Brief Description of Measure: CMS117: Childhood Immunization Status Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three or four H influenza type B (Hib); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday Description of Issue: The measure specification lists the following HiB criteria: • HiB    Children with either of the following meet criteria on or before the child’s second birthday:        - At least three HiB vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days          after birth. The measure steward received feedback that the current measure logic is not accounting for extreme edge cases, such as HiB vaccines starting on the same date and ending on different dates. Though these scenarios are not common, the measure steward proposes updating the logic to ensure that the three HiB vaccines are on different dates of service to account for these extreme edge cases. This logic update would align with the measure header specification.

Proposed Solution: //The proposed change will be applied to similar definitions in CMS117 as needed. This includes using Procedure relevantDatetime or start of relevantPeriod, or Immunization relevantDatetime for timing comparisons. This also includes using either "day of" or "date from" as appropriate.// //Numerator Logic definitions before:// define "Has Appropriate Number of Hib Immunizations":   exists ( "All Hib Vaccinations" HibImmunization //union of 3 and 4 dose immunizations //4 dose test     let HasFourDose: Count("Hib 4 Dose Immunizations or Procedures")> 0     where ( HasFourDose //if pt had at least one 4 dose code         and Count(distinct("All Hib Vaccinations" HibVaccinations               return Global."NormalizeInterval"(HibVaccinations.relevantDatetime, HibVaccinations.relevantPeriod)           )         )>= 4 //pt must have 4 regimens (e.g., 3,3,4,4 or 4,3,4,4)     )       or ( HasFourDose is false //if pt did not have at least one 4 dose code           and Count(distinct("All Hib Vaccinations" HibVaccinations                 return Global."NormalizeInterval"(HibVaccinations.relevantDatetime, HibVaccinations.relevantPeriod)             )           )>= 3 //pt must have 3 regimens of 3 dose codes       ) ) define "All Hib Vaccinations": "Hib 3 or 4 Dose Immunizations" AllHibDoses1   without "Hib 3 or 4 Dose Immunizations" AllHibDoses2     such that Global."NormalizeInterval" ( AllHibDoses1.relevantDatetime, AllHibDoses1.relevantPeriod ) less than 1 day before Global."NormalizeInterval" ( AllHibDoses2.relevantDatetime, AllHibDoses2.relevantPeriod ) define "Hib 3 Dose Immunizations or Procedures": ( ( ["Immunization, Administered": "Hib Vaccine (3 dose schedule)"]     union ["Procedure, Performed": "Hib Vaccine (3 dose schedule) Administered"] ) ThreeDoseHib     where Global."ToDateInterval" ( Global."NormalizeInterval" ( ThreeDoseHib.relevantDatetime, ThreeDoseHib.relevantPeriod ) ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old" ) define "Hib 4 Dose Immunizations or Procedures": ( ( ["Immunization, Administered": "Hib Vaccine (4 dose schedule)"]     union ["Procedure, Performed": "Hib Vaccine (4 dose schedule) Administered"] ) FourDoseHib     where Global."ToDateInterval" ( Global."NormalizeInterval" ( FourDoseHib.relevantDatetime, FourDoseHib.relevantPeriod ) ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old" ) //Numerator Logic definitions after// define "Has Appropriate Number of Hib Immunizations":   exists ( "All Hib Vaccinations" HibImmunization //union of 3 and 4 dose immunizations //4 dose test     let HasFourDose: Count("Hib 4 Dose Immunizations or Procedures")> 0     where ( HasFourDose //if pt had at least one 4 dose code         and Count(distinct("All Hib Vaccinations" HibVaccinations               return date from start of Global."NormalizeInterval"(HibVaccinations.relevantDatetime, HibVaccinations.relevantPeriod)           )         )>= 4 //pt must have 4 regimens (e.g., 3,3,4,4 or 4,3,4,4)     )       or ( HasFourDose is false //if pt did not have at least one 4 dose code           and Count(distinct("All Hib Vaccinations" HibVaccinations                 return date from start of Global."NormalizeInterval"(HibVaccinations.relevantDatetime, HibVaccinations.relevantPeriod)             )           )>= 3 //pt must have 3 regimens of 3 dose codes       ) ) define "All Hib Vaccinations": "Hib 3 or 4 Dose Immunizations" AllHibDoses1   without "Hib 3 or 4 Dose Immunizations" AllHibDoses2     such that date from start of Global."NormalizeInterval" ( AllHibDoses1.relevantDatetime, AllHibDoses1.relevantPeriod ) less than 1 day before date from start of Global."NormalizeInterval" ( AllHibDoses2.relevantDatetime, AllHibDoses2.relevantPeriod ) define "Hib 3 Dose Immunizations or Procedures":   ( ( ["Immunization, Administered": "Hib Vaccine (3 dose schedule)"]       union ["Procedure, Performed": "Hib Vaccine (3 dose schedule) Administered"] ) ThreeDoseHib       where date from start of Global."ToDateInterval" ( Global."NormalizeInterval" ( ThreeDoseHib.relevantDatetime, ThreeDoseHib.relevantPeriod ) ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"   ) define "Hib 4 Dose Immunizations or Procedures":   ( ( ["Immunization, Administered": "Hib Vaccine (4 dose schedule)"]       union ["Procedure, Performed": "Hib Vaccine (4 dose schedule) Administered"] ) FourDoseHib       where date from start of Global."ToDateInterval" ( Global."NormalizeInterval" ( FourDoseHib.relevantDatetime, FourDoseHib.relevantPeriod ) ) during day of "Vaccine Administration Interval - 42 Days up to 2 Years Old"   ) Rationale for Change: The proposed solution would ensure appropriate capture of three HiB vaccines on different dates, accounting for HiB vaccines starting on the same date and ending on different dates.