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

## Library: BCS Component Library

Official URL: http://hl7.org/fhir/uv/cqm/Library/BCSComponent | Version: 0.0.001 | Highlight text changes?
Standards status: Trial-use Draft as of 2026-04-07 | Maturity Level: 4 | Computable Name: BCSComponent
Other Identifiers: OID:2.16.840.1.113883.4.642.40.61.28.4

This library is the primary measure library for the Breast Cancer Screening component of the composite measure examples in this implementation guide.

Metadata
Title | BCS Component Library
Version | 0.0.001
Identifier | urn:oid:2.16.840.1.113883.4.642.40.61.28.4
Status | Draft
Jurisdiction | 001 from http://unstats.un.org/unsd/methods/m49/m49.htm
Steward (Publisher) | HL7 International / Clinical Quality Information
Description | This library is the primary measure library for the Breast Cancer Screening component of the composite measure examples in this implementation guide.
Type | logic-library from http://terminology.hl7.org/CodeSystem/library-type
Dependency | Description: Library FHIRHelpers Resource: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1 Canonical URL: `http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1`
Dependency | Description: Library SDE Resource: Supplemental Data Elementsversion: null2.0.000) Canonical URL: `http://hl7.org/fhir/uv/cqm/Library/SupplementalDataElements|2.0.000`
Dependency | Description: Library Global Resource: MAT Global Common Functions FHIR Libraryversion: null5.0.000) Canonical URL: `http://hl7.org/fhir/uv/cqm/Library/MATGlobalCommonFunctions|5.0.000`
Dependency | Description: Library AdultOutpatientEncounters Resource: Adult Outpatient Encounters Common Libraryversion: null2.0.000) Canonical URL: `http://hl7.org/fhir/uv/cqm/Library/AdultOutpatientEncounters|2.0.000`
Dependency | Description: Library Hospice Resource: Hospice FHIR Libraryversion: null2.0.000) Canonical URL: `http://hl7.org/fhir/uv/cqm/Library/Hospice|2.0.000`
Dependency | Description: Library Frailty Resource: Advanced Illness and Frailty Exclusion Libraryversion: null5.12.000) Canonical URL: `http://hl7.org/fhir/uv/cqm/Library/AdvancedIllnessandFrailtyExclusion|5.12.000`
Dependency | Description: Code System LOINC Resource: Logical Observation Identifiers, Names and Codes (LOINC) Canonical URL: `http://loinc.org`
Dependency | Description: Code System SNOMEDCT Resource: SNOMED CT (all versions) Canonical URL: `http://snomed.info/sct`
Dependency | Description: Value Set Bilateral Mastectomy Resource: Bilateral Mastectomy Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005`
Dependency | Description: Value Set Ethnicity Resource: Ethnicity Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.837`
Dependency | Description: Value Set Female Resource: Female Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.560.100.2`
Dependency | Description: Value Set History of bilateral mastectomy Resource: History of bilateral mastectomy Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068`
Dependency | Description: Value Set Left Resource: Left Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1036`
Dependency | Description: Value Set Mammography Resource: Mammography Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018`
Dependency | Description: Value Set ONC Administrative Sex Resource: ONC Administrative Sex Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1`
Dependency | Description: Value Set Payer Resource: Payer Type Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591`
Dependency | Description: Value Set Race Resource: Race Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.836`
Dependency | Description: Value Set Right Resource: Right Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1035`
Dependency | Description: Value Set Status Post Left Mastectomy Resource: Status Post Left Mastectomy Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069`
Dependency | Description: Value Set Status Post Right Mastectomy Resource: Status Post Right Mastectomy Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070`
Dependency | Description: Value Set Unilateral Mastectomy Left Resource: Unilateral Mastectomy Left Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1133`
Dependency | Description: Value Set Unilateral Mastectomy Right Resource: Unilateral Mastectomy Right Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1134`
Dependency | Description: Value Set Unilateral Mastectomy, Unspecified Laterality Resource: Unilateral Mastectomy, Unspecified Laterality Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071`
Data Requirement | Type: Condition Profile(s): Condition Code Filter(s): Path: code ValueSet: Status Post Right Mastectomy
Data Requirement | Type: Procedure Profile(s): Procedure Code Filter(s): Path: code ValueSet: Unilateral Mastectomy Right
Data Requirement | Type: Procedure Profile(s): Procedure Code Filter(s): Path: code ValueSet: Unilateral Mastectomy Left
Data Requirement | Type: Condition Profile(s): Condition Code Filter(s): Path: code ValueSet: History of bilateral mastectomy
Data Requirement | Type: Procedure Profile(s): Procedure Code Filter(s): Path: code ValueSet: Bilateral Mastectomy
Data Requirement | Type: DiagnosticReport Profile(s): DiagnosticReport Code Filter(s): Path: code ValueSet: Mammography
Data Requirement | Type: Condition Profile(s): Condition Code Filter(s): Path: code ValueSet: Status Post Left Mastectomy
Data Requirement | Type: Condition Profile(s): Condition Code Filter(s): Path: code ValueSet: Unilateral Mastectomy, Unspecified Laterality
Parameters
Name | Use | Card. | Type | Documentation
Measurement Period | In | 0..1 | Period |
Patient | Out | 0..1 | Patient |
SDE Ethnicity | Out | 0..* | Coding |
SDE Payer | Out | 0..* | Resource |
SDE Race | Out | 0..* | Coding |
SDE Sex | Out | 0..1 | Coding |
Initial Population | Out | 0..1 | boolean |
Denominator | Out | 0..1 | boolean |
Right Mastectomy Diagnosis | Out | 0..* | Condition |
Right Mastectomy Procedure | Out | 0..* | Procedure |
Left Mastectomy Procedure | Out | 0..* | Procedure |
Bilateral Mastectomy Diagnosis | Out | 0..* | Condition |
Bilateral Mastectomy Procedure | Out | 0..* | Procedure |
Numerator | Out | 0..1 | boolean |
Left Mastectomy | Out | 0..* | Condition |
Denominator Exclusion | Out | 0..1 | boolean |
Library Content
CQL Content |
    /*
    This example is a work in progress and should not be considered a final specification
    or recommendation for guidance. This example will help guide and direct the process
    of finding conventions and usage patterns that meet the needs of the various stakeholders
    in the measure development community.
    */
    library BCSComponent version '0.0.001'

    using FHIR version '4.0.1'

    include hl7.fhir.uv.cql.FHIRHelpers version '4.0.1' called FHIRHelpers

    include SupplementalDataElements version '2.0.000' called SDE
    include MATGlobalCommonFunctions version '5.0.000' called Global
    include AdultOutpatientEncounters version '2.0.000' called AdultOutpatientEncounters
    include Hospice version '2.0.000' called Hospice
    include AdvancedIllnessandFrailtyExclusion version '5.12.000' called Frailty

    codesystem "LOINC": 'http://loinc.org'
    codesystem "SNOMEDCT": 'http://snomed.info/sct'

    valueset "Bilateral Mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005'
    valueset "Ethnicity": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.837'
    valueset "Female": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.560.100.2'
    valueset "History of bilateral mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068'
    valueset "Left": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1036'
    valueset "Mammography": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018'
    valueset "ONC Administrative Sex": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1'
    valueset "Payer": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'
    valueset "Race": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.836'
    valueset "Right": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.122.12.1035'
    valueset "Status Post Left Mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069'
    valueset "Status Post Right Mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070'
    valueset "Unilateral Mastectomy Left": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1133'
    valueset "Unilateral Mastectomy Right": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1134'
    valueset "Unilateral Mastectomy, Unspecified Laterality": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071'

    code "Birth date": '21112-8' from "LOINC" display 'Birth date'
    code "Left (qualifier value)": '7771000' from "SNOMEDCT" display 'Left (qualifier value)'
    code "Right (qualifier value)": '24028007' from "SNOMEDCT" display 'Right (qualifier value)'

    parameter "Measurement Period" Interval<DateTime>

    context Patient

    define "SDE Ethnicity":
      SDE."SDE Ethnicity"

    define "SDE Payer":
      SDE."SDE Payer"

    define "SDE Race":
      SDE."SDE Race"

    define "SDE Sex":
      SDE."SDE Sex"

    define "Initial Population":
      Patient.gender = 'female'
          and Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[51, 74 )
          and exists AdultOutpatientEncounters."Qualifying Encounters"

    define "Denominator":
      "Initial Population"

    define "Right Mastectomy Diagnosis":
      ( ( [Condition: "Status Post Right Mastectomy"] )
          union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis
              where UnilateralMastectomyDiagnosis.bodySite in "Right"
          ) ) RightMastectomy
          where Global."Normalize Interval" ( RightMastectomy.onset ) starts on or before
          end of "Measurement Period"

    define "Right Mastectomy Procedure":
      [Procedure: "Unilateral Mastectomy Right"] UnilateralMastectomyRightPerformed
          where Global."Normalize Interval" ( UnilateralMastectomyRightPerformed.performed ) ends on or before
          end of "Measurement Period"
            and UnilateralMastectomyRightPerformed.status = 'completed'

    define "Left Mastectomy Procedure":
      [Procedure: "Unilateral Mastectomy Left"] UnilateralMastectomyLeftPerformed
          where Global."Normalize Interval" ( UnilateralMastectomyLeftPerformed.performed ) ends on or before
          end of "Measurement Period"
            and UnilateralMastectomyLeftPerformed.status = 'completed'

    define "Bilateral Mastectomy Diagnosis":
      [Condition: "History of bilateral mastectomy"] BilateralMastectomyHistory
          where Global."Normalize Interval" ( BilateralMastectomyHistory.onset ) starts on or before
          end of "Measurement Period"

    define "Bilateral Mastectomy Procedure":
      [Procedure: "Bilateral Mastectomy"] BilateralMastectomyPerformed
          where Global."Normalize Interval" ( BilateralMastectomyPerformed.performed ) ends on or before
          end of "Measurement Period"
            and BilateralMastectomyPerformed.status = 'completed'

    define "Numerator":
      exists ( [DiagnosticReport: "Mammography"] Mammogram
            where ( Global."Normalize Interval" ( Mammogram.effective ) ends 27 months or less on or before
              end of "Measurement Period"
            )
              and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' }
        )

    define "Denominator Exclusion":
      Hospice."Has Hospice"
          or ( ( exists "Right Mastectomy Diagnosis"
                or exists "Right Mastectomy Procedure"
            )
              and ( exists "Left Mastectomy"
                  or exists "Left Mastectomy Procedure"
              )
          )
          or exists "Bilateral Mastectomy Diagnosis"
          or exists "Bilateral Mastectomy Procedure"
          or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"
          or ( Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) >= 65
              and Frailty."Long Term Care Periods Longer Than 90 Consecutive Days"
          )

    define "Left Mastectomy":
      ( ( [Condition: "Status Post Left Mastectomy"] )
          union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis
              where UnilateralMastectomyDiagnosis.bodySite in "Left"
          ) ) LeftMastectomy
          where Global."Normalize Interval" ( LeftMastectomy.onset ) starts on or before
          end of "Measurement Period"
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