Metadata
Title | Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency DepartmentFHIR
Version | 2.0.000
Short Name | CMS996FHIR
GUID (Version Independent) | urn:uuid:a48685e0-4926-4ae8-9eb3-d8e8839b1704
GUID (Version Specific) | urn:uuid:f9d64706-199e-476e-b39b-9670e9dce6b8
CMS Identifier | 996FHIR
CMS Consensus Based Entity Identifier | 3613e
Effective Period | 2026-01-01 through 2026-12-31
Steward (Publisher) | Centers for Medicare & Medicaid Services (CMS)
Developer | Acumen, LLC
Description | Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or discharge to an acute care facility within 45 minutes of ED arrival
Copyright | Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. CPT(R) contained in the measure specifications is copyright 2004-2024 American Medical Association. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.
Disclaimer | These performance specifications are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES 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].
Rationale | Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Solhpour & Yusuf, 2013; Fibrinolytic Therapy Trialists’ Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an dQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the dQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported.
Clinical Recommendation Statement | Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration." "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact." Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) clinical practice guideline for the management of STEMI recommends that: "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.” Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset. Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.
Citation | Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. (1994). Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. The Lancet, 343(8893):311-22.
Citation | O’Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, Menon V, O’Neil BJ, Travers AH, Yannapoulos D. (2010) Part 10: Acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122(suppl 3): S787-S817. DOI: 10.1161/CIRCULATIONAHA.110.971028.
Citation | O'Gara P, Kushner F, Ascheim D, Casey D, Chung M, de Lemos J, Ettinger S, Fang J, Fesmire F, Franklin B, Granger C, Krumholz H, Linderbaum J, Morrow D, Newby L, Ornato J, Ou N, Radford M, Tamis-Holland J, Tommaso C, Tracy C, Woo Y, Zhao D, Anderson J, Jacobs A, Halperin J, Albert N, Brindis R, Creager M, DeMets D, Guyton R, Hochman J, Kovacs R, Kushner F, Ohman E, Stevenson W, Yancy C. (2013). 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 127(4): e362-425.
Citation | Sohlpour A, Yusuf SW. (2014). Fibrinolytic therapy in patients with ST-elevation myocardial infarction. Expert Rev. Cardiovasc. Early online, 1-15.
Guidance (Usage) | In order to support the best outcomes for patients and align with other guidelines, PCI device deployment time should be used for calculating the “PCI is performed within 90 minutes of ED arrival” numerator criteria and not the start time of the procedure. This dQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This FHIR-based measure has been derived from the QDM-based measure: CMS996v6. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
Measure Group (Rate) (ID: Group_1)
Basis | Encounter
Scoring | [http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion']
Type | [http://terminology.hl7.org/CodeSystem/measure-type#process: 'Process']
Rate Aggregation | None
Improvement Notation | [http://terminology.hl7.org/CodeSystem/measure-improvement-notation#increase: 'Increased score indicates improvement']
Initial Population | ID: InitialPopulation_1 Description: All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period Criteria: Initial Population
Denominator | ID: Denominator_1 Description: Equals Initial Population Criteria: Denominator
Denominator Exclusion | ID: DenominatorExclusion_1 Description: Patients with the following conditions are excluded from measure denominator: At some point during ED encounter: Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Starts before the start of ED encounter and does not end before ED encounter: Bleeding or bleeding diathesis (excluding menses) Known malignant intracranial neoplasm (primary or metastatic) Known structural cerebral vascular lesion (e.g., arteriovenous malformation) Advanced dementia Pregnancy Diagnosis of allergy to thrombolytics At the start of ED encounter or within 90 days or less of ED encounter: -Active oral anticoagulant therapy Occurs 24 hours or less before start of ED encounter or during ED encounter: Aortic dissection or ruptured aortic aneurysm, Angina pectoris with documented spasm, Aneurysm of heart, Ventricular aneurysm due to and following acute myocardial infarction, Takotsubo cardiomyopathy or syndrome Severe neurologic impairment Mechanical circulatory assist device placement or removal, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Occurs 21 days or less before start of ED encounter or starts during ED encounter: Major surgery Occurs within 90 days before start of or at start of ED encounter: Ischemic stroke Significant facial and/or closed head trauma Peptic ulcer Occurs 90 days or less before start of ED encounter: Intracranial or intraspinal surgery With a discharge disposition of patient expired in the ED With a discharge disposition of left against medical advice With documentation of hospice services in the 6 months within start of ED encounter, or active hospice status at start of ED encounter Criteria: Denominator Exclusions
Numerator | ID: Numerator_1 Description: Emergency department encounters with a diagnosis of STEMI: where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR where PCI is performed within 90 minutes of arrival; OR where the patient is discharged to an acute care facility within 45 minutes of ED arrival Criteria: Numerator
Denominator Exception | ID: DenominatorException_1 Description: Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours. Emergency department encounters with a documented reason for not administering fibrinolytic therapy within 30 minutes of ED arrival. Emergency department encounters with a documented reason for not performing a PCI within 90 minutes of ED arrival. Criteria: Denominator Exceptions
Supplemental Data Guidance | For every patient evaluated by this measure also identify payer, race, ethnicity and sex
Supplemental Data Elements
Supplemental Data Element | ID: sde-ethnicity Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Ethnicity Logic Definition: SDE Ethnicity
Supplemental Data Element | ID: sde-payer Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Payer Logic Definition: SDE Payer
Supplemental Data Element | ID: sde-race Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Race Logic Definition: SDE Race
Supplemental Data Element | ID: sde-sex Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Sex Logic Definition: SDE Sex
Measure Logic
Primary Library | https://madie.cms.gov/Library/CMS996FHIRAptTxforSTEMI
Contents | Population Criteria Logic Definitions Terminology Dependencies Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population
    define "Initial Population":
      "ED Encounter with STEMI Diagnosis"
Definition
Denominator
    define "Denominator":
      "Initial Population"
Definition
Denominator Exclusion
    define "Denominator Exclusions":
      "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
        union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
        union "Active Exclusion Diagnosis at Start of ED Encounter"
        union "Active use of Anticoagulants"
        union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
        union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"
        union "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
        union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
        union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
        union "ED Encounter with Discharge Disposition as Patient Expired"
        union "ED Encounter with Discharge Disposition as Left Against Medical Advice"
        union "ED Encounter with Hospice Services"
        union "Currently Pregnant"
Definition
Numerator
    define "Numerator":
      "Fibrinolytic Therapy Administration within 30 Minutes of Arrival"
        union "PCI within 90 Minutes of Arrival"
        union "ED Departure with Discharge to Acute Care Facility Within 45 Minutes Of Arrival"
Definition
Denominator Exception
    define "Denominator Exceptions":
      "Received tPA in Another Facility within 24 hours Prior to Admission"
        union "ED Encounter with a Documented Reason for No PCI Performed"
        union "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy"
Definition
Logic Definitions
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Sex":
      case
        when Patient.sex = '248153007' then "Male (finding)"
        when Patient.sex = '248152002' then "Female (finding)"
        else null
      end
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Payer":
      [Coverage: type in "Payer Type"] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Ethnicity":
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Race":
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }
Logic Definition | Library Name: FHIRHelpers
    define function ToString(value uri): value.value
Logic Definition | Library Name: FHIRHelpers
    /*
    @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
            }
Logic Definition | Library Name: FHIRHelpers
    /*
    @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
            }
Logic Definition | Library Name: FHIRHelpers
    /*
    @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]
Logic Definition | Library Name: CQMCommon
    /*
    @description: Returns the Condition resources referenced by the diagnosis element of the Encounter
    */
    define fluent function encounterDiagnosis(Encounter Encounter ):
      Encounter.reasonReference D
        return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))
Logic Definition | Library Name: CQMCommon
    /*
    @description: Returns the Location resource specified by the given reference.
    */
    define fluent function getLocation(reference Reference):
      singleton from (
        [Location] L where reference.references(L)
      )
Logic Definition | Library Name: QICoreCommon
    /*
    @description: Returns true if the given reference is to the given resourceId
    @comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.
    NOTE: This function assumes resources from the same source server.
    */
    define fluent function references(reference Reference, resourceId String):
      resourceId = Last(Split(reference.reference, '/'))
Logic Definition | Library Name: QICoreCommon
    /*
    @description: Returns true if the given reference is to the given resource
    @comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
    NOTE: This function assumes resources from the same source server.
    */
    define fluent function references(reference Reference, resource Resource):
      resource.id = Last(Split(reference.reference, '/'))
Logic Definition | Library Name: QICoreCommon
    /*
    @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
    @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
    to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
    representations for timing-valued elements in QICore, allowing this function to be used across any resource.
    The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
    The intent of this function is to provide a clear and concise mechanism to treat single
    elements that have multiple possible representations as intervals so that logic doesn't have to account
    for the variability. More complex calculations (such as medication request period or dispense period
    calculation) need specific guidance and consideration. That guidance may make use of this function, but
    the focus of this function is on single element calculations where the semantics are unambiguous.
    If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
    If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
    and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
    If the input is a DateTime Interval, the result is the input.
    If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
    is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
    immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
    If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
    */
    define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
      case
    	  when choice is DateTime then
        	Interval[choice as DateTime, choice as DateTime]
    		when choice is Interval<DateTime> then
      		choice as Interval<DateTime>
    		when choice is Quantity then
    		  Interval[Patient.birthDate + (choice as Quantity),
    			  Patient.birthDate + (choice as Quantity) + 1 year)
    		when choice is Interval<Quantity> then
    		  Interval[Patient.birthDate + (choice.low as Quantity),
    			  Patient.birthDate + (choice.high as Quantity) + 1 year)
    		when choice is Timing then
          Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
    		else
    			null as Interval<DateTime>
    	end
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "SDE Sex":
      SDE."SDE Sex"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "ED Encounter During MP":
      ["Encounter": class ~ "EMER"] EDEncounter
        where EDEncounter.type in "Emergency Department Evaluation and Management Visit"
          and EDEncounter.period ends during day of "Measurement Period"
          and EDEncounter.status = 'finished'
          and AgeInYearsAt(date from start of(EDEncounter.period)) >= 18
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "ED Encounter with STEMI Diagnosis":
      "ED Encounter During MP" EDEncounterinMP
        where ( EDEncounterinMP.reasonCode in "STEMI"
            or exists ( ( ( [ConditionProblemsHealthConcerns: "STEMI"]
                  union [ConditionEncounterDiagnosis: "STEMI"]
              ).verified ( ) ) DxSTEMI
                where ( EDEncounterinMP.encounterDiagnosis ( ).code in "STEMI"
                    or ( DxSTEMI.prevalenceInterval ( ) starts during EDEncounterinMP.period )
                )
            )
        )
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Fibrinolytic Therapy Administration within 30 Minutes of Arrival":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ["MedicationAdministration": "Fibrinolytic Therapy"] Fibrinolytic
          such that Fibrinolytic.status = 'completed'
            and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "PCI within 90 Minutes of Arrival":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ["Procedure": "Percutaneous Coronary Intervention"] PCI
          such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
            and PCI.status = 'completed'
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "ED Departure with Discharge to Acute Care Facility Within 45 Minutes Of Arrival":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        where EDwithSTEMI.currentemergencyDepartmentDepartTime ( ) 45 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
          and EDwithSTEMI.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Numerator":
      "Fibrinolytic Therapy Administration within 30 Minutes of Arrival"
        union "PCI within 90 Minutes of Arrival"
        union "ED Departure with Discharge to Acute Care Facility Within 45 Minutes Of Arrival"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Initial Population":
      "ED Encounter with STEMI Diagnosis"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Denominator":
      "Initial Population"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "SDE Payer":
      SDE."SDE Payer"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "SDE Ethnicity":
      SDE."SDE Ethnicity"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
        with ["AllergyIntolerance": "Thrombolytic medications"] ThrombolyticAllergy
          such that ThrombolyticAllergy.clinicalStatus ~ QICoreCommon."allergy-active"
            and ( ThrombolyticAllergy.verificationStatus is not null implies ( ThrombolyticAllergy.verificationStatus ~ QICoreCommon."allergy-confirmed"
                  or ThrombolyticAllergy.verificationStatus ~ QICoreCommon."allergy-unconfirmed"
              )
            )
            and ( ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.period )
                or ThrombolyticAllergy.onset before end EDwSTEMI.period
            )
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
        with [AdverseEvent: "Thrombolytics Adverse Event"] ThrombolyticAdverseEvent
          such that Coalesce(ThrombolyticAdverseEvent.date, ThrombolyticAdverseEvent.detected, ThrombolyticAdverseEvent.recordedDate) before end of ( EDwSTEMI.period )
            and ThrombolyticAdverseEvent.actuality = 'actual'
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Active Exclusion Diagnosis at Start of ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ( ( ["ConditionProblemsHealthConcerns": "Active Bleeding or Bleeding Diathesis, Excluding Menses"]
            union ["ConditionProblemsHealthConcerns": "Malignant Intracranial Neoplasm Group"]
            union ["ConditionProblemsHealthConcerns": "Cerebral Vascular Lesion"]
            union ["ConditionProblemsHealthConcerns": "Dementia and Related Intracranial Pathologies"]
            union ["ConditionProblemsHealthConcerns": "Pregnant State"]
            union ["ConditionProblemsHealthConcerns": "Allergy to thrombolytics"]
        ).verified ( ) ) ActiveExclusionDx
          such that ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.period )
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Active Oral Anticoagulant Medication at the Start of ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ["MedicationRequest": "Oral Anticoagulant Medications"] OralAnticoagulant
          such that OralAnticoagulant.status in { 'active', 'completed' }
            and OralAnticoagulant.intent = 'order'
            and OralAnticoagulant.authoredOn 90 days or less before or on start of EDwithSTEMI.period
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Active Long Term use of Anticoagulants":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ( ( ["ConditionProblemsHealthConcerns": "Long term (current) use of anticoagulants"]
            union ["ConditionEncounterDiagnosis": "Long term (current) use of anticoagulants"]
        ).verified ( ) ) LongTermAnticoagulant
          such that ( LongTermAnticoagulant.prevalenceInterval ( ) starts before or on start of EDwithSTEMI.period
              and LongTermAnticoagulant.prevalenceInterval ( ) ends on or after start of EDwithSTEMI.period
          )
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Active use of Anticoagulants":
      "Active Oral Anticoagulant Medication at the Start of ED Encounter"
        union "Active Long Term use of Anticoagulants"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ( ( ["ConditionProblemsHealthConcerns": "Aortic Dissection or Ruptured Aortic Aneurysm"]
            union ["ConditionProblemsHealthConcerns": "Neurologic impairment"]
            union ["ConditionProblemsHealthConcerns": "Angina pectoris with documented spasm"]
            union ["ConditionProblemsHealthConcerns": "Ventricular aneurysm due to and following acute myocardial infarction (disorder)"]
            union ["ConditionProblemsHealthConcerns": "Aneurysm of heart"]
            union ["ConditionProblemsHealthConcerns": "Takotsubo cardiomyopathy (disorder)"]
            union ["ConditionProblemsHealthConcerns": "Takotsubo syndrome"]
            union ["ConditionProblemsHealthConcerns": "Cardiopulmonary Emergency"]
        ).verified ( ) ) ExclusionDiagnosis
          such that ( ( ExclusionDiagnosis.prevalenceInterval ( ) starts during EDwithSTEMI.period )
              or ( ExclusionDiagnosis.prevalenceInterval ( ) starts 24 hours or less before start of EDwithSTEMI.period )
          )
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ["Procedure": "Major Surgical Procedure"] MajorSurgery
          such that ( MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of EDwithSTEMI.period
              or MajorSurgery.performed.toInterval ( ) starts during EDwithSTEMI.period
          )
            and MajorSurgery.status = 'completed'
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ( ["Procedure": "Endotracheal Intubation"]
          union ["Procedure": "Mechanical Circulatory Assist Device"] ) AirwayProcedure
          such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) )
              or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) )
          )
            and AirwayProcedure.status = 'completed'
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
        with ( ( ["ConditionProblemsHealthConcerns": "Ischemic Stroke"]
            union ["ConditionProblemsHealthConcerns": "Closed Head and Facial Trauma"]
            union ["ConditionProblemsHealthConcerns": "Active Peptic Ulcer"]
        ).verified ( ) ) ExclusionCondition
          such that ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.period )]
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ["Procedure": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery
          such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period )
            and CranialorSpinalSurgery.status = 'completed'
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "ED Encounter with Discharge Disposition as Patient Expired":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        where EDwithSTEMI.hospitalization.dischargeDisposition in "Patient Expired"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "ED Encounter with Discharge Disposition as Left Against Medical Advice":
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
        where EDwSTEMI.hospitalization.dischargeDisposition in "Left Against Medical Advice"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "ED Encounter with Hospice Services":
      from
        "ED Encounter with STEMI Diagnosis" EDwSTEMI
        let SixMonthsBeforeToEndOfSTEMI: Interval[start of ( EDwSTEMI.period ) - 6 months, end of ( EDwSTEMI.period )]
        where ( exists ( ( ( [Encounter: "Encounter Inpatient"] ).isEncounterPerformed ( ) ) InpatientEncounter
              where ( InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
                  or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
              )
                and InpatientEncounter.period starts before or on start of ( EDwSTEMI.period )
                and InpatientEncounter.period overlaps day of SixMonthsBeforeToEndOfSTEMI
          )
            or exists ( ( ( [Encounter: "Hospice Encounter"] ).isEncounterPerformed ( ) ) HospiceEncounter
                where HospiceEncounter.period starts before or on start of ( EDwSTEMI.period )
                  and ( HospiceEncounter.period overlaps day of SixMonthsBeforeToEndOfSTEMI )
            )
            or exists ( ( ( [ObservationScreeningAssessment: "Hospice care [Minimum Data Set]"] ).isAssessmentPerformed ( ) ) HospiceAssessment
                where ( HospiceAssessment as ObservationScreeningAssessment ).value ~ "Yes (qualifier value)"
                  and HospiceAssessment.effective.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
                  and ( HospiceAssessment.effective.toInterval ( ) overlaps day of SixMonthsBeforeToEndOfSTEMI )
            )
            or exists ( ( ( [ServiceRequest: "Hospice Care Ambulatory"] ).isInterventionOrder ( ) ) HospiceOrder
                where HospiceOrder.authoredOn 6 months or less before start of ( EDwSTEMI.period )
            )
            or exists ( ( ( [Procedure: "Hospice Care Ambulatory"] ).isInterventionPerformed ( ) ) HospicePerformed
                where HospicePerformed.performed.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
                  and ( HospicePerformed.performed.toInterval ( ) overlaps day of SixMonthsBeforeToEndOfSTEMI )
            )
            or exists ( ( ( [ConditionProblemsHealthConcerns: "Hospice Diagnosis"] ).verified ( ) ) HospiceCareDiagnosis
                where HospiceCareDiagnosis.prevalenceInterval ( ) ends on or after start of ( EDwSTEMI.period )
            )
        )
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Currently Pregnant":
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
        with ( ["USCoreObservationPregnancyStatusProfile"] ) PregStatus
          such that PregStatus.status = 'final'
            and ( PregStatus.value in "Pregnant State" )
            and ( PregStatus.effective during EDwSTEMI.period )
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Denominator Exclusions":
      "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
        union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
        union "Active Exclusion Diagnosis at Start of ED Encounter"
        union "Active use of Anticoagulants"
        union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
        union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"
        union "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
        union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
        union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
        union "ED Encounter with Discharge Disposition as Patient Expired"
        union "ED Encounter with Discharge Disposition as Left Against Medical Advice"
        union "ED Encounter with Hospice Services"
        union "Currently Pregnant"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "SDE Race":
      SDE."SDE Race"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Received tPA in Another Facility within 24 hours Prior to Admission":
      "ED Encounter with STEMI Diagnosis" EDwithSTEMI
        with ( ( ["ConditionProblemsHealthConcerns": "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"]
            union ["ConditionEncounterDiagnosis": "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"]
        ).verified ( ) ) TPA
          such that TPA.prevalenceInterval ( ) starts during EDwithSTEMI.period
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "ED Encounter with a Documented Reason for No PCI Performed":
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
        with ["ProcedureNotDone": "Percutaneous Coronary Intervention"] PCINotDone
          such that ( PCINotDone.statusReason in "Patient Refusal"
              or PCINotDone.statusReason in "Procedure Not Indicated/Contraindicated"
          )
            and PCINotDone.recorded during EDwSTEMI.period
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy":
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
        with ["MedicationAdministrationNotDone": "Fibrinolytic Therapy"] FibrinolyticNoMed
          such that ( FibrinolyticNoMed.statusReason in "Patient Refusal"
              or FibrinolyticNoMed.statusReason in "Drug Intervention Not Indicated/Contraindicated"
          )
            and FibrinolyticNoMed.recorded during EDwSTEMI.period
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define "Denominator Exceptions":
      "Received tPA in Another Facility within 24 hours Prior to Admission"
        union "ED Encounter with a Documented Reason for No PCI Performed"
        union "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy"
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter):
      First(EDEncounter.location EDLocation
          where exists((EDLocation.location.getLocation().type) LocationType
              where(LocationType in "Emergency Department Visit"
                  or LocationType ~ "Emergency room"
                  or LocationType ~ "Emergency trauma unit"
              )
                and start of EDLocation.period is not null
          )
          return start of EDLocation.period
          sort ascending
      )
Logic Definition | Library Name: CMS996FHIRAptTxforSTEMI
    define fluent function currentemergencyDepartmentDepartTime(EDEncounter Encounter):
      Last(EDEncounter.location EDLocation
          where exists((EDLocation.location.getLocation().type) LocationType
              where(LocationType in "Emergency Department Visit"
                  or LocationType ~ "Emergency room"
                  or LocationType ~ "Emergency trauma unit"
              )
                and
                end of EDLocation.period is not null
          )
          return
          end of EDLocation.period
          sort ascending
      )
Logic Definition | Library Name: Status
    //This library contains functions used to constrain FHIR resource elements for measures authored by NCQA, based on QICore 6.0.0 resources including IG and authoring patterns. The functions may appear similar to some QICoreCommon functions but differ in that they have constraints that are relevant for measures authored by NCQA.

    //Condition
    //Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential
    define fluent function verified(conditions List<Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>>):
      conditions C
        where C.verificationStatus is not null implies
          (C.verificationStatus ~ "confirmed"
            or C.verificationStatus ~ "unconfirmed"
            or C.verificationStatus ~ "provisional"
            or C.verificationStatus ~ "differential"
          )
Logic Definition | Library Name: Status
    //Encounter, Performed
    //General usage unless required otherwise by measure intent (e.g., follow-up encounters)
    define fluent function isEncounterPerformed(Enc List<Encounter>):
      Enc E
        where E.status = 'finished'
Logic Definition | Library Name: Status
    //Assessment, Performed
    define fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):
      Obs O
        where O.status in { 'final', 'amended', 'corrected' }
Logic Definition | Library Name: Status
    //Intervention, Order
    define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
      ServiceRequest S
        where S.status in { 'active', 'completed' }
          and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}
Logic Definition | Library Name: Status
    //Intervention, Performed
    define fluent function isInterventionPerformed(Proc List<Procedure>):
      Proc P
        where P.status ~ 'completed'
Terminology
Code System | Description: Code system SNOMEDCT Resource: http://snomed.info/sct Canonical URL: `http://snomed.info/sct`
Code System | Description: Code system ActCode Resource: http://terminology.hl7.org/CodeSystem/v3-ActCode Canonical URL: `http://terminology.hl7.org/CodeSystem/v3-ActCode`
Code System | Description: Code system ConditionVerificationStatusCodes Resource: http://terminology.hl7.org/CodeSystem/condition-ver-status Canonical URL: `http://terminology.hl7.org/CodeSystem/condition-ver-status`
Code System | Description: Code system RoleCode Resource: http://terminology.hl7.org/CodeSystem/v3-RoleCode Canonical URL: `http://terminology.hl7.org/CodeSystem/v3-RoleCode`
Code System | Description: Code system AllergyIntoleranceClinicalStatusCodes Resource: http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical Canonical URL: `http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical`
Code System | Description: Code system AllergyIntoleranceVerificationStatusCodes Resource: http://terminology.hl7.org/CodeSystem/allergyintolerance-verification Canonical URL: `http://terminology.hl7.org/CodeSystem/allergyintolerance-verification`
Code System | Description: Code system ICD10CM Resource: http://hl7.org/fhir/sid/icd-10-cm Canonical URL: `http://hl7.org/fhir/sid/icd-10-cm`
Code System | Description: Code system LOINC Resource: http://loinc.org Canonical URL: `http://loinc.org`
Value Set | Description: Value set Emergency Department Evaluation and Management Visit Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010`
Value Set | Description: Value set STEMI Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017`
Value Set | Description: Value set Fibrinolytic Therapy Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4019 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4019`
Value Set | Description: Value set Emergency Department Visit Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292`
Value Set | Description: Value set Percutaneous Coronary Intervention Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5`
Value Set | Description: Value set Discharge To Acute Care Facility Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.87`
Value Set | Description: Value set Payer Type Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591`
Value Set | Description: Value set Thrombolytic medications Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4`
Value Set | Description: Value set Thrombolytics Adverse Event Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6`
Value Set | Description: Value set Active Bleeding or Bleeding Diathesis, Excluding Menses Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4036 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4036`
Value Set | Description: Value set Malignant Intracranial Neoplasm Group Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3`
Value Set | Description: Value set Cerebral Vascular Lesion Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4025 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4025`
Value Set | Description: Value set Dementia and Related Intracranial Pathologies Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4043 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4043`
Value Set | Description: Value set Pregnant State Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4055 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4055`
Value Set | Description: Value set Allergy to thrombolytics Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5`
Value Set | Description: Value set Oral Anticoagulant Medications Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045`
Value Set | Description: Value set Aortic Dissection or Ruptured Aortic Aneurysm Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4028 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4028`
Value Set | Description: Value set Neurologic impairment Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.114.12.1012 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.114.12.1012`
Value Set | Description: Value set Cardiopulmonary Emergency Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4048 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4048`
Value Set | Description: Value set Major Surgical Procedure Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4056 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4056`
Value Set | Description: Value set Endotracheal Intubation Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.69 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.69`
Value Set | Description: Value set Mechanical Circulatory Assist Device Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4052 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4052`
Value Set | Description: Value set Ischemic Stroke Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247`
Value Set | Description: Value set Closed Head and Facial Trauma Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4026 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4026`
Value Set | Description: Value set Active Peptic Ulcer Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4031 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4031`
Value Set | Description: Value set Intracranial or Intraspinal surgery Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2`
Value Set | Description: Value set Patient Expired Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.309`
Value Set | Description: Value set Left Against Medical Advice Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.308`
Value Set | Description: Value set Encounter Inpatient Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307`
Value Set | Description: Value set Hospice Encounter Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003`
Value Set | Description: Value set Hospice Care Ambulatory Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584`
Value Set | Description: Value set Hospice Diagnosis Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165`
Value Set | Description: Value set Patient Refusal Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93`
Value Set | Description: Value set Procedure Not Indicated/Contraindicated Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1282.2 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1282.2`
Value Set | Description: Value set Drug Intervention Not Indicated/Contraindicated Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1282.1 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1282.1`
Direct Reference Code | Display: Male (finding) Code: 248153007 System: `http://snomed.info/sct`
Direct Reference Code | Display: Female (finding) Code: 248152002 System: `http://snomed.info/sct`
Direct Reference Code | Display: emergency Code: EMER System: `http://terminology.hl7.org/CodeSystem/v3-ActCode`
Direct Reference Code | Display: confirmed Code: confirmed System: `http://terminology.hl7.org/CodeSystem/condition-ver-status`
Direct Reference Code | Display: unconfirmed Code: unconfirmed System: `http://terminology.hl7.org/CodeSystem/condition-ver-status`
Direct Reference Code | Display: provisional Code: provisional System: `http://terminology.hl7.org/CodeSystem/condition-ver-status`
Direct Reference Code | Display: differential Code: differential System: `http://terminology.hl7.org/CodeSystem/condition-ver-status`
Direct Reference Code | Display: Emergency room Code: ER System: `http://terminology.hl7.org/CodeSystem/v3-RoleCode`
Direct Reference Code | Display: Emergency trauma unit Code: ETU System: `http://terminology.hl7.org/CodeSystem/v3-RoleCode`
Direct Reference Code | Display: Active Code: active System: `http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical`
Direct Reference Code | Display: Confirmed Code: confirmed System: `http://terminology.hl7.org/CodeSystem/allergyintolerance-verification`
Direct Reference Code | Display: Unconfirmed Code: unconfirmed System: `http://terminology.hl7.org/CodeSystem/allergyintolerance-verification`
Direct Reference Code | Display: Long term (current) use of anticoagulants Code: Z79.01 System: `http://hl7.org/fhir/sid/icd-10-cm`
Direct Reference Code | Display: Angina pectoris with documented spasm Code: I20.1 System: `http://hl7.org/fhir/sid/icd-10-cm`
Direct Reference Code | Display: Ventricular aneurysm due to and following acute myocardial infarction (disorder) Code: 723858002 System: `http://snomed.info/sct`
Direct Reference Code | Display: Aneurysm of heart Code: I25.3 System: `http://hl7.org/fhir/sid/icd-10-cm`
Direct Reference Code | Display: Takotsubo cardiomyopathy (disorder) Code: 441541008 System: `http://snomed.info/sct`
Direct Reference Code | Display: Takotsubo syndrome Code: I51.81 System: `http://hl7.org/fhir/sid/icd-10-cm`
Direct Reference Code | Display: Discharge to home for hospice care (procedure) Code: 428361000124107 System: `http://snomed.info/sct`
Direct Reference Code | Display: Discharge to healthcare facility for hospice care (procedure) Code: 428371000124100 System: `http://snomed.info/sct`
Direct Reference Code | Display: Hospice care [Minimum Data Set] Code: 45755-6 System: `http://loinc.org`
Direct Reference Code | Display: Yes (qualifier value) Code: 373066001 System: `http://snomed.info/sct`
Direct Reference Code | Display: Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility Code: Z92.82 System: `http://hl7.org/fhir/sid/icd-10-cm`
Dependencies
Dependency | Description: QICore model information Resource: http://hl7.org/fhir/Library/QICore-ModelInfo Canonical URL: `http://hl7.org/fhir/Library/QICore-ModelInfo`
Dependency | Description: Library SDE Resource: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000 Canonical URL: `https://madie.cms.gov/Library/SupplementalDataElements|5.1.000`
Dependency | Description: Library FHIRHelpers Resource: https://madie.cms.gov/Library/FHIRHelpers|4.4.000 Canonical URL: `https://madie.cms.gov/Library/FHIRHelpers|4.4.000`
Dependency | Description: Library Status Resource: https://madie.cms.gov/Library/Status|1.15.000 Canonical URL: `https://madie.cms.gov/Library/Status|1.15.000`
Dependency | Description: Library CQMCommon Resource: https://madie.cms.gov/Library/CQMCommon|4.1.000 Canonical URL: `https://madie.cms.gov/Library/CQMCommon|4.1.000`
Dependency | Description: Library QICoreCommon Resource: https://madie.cms.gov/Library/QICoreCommon|4.0.000 Canonical URL: `https://madie.cms.gov/Library/QICoreCommon|4.0.000`
Data Requirements
Data Requirement | Type: Patient Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient Must Support Elements: extension, birthDate, birthDate.value, url
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, hospitalization, hospitalization.dischargeDisposition, period, location, location.type, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, location, location.type, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: class, type, period, status, status.value, location, location.type, reasonCode, hospitalization, hospitalization.dischargeDisposition Code Filter(s): Path: class Code(s): http://terminology.hl7.org/CodeSystem/v3-ActCode#EMER: 'emergency'
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis Must Support Elements: code Code Filter(s): Path: code Code(s): http://hl7.org/fhir/sid/icd-10-cm#Z79.01: 'Long term (current) use of anticoagulants'
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis Must Support Elements: code Code Filter(s): Path: code Code(s): http://hl7.org/fhir/sid/icd-10-cm#Z92.82: 'Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility'
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4017
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4036
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.3
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4025
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4043
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4055
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.5
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code Code(s): http://hl7.org/fhir/sid/icd-10-cm#Z79.01: 'Long term (current) use of anticoagulants'
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4028
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.114.12.1012
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code Code(s): http://hl7.org/fhir/sid/icd-10-cm#I20.1: 'Angina pectoris with documented spasm'
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code Code(s): http://snomed.info/sct#723858002: 'Ventricular aneurysm due to and following acute myocardial infarction (disorder)'
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code Code(s): http://hl7.org/fhir/sid/icd-10-cm#I25.3: 'Aneurysm of heart'
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code Code(s): http://snomed.info/sct#441541008: 'Takotsubo cardiomyopathy (disorder)'
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code Code(s): http://hl7.org/fhir/sid/icd-10-cm#I51.81: 'Takotsubo syndrome'
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4048
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4026
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4031
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code Code(s): http://hl7.org/fhir/sid/icd-10-cm#Z92.82: 'Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility'
Data Requirement | Type: Resource Profile(s): http://hl7.org/fhir/StructureDefinition/Resource Must Support Elements: id, id.value
Data Requirement | Type: Location Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-location
Data Requirement | Type: MedicationAdministration Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration Must Support Elements: medication, status, status.value, effective Code Filter(s): Path: medication ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4019
Data Requirement | Type: MedicationAdministration Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministration Must Support Elements: medication.reference.value, status, status.value, effective
Data Requirement | Type: Medication Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication Must Support Elements: id.value, code
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, performed, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, performed, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4056
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, performed, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.69
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, performed, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4052
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, performed, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.2
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, performed, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584
Data Requirement | Type: Coverage Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Data Requirement | Type: AllergyIntolerance Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-allergyintolerance Must Support Elements: code, clinicalStatus, verificationStatus, onset Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.4
Data Requirement | Type: AdverseEvent Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-adverseevent Must Support Elements: event, date, date.value, detected, detected.value, recordedDate, recordedDate.value, actuality, actuality.value Code Filter(s): Path: event ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1170.6
Data Requirement | Type: MedicationRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest Must Support Elements: medication, status, status.value, intent, intent.value, authoredOn, authoredOn.value Code Filter(s): Path: medication ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4045
Data Requirement | Type: MedicationRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest Must Support Elements: medication.reference.value, status, status.value, intent, intent.value, authoredOn, authoredOn.value
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment Must Support Elements: code, effective, status, status.value Code Filter(s): Path: code Code(s): http://loinc.org#45755-6: 'Hospice care [Minimum Data Set]'
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment Must Support Elements: value, status, status.value
Data Requirement | Type: ServiceRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest Must Support Elements: code, authoredOn, authoredOn.value, status, status.value, intent, intent.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-pregnancystatus Must Support Elements: status, status.value, value, effective, effective.value
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedurenotdone Must Support Elements: code, statusReason, extension Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.2000.5
Data Requirement | Type: MedicationAdministration Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationadministrationnotdone Must Support Elements: medication, statusReason, extension Code Filter(s): Path: medication ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3157.4019
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