Metadata
Title | Hospital Harm - Severe HypoglycemiaFHIR
Version | 1.0.000
Short Name | CMS816FHIR
GUID (Version Independent) | urn:uuid:1238aa6c-b533-4289-9ab9-8bb9900e9736
GUID (Version Specific) | urn:uuid:7a1b776e-a7a3-4074-a523-8481a6638826
CMS Identifier | 816FHIR
CMS Consensus Based Entity Identifier | 3503e
Effective Period | 2026-01-01 through 2026-12-31
Steward (Publisher) | Centers for Medicare & Medicaid Services (CMS)
Developer | Mathematica
Description | The measure assesses the number of inpatient hospitalizations for patients age 18 and older who were administered at least one hypoglycemic medication during the encounter, who suffer the harm of a severe hypoglycemic event during the encounter
Copyright | Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third-party codes contained in the specifications. LOINC(R) copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 copyright 2024 World Health Organization. All Rights Reserved.
Disclaimer | This performance measure is not a clinical guideline and does not establish a standard of medical care, and has 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 focuses on severe hypoglycemia as an outcome in the hospital inpatient setting. In a study published by the Office of the Inspector General (OIG), in 2018 adverse drug events represented 43% of all adverse events in hospitals among Medicare patients; of those events, hypoglycemia was among the top 5 adverse drug events (Office of the Inspector General, 2022). Inpatient hypoglycemia can be life-threatening, and is associated with longer hospital stays and increased medical costs. Severe hypoglycemia (<40 mg/dL) occurs in 2-5% of hospitalized patients with diabetes mellitus, and medication-related hypoglycemic events are common causes of adverse drug events occurring in inpatient settings. Up to half of inpatient adverse drug events may be preventable, and recent studies show that rates of severe hypoglycemia vary across hospitals, suggesting opportunities for improved care (Santos et al., 2020). Rates of inpatient hypoglycemia events are considered an indicator of the quality of care provided by a hospital. Severe hypoglycemia events are largely avoidable by careful use of antihyperglycemic medication. Moreover, the rate of severe hypoglycemia varies across hospitals indicating an opportunity for improvement in care. The Agency for Healthcare Research and Quality (AHRQ) identified insulin and other hypoglycemic agents as high alert medications and associated adverse events to be included as a measure in the Medicare Patient Safety Monitoring System (MPSMS) (Classen et al., 2021). Hypoglycemic events are an adverse outcome that can cause patients to experience drowsiness, confusion, anxiety, irritability, sweating, weakness, increased heart rate, uncontrollable trembling, as well as loss of consciousness and seizure (American Diabetes Association, 2022; Cruz, 2020). It has been found that fasting glucose levels <100 mg/dL are predictors of hypoglycemia within the next 24 hours (ElSayed et al., 2023).
Clinical Recommendation Statement | From Section 16, Diabetes Care in the Hospital in the Standards of Medical Care in Diabetes by the American Diabetes Association, (American Diabetes Association, 2024): 16.12 A hypoglycemia management protocol should be adopted and implemented by each hospital or hospital system. A plan for preventing and treating hypoglycemia should be established for each individual. Episodes of hypoglycemia in the hospital should be documented in the electronic health record and tracked for quality assessment and quality improvement. 16.13 Treatment plans should be reviewed and changed as necessary to prevent hypoglycemia when a blood glucose value of <70 mg/dL (3.9 mmol/L) is documented. A standardized hospital-wide, nurse-initiated hypoglycemia treatment protocol should be in place to immediately address blood glucose levels of <70 mg/dL (3.9 mmol/L). In addition, individualized plans for preventing and treating hypoglycemia for each patient should also be developed. An American Diabetes Association consensus statement recommends that an individuals treatment plan be reviewed any time a blood glucose value of <70 mg/dL (3.9 mmol/L) occurs, as this level often predict subsequent level 3 hypoglycemia. Episodes of hypoglycemia in the hospital should be documented in the EHR and tracked. A key strategy is embedding hypoglycemia treatment into all insulin and insulin infusion orders. From the Endocrine Society clinical practice guideline on the Management of Hyperglycemia in Hospitalized Patients in Non-critical Care Setting (Korytkowski et al., 2022) as it relates to patients at high risk of hypoglycemia: Recommendation 1.1 In adults with insulin-treated diabetes hospitalized for noncritical illness who are at high risk of hypoglycemia, we suggest the use of real-time continuous glucose monitoring (CGM) with confirmatory bedside point-of-care blood glucose (POC-BG) monitoring for adjustments in insulin dosing rather than point-of-care blood glucose POC-BG testing alone in hospital settings where resources and training are available. Recommendation 2.1 Management of patients with glucocorticoid (GC)-associated hyperglycemia requires ongoing BG monitoring with adjustment of insulin dosing. All therapies require safeguards to avoid hypoglycemia when doses of GCs are tapered or abruptly discontinued. Recommendation 10.1 In adults with no prior history of diabetes hospitalized for noncritical illness with hyperglycemia [defined as BG > 140 mg/dL (7.8 mmol/L)] during hospitalization, we suggest initial therapy with correctional insulin over scheduled insulin therapy (defined as basal or basal/bolus insulin) to maintain glucose targets in the range of 100 to 180 mg/dL (5.6 to 10.0 mmol/L). For patients with persistent hyperglycemia [>= 2 POC-BG measurements >= 180 mg/dL (>=10.0 mmol/L) in a 24-hour period on correctional insulin alone], we suggest the addition of scheduled insulin therapy. Recommendation 10.2 In adults with diabetes treated with diet or noninsulin diabetes medications prior to admission, we suggest initial therapy with correctional insulin or scheduled insulin therapy to maintain glucose targets in the range of 100 to 180 mg/dL (5.6 to 10.0 mmol/L). For hospitalized adults started on correctional insulin alone and with persistent hyperglycemia [>=2 point-of-care blood glucose (POC-BG) measurements >= 180 mg/dL in a 24-hour period (>=10.0 mmol/L)], we suggest addition of scheduled insulin therapy. We suggest initiation of scheduled insulin therapy for patients with confirmed admission blood glucose (BG) >= 180 mg/dL (>=10.0 mmol/L). Recommendation 10.3 In adults with insulin-treated diabetes prior to admission who are hospitalized for noncritical illness, we recommend continuation of the scheduled insulin regimen modified for nutritional status and severity of illness to maintain glucose targets in the range of 100 to 180 mg/dL (5.6 to 10.0 mmol/L). Remarks Reductions in the dose of basal insulin (by 10% to 20%) at time of hospitalization may be required for patients on basal heavy insulin regimens (defined as doses of basal insulin >= 0.6 to 1.0 units/kg/day), in which basal insulin is being used inappropriately to cover meal-related excursions in BG.
Citation | American Diabetes Association Professional Practice Committee; 16. (2022). Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2022. Diabetes Care 1 January 2022; 45 (Supplement_1): S244-S253. https://doi.org/10.2337/dc22-S016
Citation | Classen, D. C. MD, MS; Munier, W. MD; Verzier, N. MSN, RN; Eldridge, N. MS; Hunt, D. MD; Metersky, M. MD; Richards, C. MD, MPH; Wang, Y. PhD; Brady, P. J. MD, MPH; Helwig, A. MD; Battles, J. PhD. (2021). Measuring Patient Safety: The Medicare Patient Safety Monitoring System (Past, Present, and Future). Journal of Patient Safety: April 2021 - Volume 17 - Issue 3 - p e234-e240 doi: 10.1097/PTS.0000000000000322
Citation | Cruz, P. (2020). Inpatient Hypoglycemia: The Challenge Remains. J Diabetes Sci Technol. 2020;14(3):560-566. doi:10.1177/1932296820918540
Citation | Korytkowski, M.T., Muniyappa, R., Antinori-Lent, K., Donihi, A.C., Drincic, A.T, Hirsch, I.B., Luger, A., McDonnell, M.E., Murad, M.H., Nielsen, C., Pegg, C., Rushakoff, R.J., Santesso, N., Umpierrez, G.E. (2022). Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 8, August 2022, Pages 2101-2128, https://doi.org/10.1210/clinem/dgac278
Citation | Office of Inspector General Adverse Events in Hospitals. (2022). A Quarter of Medicare Patients Experienced Harm in October 2018. https://oig.hhs.gov/oei/reports/OEI-06-18-00400.asp
Citation | Santos, C.A.Q., Conover, C., Shehab, N., et al. (2020). Electronic Measurement of a Clinical Quality Measure for Inpatient Hypoglycemic Events: A Multicenter Validation Study. Med Care. 2020;58(10):927-933. doi:10.1097/MLR.0000000000001398
Guidance (Usage) | Note the measure is currently confined to using mg/dL as the unit of measurement for glucose results. Glucose levels are determined by laboratory or point-of-care (POC) tests, including capillary/glucometer blood glucose tests, and by interstitial fluid specimens from continuous glucose monitors. Glucose test results from urine specimens are not considered. Millimoles per liter (mmol/L) should be converted to milligrams per deciliter (mg/dL) for reporting this measure. This dQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This FHIR-based measure has been derived from the QDM-based measure: CMS816v5. 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: Inpatient hospitalizations that end during the measurement period for patients age 18 and older and at least one hypoglycemic medication administration starts during the encounter Logic Definition: Initial Population
Denominator | ID: Denominator_1 Description: Equals Initial Population Logic Definition: Denominator
Numerator | ID: Numerator_1 Description: Inpatient hospitalizations where a severe hypoglycemic event occurred during the encounter. A severe hypoglycemic event is: - A glucose result less than 40 mg/dL AND - A hypoglycemic medication was administered within 24 hours before the start of the severe hypoglycemic event (i.e., the glucose test with a result less than 40 mg/dL) AND -There was no subsequent repeat test for glucose with a result greater than 80 mg/dL within five minutes or less from the start of the initial glucose test with a result less than 40mg/dL Only one qualifying severe hypoglycemic event is counted in the numerator, and only one severe hypoglycemic event is counted per encounter. The 24-hour and 5-minute timeframes are based on the time the glucose was drawn, as this reflects the time the patient was experiencing that specific glucose level. Logic Definition: Numerator
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/CMS816FHIRHHHypo
Contents | Population Criteria Logic Definitions Terminology Dependencies Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population
    define "Initial Population":
      "Encounter With Hypoglycemic Medication Administration"
Denominator
    define "Denominator":
      "Initial Population"
Numerator
    define "Numerator":
      "Encounter With Severe Hypoglycemic Harm Event"
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: CMS816FHIRHHHypo
    define "SDE Sex":
      SDE."SDE Sex"
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "Qualifying Encounter":
      ["Encounter": "Encounter Inpatient"] InpatientEncounter
        where AgeInYearsAt(date from start of InpatientEncounter.period) >= 18
          and InpatientEncounter.period ends during day of "Measurement Period"
          and InpatientEncounter.status = 'finished'
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "Hypoglycemic Medication Administration":
      ["MedicationAdministration": "Hypoglycemics Severe Hypoglycemia"] HypoMedication
        where HypoMedication.status = 'completed'
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "Encounter With Hypoglycemic Medication Administration":
      "Qualifying Encounter" InpatientHospitalization
        with "Hypoglycemic Medication Administration" HypoglycemicMedication
          such that HypoglycemicMedication.effective.toInterval ( ) starts during InpatientHospitalization.hospitalizationWithObservation ( )
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "Initial Population":
      "Encounter With Hypoglycemic Medication Administration"
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "Denominator":
      "Initial Population"
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "Glucose Test With Result Less Than 40":
      from
        "Denominator" InpatientHospitalization,
        "Hypoglycemic Medication Administration" HypoglycemicMedication,
        ["LaboratoryResultObservation": "Glucose Lab Test Mass Per Volume"] GlucoseTest
        let HospitalizationInterval: InpatientHospitalization.hospitalizationWithObservation ( ),
        HypoglycemicMedicationStart: HypoglycemicMedication.effective.toInterval ( ),
        GlucoseTestTime: GlucoseTest.effective.earliest ( )
        where GlucoseTestTime during HospitalizationInterval
          and GlucoseTest.status in { 'final', 'amended', 'corrected' }
          and GlucoseTest.value < 40 'mg/dL'
          and HypoglycemicMedicationStart starts 24 hours or less before or on GlucoseTestTime
        return GlucoseTest
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "Low Glucose Test Followed By Glucose Test Result Greater Than 80":
      from
        "Denominator" InpatientHospitalization,
        "Glucose Test With Result Less Than 40" LowGlucoseTest,
        ["LaboratoryResultObservation": "Glucose Lab Test Mass Per Volume"] FollowupGlucoseTest
        let GlucoseTestTime: LowGlucoseTest.effective.earliest ( ),
        FollowupGlucoseTestTime: FollowupGlucoseTest.effective.earliest ( )
        where FollowupGlucoseTestTime 5 minutes or less after GlucoseTestTime
          and GlucoseTestTime during InpatientHospitalization.hospitalizationWithObservation ( )
          and FollowupGlucoseTestTime during InpatientHospitalization.hospitalizationWithObservation ( )
          and FollowupGlucoseTest.id !~ LowGlucoseTest.id
          and FollowupGlucoseTest.status in { 'final', 'amended', 'corrected' }
          and FollowupGlucoseTest.value > 80 'mg/dL'
        return LowGlucoseTest
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "Severe Hypoglycemic Harm Event":
      "Glucose Test With Result Less Than 40" LowGlucoseTest
        where not ( LowGlucoseTest.id in "Low Glucose Test Followed By Glucose Test Result Greater Than 80".id )
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "Encounter With Severe Hypoglycemic Harm Event":
      from
        "Denominator" InpatientHospitalization,
        "Severe Hypoglycemic Harm Event" HypoglycemicEvent
        let GlucoseTestTime: HypoglycemicEvent.effective.earliest ( ),
        HospitalizationInterval: InpatientHospitalization.hospitalizationWithObservation ( )
        where GlucoseTestTime during HospitalizationInterval
        return InpatientHospitalization
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "Numerator":
      "Encounter With Severe Hypoglycemic Harm Event"
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "SDE Payer":
      SDE."SDE Payer"
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "SDE Ethnicity":
      SDE."SDE Ethnicity"
Logic Definition | Library Name: CMS816FHIRHHHypo
    define "SDE Race":
      SDE."SDE Race"
Logic Definition | Library Name: CQMCommon
    /*
    @description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
    */
    define fluent function hospitalizationWithObservation(TheEncounter Encounter ):
      TheEncounter Visit
      		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
      				where LastObs.status = 'finished'
                and LastObs.period ends 1 hour or less on or before start of Visit.period
      				sort by end of period
      			),
      			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
      			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
      				where LastED.status = 'finished'
                and LastED.period ends 1 hour or less on or before VisitStart
      				sort by end of period
      			)
      		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]
Logic Definition | Library Name: QICoreCommon
    /*
    @description: Given an interval, return the starting point if the interval has a starting boundary specified,
    otherwise, return the ending point
    */
    define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
      (choice.toInterval()) period
        return
          if (period."hasStart"()) then start of period
          else end of period
Logic Definition | Library Name: QICoreCommon
    /*
    @description: Given an interval, return true if the interval has a starting boundary specified
    (i.e. the start of the interval is not null and not the minimum DateTime value)
    */
    define fluent function hasStart(period Interval<DateTime> ):
      not ( start of period is null
          or start of period = minimum DateTime
      )
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 [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
            }
Terminology
Code System | Description: Code system SNOMEDCT Resource: http://snomed.info/sct Canonical URL: `http://snomed.info/sct`
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 Hypoglycemics Severe Hypoglycemia Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1196.393 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1196.393`
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 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 Glucose Lab Test Mass Per Volume Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.34 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.34`
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`
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 QICoreCommon Resource: https://madie.cms.gov/Library/QICoreCommon|4.0.000 Canonical URL: `https://madie.cms.gov/Library/QICoreCommon|4.0.000`
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`
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, status, status.value, period 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: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, status, status.value, period Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, 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: 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/2.16.840.1.113762.1.4.1196.393
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: Observation Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab Must Support Elements: code, effective, status, status.value, value, id, id.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.34
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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