{
  "description": "An example FHIR-based publishable measure",
  "_filename": "Measure-measure-publishable-exm.json",
  "package_name": "hl7.fhir.uv.cqm",
  "date": "2025-08-13",
  "group": [ {
    "id": "group-1",
    "extension": [ {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.linkId",
      "valueString": "primary"
    } ],
    "population": [ {
      "id": "initial-population",
      "code": {
        "coding": [ {
          "code": "initial-population",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Initial Population"
        } ]
      },
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Initial Population"
      },
      "extension": [ {
        "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
        "valueString": "primary-publishablexm-initial-population"
      } ]
    }, {
      "id": "measure-population",
      "code": {
        "coding": [ {
          "code": "measure-population",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Measure Population"
        } ]
      },
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Measure Population"
      },
      "extension": [ {
        "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
        "valueString": "primary-publishablexm-measure-population"
      } ]
    }, {
      "id": "measure-observation",
      "code": {
        "coding": [ {
          "code": "measure-observation",
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "display": "Measure Observation"
        } ]
      },
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "Measure Observation"
      },
      "extension": [ {
        "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.group.population.linkId",
        "valueString": "primary-publishablexm-measure-observation"
      } ]
    } ]
  } ],
  "meta": {
    "profile": [ "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-publishablemeasure", "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-computablemeasure" ]
  },
  "publisher": "HL7 International / Clinical Quality Information",
  "approvalDate": "2019-02-17",
  "disclaimer": "Example disclaimer",
  "jurisdiction": [ {
    "coding": [ {
      "code": "001",
      "system": "http://unstats.un.org/unsd/methods/m49/m49.htm"
    } ]
  } ],
  "purpose": "This measure has been developed to support improvement in clinical care.",
  "name": "PublishableMeasureEXM",
  "useContext": [ {
    "code": {
      "code": "venue",
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "display": "Clinical Venue"
    },
    "valueCodeableConcept": {
      "coding": [ {
        "code": "ec",
        "system": "http://hl7.org/fhir/uv/cqm/CodeSystem/intended-venue-codes",
        "display": "EC"
      } ]
    }
  } ],
  "copyright": "Example Copyright Statement",
  "type": "[{:coding [{:system \\\"http://terminology.hl7.org/CodeSystem/measure-type\\\", :code \\\"process\\\"}]}]",
  "experimental": "true",
  "topic": [ {
    "text": "Health Quality Measure Document",
    "coding": [ {
      "code": "57024-2",
      "system": "http://loinc.org"
    } ]
  } ],
  "resourceType": "Measure",
  "title": "EXM Publishable Measure",
  "supplementalData": [ {
    "id": "sde-ethnicity",
    "usage": [ {
      "coding": [ {
        "code": "supplemental-data",
        "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage"
      } ]
    } ],
    "criteria": {
      "language": "text/cql-identifier",
      "expression": "SDE Ethnicity"
    },
    "extension": [ {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
      "valueString": "primary-sde-ethnicity"
    } ]
  }, {
    "id": "sde-race",
    "usage": [ {
      "coding": [ {
        "code": "supplemental-data",
        "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage"
      } ]
    } ],
    "criteria": {
      "language": "text/cql-identifier",
      "expression": "SDE Race"
    },
    "extension": [ {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
      "valueString": "primary-sde-race"
    } ]
  }, {
    "id": "sde-payer",
    "usage": [ {
      "coding": [ {
        "code": "supplemental-data",
        "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage"
      } ]
    } ],
    "criteria": {
      "language": "text/cql-identifier",
      "expression": "SDE Payer"
    },
    "extension": [ {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
      "valueString": "primary-sde-payer"
    } ]
  }, {
    "id": "sde-sex",
    "usage": [ {
      "coding": [ {
        "code": "supplemental-data",
        "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage"
      } ]
    } ],
    "criteria": {
      "language": "text/cql-identifier",
      "expression": "SDE Sex"
    },
    "extension": [ {
      "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.supplementalData.linkId",
      "valueString": "primary-sde-sex"
    } ]
  } ],
  "library": [ "http://hl7.org/fhir/uv/cqm/Library/EXMPublishableLibrary" ],
  "package_version": "1.0.0",
  "author": [ {
    "name": "Example Measure Content Developer"
  } ],
  "extension": [ {
    "url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-populationBasis",
    "valueCode": "Encounter"
  }, {
    "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
    "valueReference": {
      "reference": "Device/software-system-example"
    }
  }, {
    "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Measure.term",
    "extension": [ {
      "url": "code",
      "valueCodeableConcept": {
        "coding": [ {
          "code": "example-term-code",
          "system": "http://example.org/fhir/CodeSystem/measure-terms",
          "display": "Example Term Display"
        } ]
      }
    }, {
      "url": "definition",
      "valueMarkdown": "A term used in the measure that bears clearly definition to communicate the measure intent"
    } ]
  }, {
    "id": "effective-data-requirements",
    "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
    "valueCanonical": "#effective-data-requirements"
  }, {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "cqi"
  } ],
  "contained": [ {
    "dataRequirement": [ {
      "type": "Patient",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Patient" ],
      "mustSupport": [ "url", "extension", "value" ]
    }, {
      "type": "Coverage",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Coverage" ],
      "codeFilter": [ {
        "path": "type",
        "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
      } ],
      "mustSupport": [ "type", "period" ]
    }, {
      "type": "Encounter",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ],
      "codeFilter": [ {
        "path": "type",
        "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
      } ],
      "mustSupport": [ "type", "status", "period" ]
    }, {
      "type": "Encounter",
      "profile": [ "http://hl7.org/fhir/StructureDefinition/Encounter" ],
      "mustSupport": [ "period" ]
    } ],
    "name": "EffectiveDataRequirements",
    "type": {
      "coding": [ {
        "code": "module-definition",
        "system": "http://terminology.hl7.org/CodeSystem/library-type"
      } ]
    },
    "resourceType": "Library",
    "extension": [ {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMPublishableLibrary"
      }, {
        "url": "name",
        "valueString": "SDE Sex"
      }, {
        "url": "statement",
        "valueString": "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"
      }, {
        "url": "displaySequence",
        "valueInteger": 0
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMPublishableLibrary"
      }, {
        "url": "name",
        "valueString": "SDE Payer"
      }, {
        "url": "statement",
        "valueString": "define \"SDE Payer\":     [Coverage: type in \"Payer\"] Payer       return {         code: Payer.type,         period: Payer.period       }"
      }, {
        "url": "displaySequence",
        "valueInteger": 1
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMPublishableLibrary"
      }, {
        "url": "name",
        "valueString": "Inpatient Encounter"
      }, {
        "url": "statement",
        "valueString" : "define \"Inpatient Encounter\":   [\"Encounter\"] Encounter     where LengthInDays(Encounter.period) <= 120       and Encounter.period ends during \"Measurement Period\""
      }, {
        "url": "displaySequence",
        "valueInteger": 2
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMPublishableLibrary"
      }, {
        "url": "name",
        "valueString": "Initial Population"
      }, {
        "url": "statement",
        "valueString" : "define \"Initial Population\":   \"Inpatient Encounter\" Encounter"
      }, {
        "url": "displaySequence",
        "valueInteger": 3
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMPublishableLibrary"
      }, {
        "url": "name",
        "valueString": "SDE Ethnicity"
      }, {
        "url": "statement",
        "valueString": "define \"SDE Ethnicity\":   (flatten (     Patient.extension Extension       where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'         return Extension.extension   )) E     where E.url = 'ombCategory'       or E.url = 'detailed'     return E.value as Coding"
      }, {
        "url": "displaySequence",
        "valueInteger": 4
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMPublishableLibrary"
      }, {
        "url": "name",
        "valueString": "SDE Race"
      }, {
        "url": "statement",
        "valueString": "define \"SDE Race\":   (flatten (     Patient.extension Extension       where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'         return Extension.extension   )) E     where E.url = 'ombCategory'       or E.url = 'detailed'     return E.value as Coding"
      }, {
        "url": "displaySequence",
        "valueInteger": 5
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMPublishableLibrary"
      }, {
        "url": "name",
        "valueString": "Measure Population"
      }, {
        "url": "statement",
        "valueString" : "define \"Measure Population\":   \"Initial Population\""
      }, {
        "url": "displaySequence",
        "valueInteger": 6
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "FHIRHelpers"
      }, {
        "url": "name",
        "valueString": "ToString"
      }, {
        "url": "statement",
        "valueString": "define function ToString(value AdministrativeGender): value.value"
      }, {
        "url": "displaySequence",
        "valueInteger": 7
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMPublishableLibrary"
      }, {
        "url": "name",
        "valueString": "LengthInDays"
      }, {
        "url": "statement",
        "valueString": "define function \"LengthInDays\"(Value Interval):  difference in days between start of Value and end of Value"
      }, {
        "url": "displaySequence",
        "valueInteger": 8
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "FHIRHelpers"
      }, {
        "url": "name",
        "valueString": "ToInterval"
      }, {
        "url": "statement",
        "valueString": "/* @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]"
      }, {
        "url": "displaySequence",
        "valueInteger": 9
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "FHIRHelpers"
      }, {
        "url": "name",
        "valueString": "ToString"
      }, {
        "url": "statement",
        "valueString": "define function ToString(value uri): value.value"
      }, {
        "url": "displaySequence",
        "valueInteger": 10
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMPublishableLibrary"
      }, {
        "url": "name",
        "valueString": "Measure Observation"
      }, {
        "url": "statement",
        "valueString": "define function \"Measure Observation\" (Encounter \"Encounter\" ) :   duration in minutes of \"Related ED Visit\"(Encounter).period"
      }, {
        "url": "displaySequence",
        "valueInteger": 11
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "EXMPublishableLibrary"
      }, {
        "url": "name",
        "valueString": "Related ED Visit"
      }, {
        "url": "statement",
        "valueString" : "//Measure Observation define function \"Related ED Visit\" (Encounter \"Encounter\" ) :   Last([\"Encounter\": \"Emergency Department Visit\"] ED     where ED.status = 'finished'       and ED.period ends 1 hour or less before start of Encounter.period     sort by start of period )"
      }, {
        "url": "displaySequence",
        "valueInteger": 12
      } ]
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition",
      "extension": [ {
        "url": "libraryName",
        "valueString": "FHIRHelpers"
      }, {
        "url": "name",
        "valueString": "ToString"
      }, {
        "url": "statement",
        "valueString": "define function ToString(value EncounterStatus): value.value"
      }, {
        "url": "displaySequence",
        "valueInteger": 13
      } ]
    } ],
    "status": "active",
    "id": "effective-data-requirements",
    "relatedArtifact": [ {
      "type": "depends-on",
      "display": "Library FHIRHelpers",
      "resource": "http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1"
    }, {
      "type": "depends-on",
      "display": "Value set Payer",
      "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
    }, {
      "type": "depends-on",
      "display": "Value set Emergency Department Visit",
      "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
    } ],
    "parameter": [ {
      "max": "1",
      "min": 0,
      "use": "in",
      "name": "Measurement Period",
      "type": "Period"
    }, {
      "max": "1",
      "min": 0,
      "use": "out",
      "name": "SDE Sex",
      "type": "Coding"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "SDE Payer",
      "type": "Resource"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "Initial Population",
      "type": "Encounter"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "SDE Ethnicity",
      "type": "Coding"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "SDE Race",
      "type": "Coding"
    }, {
      "max": "*",
      "min": 0,
      "use": "out",
      "name": "Measure Population",
      "type": "Encounter"
    } ]
  } ],
  "usage": "Users of this measure should be aware of...",
  "rationale": "The rationale of this measure is to...",
  "status": "active",
  "id": "27bf020f-4484-49ed-8ea9-1975f31a973c",
  "kind": null,
  "url": "http://hl7.org/fhir/uv/cqm/Measure/measure-publishable-exm",
  "identifier": [ {
    "use": "usual",
    "type": {
      "coding": [ {
        "code": "short-name",
        "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type"
      } ]
    },
    "value": "EXM-123",
    "system": "http://example.org/fhir/cqi/ecqm/Measure/Identifier/exm"
  }, {
    "use": "official",
    "type": {
      "coding": [ {
        "code": "version-independent",
        "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type"
      } ]
    },
    "value": "urn:uuid:11873bc9-ca0a-4cf3-b8f2-605a950aac74",
    "system": "urn:ietf:rfc:3986"
  }, {
    "use": "official",
    "type": {
      "coding": [ {
        "code": "version-specific",
        "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type"
      } ]
    },
    "value": "urn:uuid:b366f29b-347f-464e-8064-c83842d825c7",
    "system": "urn:ietf:rfc:3986"
  }, {
    "use": "official",
    "type": {
      "coding": [ {
        "code": "endorser",
        "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type"
      } ]
    },
    "value": "NQF-123",
    "system": "http://example.org/fhir/cqi/ecqm/Measure/Identifier/nqf",
    "assigner": {
      "display": "NQF"
    }
  }, {
    "use": "official",
    "type": {
      "coding": [ {
        "code": "publisher",
        "system": "http://terminology.hl7.org/CodeSystem/artifact-identifier-type"
      } ]
    },
    "value": "CMS-123",
    "system": "http://example.org/fhir/cqi/ecqm/Measure/Identifier/cms",
    "assigner": {
      "display": "CMS"
    }
  }, {
    "value": "urn:oid:2.16.840.1.113883.4.642.40.61.29.23",
    "system": "urn:ietf:rfc:3986"
  } ],
  "lastReviewDate": "2019-02-17",
  "riskAdjustment": "Risk adjustment for this measure is performed by...",
  "scoring": {
    "coding": [ {
      "code": "continuous-variable",
      "system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
      "display": "Continuous Variable"
    } ]
  },
  "version": "2.0.0",
  "relatedArtifact": [ {
    "url": "https://pubmed.ncbi.nlm.nih.gov/16278359/",
    "type": "citation",
    "citation": "Linder, J.A., D.W. Bates, G.M. Lee, J.A. Finkelstein. 2005. 'Antibiotic treatment       of children with sore throat.' JAMA 294(18):2315-2322.",
    "document": {
      "url": "https://pubmed.ncbi.nlm.nih.gov/16278359/"
    },
    "extension": [ {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-isPrimaryCitation",
      "valueBoolean": true
    } ]
  }, {
    "url": "https://pubmed.ncbi.nlm.nih.gov/23091044/",
    "type": "citation",
    "citation": "Infectious Diseases Society of America. 2012. 'Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update.'",
    "document": {
      "url": "https://pubmed.ncbi.nlm.nih.gov/23091044/"
    },
    "extension": [ {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-isPrimaryCitation",
      "valueBoolean": true
    } ]
  }, {
    "url": "https://pubmed.ncbi.nlm.nih.gov/19739972/",
    "type": "citation",
    "citation": "Roberts, R.R., B. Hota, I. Ahmad, et al. 'Hospital and Societal Costs of Antimicrobial-Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship.' Clin Infect Dis. Oct 2009; 49(8):1175-84.",
    "document": {
      "url": "https://pubmed.ncbi.nlm.nih.gov/19739972/"
    },
    "extension": [ {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-isPrimaryCitation",
      "valueBoolean": true
    } ]
  }, {
    "url": "http://example.org/publications/1234",
    "type": "citation",
    "citation": "Example citation to draft publication",
    "document": {
      "url": "http://example.org/publications/1234"
    },
    "extension": [ {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-publicationStatus",
      "valueCode": "draft"
    }, {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-publicationDate",
      "valueDate": "2019-01-01"
    } ]
  } ],
  "contact": [ {
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/cqi",
      "system": "url"
    } ]
  } ],
  "improvementNotation": {
    "coding": [ {
      "code": "increase",
      "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
      "display": "Increased score indicates improvement"
    } ]
  },
  "rateAggregation": "Rate aggregation for this measure is performed by...",
  "effectivePeriod": {
    "end": "2018-12-31",
    "start": "2018-01-01",
    "extension": [ {
      "url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-effectivePeriodAnchor",
      "valueDateTime": "2018-01-01"
    }, {
      "url": "http://hl7.org/fhir/uv/cqm/StructureDefinition/cqm-effectivePeriodDuration",
      "valueDuration": {
        "code": "a",
        "value": 1,
        "system": "http://unitsofmeasure.org"
      }
    } ]
  },
  "clinicalRecommendationStatement": "The clinical recommendation statement for this measure is..."
}