgeInYearsAt&quot;(FHIRHelpers.ToDate(Patient.birthDate), start of &quot;Measurement Period&quot;) in Interval[23, 64]
		and exists AdultOutpatientEncounters.&quot;Qualifying Encounters&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="10"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </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="11"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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 = &#39;http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity&#39;
          return Extension.extension
    )) E
      where E.url = &#39;ombCategory&#39;
        or E.url = &#39;detailed&#39;
      return E.value as Coding"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="12"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </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;Absence of Cervix&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="13"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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 = &#39;finished&#39;
		    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 = &#39;order&#39;
            and HospiceOrder.authoredOn in &quot;Measurement Period&quot;
    )
    or exists (
      [Procedure: &quot;Hospice care ambulatory&quot;] HospicePerformed
        where HospicePerformed.status = &#39;completed&#39;
          and Global.&quot;Normalize Interval&quot;(HospicePerformed.performed) overlaps &quot;Measurement Period&quot;
    )"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="14"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </extension>
    <extension url="name">
      <valueString value="Absence of Cervix"/>
    </extension>
    <extension url="statement">
      <valueString
                   value="define &quot;Absence of Cervix&quot;:
  ([Procedure: &quot;Hysterectomy with No Residual Cervix&quot;] NoCervixProcedure
   where Global.&quot;Normalize Interval&quot;(NoCervixProcedure.performed) ends on or before end of &quot;Measurement Period&quot;
     and NoCervixProcedure.status = &#39;completed&#39;
     )
  union [Condition : &quot;Congenital absence of cervix (disorder)&quot;] NoCervixBirth
		where Global.&quot;Normalize Interval&quot;(NoCervixBirth.onset) starts on or before end of &quot;Measurement Period&quot;"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="15"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
    <extension url="libraryName">
      <valueString value="EXM124"/>
    </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="16"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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 = &#39;http://hl7.org/fhir/us/core/StructureDefinition/us-core-race&#39;
          return Extension.extension
    )) E
      where E.url = &#39;ombCategory&#39;
        or E.url = &#39;detailed&#39;
      return E.value as Coding"/>
    </extension>
    <extension url="displaySequence">
      <valueInteger value="17"/>
    </extension>
  </extension>
  <url value="http://hl7.org/fhir/us/cqfmeasures/Measure/measure-exm124-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>
  <version value="9.0.000"/>
  <name value="EXM124"/>
  <title value="Cervical Cancer Screening"/>
  <status value="active"/>
  <experimental value="true"/>
  <date value="2021-04-03"/>
  <publisher value="Clinical Quality Information WG"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cqi/index.cfm"/>
    </telecom>
  </contact>
  <description
               value="Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: 
 *  Women age 21-64 who had cervical cytology performed every 3 years &lt;br.*  Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years "/>
  <useContext>
    <code>
      <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
      <code value="program"/>
    </code>
    <valueCodeableConcept>
      <coding>
        <system
                value="http://hl7.org/fhir/us/cqfmeasures/CodeSystem/quality-programs"/>
        <code value="ep-ec"/>
        <display value="EP/EC"/>
      </coding>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <purpose
           value="Women 23-64 years of age with a visit during the measurement period"/>
  <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>
  <relatedArtifact>
    <type value="depends-on"/>
    <display value="Library SDE"/>
    <resource
              value="http://hl7.org/fhir/us/cqfmeasures/Library/SupplementalDataElements|2.0.000"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="depends-on"/>
    <display value="Library FHIRHelpers"/>
    <resource
              value="http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="depends-on"/>
    <display value="Library Global"/>
    <resource
              value="http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="depends-on"/>
    <display value="Library AdultOutpatientEncounters"/>
    <resource
              value="http://hl7.org/fhir/us/cqfmeasures/Library/AdultOutpatientEncounters|2.0.000"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="depends-on"/>
    <display value="Library FHIRHelpers"/>
    <resource
              value="http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="depends-on"/>
    <display value="Library Hospice"/>
    <resource value="http://hl7.org/fhir/us/cqfmeasures/Library/Hospice|2.0.000"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="depends-on"/>
    <display value="Library FHIRHelpers"/>
    <resource
              value="http://fhir.org/guides/cqf/common/Library/FHIRHelpers|4.0.1"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="depends-on"/>
    <display value="Library Global"/>
    <resource
              value="http://hl7.org/fhir/us/cqfmeasures/Library/MATGlobalCommonFunctions|5.0.000"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="depends-on"/>
    <display value="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="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 Pap Test"/>
    <resource
              value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1017"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="depends-on"/>
    <display value="Value set HPV Test"/>
    <resource
              value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1059"/>
  </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 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 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 Hysterectomy with No Residual Cervix"/>
    <resource
              value="http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1014"/>
  </relatedArtifact>
  <library value="http://hl7.org/fhir/us/cqfmeasures/Library/EXM124"/>
  <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="Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Howlader et al, 2016). In 2013, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Howlader et al, 2016). 
 While there are other factors that affect a woman&#39;s risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Howlader et al, 2016). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 235; by age 50 it becomes 1 in 54; by age 60, it is 1 in 25 (National Business Group on Health, 2011). 
 In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits and procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (National Business Group on Health, 2011). If breast cancer is detected through mammography screening and diagnosed in its earliest stages, treatment may be less expensive (Feig, 2011)."/>
  <clinicalRecommendationStatement
                                   value="The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation).  
 The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (C recommendation). (USPSTF, 2016) 
 The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement). (USPSTF, 2016) 
 The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I Statement). (USPSTF, 2016)  
 The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement). (USPSTF, 2016)"/>
  <improvementNotation>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/>
      <code value="increase"/>
      <display value="Increased score indicates improvement"/>
    </coding>
  </improvementNotation>
  <guidance
            value="To ensure the measure is only looking for a cervical cytology test only after a woman turns 21 years of age, the youngest age in the initial population is 23. 
 Patient self-report for procedures as well as diagnostic studies should be recorded in &#39;Procedure, Performed&#39; template or &#39;Diagnostic Study, Performed&#39; template in QRDA-1. 
 Include only cytology and HPV &quot;co-testing&quot;; in co-testing, both cytology and HPV tests are performed (i.e., the samples are collected and both tests are ordered, regardless of the cytology result) on the same date of service. Do not include reflex testing. In addition, if the medical record indicates the HPV test was performed only after determining the cytology result, this is considered reflex testing and does not meet criteria for the measure."/>
  <group>
    <population>
      <code>
        <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>
      <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>
      <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>
      <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>
    <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>
    <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>
    <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>
    <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>