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EXM108_FHIR4-8.2.000.cql
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EXM108_FHIR4-8.2.000.cql
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library EXM108_FHIR4 version '8.2.000'
//for 2020 reporting year. QDM to QI-4
//Venous Thromboembolism Prophylaxis
//Author: TJC
using FHIR version '4.0.0'
include FHIRHelpers version '4.0.0' called FHIRHelpers
include MATGlobalCommonFunctions_FHIR4 version '4.0.000' called Global
include SupplementalDataElements_FHIR4 version '1.0.0' called SDE
include VTEICU_FHIR4 version '3.1.000' called VTEICU
include TJCOverall_FHIR4 version '4.0.000' called TJC
codesystem "SNOMEDCT": 'http://snomed.info/sct/731000124108'
codesystem "LOINC": 'http://loinc.org'
// NOTE: R4 code system URLs changed to be based on terminology.hl7.org...
codesystem "RequestIntent": 'http://terminology.hl7.org/CodeSystem/request-intent'
//NOTE: Created for condition.clinicalStatus which is codeableConcept
codesystem "ConditionClinicalStatusCodes": 'http://terminology.hl7.org/CodeSystem/condition-clinical'
//NOTE: Created for ActPriority for Encounter.category which is codeableConcept
codesystem "ActPriority": 'http://terminology.hl7.org/ValueSet/v3-ActPriority'
valueset "Device Application": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.48'
valueset "Atrial Fibrillation/Flutter": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.202'
valueset "Comfort Measures": 'http://cts.nlm.nih.gov/fhir/ValueSet/1.3.6.1.4.1.33895.1.3.0.45'
valueset "Direct Thrombin Inhibitor": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.205'
valueset "Emergency Department Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292'
valueset "General or Neuraxial Anesthesia": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.1743'
valueset "General Surgery": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.255'
valueset "Glycoprotein IIb/IIIa Inhibitors": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.41'
valueset "Graduated compression stockings (GCS)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.256'
valueset "Gynecological Surgery": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.257'
valueset "Hemorrhagic Stroke": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.212'
valueset "Hip Fracture Surgery": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.258'
valueset "Hip Replacement Surgery": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.259'
valueset "Injectable Factor Xa Inhibitor for VTE Prophylaxis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.211'
valueset "INR": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.213'
valueset "Intermittent pneumatic compression devices (IPC)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.214'
valueset "Intracranial Neurosurgery": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.260'
valueset "Intravenous route": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.222'
valueset "Ischemic Stroke": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.247'
valueset "Knee Replacement Surgery": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.261'
valueset "Low Dose Unfractionated Heparin for VTE Prophylaxis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1045.39'
valueset "Low Molecular Weight Heparin for VTE Prophylaxis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.219'
valueset "Low Risk": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.400'
valueset "Medical Reason": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.473'
valueset "Mental Health Diagnoses": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1004'
valueset "Obstetrics": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.263'
valueset "Obstetrics VTE": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.264'
valueset "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.134'
valueset "Patient Refusal": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.93'
valueset "Subcutaneous route": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.223'
valueset "Unfractionated Heparin": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.218'
valueset "Urological Surgery": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.272'
valueset "Venous foot pumps (VFP)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.230'
valueset "Venous Thromboembolism": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.279'
valueset "Warfarin": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.232'
valueset "Intensive Care Unit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1110.23'
code "Risk for venous thromboembolism": '72136-5' from "LOINC" display 'Risk for venous thromboembolism'
//NOTE: Created for condition.clinicalStatus which is codeableConcept
code "active": 'active' from "ConditionClinicalStatusCodes"
code "recurrence": 'recurrence' from "ConditionClinicalStatusCodes"
code "relapse": 'relapse' from "ConditionClinicalStatusCodes"
code "inactive": 'inactive' from "ConditionClinicalStatusCodes"
code "remission": 'remission' from "ConditionClinicalStatusCodes"
code "resolved": 'resolved' from "ConditionClinicalStatusCodes"
context Patient
define "SDE Ethnicity":
SDE."SDE Ethnicity"
define "SDE Payer":
SDE."SDE Payer"
define "SDE Race":
SDE."SDE Race"
define "SDE Sex":
SDE."SDE Sex"
define "Initial Population":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"
// Note: added FHIRHelpers.ToDate() in R4
define "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions":
( Global."Inpatient Encounter" InpatientEncounter
with ["Patient"] BirthDate
such that Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(BirthDate.birthDate), start of InpatientEncounter.period) >= 18
)
intersect "Admission Without VTE or Obstetrical Conditions"
define "Admission Without VTE or Obstetrical Conditions":
Global."Inpatient Encounter" InpatientEncounter
where not (exists (Global.EncounterDiagnosis(InpatientEncounter)) EncounterDiagnosis
where (EncounterDiagnosis.code in "Obstetrics"
or EncounterDiagnosis.code in "Venous Thromboembolism"
or EncounterDiagnosis.code in "Obstetrics VTE"
)
)
define "Denominator":
"Initial Population"
define "Denominator Exclusion":
"Encounter Less Than 2 Days"
union "Encounter With ICU Location Stay 1 Day or More"
union "Encounter With Principal Diagnosis of Mental Disorder or Stroke"
union "Encounter With Principal Procedure of SCIP VTE Selected Surgery"
union "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission"
union "Encounter With Intervention Comfort Measures on Day of or Day After Procedure"
define "Encounter Less Than 2 Days":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where Global."LengthInDays"(QualifyingEncounter.period)< 2
define "Encounter With ICU Location Stay 1 Day or More":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where exists ( QualifyingEncounter.location Location
where Global.GetLocation(Location.location).type in "Intensive Care Unit"
and Global."LengthInDays"(Location.period)>= 1
and Location.period starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
)
define "Encounter With Principal Diagnosis of Mental Disorder or Stroke":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Mental Health Diagnoses"
or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Hemorrhagic Stroke"
or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Ischemic Stroke"
define function GetExtension(Resource FHIR.DomainResource, Url String):
First(
Resource.extension E
where E.url = Url
)
define function GetExtension(Element FHIR.Element, Url String):
First(
Element.extension E
where E.url = Url
)
/* NOTE: 2 options to express Principal Procedure to retrive "encounter Procedure as an url" and proedure "rank as extension" in R4
VTE-1 uses Option 1 - generic extension funtion
VTE-2 uses Option 2 - Specific extension functions
TODO: Mapping Table needs revision on using "Encounter.procedure.code", "Encounter.procedure.sequence"
*/
define "Encounter With Principal Procedure of SCIP VTE Selected Surgery":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
"SCIP VTE Selected Surgery" SelectedProcedure
let EncounterProcedure: GetExtension(QualifyingEncounter, 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter-procedure')
where FHIRHelpers.ToInteger(GetExtension(EncounterProcedure, 'rank').value as FHIR.positiveInt) = 1
and Global.GetId(FHIRHelpers.ToString((GetExtension(EncounterProcedure, 'procedure').value as FHIR.Reference).reference)) = SelectedProcedure.id
and SelectedProcedure.performed as Period during QualifyingEncounter.period
define "SCIP VTE Selected Surgery":
( ["Procedure": "General Surgery"]
union ["Procedure": "Gynecological Surgery"]
union ["Procedure": "Hip Fracture Surgery"]
union ["Procedure": "Hip Replacement Surgery"]
union ["Procedure": "Intracranial Neurosurgery"]
union ["Procedure": "Knee Replacement Surgery"]
union ["Procedure": "Urological Surgery"] ) Procedure
where Procedure.status = 'completed'
//NOTE: need FHIRHelpers.ToInterval() when using start of or end of xxxx .
define "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "Intervention Comfort Measures" ComfortMeasure
such that Coalesce( start of FHIRHelpers.ToInterval(ComfortMeasure.performed as Period), ComfortMeasure.authoredOn) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
//10/29: removed 'plan' from RequestIntent value. it was P.intent in {'order', 'plan'}
define "Intervention Comfort Measures":
(["ServiceRequest": "Comfort Measures"] P
where P.intent = 'order'
)
union
(["Procedure": "Comfort Measures"] IntervetionPerformed
where IntervetionPerformed.status in {'completed', 'in-progress'})
define "Encounter With Intervention Comfort Measures on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"Intervention Comfort Measures" ComfortMeasure
where AnesthesiaProcedure.status = 'completed'
and AnesthesiaProcedure.performed as Period ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(start of FHIRHelpers.ToInterval(ComfortMeasure.performed as Period), ComfortMeasure.authoredOn) during TJC."CalendarDayOfOrDayAfter"(end of FHIRHelpers.ToInterval(AnesthesiaProcedure.performed as Period))
return QualifyingEncounter
define "Numerator":
"Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure"
union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"
intersect ( "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE"
union "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery"
)
)
union "Encounter With Low Risk for VTE or Anticoagulant Administered"
union "Encounter With No VTE Prophylaxis Due to Medical Reason"
union "Encounter With No VTE Prophylaxis Due to Patient Refusal"
define "Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure":
( from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
"VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis
//Measure Review: VTEProphylaxis is the result of the union of different types, not all of which have an 'effective' attribute.
//This is causing an "attribute not found" exception when the result only contains data for the type without an 'effective' attribute.
//Not sure if this is desired behavior (and the code should be changed) or a bug (and the tooling should be fixed).
where Coalesce(VTEProphylaxis.effective as Period, VTEProphylaxis.performed as Period) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
return QualifyingEncounter
)
union ( from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis
where AnesthesiaProcedure.performed as Period ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(VTEProphylaxis.effective as Period, VTEProphylaxis.performed as Period) starts during TJC."CalendarDayOfOrDayAfter"(end of FHIRHelpers.ToInterval(AnesthesiaProcedure.performed as Period))
return QualifyingEncounter
)
// 10/29: Replaced DeviceUseStatement with Procedure with a new value set and procedure.usdCode for specifying devices
define "VTE Prophylaxis by Medication Administered or Device Applied":
( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
where VTEMedication.status ='completed'
and VTEMedication.dosage.route in "Subcutaneous route"
)
union (["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] LMWH where LMWH.status = 'completed')
union (["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] FactorXa where FactorXa.status = 'completed')
union (["MedicationAdministration": medication in "Warfarin"] Warfarin where Warfarin.status = 'completed')
union (
["Procedure": "Device Application"] DeviceApplied
where DeviceApplied.status = 'complete'
and (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)"
or DeviceApplied.usedCode in"Venous foot pumps (VFP)"
or DeviceApplied.usedCode in "Graduated compression stockings (GCS)"
)
)
define "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure":
( from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
where FactorXaMedication.status = 'completed'
and FactorXaMedication.effective as Period starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
return QualifyingEncounter
)
union ( from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
where FactorXaMedication.status = 'completed'
and AnesthesiaProcedure.status = 'completed'
and AnesthesiaProcedure.performed as Period ends 1 day after day of start of QualifyingEncounter.period
and FactorXaMedication.effective as Period starts during TJC."CalendarDayOfOrDayAfter"(end of FHIRHelpers.ToInterval(AnesthesiaProcedure.performed as Period))
return QualifyingEncounter
)
/*NOTE: Feedback at Digitial Quality Summit 2019 indicates verificationStatus may be difficult for implementers to retrieve
both condition.clinicalStatus and condition.verificationStatus = 'confirmed'
*/
define "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE":
( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with ["Condition": code in "Atrial Fibrillation/Flutter"] AtrialFibrillation
such that FHIRHelpers.ToConcept(AtrialFibrillation.clinicalStatus) in {"active", "recurrence", "relapse"}
and AtrialFibrillation.onset on or before end of QualifyingEncounter.period
)
union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
where Global.EncounterDiagnosis(QualifyingEncounter).code in "Atrial Fibrillation/Flutter"
)
union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with ["Condition": code in "Venous Thromboembolism"] VTEDiagnosis
such that FHIRHelpers.ToConcept(VTEDiagnosis.clinicalStatus) in { "inactive", "remission", "resolved" }
//and VTEDiagnosis.verificationStatus = 'confirmed'
and VTEDiagnosis.onset as dateTime before start of QualifyingEncounter.period
)
define "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with ( ["Procedure": "Hip Replacement Surgery"]
union ["Procedure": "Knee Replacement Surgery"] ) HipKneeProcedure
such that HipKneeProcedure.status = 'completed'
and HipKneeProcedure.performed as Period starts on or before end of QualifyingEncounter.period
define "Encounter With Low Risk for VTE or Anticoagulant Administered":
"Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission"
union "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure"
define "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment
such that VTERiskAssessment.effective as dateTime during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
define "Is In Low Risk for VTE or On Anticoagulant":
( ["Observation": "Risk for venous thromboembolism"] VTERiskAssessment
where VTERiskAssessment.value in "Low Risk"
and VTERiskAssessment.status in {'final','amended', 'corrected'}
)
union ( ["Observation": "INR"] INRLabTest
where INRLabTest.value as Quantity > 3.0
and INRLabTest.status in {'final','amended', 'corrected'}
return "Observation" { id: INRLabTest.id, effective: INRLabTest.issued }
)
union ((( ["MedicationAdministration": "Unfractionated Heparin"] UnfractionatedHeparin
where UnfractionatedHeparin.dosage.route in "Intravenous route"
)
union ["MedicationAdministration": "Direct Thrombin Inhibitor"]
union ["MedicationAdministration": "Glycoprotein IIb/IIIa Inhibitors"] ) AnticoagulantMedication
where AnticoagulantMedication.status = 'complete'
return "Observation" { id: AnticoagulantMedication.id, effective: (AnticoagulantMedication.effective as Period).start}
)
define "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment
where AnesthesiaProcedure.performed as Period ends 1 day after day of start of QualifyingEncounter.period
and VTERiskAssessment.effective as dateTime during TJC."CalendarDayOfOrDayAfter"(end of FHIRHelpers.ToInterval(AnesthesiaProcedure.performed as Period))
return QualifyingEncounter
define "Encounter With No VTE Prophylaxis Due to Medical Reason":
( "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
intersect "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
)
union ( "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure"
intersect "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure"
)
define "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
such that Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason"
and Coalesce(NoVTEMedication.authoredOn, start of FHIRHelpers.ToInterval(NoVTEMedication.effective as Period)) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
define "No VTE Prophylaxis Medication Administered or Ordered":
(( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
union
["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"]
union
["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
union
["MedicationAdministration": medication in "Warfarin"]
) MedicationAdm
where MedicationAdm.status = 'not-done'
)
union
(( ["MedicationRequest": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
union
["MedicationRequest": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"]
union
["MedicationRequest": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
union
["MedicationRequest": medication in "Warfarin"]
) MedicationOrder
where MedicationOrder.doNotPerform is true
and MedicationOrder.status in {'completed', 'cancelled'}
//11/5 discussion: all expressions for QI-Core must include a status.
//Therefore, we need ServiceRequest.status = completed; and MedicationRequest.status = cancelled (or completed, since cancelled indicates it was once ordered but intentionally never filled).
//So the not done issue is handled by ServiceRequest.doNotPerform = True Or MedicationRequest.doNotPerform = True
)
define "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason"
and AnesthesiaProcedure.status = 'completed'
and AnesthesiaProcedure.performed as Period ends 1 day after day of start of FHIRHelpers.ToInterval(QualifyingEncounter.period as Period)
and Coalesce(NoVTEMedication.authoredOn, start of FHIRHelpers.ToInterval(NoVTEMedication.effective as Period)) during TJC."CalendarDayOfOrDayAfter"(end of FHIRHelpers.ToInterval(AnesthesiaProcedure.performed as Period))
return QualifyingEncounter
define "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
such that NoVTEDevice.requestStatusReason in "Medical Reason"
and NoVTEDevice.authoredOn during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
//11/5: ServiceRequest not done reason is an extension in QI-Core R4 as ServiceRequest.extension:statusReason
define function GetStatusReason(requestReason ServiceRequest):
GetExtension(requestReason, 'http://hl7.org/fhir/StructureDefinition/request-statusReason')
define "No VTE Prophylaxis Device Applied or Ordered":
((
["ServiceRequest": "Venous foot pumps (VFP)"]
union ["ServiceRequest": "Intermittent pneumatic compression devices (IPC)"]
union ["ServiceRequest": "Graduated compression stockings (GCS)"]
) DeviceOrder
where DeviceOrder.status = 'completed'
//11/5 discussion: all expressions for QI-Core must include a status
//ServiceRequest.status - draft | active | suspended | completed | entered-in-error | cancelled
and DeviceOrder.doNotPerform is true
return {id: DeviceOrder.id, requestStatusReason: GetStatusReason(DeviceOrder), authoredOn: DeviceOrder.authoredOn}
)
union
(
["Procedure": "Device Application"] DeviceApplied
let DeviceNotDoneTiming: GetExtension(DeviceApplied, 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded').value
where (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)"
or DeviceApplied.usedCode in "Venous foot pumps (VFP)"
or DeviceApplied.usedCode in "Graduated compression stockings (GCS)"
)
and DeviceApplied.status = 'not-done'
return {id: DeviceApplied.id, requestStatusReason: DeviceApplied.statusReason, authoredOn: DeviceNotDoneTiming}
)
define "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
where NoVTEDevice.requestStatusReason in "Medical Reason"
and AnesthesiaProcedure.status = 'completed'
and AnesthesiaProcedure.performed as Period ends 1 day after day of start of QualifyingEncounter.period
and NoVTEDevice.authoredOn during TJC."CalendarDayOfOrDayAfter"(end of FHIRHelpers.ToInterval(AnesthesiaProcedure.performed as Period))
return QualifyingEncounter
define "Encounter With No VTE Prophylaxis Due to Patient Refusal":
"No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission"
union "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure"
define "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission":
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
with "No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
such that Coalesce(PatientRefusal.effective as dateTime, PatientRefusal.authoredOn)
during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)
define "No VTE Prophylaxis Medication or Device Due to Patient Refusal":
( "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Patient Refusal"
)
union ("No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
where NoVTEDevice.requestStatusReason in "Patient Refusal"
)
define "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure":
from
"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
"No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
where AnesthesiaProcedure.performed as Period ends 1 day after day of start of QualifyingEncounter.period
and Coalesce(PatientRefusal.effective as dateTime, PatientRefusal.authoredOn)
during TJC."CalendarDayOfOrDayAfter"(end of FHIRHelpers.ToInterval(AnesthesiaProcedure.performed as Period))
return QualifyingEncounter