============================================================================================= StatinTherapyForThePreventionAndTreatmentOfCVDeCQMDerived Change Log ============================================================================================= The following CQL downloads are currently available on CDS Connect. Older versions may be available by request. - StatinTherapyForThePreventionAndTreatmentOfCVDeCQMDerivedFHIRv102_v4.0.0_CQL.zip - StatinTherapyForThePreventionAndTreatmentOfCVDeCQMDerivedFHIRv401_v4.0.0_CQL.zip ============================================================================================= Statin_Therapy_for_the_Prevention_and_Treatment_of_CVD_eCQM_Derived_FHIRv102 (FHIR DSTU2) ============================================================================================= --------------------------------------------------------------------------------------------- VERSION 1.0.0 --------------------------------------------------------------------------------------------- Initial FHIR DSTU2 version. --------------------------------------------------------------------------------------------- VERSION 1.0.1 --------------------------------------------------------------------------------------------- Version 1.0.1 updated the CDS Connect Commons library to 1.1.1 to resolve an implicit conversion from FHIR.Date to System.DateTime that is no longer allowed by the CQL-to-ELM translator. --------------------------------------------------------------------------------------------- VERSION 1.1.0 --------------------------------------------------------------------------------------------- Version 1.1.0 applies updates to value sets based on changes to the source eCQM: - Replace "LDL Test" (2.16.840.1.113883.3.464.1003.198.11.1029) with "LDL-c" (2.16.840.1.113883.3.117.1.7.1.215) - Replace "Statin allergen" (2.16.840.1.113883.3.117.1.7.1.423) with "Statin Allergen" (2.16.840.1.113762.1.4.1110.42) - Renamed "Palliative Care" (2.16.840.1.113883.3.600.1.1579) to "Palliative or Hospice Care" (2.16.840.1.113883.3.600.1.1579) --------------------------------------------------------------------------------------------- VERSION 1.2.0 --------------------------------------------------------------------------------------------- Version 1.2.0 applies the following updates to align more closely with the latest version of the eCQM (CMS347v4): - Population 2: do not include patients with a history of ASCVD - Population 3: do not include patients with a history of ASCVD or with Familial Hypercholesterolemia - Population 3: highest LDL cholesterol in the past 3 years should be in the range 70 - 189 mg/dL - Exclusions: additionally check for palliative care procedure requests and encounters - Add "Encounter for palliative care" (ICD-10-CM Z51.5) concept for detecting palliative care encounters - Add "CABG, PCI Procedure" (2.16.840.1.113762.1.4.1138.566) value set for detecting ASCVD procedures - Add "Hospice Care Ambulatory" (2.16.840.1.113883.3.526.3.1584) value set for detecting hospice care - Replace "LDL-c" (2.16.840.1.113883.3.117.1.7.1.215) value set with "LDL Cholesterol" (2.16.840.1.113883.3.526.3.1573) - Replace "Low intensity statin therapy" (2.16.840.1.113762.1.4.1047.107) value set with "Low Intensity Statin Therapy" (2.16.840.1.113883.3.526.3.1574) - Replace "Moderate intensity statin therapy" (2.16.840.1.113762.1.4.1047.98) value set with "Moderate Intensity Statin Therapy" (2.16.840.1.113883.3.526.3.1575) - Replace "High intensity statin therapy" (2.16.840.1.113762.1.4.1047.97) value set with "High Intensity Statin Therapy" (2.16.840.1.113883.3.526.3.1572) In addition to changes related to the eCQM, the following additional changes were made based on new capabilities in later versions of the CQL spec and tooling: - ICD-10-CM is now represented using the FHIR URL (http://hl7.org/fhir/sid/icd-10-cm) rather than the OID - URL-based value set identifiers are used rather than plain OIDs - code/concept pairs are no longer needed; code definitions are sufficient, so concept definitions have been removed - CQL retrieves now support codes, so ObservationsByConcept and ConditionsByConcept were replaced by simpler retrieves ============================================================================================= StatinTherapyForThePreventionAndTreatmentOfCVDeCQMDerivedFHIRv102 (FHIR DSTU2) ============================================================================================= --------------------------------------------------------------------------------------------- VERSION 2.0.0 --------------------------------------------------------------------------------------------- Version 2.0.0 implements several best practices prescribed by FHIR Clinical Guidelines, including: - Renamed library from Statin_Therapy_for_the_Prevention_and_Treatment_of_CVD_eCQM_Derived_FHIRv102 to StatinTherapyForThePreventionAndTreatmentOfCVDeCQMDerivedFHIRv102 - Updated CDS Connect Commons library to CDSConnectCommonsForFHIRv102 version 2.0.0 - Surrounded all library-level identifiers and datatypes in quotes - Used descriptive names (no abbreviations) for query aliases and function arguments - Fixed non-standard use of Exists(...) as a function In addition, version 2.0.0 was updated from the previous version to update dependencies and reflect changes in version 5 of the eMeasure. These changes include the following: - Codes: Removed Familial hypercholesterolemia reference code since it is now in the value set - Value Sets: Added Statin Associated Muscle Symptoms value set (2.16.840.1.113762.1.4.1108.85) - Population 1 Inclusions: Removed age restriction criteria (was >= 21 years; now unrestricted) - Population 2 Inclusions: Changed age restriction from >= 21 years to >= 20 years - Population 3 Inclusions: Removed requirement for LDL between 70 mg/dL and 190 mg/dL in the past three years - Population 3 Inclusions: Removed requirement for most recent LDL >= 70 mg/dL - Exclusions: Added Statin Associated Muscle Symptoms - Recommendations: Adjusted text to reflect changes in inclusions criteria - Errors: Removed check for recent LDL measurement since 3-year LDL time window was removed NOTE: This artifact has not been piloted in a clinical setting, but has undergone logic testing and review. --------------------------------------------------------------------------------------------- VERSION 3.0.0 --------------------------------------------------------------------------------------------- Version 3.0.0 was updated from the 2.0.0 version to reflect changes in version 6 of the eMeasure. These changes include the following: - Value Sets: Removed Palliative or Hospice Care (2.16.840.1.113883.3.600.1.1579) in favor of more specific value sets - Value Sets: Added Encounter Inpatient (2.16.840.1.113883.3.666.5.307) - Value Sets: Added Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) - Value Sets: Added Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090) - Value Sets: Added Palliative Care Intervention(2.16.840.1.113883.3.464.1003.198.12.1135) - Codes: added Discharge to healthcare facility for hospice care (procedure) - Codes: added Discharge to home for hospice care (procedure) - Codes: added Hospice care [Minimum Data Set] - Codes: added Yes (qualifier value) - Codes: added Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal) - Inclusions: Only active ASCVD is considered (previous logic allowed for inactive ASCVD diagnoses) - Exclusions: Removed pregnancy to align w/ eCQM and revised FDA guidance - Exclusions: Separated "IsInPalliativeCare" definition into two: "HasHospiceServices" and "IsInPalliativeCare" - Exclusions: Added encounters with discharge to hospice care - Exclusions: Added hospice and palliative care encounters - Exclusions: Added observations for Hospice care [Minimum Data Set] and FACIT-Pal Questionnaire - Exclusions: Fixed "Encounter for palliative care" to search Conditions since it is a Diagnosis code - Recommendations: Updated population 1 wording for improved readability - Recommendations: Split population 3 by pregnancy status to provide additional guidance for pregnant patients NOTE: This artifact has not been piloted in a clinical setting, but has undergone logic testing and review. --------------------------------------------------------------------------------------------- VERSION 4.0.0 --------------------------------------------------------------------------------------------- Version 4.0.0 was updated from the 3.0.0 version to reflect changes in version 7 of the eMeasure as well as to introduce a grouping value set for more robust capture of statin allergens. These changes include the following: - Dependencies: Updated CDSConnectCommonsForFHIRv102 to version 2.1.1 - Value Sets: Added Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165) - Value Sets: Added Palliative Care Diagnosis (2.16.840.1.113883.3.464.1003.1167) - Value Sets: Added Cardiovascular disease 10Y risk (2.16.840.1.113762.1.4.1032.308) - Value Sets: Replaced Myocardial Infarction (2.16.840.1.113883.3.526.3.403) with Myocardial Infarction (2.16.840.1.113762.1.4.1108.101) - Value Sets: Replaced Statin Allergen (2.16.840.1.113762.1.4.1110.42) with Statin Allergen Grouping (2.16.840.1.113762.1.4.1032.313) - Value Sets: Replaced Familial Hypercholesterolemia (2.16.840.1.113762.1.4.1032.15) with Familial Hypercholesterolemia (2.16.840.1.113762.1.4.1047.100) - Value Sets: Renamed "CABG, PCI Procedure" to "CABG or PCI Procedure" (2.16.840.1.113762.1.4.1138.566) - Value Sets: Renamed "Ischemic Heart Disease or Other Related Diagnoses" to "Ischemic Heart Disease or Related Diagnoses" (2.16.840.1.113762.1.4.1047.46) - Codes: Removed Encounter for palliative care (ICD-10-CM Z51.5) (now in Palliative Care Diagnosis value set) - Inclusions: Population 1: Include inactive ASCVD diagnoses in addition to currently active diagnoses - Inclusions: Population 2: Changed age range from 20+ years old to 20 - 75 years old - Inclusions: Population 4: New population for patients age 40 to 75 years w/ 10-year ASCVD risk score >= 20% and not in populations 1 - 3 - Exclusions: Added hospice diagnosis conditions - Exclusions: Changed palliative care diagnosis conditions to use value set instead of code - Recommendations: Population 2: Update recommendation with new age range 20 - 75 years old and remove note regarding age > 75 - Recommendations: Population 4: Add new recommendations for population 4 - Errors: MissingAge: Modify text for consistency with other error messages - Errors: MissingCVDRiskScore: Add error for missing 10-year ASCVD risk score when it impacts ability to provide recommendation NOTE: This artifact has not been piloted in a clinical setting, but has undergone logic testing and review. ============================================================================================= Statin_Therapy_for_the_Prevention_and_Treatment_of_CVD_eCQM_Derived_FHIRv401 (FHIR R4) ============================================================================================= --------------------------------------------------------------------------------------------- VERSION 1.0.0 --------------------------------------------------------------------------------------------- The Statin_Therapy_for_the_Prevention_and_Treatment_of_CVD_eCQM_Derived_FHIRv401 version 1.0.0 library is a FHIR R4 port of Statin_Therapy_for_the_Prevention_and_Treatment_of_CVD_eCQM_Derived_FHIRv102 version 1.2.0. While the intent of the logic remains the same as the FHIR DSTU2-based version, changes in the FHIR specification (from DSTU2 to R4) require additional changes in the CQL logic. This R4 representation contains the following changes related to the movement from FHIR DSTU2 to FHIR R4: - FHIR data model is now version 4.0.1 - FHIRHelpers is now version 4.0.1 - CDS_Connect_Commons_for_FHIRv102 has been replaced by CDS_Connect_Commons_for_FHIRv401 version 1.0.0 - MedicationOrder is replaced by MedicationRequest - ProcedureRequest is replaced by ServiceRequest ============================================================================================= StatinTherapyForThePreventionAndTreatmentOfCVDeCQMDerivedFHIRv401 (FHIR R4) ============================================================================================= --------------------------------------------------------------------------------------------- VERSION 2.0.0 --------------------------------------------------------------------------------------------- Version 2.0.0 implements several best practices prescribed by FHIR Clinical Guidelines, including: - Renamed library from Statin_Therapy_for_the_Prevention_and_Treatment_of_CVD_eCQM_Derived_FHIRv401 to StatinTherapyForThePreventionAndTreatmentOfCVDeCQMDerivedFHIRv401 - Updated CDS Connect Commons library to CDSConnectCommonsForFHIRv401 version 2.0.0 - Surrounded all library-level identifiers and datatypes in quotes - Used descriptive names (no abbreviations) for query aliases and function arguments - Fixed non-standard use of Exists(...) as a function In addition, version 2.0.0 was updated from the initial 1.0.0 version to update dependencies and reflect changes in version 5 of the eMeasure. These changes include the following: - Codes: Removed Familial hypercholesterolemia reference code since it is now in the value set - Value Sets: Added Statin Associated Muscle Symptoms value set (2.16.840.1.113762.1.4.1108.85) - Population 1 Inclusions: Removed age restriction criteria (was >= 21 years; now unrestricted) - Population 2 Inclusions: Changed age restriction from >= 21 years to >= 20 years - Population 3 Inclusions: Removed requirement for LDL between 70 mg/dL and 190 mg/dL in the past three years - Population 3 Inclusions: Removed requirement for most recent LDL >= 70 mg/dL - Exclusions: Added Statin Associated Muscle Symptoms - Recommendations: Adjusted text to reflect changes in inclusions criteria - Errors: Removed check for recent LDL measurement since 3-year LDL time window was removed NOTE: This artifact has not been piloted in a clinical setting, but has undergone logic testing and review. --------------------------------------------------------------------------------------------- VERSION 3.0.0 --------------------------------------------------------------------------------------------- Version 3.0.0 was updated from the 2.0.0 version to reflect changes in version 6 of the eMeasure. These changes include the following: - Value Sets: Removed Palliative or Hospice Care (2.16.840.1.113883.3.600.1.1579) in favor of more specific value sets - Value Sets: Added Encounter Inpatient (2.16.840.1.113883.3.666.5.307) - Value Sets: Added Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) - Value Sets: Added Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090) - Value Sets: Added Palliative Care Intervention(2.16.840.1.113883.3.464.1003.198.12.1135) - Codes: added Discharge to healthcare facility for hospice care (procedure) - Codes: added Discharge to home for hospice care (procedure) - Codes: added Hospice care [Minimum Data Set] - Codes: added Yes (qualifier value) - Codes: added Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal) - Inclusions: Only active ASCVD is considered (previous logic allowed for inactive ASCVD diagnoses) - Exclusions: Removed pregnancy to align w/ eCQM and revised FDA guidance - Exclusions: Separated "IsInPalliativeCare" definition into two: "HasHospiceServices" and "IsInPalliativeCare" - Exclusions: Added encounters with discharge to hospice care - Exclusions: Added hospice and palliative care encounters - Exclusions: Added observations for Hospice care [Minimum Data Set] and FACIT-Pal Questionnaire - Exclusions: Fixed "Encounter for palliative care" to search Conditions since it is a Diagnosis code - Recommendations: Updated population 1 wording for improved readability - Recommendations: Split population 3 by pregnancy status to provide additional guidance for pregnant patients NOTE: This artifact has not been piloted in a clinical setting, but has undergone logic testing and review. --------------------------------------------------------------------------------------------- VERSION 4.0.0 --------------------------------------------------------------------------------------------- Version 4.0.0 was updated from the 3.0.0 version to reflect changes in version 7 of the eMeasure as well as to introduce a grouping value set for more robust capture of statin allergens. These changes include the following: - Dependencies: Updated CDSConnectCommonsForFHIRv401 to version 2.1.1 - Value Sets: Added Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165) - Value Sets: Added Palliative Care Diagnosis (2.16.840.1.113883.3.464.1003.1167) - Value Sets: Added Cardiovascular disease 10Y risk (2.16.840.1.113762.1.4.1032.308) - Value Sets: Replaced Myocardial Infarction (2.16.840.1.113883.3.526.3.403) with Myocardial Infarction (2.16.840.1.113762.1.4.1108.101) - Value Sets: Replaced Statin Allergen (2.16.840.1.113762.1.4.1110.42) with Statin Allergen Grouping (2.16.840.1.113762.1.4.1032.313) - Value Sets: Replaced Familial Hypercholesterolemia (2.16.840.1.113762.1.4.1032.15) with Familial Hypercholesterolemia (2.16.840.1.113762.1.4.1047.100) - Value Sets: Renamed "CABG, PCI Procedure" to "CABG or PCI Procedure" (2.16.840.1.113762.1.4.1138.566) - Value Sets: Renamed "Ischemic Heart Disease or Other Related Diagnoses" to "Ischemic Heart Disease or Related Diagnoses" (2.16.840.1.113762.1.4.1047.46) - Codes: Removed Encounter for palliative care (ICD-10-CM Z51.5) (now in Palliative Care Diagnosis value set) - Inclusions: Population 1: Include inactive ASCVD diagnoses in addition to currently active diagnoses - Inclusions: Population 2: Changed age range from 20+ years old to 20 - 75 years old - Inclusions: Population 4: New population for patients age 40 to 75 years w/ 10-year ASCVD risk score >= 20% and not in populations 1 - 3 - Exclusions: Added hospice diagnosis conditions - Exclusions: Changed palliative care diagnosis conditions to use value set instead of code - Recommendations: Population 2: Update recommendation with new age range 20 - 75 years old and remove note regarding age > 75 - Recommendations: Population 4: Add new recommendations for population 4 - Errors: MissingAge: Modify text for consistency with other error messages - Errors: MissingCVDRiskScore: Add error for missing 10-year ASCVD risk score when it impacts ability to provide recommendation NOTE: This artifact has not been piloted in a clinical setting, but has undergone logic testing and review.