Metadata
Title | Emergency Care Access & Timeliness (REHQR)FHIR
Version | 1.0.000
Short Name | CMS1264FHIR
GUID (Version Independent) | urn:uuid:eb3e269b-97ef-4548-9e87-c89b25789184
GUID (Version Specific) | urn:uuid:c83b4461-25cb-4d66-af72-6502b14ebab8
CMS Identifier | 1264FHIR
CMS Consensus Based Entity Identifier | 4625e
Effective Period | 2027-01-01 through 2027-12-31
Steward (Publisher) | Centers for Medicare & Medicaid Services (CMS)
Developer | Acumen, LLC
Description | This measure assesses the variation in access and timeliness of emergency care to support rural emergency hospital (REH) quality improvement for patients requiring emergency care in an emergency department (ED). This measure is designed to align with incentives to promote improved care both in EDs and the broader health system to help identify where patients do not receive timely access to emergency care. Emergency care access and timeliness gaps are inclusive of several concepts pertaining to boarding and crowding in an ED, including significantly longer ED wait times, higher left without being seen rates, longer boarding times, and longer total length of stay in the ED.
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. ICD-10 copyright 2024 World Health Organization. All Rights Reserved. CPT(R) contained in the measure specifications is copyright 2004-2024 American Medical Association.
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 | This measure aims to reduce patient harm and improve outcomes for patients requiring emergency care in an ED by addressing the variation in emergency care and measuring access and timeliness of emergency care. There are long-standing concerns about parameters that impact access and timeliness of care in the ED. Currently, there are no national metrics to assess the proportion of patients impacted by access and timeliness of ED care.
Clinical Recommendation Statement | Changes in care provision and workflow are anticipated from implementing this Emergency Care Access & Timeliness (ECAT) REH dQM. To improve time to place a patient in a treatment space (as defined by the numerator below), changes in care may include improving patient flow processes, triaging interventions (such as inclusion of predictive models or different clinical deployment), or increased availability and access to outpatient clinical and social services. Other changes in care may include increases in local healthcare capacity including mental health care (mental health liaisons, co-located mental health services, or specialist psychiatry services), and use of ‘hospital home’ care models. Furthermore, changes to the following may also be considered: staffing models, ED observation units, diagnostic testing and imaging processes, or physical changes to ED layout. Such changes may result in the following: decreased waiting room time, decreased door to provider times, higher proportion of patients seen within 1 hour, decrease in proportion of patients who leave without being evaluated, better management of mental health diagnoses, reduced length of stay in the ED, decreased turnaround time for diagnostic tests and imaging, improved time to treatment, and decreased ambulance diversion. Changes in clinician or patient-reported outcomes and costs may include the following: improved patient experience, decrease in morbidity and mortality, increased ED revenue, and improved patient outcomes.
Citation | American Medical Association. (2022). What is Behavioral Health. https://www.ama-assn.org/delivering-care/public-health/what-behavioral-health
Definition | Boarding: The practice of holding transfer patients in the emergency department after a decision to transfer has been made.
Definition | ED Observation: Observation stays are inclusive of both ED observation care in which a patient initially evaluated in the ED is cared for under observation status for an extended period of time in the ED or in a care area dedicated to observation care, as well as hospital observation stays in which a patient initially evaluated in the ED is cared for in observation status often in a hospital bed used for both inpatient or observation status admissions. Because these two forms of observation stays cannot be easily distinguished in a standardized fashion in existing electronic health record data ontologies, for the purposes of this quality measure all observation stays have been considered an exclusion from both numerator outcomes 3 and 4.
Definition | Left Without Being Seen (LWBS): Patients arrive to the ED for evaluation and leave before seeing a physician, advanced practice nurse, or physician’s assistant.
Definition | Mental Health: Mental health generally refers to mental health diagnoses, life stressors and crises, and stress-related physical symptoms (American Medical Association [AMA], 2022). For this measure, mental health conditions will be defined separately from substance use disorders.
Guidance (Usage) | Measure Score Calculation The measure score is calculated at the individual ED level as the proportion of ED visits where any one of the four outcomes occurred, as defined by the numerator. For CMS Certification Numbers (CCNs) with more than one ED, scores are combined as a weighted average for that CCN. This dQM is an episode-based measure. An episode is defined as an ED visit that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS1264v1. 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#outcome: 'Outcome']
Rate Aggregation | None
Improvement Notation | [http://terminology.hl7.org/CodeSystem/measure-improvement-notation#decrease: 'Decreased score indicates improvement']
Initial Population | ID: InitialPopulation_1 Description: All ED visits at REHs that end during the measurement period for all patients Logic Definition: Initial Population
Denominator | ID: Denominator_1 Description: Equals Initial Population Logic Definition: Denominator
Numerator | ID: Numerator_1 Description: The numerator is comprised of any ED visit in the denominator with any quality gap in access; if the patient experiences any of the following during a visit, the visit is included in the numerator: 1. The patient waited longer than 60 minutes (1 hour) after arrival to ED to be placed in a treatment room or dedicated treatment area that allows for audiovisual privacy during history-taking and physical examination, or 2. The patient left the ED without being evaluated, or 3. The patient, if transferred, boarded for longer than 240 minutes (4 hours), or 4. The patient had an ED length of stay (LOS) (time from ED arrival to ED departure as defined by the ED departure timestamp indicating when the patient physically left the ED) of longer than 480 minutes (8 hours). ED encounters with ED observation stays are excluded from criteria #3 (boarded) and #4 (ED LOS) Logic Definition: Numerator
Stratifier | ID: Stratification_1_1 Description: All patients aged less than 18 years seen in the ED who do not have an ED encounter principal diagnosis consistent with mental health diagnosis. Patients who have an ED encounter principal diagnosis consistent with substance use disorders will be included in this stratification.
Stratifier | ID: Stratification_1_2 Description: All patients aged 18 years and older seen in the ED who do not have an ED encounter principal diagnosis consistent with mental health diagnosis. Patients who have an ED encounter principal diagnosis consistent with substance use disorders will be included in this stratification.
Stratifier | ID: Stratification_1_3 Description: All patients aged less than 18 years seen in the ED who have an ED encounter principal diagnosis consistent with mental health diagnosis.
Stratifier | ID: Stratification_1_4 Description: All patients aged 18 years and older seen in the ED who have an ED encounter principal diagnosis consistent with mental health diagnosis.
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/CMS1264FHIRECATREHQR
Contents | Population Criteria Logic Definitions Terminology Dependencies Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population
    define "Initial Population":
      "ED Evaluation and Management"
        union "ED Triage Excluding Those Prior To ED Encounters"
Denominator
    define "Denominator":
      "Initial Population"
Numerator
    define "Numerator":
      "Time to Treatment Room Greater Than 60 Minutes"
        union "ED Arrival Left Without Being Seen"
        union "Boarded Time Greater Than 240 Minutes and No Observation Stay"
        union "ED Length of Stay Greater Than 480 Minutes and No Observation Stay"
Stratifier
    define "Stratification 1":
      "Pediatric With No Mental Health Diagnosis"
Stratifier
    define "Stratification 2":
      "Adult With No Mental Health Diagnosis"
Stratifier
    define "Stratification 3":
      "Pediatric With Mental Health Diagnosis"
Stratifier
    define "Stratification 4":
      "Adult With Mental Health Diagnosis"
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 [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: 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: CMS1264FHIRECATREHQR
    define "SDE Sex":
      SDE."SDE Sex"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Evaluation and Management":
      [Encounter: "Emergency Department Evaluation and Management Visit"] EDEvalManagementVisit
        where EDEvalManagementVisit.period ends during day of "Measurement Period"
          and EDEvalManagementVisit.status = 'finished'
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Triage":
      [Encounter: "Triage"] EDTriage
        where EDTriage.period ends during day of "Measurement Period"
          and EDTriage.status in { 'finished', 'triaged' }
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Triage Excluding Those Prior To ED Encounters":
      "ED Triage" EDTriageinMP
        where not exists ( "ED Evaluation and Management" EDEvalManagementinMP
            where ( ( EDTriageinMP.period overlaps before EDEvalManagementinMP.period )
                or ( EDTriageinMP.period during EDEvalManagementinMP.period )
                or ( EDEvalManagementinMP.period during EDTriageinMP.period )
                or ( EDTriageinMP.period ends 120 minutes or less before start of EDEvalManagementinMP.period )
            )
        )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Initial Population":
      "ED Evaluation and Management"
        union "ED Triage Excluding Those Prior To ED Encounters"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Denominator":
      "Initial Population"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Triage Before Evaluation Management":
      "ED Triage" EDTriageinMP
        with "Denominator" EDEncounter
          such that ( ( EDTriageinMP.period overlaps before EDEncounter.period )
              or ( EDTriageinMP.period during EDEncounter.period )
              or ( EDEncounter.period during EDTriageinMP.period )
              or ( EDTriageinMP.period ends 120 minutes or less before start of EDEncounter.period )
          )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Triage and Evaluation Management":
      "Denominator"
        union "ED Triage Before Evaluation Management"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Time to Treatment Room Greater Than 60 Minutes":
      "ED Evaluation and Management" EDEvalManagementinMP
        where EDEvalManagementinMP.edArrivalTime ( ) 61 minutes or more before EDEvalManagementinMP.edTreatmentRoomTimeArrivalTime ( )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Arrival Left Without Being Seen":
      "Denominator" EDEncounter
        where EDEncounter.hospitalization.dischargeDisposition ~ "Patient left without being seen (finding)"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Boarded Time Greater Than 240 Minutes":
      "Denominator" EDEncounter
        where EDEncounter.TransferDecisionUsingOrder ( ) 241 minutes or more before EDEncounter.edDepartureTime ( )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Observation Status":
      [Encounter: "Observation Services"] EDObsEncounter
        with "Denominator" EDStay
          such that EDObsEncounter.period during EDStay.period
            and EDObsEncounter.status = 'finished'
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Boarded Time Greater Than 240 Minutes and No Observation Stay":
      ( "Boarded Time Greater Than 240 Minutes" Boarding
          where not exists ( "ED Observation Status" EDObs
              where ( EDObs.period during Boarding.period )
          )
      )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Length of Stay Greater Than 480 Minutes":
      "Denominator" EDEncounter
        where EDEncounter.edArrivalTime ( ) 481 minutes or more before EDEncounter.edDepartureTime ( )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Length of Stay Greater Than 480 Minutes and No Observation Stay":
      ( "ED Length of Stay Greater Than 480 Minutes" EDStay
          where not exists ( "ED Observation Status" EDObs
              where ( EDObs.period during EDStay.period )
          )
      )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Numerator":
      "Time to Treatment Room Greater Than 60 Minutes"
        union "ED Arrival Left Without Being Seen"
        union "Boarded Time Greater Than 240 Minutes and No Observation Stay"
        union "ED Length of Stay Greater Than 480 Minutes and No Observation Stay"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Encounter or Triage of Patients 18 Years and Older":
      "Denominator" EDEncounter
        where AgeInYearsAt(date from start of EDEncounter.period) >= 18
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Adult With Mental Health Diagnosis":
      ( "ED Encounter or Triage of Patients 18 Years and Older" AdultEDEncounters
          where ( AdultEDEncounters.hasPrincipalDiagnosisOf ( "Mental Health Diagnosis without Substance Use Disorders" ) )
      )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Stratification 4":
      "Adult With Mental Health Diagnosis"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "ED Encounter or Triage of Patients Less Than 18 Years":
      "Denominator" EDEncounter
        where AgeInYearsAt(date from start of EDEncounter.period) < 18
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Pediatric With Mental Health Diagnosis":
      ( "ED Encounter or Triage of Patients Less Than 18 Years" PediatricEDEncounters
          where ( PediatricEDEncounters.hasPrincipalDiagnosisOf ( "Mental Health Diagnosis without Substance Use Disorders" ) )
      )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Stratification 3":
      "Pediatric With Mental Health Diagnosis"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Adult With No Mental Health Diagnosis":
      ( "ED Encounter or Triage of Patients 18 Years and Older" AdultEDEncounters
          where not ( AdultEDEncounters.hasPrincipalDiagnosisOf ( "Mental Health Diagnosis without Substance Use Disorders" ) )
      )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Stratification 2":
      "Adult With No Mental Health Diagnosis"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Pediatric With No Mental Health Diagnosis":
      ( "ED Encounter or Triage of Patients Less Than 18 Years" PediatricEDEncounters
          where not ( PediatricEDEncounters.hasPrincipalDiagnosisOf ( "Mental Health Diagnosis without Substance Use Disorders" ) )
      )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "Stratification 1":
      "Pediatric With No Mental Health Diagnosis"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "SDE Payer":
      SDE."SDE Payer"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "SDE Ethnicity":
      SDE."SDE Ethnicity"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define "SDE Race":
      SDE."SDE Race"
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define fluent function "edArrivalTime"(EDEncounter Encounter):
      Last("ED Triage and Evaluation Management".location Location
          where exists((Location.location.getLocation().type) LocationType
              where(LocationType in "Emergency Department Location"
                  or LocationType ~ "Emergency room"
                  or LocationType ~ "Emergency trauma unit"
              )
          )
            and start of Location.period is not null
            and(Location.period ends 120 minutes or less before start of EDEncounter.period
                or Location.period overlaps before EDEncounter.period
                or EDEncounter.period overlaps before Location.period
                or Location.period starts same as start of EDEncounter.period
            )
          return start of Location.period
          sort ascending
      )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define fluent function "edTreatmentRoomTimeArrivalTime"(EDEncounter Encounter):
      First(EDEncounter.location Location
          where Location.location.getLocation().type in "Emergency Department Treatment Location"
            and start of Location.period is not null
          return start of Location.period
          sort ascending
      )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define fluent function "TransferDecisionUsingOrder"(EDEncounter Encounter):
      Last([ServiceRequest: "Decision to Transfer"] TransferOrder
          where TransferOrder.authoredOn during EDEncounter.period
            and TransferOrder.intent = 'order'
            and TransferOrder.status in { 'active', 'completed' }
          return TransferOrder.authoredOn
          sort ascending
      )
Logic Definition | Library Name: CMS1264FHIRECATREHQR
    define fluent function "edDepartureTime"(EDEncounter Encounter):
      Last("ED Triage and Evaluation Management".location Location
          where exists((Location.location.getLocation().type) LocationType
              where(LocationType in "Emergency Department Location"
                  or LocationType ~ "Emergency room"
                  or LocationType ~ "Emergency trauma unit"
              )
          )
            and
            end of Location.period is not null
            and(Location.period ends 120 minutes or less before start of EDEncounter.period
                or Location.period overlaps before EDEncounter.period
                or EDEncounter.period overlaps before Location.period
                or Location.period starts same as start of EDEncounter.period
            )
          return
          end of Location.period
          sort ascending
      )
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: CQMCommon
    /*
     @description: Returns the condition that is specified as the principal diagnosis for the encounter and has a code in the given valueSet.
     @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
     */
     define fluent function hasPrincipalDiagnosisOf(encounter Encounter, valueSet ValueSet):
       (encounter.principalDiagnosis()) PD
         return PD.diagnosis in valueSet
           or PD.diagnosis.getCondition().code in valueSet
Logic Definition | Library Name: CQMCommon
    /*
    @description: Returns the claim diagnosis element that is specified as the principal diagnosis for the encounter
     @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
    */
    define fluent function principalDiagnosis(encounter Encounter):
    singleton from (
         (encounter.claimDiagnosis()) CD
           where CD.type.includesCode("Principal Diagnosis")
       )
Logic Definition | Library Name: CQMCommon
    /*
    @description: Returns the claim diagnosis elements for the given encounter
    @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
    */
    define fluent function claimDiagnosis(encounter Encounter):
      encounter E
        let
          claim: ([Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E))),
          claimItem: (claim.item I where I.encounter.references(E))
        return claim.diagnosis D where D.sequence in claimItem.diagnosisSequence
Logic Definition | Library Name: CQMCommon
    /*
    @description: Returns the Condition resource for the given reference
    */
    define fluent function getCondition(reference Reference):
      singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where reference.references(C.id))
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: Returns true if any of the given references are to the given resource
    @comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.
    NOTE: This function assumes resources from the same source server.
    */
    define fluent function references(references List<Reference>, resource Resource):
      exists (references R where R.references(resource))
Logic Definition | Library Name: QICoreCommon
    /*
    @description: Returns true if the given code is in the given codeList
    @comment: Returns true if the `code` is equivalent to any of the codes in the given `codeList`, false otherwise.
    */
    define fluent function includesCode(codeList List<Concept>, code Code):
      exists (codeList C where C ~ code)
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, '/'))
Terminology
Code System | Description: Code system SNOMEDCT Resource: http://snomed.info/sct Canonical URL: `http://snomed.info/sct`
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 Diagnosis Type Resource: http://terminology.hl7.org/CodeSystem/ex-diagnosistype Canonical URL: `http://terminology.hl7.org/CodeSystem/ex-diagnosistype`
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 Triage Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.279 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.279`
Value Set | Description: Value set Emergency Department Location Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.284 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.284`
Value Set | Description: Value set Emergency Department Treatment Location Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.278 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.278`
Value Set | Description: Value set Decision to Transfer Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.286 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.286`
Value Set | Description: Value set Observation Services Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143`
Value Set | Description: Value set Mental Health Diagnosis without Substance Use Disorders Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.285 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.285`
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`
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 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: Patient left without being seen (finding) Code: 21541000119102 System: `http://snomed.info/sct`
Direct Reference Code | Display: Principal Diagnosis Code: principal System: `http://terminology.hl7.org/CodeSystem/ex-diagnosistype`
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 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, url
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, status, status.value, location, location.type, hospitalization, hospitalization.dischargeDisposition, diagnosis, diagnosis.code Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.279
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, status, status.value, location, location.type, hospitalization, hospitalization.dischargeDisposition, diagnosis, diagnosis.code Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: period, location, location.type, hospitalization, hospitalization.dischargeDisposition, type, diagnosis, diagnosis.code
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, status, status.value, location, location.type, hospitalization, hospitalization.dischargeDisposition, diagnosis, diagnosis.code Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
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: ServiceRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest Must Support Elements: code, authoredOn, authoredOn.value, intent, intent.value, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.286
Data Requirement | Type: Claim Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim Must Support Elements: status, status.value, use, use.value, item
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-problems-health-concerns
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
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