# EXM130 - Colorectal Cancer Screening Measure - Quality Measure Implementation Guide v2.0.0-ballot

## Measure: EXM130 - Colorectal Cancer Screening Measure (Experimental) 

 
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer 

* Metadata: Title
  * ?: EXM130 - Colorectal Cancer Screening Measure
* Metadata: Version
  * ?: 8.0.000
* Metadata: Identifier
  * ?: 130
* Metadata: Identifier
  * ?: 0034
* Metadata: Identifier
  * ?: urn:oid:2.16.840.1.113883.4.642.40.61.29.6
* Metadata: Effective Period
  * ?: 2018-01-01 through 2018-12-31
* Metadata: Approval Date
  * ?: 2016-01-01
* Metadata: Last Review Date
  * ?: 2016-09-01
* Metadata: Experimental
  * ?: true
* Metadata: Use Context
  * ?: Clinical Venue = EC
* Metadata: Jurisdiction
  * ?: 001 from[http://unstats.un.org/unsd/methods/m49/m49.htm](http://unstats.un.org/unsd/methods/m49/m49.htm)
* Metadata: Topic
  * ?: Health Quality Measure Document
* Metadata: Steward (Publisher)
  * ?: HL7 International / Clinical Quality Information
* Metadata: Description
  * ?: Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer
* Metadata: Purpose
  * ?: This measure has been developed to support improvement in clinical care.
* Metadata: Copyright
  * ?: 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.
* Metadata: Disclaimer
  * ?: 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 "AS IS" 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].
* Metadata: Measure Basis
  * ?: boolean
* Metadata: Measure Scoring
  * ?: Proportion
* Metadata: Improvement Notation
  * ?: Increased score indicates improvement
* Metadata: Measure Type
  * ?: process from[http://terminology.hl7.org/CodeSystem/measure-type](http://terminology.hl7.org/7.1.0/CodeSystem-measure-type.html)
* Metadata: Rationale
  * ?: 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).
* Metadata: Clinical Recommendation Statement
  * ?: 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)
* Metadata: Measure Group (Rate) (ID: primary)
* Metadata: Supplemental Data Elements
* Metadata: Supplemental Data Element
  * ?: **Usage Code**:Supplemental Data**Description**: No description provided**Logic Definition**:[SDE Ethnicity](#exm130-sde-ethnicity)
* Metadata: Supplemental Data Element
  * ?: **Usage Code**:Supplemental Data**Description**: No description provided**Logic Definition**:[SDE Payer](#exm130-sde-payer)
* Metadata: Supplemental Data Element
  * ?: **Usage Code**:Supplemental Data**Description**: No description provided**Logic Definition**:[SDE Race](#exm130-sde-race)
* Metadata: Supplemental Data Element
  * ?: **Usage Code**:Supplemental Data**Description**: No description provided**Logic Definition**:[SDE Sex](#exm130-sde-sex)
* Metadata: Measure Logic
* Metadata: Primary Library
  * ?: [EXM130 - Colorectal Cancer Screening Library](Library-EXM130.md)
* Metadata: Contents
  * ?: **[Population Criteria](#population-criteria)****[Logic Definitions](#definitions)****[Terminology](#terminology)****[Dependencies](#dependencies)****[Data Requirements](#data-requirements)****[Parameters](#parameters)**
* Metadata:  Population Criteria
* Metadata: Measure Group (Rate) (ID: primary)
* Metadata:  Logic Definitions
* Metadata: Logic Definition
  * ?: **Library Name:**AdultOutpatientEncounters
* Metadata:  ````define "Qualifying Encounters": ([Encounter: "Office Visit"] union [Encounter: "Annual Wellness Visit"] union [Encounter: "Preventive Care Services - Established Office Visit, 18 and Up"] union [Encounter: "Preventive Care Services-Initial Office Visit, 18 and Up"] union [Encounter: "Home Healthcare Services"] ) ValidEncounter where ValidEncounter.period during "Measurement Period" and ValidEncounter.status = 'finished'````
* Metadata: Logic Definition
  * ?: **Library Name:**Hospice
* Metadata:  ````define "Has Hospice": exists ( [Encounter: "Encounter Inpatient"] DischargeHospice where DischargeHospice.status = 'finished' and ( DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and DischargeHospice.period ends during "Measurement Period" ) or exists ( [ServiceRequest: "Hospice care ambulatory"] HospiceOrder where HospiceOrder.intent = 'order' and HospiceOrder.authoredOn in "Measurement Period" ) or exists ( [Procedure: "Hospice care ambulatory"] HospicePerformed where HospicePerformed.status = 'completed' and Global."Normalize Interval"(HospicePerformed.performed) overlaps "Measurement Period" )````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Sex": case when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' } when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' } else null end````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Payer": [Coverage: type in "Payer"] Payer return { code: Payer.type, period: Payer.period }````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Ethnicity": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding````
* Metadata: Logic Definition
  * ?: **Library Name:**SupplementalDataElements
* Metadata:  ````define "SDE Race": (flatten ( Patient.extension Extension where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race' return Extension.extension )) E where E.url = 'ombCategory' or E.url = 'detailed' return E.value as Coding````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "SDE Sex": SDE."SDE Sex"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "Colonoscopy Performed": [Procedure: "Colonoscopy"] Colonoscopy where Colonoscopy.status = 'completed' and Global."Normalize Interval"(Colonoscopy.performed) ends 10 years or less on or before end of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "Fecal Occult Blood Test Performed": [Observation: "Fecal Occult Blood Test (FOBT)"] FecalOccultResult where FecalOccultResult.status in {'final', 'amended', 'corrected', 'preliminary'} and FecalOccultResult.value is not null and Global."Normalize Interval"(FecalOccultResult.effective) during day of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "Flexible Sigmoidoscopy Performed": [Procedure: "Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy where FlexibleSigmoidoscopy.status = 'completed' and Global."Normalize Interval"(FlexibleSigmoidoscopy.performed) ends 5 years or less on or before end of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "Fecal Immunochemical Test DNA": [Observation: "FIT DNA"] FitDNA where FitDNA.status in {'final', 'amended', 'corrected', 'preliminary'} and FitDNA.value is not null and Global."Normalize Interval"(FitDNA.effective) occurs 3 years or less on or before day of end of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "CT Colonography Performed": [Procedure: "CT Colonography"] Colonography where Colonography.status = 'completed' and Global."Normalize Interval"(Colonography.performed) ends 5 years or less on or before end of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "Numerator": exists "Colonoscopy Performed" or exists "Fecal Occult Blood Test Performed" or exists "Flexible Sigmoidoscopy Performed" or exists "Fecal Immunochemical Test DNA" or exists "CT Colonography Performed"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "Denominator": true````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "SDE Payer": SDE."SDE Payer"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "Initial Population": Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[50, 75] and exists AdultOutpatientEncounters."Qualifying Encounters"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "SDE Ethnicity": SDE."SDE Ethnicity"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "Malignant Neoplasm Ever": [Condition: "Malignant Neoplasm of Colon"] ColorectalCancer where Global."Normalize Interval"(ColorectalCancer.onset) starts on or before end of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "Total Colectomy Performed": [Procedure: "Total Colectomy"] Colectomy where Colectomy.status = 'completed' and Global."Normalize Interval"(Colectomy.performed) starts on or before end of "Measurement Period"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "Denominator Exclusion": Hospice."Has Hospice" or exists "Malignant Neoplasm Ever" or exists "Total Colectomy Performed"````
* Metadata: Logic Definition
  * ?: **Library Name:**EXM130
* Metadata:  ````define "SDE Race": SDE."SDE Race"````
* Metadata: Logic Definition
  * ?: **Library Name:**MATGlobalCommonFunctions
* Metadata:  ````/* * * CQFMeasures Common Logic * */ define function "Normalize Interval"(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>): case when choice is FHIR.dateTime then Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)] when choice is FHIR.Period then FHIRHelpers.ToInterval(choice as FHIR.Period) when choice is FHIR.instant then Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)] when choice is FHIR.Age then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year) when choice is FHIR.Range then Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low), FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year) when choice is FHIR.Timing then Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute a single interval from a Timing type') when choice is FHIR.string then Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value') else null as Interval<DateTime> end````
* Metadata: Logic Definition
  * ?: **Library Name:**MATGlobalCommonFunctions
* Metadata:  ````define function "CalendarAgeInYearsAt"(BirthDateTime DateTime, AsOf DateTime): years between ToDate(BirthDateTime)and ToDate(AsOf)````
* Metadata: Logic Definition
  * ?: **Library Name:**MATGlobalCommonFunctions
* Metadata:  ````define function "ToDate"(Value DateTime): DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value AdministrativeGender): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ProcedureStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDateTime(value dateTime): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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."start" is null then Interval(period."start".value, period."end".value] else Interval[period."start".value, period."end".value]````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDateTime(value instant): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToDate(value date): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) value to a CQL Quantity @comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity has a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`) an error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used. @seealso: ToCalendarUnit */ define function ToQuantity(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.comparator is not null then Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.') when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @description: Converts a UCUM definite duration unit to a CQL calendar duration unit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) topic of the CQL specification. @comment: Note that for durations above days (or weeks), the conversion is understood to be approximate */ define function ToCalendarUnit(unit System.String): case unit when 'ms' then 'millisecond' when 's' then 'second' when 'min' then 'minute' when 'h' then 'hour' when 'd' then 'day' when 'wk' then 'week' when 'mo' then 'month' when 'a' then 'year' else unit end````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ObservationStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value EncounterStatus): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value uri): value.value````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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 }````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````/* @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 }````
* Metadata: Logic Definition
  * ?: **Library Name:**FHIRHelpers
* Metadata:  ````define function ToString(value ServiceRequestIntent): value.value````
* Metadata:  Terminology
* Metadata: Code System
  * ?: **Description**: Code system SNOMEDCT:2017-09**Resource**:`http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709`**Canonical URL**:http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709
* Metadata: Value Set
  * ?: **Description**: Value set Colonoscopy**Resource**:[Colonoscopy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1020/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020
* Metadata: Value Set
  * ?: **Description**: Value set Fecal Occult Blood Test (FOBT)**Resource**:[Fecal Occult Blood Test (FOBT)](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1011/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011
* Metadata: Value Set
  * ?: **Description**: Value set Flexible Sigmoidoscopy**Resource**:[Flexible Sigmoidoscopy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1010/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010
* Metadata: Value Set
  * ?: **Description**: Value set FIT DNA**Resource**:[sDNA FIT Test](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1039/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039
* Metadata: Value Set
  * ?: **Description**: Value set CT Colonography**Resource**:[CT Colonography](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1038/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038
* Metadata: Value Set
  * ?: **Description**: Value set Payer**Resource**:[Payer Type](https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
* Metadata: Value Set
  * ?: **Description**: Value set Office Visit**Resource**:[Office Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
* Metadata: Value Set
  * ?: **Description**: Value set Annual Wellness Visit**Resource**:[Annual Wellness Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240
* Metadata: Value Set
  * ?: **Description**: Value set Preventive Care Services - Established Office Visit, 18 and Up**Resource**:[Preventive Care Services Established Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
* Metadata: Value Set
  * ?: **Description**: Value set Preventive Care Services-Initial Office Visit, 18 and Up**Resource**:[Preventive Care Services Initial Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
* Metadata: Value Set
  * ?: **Description**: Value set Home Healthcare Services**Resource**:[Home Healthcare Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
* Metadata: Value Set
  * ?: **Description**: Value set Encounter Inpatient**Resource**:[Encounter Inpatient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
* Metadata: Value Set
  * ?: **Description**: Value set Hospice care ambulatory**Resource**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1108.15/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15
* Metadata: Value Set
  * ?: **Description**: Value set Malignant Neoplasm of Colon**Resource**:[Malignant Neoplasm of Colon](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1001/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001
* Metadata: Value Set
  * ?: **Description**: Value set Total Colectomy**Resource**:[Total Colectomy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1019/expansion)**Canonical URL**:http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019
* Metadata: Direct Reference Code
  * ?: **Display**: Discharge to home for hospice care (procedure)**Code**: 428361000124107**System**:http://snomed.info/sct
* Metadata: Direct Reference Code
  * ?: **Display**: Discharge to healthcare facility for hospice care (procedure)**Code**: 428371000124100**System**:http://snomed.info/sct
* Metadata:  Dependencies
* Metadata: Dependency
  * ?: **Description**: FHIR model information**Resource**:[http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1](http://hl7.org/fhir/uv/cql/STU2/Library-FHIR-ModelInfo.html)**Canonical URL**:http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
* Metadata: Dependency
  * ?: **Description**: Library SDE**Resource**:[Supplemental Data Elementsversion: null2.0.000)](Library-SupplementalDataElements.md)**Canonical URL**:http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements|2.0.000
* Metadata: Dependency
  * ?: **Description**: Library FHIRHelpers**Resource**:[http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1](http://hl7.org/fhir/uv/cql/STU2/Library-FHIRHelpers.html)**Canonical URL**:http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
* Metadata: Dependency
  * ?: **Description**: Library Global**Resource**:[MAT Global Common Functions FHIR Libraryversion: null5.0.000)](Library-MATGlobalCommonFunctions.md)**Canonical URL**:http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000
* Metadata: Dependency
  * ?: **Description**: Library AdultOutpatientEncounters**Resource**:[Adult Outpatient Encounters Common Libraryversion: null2.0.000)](Library-AdultOutpatientEncounters.md)**Canonical URL**:http://hl7.org/fhir/uv/cqm/Library/AdultOutpatientEncounters|2.0.000
* Metadata: Dependency
  * ?: **Description**: Library Hospice**Resource**:[Hospice FHIR Libraryversion: null2.0.000)](Library-Hospice.md)**Canonical URL**:http://hl7.org/fhir/uv/cqm/Library/Hospice|2.0.000
* Metadata:  Data Requirements
* Metadata: Data Requirement
  * ?: **Type**: Patient**Profile(s)**:[Patient](http://hl7.org/fhir/R4/patient.html)**Must Support Elements**: url, extension, value
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[Procedure](http://hl7.org/fhir/R4/procedure.html)**Must Support Elements**: code, status, performed**Code Filter(s)**:**Path**: code**ValueSet**:[Colonoscopy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1020/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[Procedure](http://hl7.org/fhir/R4/procedure.html)**Must Support Elements**: code, status, performed**Code Filter(s)**:**Path**: code**ValueSet**:[Flexible Sigmoidoscopy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1010/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[Procedure](http://hl7.org/fhir/R4/procedure.html)**Must Support Elements**: code, status, performed**Code Filter(s)**:**Path**: code**ValueSet**:[CT Colonography](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1038/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[Procedure](http://hl7.org/fhir/R4/procedure.html)**Must Support Elements**: code, status, performed**Code Filter(s)**:**Path**: code**ValueSet**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1108.15/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Procedure**Profile(s)**:[Procedure](http://hl7.org/fhir/R4/procedure.html)**Must Support Elements**: code, status, performed**Code Filter(s)**:**Path**: code**ValueSet**:[Total Colectomy](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1019/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[Observation](http://hl7.org/fhir/R4/observation.html)**Must Support Elements**: code, status, value, effective**Code Filter(s)**:**Path**: code**ValueSet**:[Fecal Occult Blood Test (FOBT)](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.198.12.1011/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Observation**Profile(s)**:[Observation](http://hl7.org/fhir/R4/observation.html)**Must Support Elements**: code, status, value, effective**Code Filter(s)**:**Path**: code**ValueSet**:[sDNA FIT Test](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1039/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Coverage**Profile(s)**:[Coverage](http://hl7.org/fhir/R4/coverage.html)**Must Support Elements**: type, period**Code Filter(s)**:**Path**: type**ValueSet**:[Payer Type](https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, period, status**Code Filter(s)**:**Path**: type**ValueSet**:[Office Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, period, status**Code Filter(s)**:**Path**: type**ValueSet**:[Annual Wellness Visit](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1240/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, period, status**Code Filter(s)**:**Path**: type**ValueSet**:[Preventive Care Services Established Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1025/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, period, status**Code Filter(s)**:**Path**: type**ValueSet**:[Preventive Care Services Initial Office Visit, 18 and Up](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1023/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, period, status**Code Filter(s)**:**Path**: type**ValueSet**:[Home Healthcare Services](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1016/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Encounter**Profile(s)**:[Encounter](http://hl7.org/fhir/R4/encounter.html)**Must Support Elements**: type, status, hospitalization, hospitalization.dischargeDisposition, period**Code Filter(s)**:**Path**: type**ValueSet**:[Encounter Inpatient](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion)
* Metadata: Data Requirement
  * ?: **Type**: ServiceRequest**Profile(s)**:[ServiceRequest](http://hl7.org/fhir/R4/servicerequest.html)**Must Support Elements**: code, intent, authoredOn**Code Filter(s)**:**Path**: code**ValueSet**:[Hospice Care Ambulatory](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1108.15/expansion)
* Metadata: Data Requirement
  * ?: **Type**: Condition**Profile(s)**:[Condition](http://hl7.org/fhir/R4/condition.html)**Must Support Elements**: code, onset**Code Filter(s)**:**Path**: code**ValueSet**:[Malignant Neoplasm of Colon](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.108.12.1001/expansion)
* Metadata:  Parameters
* Metadata: 
  * ?: 
| | | | | |
| :--- | :--- | :--- | :--- | :--- |
| **Name** | **Use** | **Card.** | **Type** | **Documentation** |
| Measurement Period | In | 0..1 | Period |  |
| SDE Sex | Out | 0..1 | Coding |  |
| Numerator | Out | 0..1 | boolean |  |
| Denominator | Out | 0..1 | boolean |  |
| SDE Payer | Out | 0..* | Resource |  |
| Initial Population | Out | 0..1 | boolean |  |
| SDE Ethnicity | Out | 0..* | Coding |  |
| Denominator Exclusion | Out | 0..1 | boolean |  |
| SDE Race | Out | 0..* | Coding |  |

* Metadata: Generated using version 0.5.4 of the sample-content-ig Liquid templates



## Resource Content

```json
{
  "resourceType" : "Measure",
  "id" : "EXM130-FHIR",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-proportionmeasure",
    "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure",
    "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-cqlmeasure",
    "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure"]
  },
  "contained" : [{
    "resourceType" : "Library",
    "id" : "effective-data-requirements",
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "version" : "http://snomed.info/sct/731000124108/version/201709",
        "code" : "428361000124107",
        "display" : "Discharge to home for hospice care (procedure)"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-directReferenceCode",
      "valueCoding" : {
        "system" : "http://snomed.info/sct",
        "version" : "http://snomed.info/sct/731000124108/version/201709",
        "code" : "428371000124100",
        "display" : "Discharge to healthcare facility for hospice care (procedure)"
      }
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Sex"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Sex\":\n  case\n      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }\n      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }\n      else null\n    end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 0
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "SDE Sex"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 1
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "Colonoscopy Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Colonoscopy Performed\":\n\t[Procedure: \"Colonoscopy\"] Colonoscopy\n\t\twhere Colonoscopy.status = 'completed'\n\t\t  and Global.\"Normalize Interval\"(Colonoscopy.performed) ends 10 years or less on or before end of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 2
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "Fecal Occult Blood Test Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Fecal Occult Blood Test Performed\":\n\t[Observation: \"Fecal Occult Blood Test (FOBT)\"] FecalOccultResult\n\t\twhere FecalOccultResult.status in {'final', 'amended', 'corrected', 'preliminary'}\n\t\t\tand FecalOccultResult.value is not null\n\t\t\tand Global.\"Normalize Interval\"(FecalOccultResult.effective) during day of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 3
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "Flexible Sigmoidoscopy Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Flexible Sigmoidoscopy Performed\":\n\t[Procedure: \"Flexible Sigmoidoscopy\"] FlexibleSigmoidoscopy\n\t\twhere FlexibleSigmoidoscopy.status = 'completed'\n\t\t\tand Global.\"Normalize Interval\"(FlexibleSigmoidoscopy.performed) ends 5 years or less on or before end of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 4
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "Fecal Immunochemical Test DNA"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Fecal Immunochemical Test DNA\":\n\t[Observation: \"FIT DNA\"] FitDNA\n\t\twhere FitDNA.status in {'final', 'amended', 'corrected', 'preliminary'}\n\t\t\tand FitDNA.value is not null\n\t\t\tand Global.\"Normalize Interval\"(FitDNA.effective) occurs 3 years or less on or before day of end of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 5
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "CT Colonography Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"CT Colonography Performed\":\n\t[Procedure: \"CT Colonography\"] Colonography\n\t\twhere Colonography.status = 'completed'\n\t\t\tand Global.\"Normalize Interval\"(Colonography.performed) ends 5 years or less on or before end of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 6
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "Numerator"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Numerator\":\n\texists \"Colonoscopy Performed\"\n\t\tor exists \"Fecal Occult Blood Test Performed\"\n\t\tor exists \"Flexible Sigmoidoscopy Performed\"\n\t\tor exists \"Fecal Immunochemical Test DNA\"\n\t\tor exists \"CT Colonography Performed\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 7
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "Denominator"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Denominator\":\n\ttrue"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 8
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Payer"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Payer\":\n  [Coverage: type in \"Payer\"] Payer\n        return {\n          code: Payer.type,\n          period: Payer.period\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 9
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "SDE Payer"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 10
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "AdultOutpatientEncounters"
      },
      {
        "url" : "name",
        "valueString" : "Qualifying Encounters"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Qualifying Encounters\":\n  ([Encounter: \"Office Visit\"]\n    union [Encounter: \"Annual Wellness Visit\"]\n    union [Encounter: \"Preventive Care Services - Established Office Visit, 18 and Up\"]\n    union [Encounter: \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\n    union [Encounter: \"Home Healthcare Services\"]\n  ) ValidEncounter\n    where ValidEncounter.period during \"Measurement Period\"\n      and ValidEncounter.status  = 'finished'"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 11
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "Initial Population"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Initial Population\":\n\tGlobal.\"CalendarAgeInYearsAt\"(FHIRHelpers.ToDate(Patient.birthDate), start of \"Measurement Period\") in Interval[50, 75]\n\t\t\tand exists AdultOutpatientEncounters.\"Qualifying Encounters\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 12
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Ethnicity\":\n  (flatten (\n      Patient.extension Extension\n        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'\n          return Extension.extension\n    )) E\n      where E.url = 'ombCategory'\n        or E.url = 'detailed'\n      return E.value as Coding"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 13
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "SDE Ethnicity"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 14
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "Hospice"
      },
      {
        "url" : "name",
        "valueString" : "Has Hospice"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Has Hospice\":\n\texists (\n    [Encounter: \"Encounter Inpatient\"] DischargeHospice\n\t\t\twhere DischargeHospice.status = 'finished'\n\t\t    and (\n\t        DischargeHospice.hospitalization.dischargeDisposition ~ \"Discharge to home for hospice care (procedure)\"\n\t\t\t\t    or DischargeHospice.hospitalization.dischargeDisposition ~ \"Discharge to healthcare facility for hospice care (procedure)\"\n\t    \t)\n\t\t\t\tand DischargeHospice.period ends during \"Measurement Period\"\n\t)\n    or exists (\n      [ServiceRequest: \"Hospice care ambulatory\"] HospiceOrder\n        where HospiceOrder.intent = 'order'\n            and HospiceOrder.authoredOn in \"Measurement Period\"\n    )\n    or exists (\n      [Procedure: \"Hospice care ambulatory\"] HospicePerformed\n        where HospicePerformed.status = 'completed'\n          and Global.\"Normalize Interval\"(HospicePerformed.performed) overlaps \"Measurement Period\"\n    )"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 15
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "Malignant Neoplasm Ever"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Malignant Neoplasm Ever\":\n\t[Condition: \"Malignant Neoplasm of Colon\"] ColorectalCancer\n\t\twhere Global.\"Normalize Interval\"(ColorectalCancer.onset) starts on or before end of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 16
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "Total Colectomy Performed"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Total Colectomy Performed\":\n\t[Procedure: \"Total Colectomy\"] Colectomy\n\t\twhere Colectomy.status = 'completed'\n\t\t\tand Global.\"Normalize Interval\"(Colectomy.performed) starts on or before end of \"Measurement Period\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 17
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "Denominator Exclusion"
      },
      {
        "url" : "statement",
        "valueString" : "define \"Denominator Exclusion\":\n\tHospice.\"Has Hospice\"\n\t\tor exists \"Malignant Neoplasm Ever\"\n\t\tor exists \"Total Colectomy Performed\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 18
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "SupplementalDataElements"
      },
      {
        "url" : "name",
        "valueString" : "SDE Race"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Race\":\n  (flatten (\n      Patient.extension Extension\n        where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'\n          return Extension.extension\n    )) E\n      where E.url = 'ombCategory'\n        or E.url = 'detailed'\n      return E.value as Coding"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 19
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "EXM130"
      },
      {
        "url" : "name",
        "valueString" : "SDE Race"
      },
      {
        "url" : "statement",
        "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 20
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value AdministrativeGender): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 21
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ProcedureStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 22
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "MATGlobalCommonFunctions"
      },
      {
        "url" : "name",
        "valueString" : "Normalize Interval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n*\n*    CQFMeasures Common Logic\n*\n*/\n\ndefine function \"Normalize Interval\"(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):\n  case\n\t  when choice is FHIR.dateTime then\n    \tInterval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]\n\t\twhen choice is FHIR.Period then\n  \t\tFHIRHelpers.ToInterval(choice as FHIR.Period)\n\t\twhen choice is FHIR.instant then\n\t\t\tInterval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]\n\t\twhen choice is FHIR.Age then\n\t\t  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),\n\t\t\t  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)\n\t\twhen choice is FHIR.Range then\n\t\t  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),\n\t\t\t  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)\n\t\twhen choice is FHIR.Timing then\n\t\t  Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute a single interval from a Timing type')\n    when choice is FHIR.string then\n      Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value')\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 23
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDateTime"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDateTime(value dateTime): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 24
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToInterval"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period.\"start\" is null then\n            Interval(period.\"start\".value, period.\"end\".value]\n        else\n            Interval[period.\"start\".value, period.\"end\".value]"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 25
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDateTime"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDateTime(value instant): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 26
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToDate"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToDate(value date): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 27
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToQuantity"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) \nvalue to a CQL Quantity\n@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity\nhas a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)\nan error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.\n@seealso: ToCalendarUnit\n*/\ndefine function ToQuantity(quantity FHIR.Quantity):\n    case\n        when quantity is null then null\n        when quantity.value is null then null\n        when quantity.comparator is not null then\n            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')\n        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'\n              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then\n            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }\n        else\n            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')\n    end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 28
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToCalendarUnit"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts a UCUM definite duration unit to a CQL calendar duration\nunit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) \ntopic of the CQL specification.\n@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate\n*/\ndefine function ToCalendarUnit(unit System.String):\n    case unit\n        when 'ms' then 'millisecond'\n        when 's' then 'second'\n        when 'min' then 'minute'\n        when 'h' then 'hour'\n        when 'd' then 'day'\n        when 'wk' then 'week'\n        when 'mo' then 'month'\n        when 'a' then 'year'\n        else unit\n    end"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 29
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ObservationStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 30
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "MATGlobalCommonFunctions"
      },
      {
        "url" : "name",
        "valueString" : "CalendarAgeInYearsAt"
      },
      {
        "url" : "statement",
        "valueString" : "define function \"CalendarAgeInYearsAt\"(BirthDateTime DateTime, AsOf DateTime):\n\tyears between ToDate(BirthDateTime)and ToDate(AsOf)"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 31
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "MATGlobalCommonFunctions"
      },
      {
        "url" : "name",
        "valueString" : "ToDate"
      },
      {
        "url" : "statement",
        "valueString" : "define function \"ToDate\"(Value DateTime):\n\tDateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 32
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value EncounterStatus): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 33
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value uri): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 34
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToConcept"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 35
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToCode"
      },
      {
        "url" : "statement",
        "valueString" : "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 36
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [{
        "url" : "libraryName",
        "valueString" : "FHIRHelpers"
      },
      {
        "url" : "name",
        "valueString" : "ToString"
      },
      {
        "url" : "statement",
        "valueString" : "define function ToString(value ServiceRequestIntent): value.value"
      },
      {
        "url" : "displaySequence",
        "valueInteger" : 37
      }],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    }],
    "name" : "EffectiveDataRequirements",
    "status" : "active",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/library-type",
        "code" : "module-definition"
      }]
    },
    "relatedArtifact" : [{
      "type" : "depends-on",
      "display" : "FHIR model information",
      "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1"
    },
    {
      "type" : "depends-on",
      "display" : "Library SDE",
      "resource" : "http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements|2.0.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library FHIRHelpers",
      "resource" : "http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1"
    },
    {
      "type" : "depends-on",
      "display" : "Library Global",
      "resource" : "http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library AdultOutpatientEncounters",
      "resource" : "http://hl7.org/fhir/uv/cqm/Library/AdultOutpatientEncounters|2.0.000"
    },
    {
      "type" : "depends-on",
      "display" : "Library Hospice",
      "resource" : "http://hl7.org/fhir/uv/cqm/Library/Hospice|2.0.000"
    },
    {
      "type" : "depends-on",
      "display" : "Code system SNOMEDCT:2017-09",
      "resource" : "http://snomed.info/sct|http://snomed.info/sct/731000124108/version/201709"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Colonoscopy",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Fecal Occult Blood Test (FOBT)",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Flexible Sigmoidoscopy",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010"
    },
    {
      "type" : "depends-on",
      "display" : "Value set FIT DNA",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039"
    },
    {
      "type" : "depends-on",
      "display" : "Value set CT Colonography",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Payer",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Office Visit",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Annual Wellness Visit",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Preventive Care Services - Established Office Visit, 18 and Up",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Preventive Care Services-Initial Office Visit, 18 and Up",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Home Healthcare Services",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Encounter Inpatient",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Hospice care ambulatory",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Malignant Neoplasm of Colon",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001"
    },
    {
      "type" : "depends-on",
      "display" : "Value set Total Colectomy",
      "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019"
    }],
    "parameter" : [{
      "name" : "Measurement Period",
      "use" : "in",
      "min" : 0,
      "max" : "1",
      "type" : "Period"
    },
    {
      "name" : "SDE Sex",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "Coding"
    },
    {
      "name" : "Numerator",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "Denominator",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "SDE Payer",
      "use" : "out",
      "min" : 0,
      "max" : "*",
      "type" : "Resource"
    },
    {
      "name" : "Initial Population",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "SDE Ethnicity",
      "use" : "out",
      "min" : 0,
      "max" : "*",
      "type" : "Coding"
    },
    {
      "name" : "Denominator Exclusion",
      "use" : "out",
      "min" : 0,
      "max" : "1",
      "type" : "boolean"
    },
    {
      "name" : "SDE Race",
      "use" : "out",
      "min" : 0,
      "max" : "*",
      "type" : "Coding"
    }],
    "dataRequirement" : [{
      "type" : "Patient",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Patient"],
      "mustSupport" : ["url", "extension", "value"]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code", "status", "performed"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020"
      }]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code", "status", "performed"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010"
      }]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code", "status", "performed"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038"
      }]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code", "status", "performed"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"
      }]
    },
    {
      "type" : "Procedure",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Procedure"],
      "mustSupport" : ["code", "status", "performed"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019"
      }]
    },
    {
      "type" : "Observation",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Observation"],
      "mustSupport" : ["code", "status", "value", "effective"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011"
      }]
    },
    {
      "type" : "Observation",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Observation"],
      "mustSupport" : ["code", "status", "value", "effective"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039"
      }]
    },
    {
      "type" : "Coverage",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Coverage"],
      "mustSupport" : ["type", "period"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type", "period", "status"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type", "period", "status"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type", "period", "status"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type", "period", "status"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type", "period", "status"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016"
      }]
    },
    {
      "type" : "Encounter",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Encounter"],
      "mustSupport" : ["type",
      "status",
      "hospitalization",
      "hospitalization.dischargeDisposition",
      "period"],
      "codeFilter" : [{
        "path" : "type",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
      }]
    },
    {
      "type" : "ServiceRequest",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/ServiceRequest"],
      "mustSupport" : ["code", "intent", "authoredOn"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15"
      }]
    },
    {
      "type" : "Condition",
      "profile" : ["http://hl7.org/fhir/StructureDefinition/Condition"],
      "mustSupport" : ["code", "onset"],
      "codeFilter" : [{
        "path" : "code",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001"
      }]
    }]
  }],
  "extension" : [{
    "url" : "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis",
    "valueCode" : "boolean"
  },
  {
    "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
    "valueReference" : {
      "reference" : "Device/software-system-example"
    }
  },
  {
    "url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
    "valueCanonical" : "#effective-data-requirements"
  }],
  "url" : "http://hl7.org/fhir/uv/cqm/Measure/EXM130-FHIR",
  "identifier" : [{
    "use" : "official",
    "system" : "http://example.org/fhir/cqi/ecqm/Measure/Identifier/cms",
    "value" : "130"
  },
  {
    "use" : "official",
    "system" : "http://example.org/fhir/cqi/ecqm/Measure/Identifier/nqf",
    "value" : "0034"
  },
  {
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.61.29.6"
  }],
  "version" : "8.0.000",
  "name" : "EXM130",
  "title" : "EXM130 - Colorectal Cancer Screening Measure",
  "status" : "active",
  "experimental" : true,
  "date" : "2025-08-13",
  "publisher" : "HL7 International / Clinical Quality Information",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cqi"
    }]
  }],
  "description" : "Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer",
  "useContext" : [{
    "code" : {
      "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code" : "venue",
      "display" : "Clinical Venue"
    },
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes",
        "code" : "ec",
        "display" : "EC"
      }]
    }
  }],
  "jurisdiction" : [{
    "coding" : [{
      "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
      "code" : "001"
    }]
  }],
  "purpose" : "This measure has been developed to support improvement in clinical care.",
  "copyright" : "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" : "2016-01-01",
  "lastReviewDate" : "2016-09-01",
  "effectivePeriod" : {
    "start" : "2018-01-01",
    "end" : "2018-12-31"
  },
  "topic" : [{
    "coding" : [{
      "system" : "http://loinc.org",
      "code" : "57024-2",
      "display" : "Health Quality Measure Document"
    }]
  }],
  "library" : ["http://hl7.org/fhir/uv/cqm/Library/EXM130"],
  "disclaimer" : "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 \"AS IS\" 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" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
      "code" : "proportion",
      "display" : "Proportion"
    }]
  },
  "type" : [{
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
      "code" : "process"
    }]
  }],
  "rationale" : "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" : "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" : "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
      "code" : "increase",
      "display" : "Increased score indicates improvement"
    }]
  },
  "guidance" : "Patient self-report for procedures as well as diagnostic studies should be recorded in \"Procedure, Performed\" template or \"Diagnostic Study, Performed\" 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" : "primary"
    }],
    "population" : [{
      "extension" : [{
        "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
        "valueString" : "primary-exm130-initial-population"
      }],
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "initial-population",
          "display" : "Initial Population"
        }]
      },
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Initial Population"
      }
    },
    {
      "extension" : [{
        "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
        "valueString" : "primary-exm130-numerator"
      }],
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "numerator",
          "display" : "Numerator"
        }]
      },
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Numerator"
      }
    },
    {
      "extension" : [{
        "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
        "valueString" : "primary-exm130-denominator"
      }],
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "denominator",
          "display" : "Denominator"
        }]
      },
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Denominator"
      }
    },
    {
      "extension" : [{
        "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
        "valueString" : "primary-exm130-denominator-exclusion"
      }],
      "code" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
          "code" : "denominator-exclusion",
          "display" : "Denominator Exclusion"
        }]
      },
      "criteria" : {
        "language" : "text/cql-identifier",
        "expression" : "Denominator Exclusion"
      }
    }]
  }],
  "supplementalData" : [{
    "extension" : [{
      "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
      "valueString" : "primary-sde-ethnicity"
    }],
    "usage" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    }],
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Ethnicity"
    }
  },
  {
    "extension" : [{
      "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
      "valueString" : "primary-sde-epayer"
    }],
    "usage" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    }],
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Payer"
    }
  },
  {
    "extension" : [{
      "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
      "valueString" : "primary-sde-race"
    }],
    "usage" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    }],
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Race"
    }
  },
  {
    "extension" : [{
      "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
      "valueString" : "primary-sde-sex"
    }],
    "usage" : [{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
        "code" : "supplemental-data"
      }]
    }],
    "criteria" : {
      "language" : "text/cql-identifier",
      "expression" : "SDE Sex"
    }
  }]
}

```
