Title: | Core Clinical Data Elements for the Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure (HWM)FHIR
Id: | HybridHospitalWideMortalityFHIR
Download cql: | HybridHospitalWideMortalityFHIR.cql
Version: | 0.0.001
Url: | https://madie.cms.gov/Measure/HybridHospitalWideMortalityFHIR
short-name identifier: | CMS844FHIR
version-independent identifier: | urn:uuid:965255e9-dfeb-42d0-8416-2c4b7ecc5109
version-specific identifier: | urn:uuid:2c92808482113ece0182c5d4fc662f1a
endorser (NQF) identifier: | 3502
publisher (CMS) identifier: | 844FHIR
Effective Period: | 2025-07-01 ..2026-06-30
Status: | draft
Date: | 2023-11-10T13:58:12+00:00
Approval Date: | 2023-11-10
Last Review Date: | 2023-11-10
Name: | HybridHospitalWideMortalityFHIR
Publisher: | Centers for Medicare & Medicaid Services (CMS)
Description: | This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWM outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.
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 2004-2023 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc.
Disclaimer: | These performance specifications are not clinical guidelines and 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].
Guidance (Usage): | These specifications are for use for data with discharges that occur between July 1, 2025 and June 30, 2026. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2027. This logic guides the user to extract the FIRST resulted HWM-specific CCDEs for all Medicare FFS and MA encounters for patients aged 65 through 94 years (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area, such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST set of HWM-specific CCDEs in two different ways, depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs (physical exams) within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted. Value sets for the laboratory tests are represented using Logical Observation Identifiers Names and Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements. NOTE: Do not report ALL values on an encounter during their entire admission. Only report the FIRST resulted value for EACH CCDE collected in the appropriate timeframe, if available. For each CCDE, it is recommended that hospitals report the below UCUM units, however, any unit may be submitted. CCDE UCUM Unit: Bicarbonate-------------------------------------meq/L mmol/L Creatinine---------------------------------------mg/dL Heart rate---------------------------------------{Beats}/min Hematocrit -------------------------------------% Oxygen saturation (by pulse oximetry)------------% Platelet-----------------------------------------10*3/uL Sodium-----------------------------------------meq/L mmol/L Systolic blood pressure--------------------------mm[Hg] Temperature------------------------------------Cel [degF] White blood cell count --------------------------{Cells}/uL 10*3/uL 10*9/L For each encounter please also submit the following Linking Variables: CMS Certification Number (CCN) for Medicare FFS patients or National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Date of Birth; Sex; Inpatient Admission Date; and Discharge Date. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This version of the specifications uses Quality Data Model (QDM) version 5.6. Please refer to the eCQI Resource Center (https://ecqi.healthit.gov/qdm) for more information on the QDM. programs, who are treated and billed as inpatients but receive care in their home.
Population Criteria: |
6385011c4ba3d47c885c02aa
Initial Population: | All Medicare FFS and MA encounters for patients aged 65 through 94 years at the start of an inpatient admission, who are discharged during the measurement period (length of stay <365 days). NOTE: All Medicare FFS and MA encounters meeting the above criteria should be included, regardless of whether Medicare FFS/MA is the primary, secondary, or tertiary payer.
Supplemental Data Guidance : |
Supplemental Data Elements: | SDE Ethnicity SDE Payer SDE Race SDE Sex Encounter with First Bicarbonate Lab Test Encounter with First Body Temperature Encounter with First Creatinine Lab Test Encounter with First Heart Rate Encounter with First Hematocrit Lab Test Encounter with First Oxygen Saturation Encounter with First Platelet Lab Test Encounter with First Sodium Lab Test Encounter with First Systolic Blood Pressure Encounter with First White Blood Cells Lab Test
Libraries: |
https://madie.cms.gov/Library/HybridHospitalWideMortalityFHIR
Related Artifact Dependencies: | Library/CQMCommon|2.0.000 Library/FHIRHelpers|4.3.000 Library/QICoreCommon|2.0.000 Library/SupplementalDataElements|3.4.000 http://loinc.org http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.38 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119
Parameters: |
name | use | min | max | type
--- | --- | --- | --- | ---
Measurement Period | in | 0 | 1 | Period
Initial Population | out | 0 | * | Resource
Encounter with First Bicarbonate Lab Test | out | 0 | * | Resource
Encounter with First Heart Rate | out | 0 | * | Resource
Encounter with First White Blood Cells Lab Test | out | 0 | * | Resource
Encounter with First Hematocrit Lab Test | out | 0 | * | Resource
Encounter with First Platelet Lab Test | out | 0 | * | Resource
SDE Race | out | 0 | 1 | Resource
Encounter with First Systolic Blood Pressure | out | 0 | * | Resource
SDE Sex | out | 0 | 1 | Coding
Encounter with First Creatinine Lab Test | out | 0 | * | Resource
Encounter with First Body Temperature | out | 0 | * | Resource
SDE Payer | out | 0 | * | Resource
SDE Ethnicity | out | 0 | 1 | Resource
Encounter with First Oxygen Saturation | out | 0 | * | Resource
Encounter with First Sodium Lab Test | out | 0 | * | Resource
DataRequirements: |
Type | Elements | Valueset Name | Valueset
--- | --- | --- | ---
Encounter | type status status.value period | Observation Services | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
Encounter | type status status.value period | Emergency Department Visit | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292
Encounter | type period | Outpatient Surgery Service | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.38
Encounter | type status status.value period | Encounter Inpatient | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Patient | url extension |  |
Coverage | type | Medicare payer | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.10
Coverage | type | Medicare Advantage payer | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1104.12
Coverage | type period | Payer Type | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Observation | code issued issued.value status status.value value | Bicarbonate lab test | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.139
Observation | code issued issued.value status status.value value | White blood cells count lab test | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.129
Observation | code issued issued.value status status.value value | Hematocrit lab test | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.114
Observation | code issued issued.value status status.value value | Platelet count lab test | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.127
Observation | code issued issued.value status status.value value | Creatinine lab test | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.2363
Observation | code issued issued.value status status.value value | Sodium lab test | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.119
Observation | effective status status.value value |  |
uri | value |  |
Observation | effective status status.value value component |  |
Patient | gender gender.value |  |
Observation | effective status status.value value |  |
Observation | effective status status.value value |  |
Direct Reference Codes: |
display | code | system
--- | --- | ---
Systolic BP | 8480-6 | http://loinc.org
Logic Definitions: |
Group | Scoring | Population Criteria | Expression
--- | --- | --- | ---
6385011c4ba3d47c885c02aa | Group scoring: cohort
|  | Initial Population |
    define "Initial Population":
      "Inpatient Encounters"

Library Name | Name
--- | ---
HybridHospitalWideMortalityFHIR | Inpatient Encounters
    define "Inpatient Encounters":
      [Encounter: "Encounter Inpatient"] InpatientEncounter
        with ( [Coverage: "Medicare payer"]
          union [Coverage: "Medicare Advantage payer"] ) MedicarePayer
          such that CQMCommon."LengthInDays" ( InpatientEncounter.hospitalizationWithObservationAndOutpatientSurgeryService ( ) ) < 365
            and InpatientEncounter.status = 'finished'
            and AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[65, 94]
            and InpatientEncounter.period ends during day of "Measurement Period"
Library Name | Name
HybridHospitalWideMortalityFHIR | Encounter with First Bicarbonate Lab Test
    define "Encounter with First Bicarbonate Lab Test":
      "Inpatient Encounters" EncounterInpatient
        let FirstBicarbonateLab: First(["USCoreLaboratoryResultObservationProfile": "Bicarbonate lab test"] BicarbonateLab
            where BicarbonateLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
              and BicarbonateLab.status in { 'final', 'amended', 'corrected' }
              and BicarbonateLab.value is not null
            sort by issued.earliest()
        )
        return {
          EncounterId: EncounterInpatient.id,
          FirstBicarbonateResult: FirstBicarbonateLab.value as Quantity,
          Timing: FirstBicarbonateLab.issued
        }
Library Name | Name
HybridHospitalWideMortalityFHIR | Encounter with First Heart Rate
    define "Encounter with First Heart Rate":
      "Inpatient Encounters" EncounterInpatient
        let FirstHeartRate: First(["observation-heartrate"] HeartRate
            where HeartRate.effective.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
              and HeartRate.status in { 'final', 'amended', 'corrected' }
              and HeartRate.value is not null
            sort by effective.earliest()
        )
        return {
          EncounterId: EncounterInpatient.id,
          FirstHeartRateResult: FirstHeartRate.value as Quantity,
          Timing: FirstHeartRate.effective.earliest ( )
        }
Library Name | Name
HybridHospitalWideMortalityFHIR | Encounter with First White Blood Cells Lab Test
    define "Encounter with First White Blood Cells Lab Test":
      "Inpatient Encounters" EncounterInpatient
        let FirstWhiteBloodCellLab: First(["USCoreLaboratoryResultObservationProfile": "White blood cells count lab test"] WhiteBloodCellLab
            where WhiteBloodCellLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
              and WhiteBloodCellLab.status in { 'final', 'amended', 'corrected' }
              and WhiteBloodCellLab.value is not null
            sort by issued.earliest()
        )
        return {
          EncounterId: EncounterInpatient.id,
          FirstWhiteBloodCellResult: FirstWhiteBloodCellLab.value as Quantity,
          Timing: FirstWhiteBloodCellLab.issued
        }
Library Name | Name
HybridHospitalWideMortalityFHIR | Encounter with First Hematocrit Lab Test
    define "Encounter with First Hematocrit Lab Test":
      "Inpatient Encounters" EncounterInpatient
        let FirstHematocritLab: First(["USCoreLaboratoryResultObservationProfile": "Hematocrit lab test"] HematocritLab
            where HematocritLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
              and HematocritLab.status in { 'final', 'amended', 'corrected' }
              and HematocritLab.value is not null
            sort by issued.earliest()
        )
        return {
          EncounterId: EncounterInpatient.id,
          FirstHematocritResult: FirstHematocritLab.value as Quantity,
          Timing: FirstHematocritLab.issued
        }
Library Name | Name
HybridHospitalWideMortalityFHIR | Encounter with First Platelet Lab Test
    define "Encounter with First Platelet Lab Test":
      "Inpatient Encounters" EncounterInpatient
        let FirstPlateletLab: First(["USCoreLaboratoryResultObservationProfile": "Platelet count lab test"] PlateletLab
            where PlateletLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
              and PlateletLab.status in { 'final', 'amended', 'corrected' }
              and PlateletLab.value is not null
            sort by issued.earliest()
        )
        return {
          EncounterId: EncounterInpatient.id,
          FirstPlateletResult: FirstPlateletLab.value as Quantity,
          Timing: FirstPlateletLab.issued
        }
Library Name | Name
SupplementalDataElements | SDE Race
    define "SDE Race":
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }
Library Name | Name
HybridHospitalWideMortalityFHIR | SDE Race
    define "SDE Race":
      SDE."SDE Race"
Library Name | Name
HybridHospitalWideMortalityFHIR | Encounter with First Systolic Blood Pressure
    define "Encounter with First Systolic Blood Pressure":
      "Inpatient Encounters" EncounterInpatient
        let FirstSystolicBP: First(["observation-bp"] SystolicBP
            where SystolicBP.effective.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
              and SystolicBP.status in { 'final', 'amended', 'corrected' }
              and SystolicBP.value is not null
            sort by effective.earliest()
        )
        return {
          EncounterId: EncounterInpatient.id,
          FirstSystolicResult: FirstSystolicBP.component ComponentSystolic
            where ComponentSystolic.code ~ "Systolic blood pressure"
            return ComponentSystolic.value as Quantity,
          Timing: FirstSystolicBP.effective.earliest ( )
        }
Library Name | Name
SupplementalDataElements | SDE Sex
    define "SDE Sex":
      case
          when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
          when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
          else null
        end
Library Name | Name
HybridHospitalWideMortalityFHIR | SDE Sex
    define "SDE Sex":
      SDE."SDE Sex"
Library Name | Name
HybridHospitalWideMortalityFHIR | Encounter with First Creatinine Lab Test
    define "Encounter with First Creatinine Lab Test":
      "Inpatient Encounters" EncounterInpatient
        let FirstCreatinineLab: First(["USCoreLaboratoryResultObservationProfile": "Creatinine lab test"] CreatinineLab
            where CreatinineLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
              and CreatinineLab.status in { 'final', 'amended', 'corrected' }
              and CreatinineLab.value is not null
            sort by issued.earliest()
        )
        return {
          EncounterId: EncounterInpatient.id,
          FirstCreatinineResult: FirstCreatinineLab.value as Quantity,
          Timing: FirstCreatinineLab.issued
        }
Library Name | Name
HybridHospitalWideMortalityFHIR | Encounter with First Body Temperature
    define "Encounter with First Body Temperature":
      "Inpatient Encounters" EncounterInpatient
        let FirstTemperature: First(["observation-bodytemp"] temperature
            where temperature.effective.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
              and temperature.status in { 'final', 'amended', 'corrected' }
              and temperature.value is not null
            sort by effective.earliest()
        )
        return {
          EncounterId: EncounterInpatient.id,
          FirstTemperatureResult: FirstTemperature.value as Quantity,
          Timing: FirstTemperature.effective.earliest ( )
        }
Library Name | Name
SupplementalDataElements | SDE Payer
    define "SDE Payer":
      [Coverage: type in "Payer Type"] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }
Library Name | Name
HybridHospitalWideMortalityFHIR | SDE Payer
    define "SDE Payer":
      SDE."SDE Payer"
Library Name | Name
HybridHospitalWideMortalityFHIR | Initial Population
    define "Initial Population":
      "Inpatient Encounters"
Library Name | Name
SupplementalDataElements | SDE Ethnicity
    define "SDE Ethnicity":
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }
Library Name | Name
HybridHospitalWideMortalityFHIR | SDE Ethnicity
    define "SDE Ethnicity":
      SDE."SDE Ethnicity"
Library Name | Name
HybridHospitalWideMortalityFHIR | Encounter with First Oxygen Saturation
    define "Encounter with First Oxygen Saturation":
      "Inpatient Encounters" EncounterInpatient
        let FirstOyygenSat: First(["observation-oxygensat"] O2Saturation
            where O2Saturation.effective.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 120 minutes]
              and O2Saturation.status in { 'final', 'amended', 'corrected' }
              and O2Saturation.value is not null
            sort by effective.earliest()
        )
        return {
          EncounterId: EncounterInpatient.id,
          FirstOyygenSatResult: FirstOyygenSat.value as Quantity,
          Timing: FirstOyygenSat.effective.earliest ( )
        }
Library Name | Name
HybridHospitalWideMortalityFHIR | Encounter with First Sodium Lab Test
    define "Encounter with First Sodium Lab Test":
      "Inpatient Encounters" EncounterInpatient
        let FirstSodiumLab: First(["USCoreLaboratoryResultObservationProfile": "Sodium lab test"] SodiumLab
            where SodiumLab.issued.earliest() during Interval[start of EncounterInpatient.period - 1440 minutes, start of EncounterInpatient.period + 1440 minutes]
              and SodiumLab.status in { 'final', 'amended', 'corrected' }
              and SodiumLab.value is not null
            sort by issued.earliest()
        )
        return {
          EncounterId: EncounterInpatient.id,
          FirstSodiumResult: FirstSodiumLab.value as Quantity,
          Timing: FirstSodiumLab.issued
        }

Purpose: UNKNOWN