During analysis of CQLIT-479 re Labor timing element for Elective Delivery, an issue was noted when entering test case data element for "LastEstimatedGestationalAge" as a quantity.  Test cases in Bonnie could enter 38 'weeks' but in MADiE QDM validation will not accept 'weeks' since is not UCUM.  Measure reporter MBreth@jointcommission.org could not be added as a watcher, please add as watcher and contact if more detail is needed..

Impact: Test cases imported from Bonnie QDM may contain 'weeks' but those cases cannot be manually entered in MADiE. Quantity results for Estimated Gestational Age do not meet logic criteria.

Validation error message noted during test case entry:
"weeks is not a valid UCUM code. We found possible units that might be what was meant:: wk, /wk, mg/wk,"

Snippet from ElectiveDelivery v13.0.0:
```
define "Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks and Less than 39 Weeks":
  PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter
    where PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ) is null
      and ( PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter ) >= 37 weeks
          and PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter ) < 39 weeks
      )
```
Snippet from ElectiveDelivery v13.0.0:
```
define function "LastEstimatedGestationalAge"(Encounter "Encounter, Performed" ):
  Last(["Assessment, Performed": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
      let EGATiming: Global."EarliestOf"(EstimatedGestationalAge.relevantDatetime, EstimatedGestationalAge.relevantPeriod)
      where(EGATiming 24 hours or less before or on "LastTimeOfDelivery"(Encounter)
          and EstimatedGestationalAge.result is not null
      )
        or(EGATiming same day as "LastTimeOfDelivery"(Encounter)
            and EGATiming during "HospitalizationWithEDOBTriageObservation"(Encounter)
            and EstimatedGestationalAge.result is not null
        )
      sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
  ).result as Quantity
```

This issue was discussed today in FHIRside Chat with Bryn, Yan, Floyd and Jen:
Bryn indicated that CQL weeks is appropriate for calendar unit timing and that QDM does not specify UCUM as required.
Bryn pointed out that QICore/FHIR utilize FHIRHelpers ToCalendarUnit() to convert 'wk' to 'weeks'.
Yan indicated that Receiving systems have been accepting 'weeks' for the maternal measures in QDM.
Bryn recommended that the UCUM validation constraint be eased for the case of 'weeks' vs 'wk' in MADiE.

Thank you
PMuir MD   eCQM Standards Team