CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG
1.0.0 - Release 1

CDC National Healthcare Safety Network (NHSN) Digital Quality Measures (dQM) Content Package IG - Downloaded Version 1.0.0 See the Directory of published versions

## Library: NHSN Acute Care Hospital Daily Initial Population Library

Official URL: http://www.cdc.gov/nhsn/fhirportal/dqm/ig/Library/NHSNAcuteCareHospitalDailyInitialPopulation | Version: 1.0.0
Standards status: Trial-use | Maturity Level: 1 | Computable Name: NHSNAcuteCareHospitalDailyInitialPopulation

Id: | NHSNAcuteCareHospitalDailyInitialPopulation
Version: | 1.0.0
Url: | NHSNAcuteCareHospitalDailyInitialPopulation
Status: | draft
Type: | system: http://terminology.hl7.org/CodeSystem/library-type code: logic-library
Date: | 2025-09-15 11:51:36-0400
Publisher: | CDC National Healthcare Safety Network (NHSN)
Jurisdiction: | US
Related Artifacts: | Dependencies http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1 `http://www.cdc.gov/nhsn/fhirportal/dqm/ig/Library/FHIRHelpers|4.0.2` `http://www.cdc.gov/nhsn/fhirportal/dqm/ig/Library/NHSNHelpers|0.0.002` `http://www.cdc.gov/nhsn/fhirportal/dqm/ig/Library/SharedResourceCreation|0.1.010` ActCodeversion: null9.0.0) Logical Observation Identifiers, Names and Codes (LOINC) Observation Category Codesversion: null1.0.1) RxNorm Encounter Inpatient http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265 Observation Services Discharge dispositionversion: null1.0.1) COVID_19 (Tests for SARS_CoV_2 Nucleic Acid) COVID_19 (Tests for SARS_CoV_2 Antigen) COVID_19 (Organism or Substance in Lab Results) Influenza (Tests for influenza A or B virus Nucleic Acid) Influenza (Tests for influenza A or B virus Antigen) Influenza (influenza A or B virus in Lab Results) http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1311 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1312 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1308 LIVD SARS CoV2 Test Result Codes Baricitinib Anakinra Sarilumab COVID19 RxNorm Value Set for Tocilizumab http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2097 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2098 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2099 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2100 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2101 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2102 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2103 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2119 Remdesivir http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2104 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2105 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1190.85 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1190.86 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1190.87 Oseltamivir http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.10.20.22.5.300 http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.274
Parameters: |
Name | Type | Min | Max | In/Out
--- | --- | --- | --- | ---
Measurement Period | Period | 0 | 1 | In
Patient | Patient | 0 | 1 | Out
EncounterInpatient | Encounter | 0 | * | Out
EncounterObservation | Encounter | 0 | * | Out
Encounters with Patient Hospital Locations | Encounter | 0 | * | Out
Initial Population | Encounter | 0 | * | Out
COVID And Influenza Observation | Observation | 0 | * | Out
RSV Observation | Observation | 0 | * | Out
ACH Daily Observation | Observation | 0 | * | Out
COVID And Influenza PRE Admission Observation | Observation | 0 | * | Out
RSV PRE Admission Observation | Observation | 0 | * | Out
COVID And Influenza DiagnosticReport | DiagnosticReport | 0 | * | Out
RSV DiagnosticReport | DiagnosticReport | 0 | * | Out
ACH Daily DiagnosticReport | DiagnosticReport | 0 | * | Out
COVID And Influenza DiagnosticReport PRE Admission | DiagnosticReport | 0 | * | Out
RSV DiagnosticReport PRE Admission | DiagnosticReport | 0 | * | Out
DiagnosticReports | DiagnosticReport | 0 | * | Out
Observations | Observation | 0 | * | Out
COVID and Influenza DiagnosticReport Observations | Observation | 0 | * | Out
COVID and Influenza DiagnosticReport Result from Lab | DiagnosticReport | 0 | * | Out
RSV Observations | Observation | 0 | * | Out
RSV DiagnosticReport Observations | DiagnosticReport | 0 | * | Out
RSV DiagnosticReport Result from Lab | DiagnosticReport | 0 | * | Out
ACH Daily DiagnosticReport Result from Lab | DiagnosticReport | 0 | * | Out
COVID and Influenza DiagnosticReport Result from Lab PRE Admission | DiagnosticReport | 0 | * | Out
RSV DiagnosticReport Result from Lab PRE Admission | DiagnosticReport | 0 | * | Out
SDE IP Encounters | Encounter | 0 | * | Out
Encounters | Encounter | 0 | * | Out
SDE Encounter | Encounter | 0 | * | Out
SDE Minimal Patient | Patient | 0 | 1 | Out
SDE Location | Location | 0 | * | Out
SDE Encounter Discharge Dispositions | Encounter | 0 | * | Out
SDE ACH Daily Observation | Observation | 0 | * | Out
SDE RSV PRE Admission Observation | Observation | 0 | * | Out
SDE COVID And Influenza PRE Admission Observation | Observation | 0 | * | Out
SDE ACH Daily Specimen | Specimen | 0 | * | Out
SDE RSV Specimen | Specimen | 0 | * | Out
SDE COVID And Influenza Specimen | Specimen | 0 | * | Out
SDE ACH Daily DiagnosticReport | DiagnosticReport | 0 | * | Out
SDE COVID And Influenza DiagnosticReport | DiagnosticReport | 0 | * | Out
SDE RSV DiagnosticReport | DiagnosticReport | 0 | * | Out
SDE ACH Daily DiagnosticReport Result from Lab | DiagnosticReport | 0 | * | Out
SDE COVID and Influenza DiagnosticReport Result from Lab | DiagnosticReport | 0 | * | Out
SDE RSV DiagnosticReport Result from Lab | DiagnosticReport | 0 | * | Out
SDE ACH Daily ServiceRequest | ServiceRequest | 0 | * | Out
SDE Isolation Precautions Implemented | Procedure | 0 | * | Out
SDE Covid or Influenza Medication Administered | MedicationAdministration | 0 | * | Out
SDE Covid or Influenza Medication Ordered | MedicationRequest | 0 | * | Out
SDE Medication | Medication | 0 | * | Out
SDE All Observations | Observation | 0 | * | Out
SDE All ServiceRequests | ServiceRequest | 0 | * | Out
SDE All Procedures | Procedure | 0 | * | Out
Data Requirements: |
Type | Profile | MS | Code Filter
--- | --- | --- | ---
Patient | http://hl7.org/fhir/StructureDefinition/Patient |  |
Encounter | http://hl7.org/fhir/StructureDefinition/Encounter | ;;;;;; | code filter: path: type value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Encounter | http://hl7.org/fhir/StructureDefinition/Encounter | ;;;;;; | code filter: path: class value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.274
Encounter | http://hl7.org/fhir/StructureDefinition/Encounter | ;;;;;; | code filter: path: type value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143
Encounter | http://hl7.org/fhir/StructureDefinition/Encounter | ;;;;;; | code filter: path: class system: http://terminology.hl7.org/CodeSystem/v3-ActCode code: OBSENC display: observation encounter
Encounter | http://hl7.org/fhir/StructureDefinition/Encounter | ;;;;;; |
Observation | http://hl7.org/fhir/StructureDefinition/Observation | ;;;;;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.336
Observation | http://hl7.org/fhir/StructureDefinition/Observation | ;;;;;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.337
Observation | http://hl7.org/fhir/StructureDefinition/Observation | ;;;;;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1142
Observation | http://hl7.org/fhir/StructureDefinition/Observation | ;;;;;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1158
Observation | http://hl7.org/fhir/StructureDefinition/Observation | ;;;;;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1312
Observation | http://hl7.org/fhir/StructureDefinition/Observation | ;;;;;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1311
Observation | http://hl7.org/fhir/StructureDefinition/Observation | ;;;;;;; |
Specimen | http://hl7.org/fhir/StructureDefinition/Specimen | ; |
DiagnosticReport | http://hl7.org/fhir/StructureDefinition/DiagnosticReport | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1142
DiagnosticReport | http://hl7.org/fhir/StructureDefinition/DiagnosticReport | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1158
DiagnosticReport | http://hl7.org/fhir/StructureDefinition/DiagnosticReport | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.336
DiagnosticReport | http://hl7.org/fhir/StructureDefinition/DiagnosticReport | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.337
DiagnosticReport | http://hl7.org/fhir/StructureDefinition/DiagnosticReport | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1312
DiagnosticReport | http://hl7.org/fhir/StructureDefinition/DiagnosticReport | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1311
DiagnosticReport | http://hl7.org/fhir/StructureDefinition/DiagnosticReport | ;;; |
Location | http://hl7.org/fhir/StructureDefinition/Location |  |
ServiceRequest | http://hl7.org/fhir/StructureDefinition/ServiceRequest | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1142
ServiceRequest | http://hl7.org/fhir/StructureDefinition/ServiceRequest | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1158
ServiceRequest | http://hl7.org/fhir/StructureDefinition/ServiceRequest | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.336
ServiceRequest | http://hl7.org/fhir/StructureDefinition/ServiceRequest | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.337
ServiceRequest | http://hl7.org/fhir/StructureDefinition/ServiceRequest | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1312
ServiceRequest | http://hl7.org/fhir/StructureDefinition/ServiceRequest | ;;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1311
ServiceRequest | http://hl7.org/fhir/StructureDefinition/ServiceRequest | ;; |
Procedure | http://hl7.org/fhir/StructureDefinition/Procedure | ;; | code filter: path: code value set: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.10.20.22.5.300
Procedure | http://hl7.org/fhir/StructureDefinition/Procedure |  |
Medication | http://hl7.org/fhir/StructureDefinition/Medication | ; | code filter: path: id
MedicationAdministration | http://hl7.org/fhir/StructureDefinition/MedicationAdministration | ;;; |
MedicationRequest | http://hl7.org/fhir/StructureDefinition/MedicationRequest | ;; |
Content: text/cql
    library NHSNAcuteCareHospitalDailyInitialPopulation version '1.0.0-dev'

    using FHIR version '4.0.1'

    include FHIRHelpers version '4.0.2' called FHIRHelpers
    include NHSNHelpers version '0.0.002' called NHSNHelpers
    include SharedResourceCreation version '0.1.010' called SharedResource

    codesystem "ActCode": 'http://terminology.hl7.org/CodeSystem/v3-ActCode'
    codesystem "LOINC": 'http://loinc.org'
    codesystem "Observation Category": 'http://terminology.hl7.org/CodeSystem/observation-category'
    codesystem "RXNORM": 'http://www.nlm.nih.gov/research/umls/rxnorm'

    valueset "Encounter Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307'
    valueset "Inpatient, Emergency, and Observation Locations": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.265'
    valueset "Observation Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143'
    valueset "Discharge Disposition": 'http://terminology.hl7.org/ValueSet/encounter-discharge-disposition'

    //COVID-19 lab tests
    valueset "COVID_19 (Tests for SARS_CoV_2 Nucleic Acid)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1142'
    valueset "COVID_19 (Tests for SARS_CoV_2 Antigen)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1158'

    //COVID-19 test results (unused)
    valueset "COVID_19 (Organism or Substance in Lab Results)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1143'

    //Influenza lab tests
    valueset "Influenza (Tests for influenza A or B virus Nucleic Acid)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.336'
    valueset "Influenza (Tests for influenza A or B virus Antigen)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.337'

    //Influenza test Results (unused)
    valueset "Influenza (influenza A or B virus in Lab Results)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.340'

    //RSV lab tests
    valueset "RSV (Tests for RSV Antigen)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1311'
    valueset "RSV (Tests for RSV Nucleic Acid)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1312'

    //RSV test results (unused)
    valueset "RSV (Organism or Substance in Lab Results)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1146.1308'

    //Test results shared among COVID-19, Influenza and RSV (unused)
    valueset "LIVD SARS CoV2 Test Result Codes": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1114.10'

    //COVID-19 medications
    valueset "Baricitinib": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2046'
    valueset "Anakinra": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2054'
    valueset "Sarilumab": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2084'
    valueset "COVID19 RxNorm Value Set for Tocilizumab": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2087'
    valueset "Casirivimab": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2097'
    valueset "Imdevimab": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2098'
    valueset "Bamlanivimab": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2099'
    valueset "Etesevimab": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2100'
    valueset "Sotrovimab": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2101'
    valueset "Tofacitinib": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2102'
    valueset "Casirivimab / Imdevimab": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2103'
    valueset "Molnupiravir": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2119'
    valueset "Remdesivir": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2081'
    valueset "Nirmatrelvir / Ritonavir": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2104'
    valueset "Bebtelovimab": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2105'

    //Influenza medications
    valueset "Baloxavir": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1190.85'
    valueset "Peramivir": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1190.86'
    valueset "Zanamivir": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1190.87'
    valueset "Oseltamivir": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.3616.200.110.102.2078'

    //Isolation Precautions
    valueset "Transmission Based Precaution Types": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.10.20.22.5.300'

    //Encounter Class Codes
    valueset "NHSN Inpatient Encounter Class Codes": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.274'

    //Observation Category Codes
    code "laboratory": 'laboratory' from "Observation Category" display 'Laboratory'

    //Observation Encounter Class Code
    code "observation encounter": 'OBSENC' from "ActCode" display 'observation encounter'

    parameter "Measurement Period"
      default Interval[@2022-01-01T00:00:00.0, @2022-01-02T00:00:00.0)

    context Patient

    //----------------------------------
    // Initial Population
    //----------------------------------
    define "Initial Population":
      EncounterInpatient
      union EncounterObservation
      union "Encounters with Patient Hospital Locations"

    define "EncounterInpatient":
      ([Encounter: "Encounter Inpatient"]
        union [Encounter: class in "NHSN Inpatient Encounter Class Codes"]) Encounters
      where Encounters.status in {'in-progress', 'finished', 'triaged', 'onleave', 'entered-in-error'}
        and Encounters.period overlaps "Measurement Period"

    define "EncounterObservation":
      ([Encounter: "Observation Services"]
        union [Encounter: class in {"observation encounter"}]) Encounters
      where Encounters.status in {'in-progress', 'finished', 'triaged', 'onleave', 'entered-in-error'}
        and Encounters.period overlaps "Measurement Period"

    define "Encounters with Patient Hospital Locations":
      [Encounter] Encounters
      where exists(
        Encounters.location EncounterLocation
        let types: NHSNHelpers.GetLocation(EncounterLocation.location).type
        where exists(
          types type
          where type in "Inpatient, Emergency, and Observation Locations"
        )
        and EncounterLocation.period overlaps Encounters.period
        and Encounters.status in {'in-progress', 'finished', 'triaged', 'onleave', 'entered-in-error' }
        and Encounters.period overlaps "Measurement Period"
      )

    //-----------------------------------------------
    // Logic related to Laboratory
    //-----------------------------------------------
    //Lab Observations
    define "COVID And Influenza Observation":
      ([Observation: "Influenza (Tests for influenza A or B virus Nucleic Acid)"]
      union [Observation: "Influenza (Tests for influenza A or B virus Antigen)"]
      union [Observation: "COVID_19 (Tests for SARS_CoV_2 Nucleic Acid)"]
      union [Observation: "COVID_19 (Tests for SARS_CoV_2 Antigen)"]
      ) Observations
        where exists(Observations.category Category where Category ~ "laboratory")
          and Observations.status in {'final','registered','preliminary','partial'}
          and exists("Initial Population")

    define "RSV Observation":
      ([Observation: "RSV (Tests for RSV Nucleic Acid)"]
      union [Observation: "RSV (Tests for RSV Antigen)"]
      ) Observations
        where exists(Observations.category Category where Category ~ "laboratory")
          and Observations.status in {'final','registered','preliminary','partial'}
          and exists("Initial Population")

    define "ACH Daily Observation":
      "RSV Observation"
      union "COVID And Influenza Observation"

    //further constrain COVID-19 and Influenza Observations for 14 day lookback
    define "COVID And Influenza PRE Admission Observation":
      "COVID And Influenza Observation" O
       where exists( EncounterInpatient E
        where (
          NHSNHelpers."Normalize Interval"(O.effective) 14 days or less on or before start of E.period
          or NHSNHelpers."Normalize Interval"(GetSpecimen(O.specimen).collection.collected) 14 days or less on or before start of E.period
          )
          and start of E.period during "Measurement Period"
        )

    //further constrain RSV observation for 8 day lookback
    define "RSV PRE Admission Observation":
      "RSV Observation" O
      where exists(EncounterInpatient E
        where (
          NHSNHelpers."Normalize Interval"(O.effective) 8 days or less on or before start of E.period
          or NHSNHelpers."Normalize Interval"(GetSpecimen(O.specimen).collection.collected) 8 days or less on or before start of E.period
          )
          and start of E.period during "Measurement Period"
        )

    //Lab DiagnosticReport
    define "COVID And Influenza DiagnosticReport":
      ([DiagnosticReport: "COVID_19 (Tests for SARS_CoV_2 Nucleic Acid)"]
        union [DiagnosticReport: "COVID_19 (Tests for SARS_CoV_2 Antigen)"]
        union [DiagnosticReport: "Influenza (Tests for influenza A or B virus Nucleic Acid)"]
        union [DiagnosticReport: "Influenza (Tests for influenza A or B virus Antigen)"]
      ) Reports
        where exists("Initial Population")
          and Reports.status in {'final','registered','preliminary','partial'}

    define "RSV DiagnosticReport":
      ([DiagnosticReport: "RSV (Tests for RSV Nucleic Acid)"]
        union [DiagnosticReport: "RSV (Tests for RSV Antigen)"]
      ) Reports
        where exists("Initial Population")
          and Reports.status in {'final','registered','preliminary','partial'}

    define "ACH Daily DiagnosticReport":
      "COVID And Influenza DiagnosticReport"
        union "RSV DiagnosticReport"

    //further constrain COVID-19 and Influenza with 14 day lookback
    define "COVID And Influenza DiagnosticReport PRE Admission":
      "COVID And Influenza DiagnosticReport" R
      where exists(EncounterInpatient E
        where (
          NHSNHelpers."Normalize Interval"(R.effective) 14 days or less on or before start of E.period)
          and start of E.period during "Measurement Period"
        )

    //further constrain RSV for 8 day lookback
    define "RSV DiagnosticReport PRE Admission":
      "RSV DiagnosticReport" R
      where exists(EncounterInpatient E
        where (
          NHSNHelpers."Normalize Interval"(R.effective) 8 days or less on or before start of E.period)
          and start of E.period during "Measurement Period"
        )

    define "COVID and Influenza DiagnosticReport Result from Lab":
      "DiagnosticReports" Reports
        where exists(
          "COVID and Influenza DiagnosticReport Observations" Observations
          where Reports.result.references(Observations)
        )
        and Reports.status in {'final','registered','preliminary','partial'}
        and exists("Initial Population")

    define "COVID and Influenza DiagnosticReport Observations":
      "Observations" Observations
      where Observations.code in "COVID_19 (Tests for SARS_CoV_2 Nucleic Acid)"
        or Observations.code in "COVID_19 (Tests for SARS_CoV_2 Antigen)"
        or Observations.code in "Influenza (Tests for influenza A or B virus Nucleic Acid)"
        or Observations.code in "Influenza (Tests for influenza A or B virus Antigen)"

    define "RSV DiagnosticReport Result from Lab":
      [DiagnosticReport] Reports
        where exists("RSV DiagnosticReport Observations")
          and Reports.status in {'final','registered','preliminary','partial'}
          and exists("Initial Population")

    define "RSV Observations":
      "Observations" Observations
      where Observations.code in "RSV (Tests for RSV Nucleic Acid)"
        or Observations.code in "RSV (Tests for RSV Antigen)"

    define "RSV DiagnosticReport Observations":
      "DiagnosticReports" Reports
      where exists(
        "RSV Observations" Observations
        where Reports.result.references(Observations)
      )

    define "ACH Daily DiagnosticReport Result from Lab":
      "COVID and Influenza DiagnosticReport Result from Lab"
        union "RSV DiagnosticReport Result from Lab"

    //further constrain COVID-19 and Influenza with 14 day lookback
    define "COVID and Influenza DiagnosticReport Result from Lab PRE Admission":
      "COVID and Influenza DiagnosticReport Result from Lab" R
      where exists(EncounterInpatient E
        where (
          NHSNHelpers."Normalize Interval"(R.effective) 14 days or less on or before start of E.period)
          and start of E.period during "Measurement Period"
        )

    //further constrain RSV with 8 day lookback
    define "RSV DiagnosticReport Result from Lab PRE Admission":
      "RSV DiagnosticReport Result from Lab" R
      where exists(EncounterInpatient E
        where (
          NHSNHelpers."Normalize Interval"(R.effective) 8 days or less on or before start of E.period)
          and start of E.period during "Measurement Period"
        )

    //----------------------------------
    // SDE
    //----------------------------------
    define "SDE IP Encounters":
      "Initial Population" IP
      return SharedResource.EncounterResource(IP,
      {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-encounter'}})

    define "SDE Encounter":
      "Encounters" Encounters
      where not CheckIP(Encounters)
      and exists(
        "Initial Population" IP
        where Encounters.period overlaps IP.period)
      return SharedResource.EncounterResource(Encounters,
      {FHIR.canonical{value: 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter'}})

    define "SDE Minimal Patient":
      Patient p
      where exists("Initial Population")
      return SharedResource.PatientResource(p,
      {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/cross-measure-patient'}})

    define "SDE Location":
      [Location] Locations
      where exists("Initial Population")
      return SharedResource.LocationResource(Locations,
      {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-location'}})

    define "SDE Encounter Discharge Dispositions":
    	"Initial Population" DischargeDispositions
      where DischargeDispositions.hospitalization.dischargeDisposition in "Discharge Disposition"
      return SharedResource.EncounterResource(DischargeDispositions,
      {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-encounter'}})

    //return the Observation during the Measurement Period
    define "SDE ACH Daily Observation":
      "ACH Daily Observation" Observations
        return SharedResource.ObservationLabResource(Observations,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-observation-lab'}})

    //return the RSV Observation Pre Admission
    define "SDE RSV PRE Admission Observation":
      "RSV PRE Admission Observation" Observations
        return SharedResource.ObservationLabResource(Observations,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-observation-lab'}})

    //return the COVID-19 and Influenza Observation Pre Admission
    define "SDE COVID And Influenza PRE Admission Observation":
      "COVID And Influenza PRE Admission Observation" Observations
        return SharedResource.ObservationLabResource(Observations,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-observation-lab'}})

    //return the Specimen related to the Observation during the Measurement Period
    define "SDE ACH Daily Specimen":
      "ACH Daily Observation" ObservationWithSpecimen
        let Specimen: GetSpecimen(ObservationWithSpecimen.specimen)
        return SharedResource.SpecimenResource(Specimen,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-specimen'}})

    //return the Specimen related to the RSV Observation Pre Admission
    define "SDE RSV Specimen":
      "RSV PRE Admission Observation" ObservationWithSpecimen
        let Specimen: GetSpecimen(ObservationWithSpecimen.specimen)
        return SharedResource.SpecimenResource(Specimen,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-specimen'}})

    //return the Specimen related to the COVID-19 And Influenza Observation Pre Admission
    define "SDE COVID And Influenza Specimen":
      "COVID And Influenza PRE Admission Observation" ObservationWithSpecimen
        let Specimen: GetSpecimen(ObservationWithSpecimen.specimen)
        return SharedResource.SpecimenResource(Specimen,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-specimen'}})

    //return the DiagnosticReport during the Measurement Period
    define "SDE ACH Daily DiagnosticReport":
      "ACH Daily DiagnosticReport" Reports
        return SharedResource.DiagnosticReportLabResource(Reports,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-diagnosticreport-lab'}})

    //return the COVID-19 And Influenza DiagnosticReport pre admission
    define "SDE COVID And Influenza DiagnosticReport":
      "COVID And Influenza DiagnosticReport" Reports
        return SharedResource.DiagnosticReportLabResource(Reports,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-diagnosticreport-lab'}})

    //return the RSV DiagnosticReport pre admission
    define "SDE RSV DiagnosticReport":
      "RSV DiagnosticReport" Reports
        return SharedResource.DiagnosticReportLabResource(Reports,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-diagnosticreport-lab'}})

    //return the DiagnosticReport based on the result during the Measurement Period
    define "SDE ACH Daily DiagnosticReport Result from Lab":
      "ACH Daily DiagnosticReport Result from Lab" Reports
        return SharedResource.DiagnosticReportLabResource(Reports,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-diagnosticreport-lab'}})

    //return the COVID-19 and Influenza DiagnosticReport based on the result pre admission
    define "SDE COVID and Influenza DiagnosticReport Result from Lab":
      "COVID and Influenza DiagnosticReport Result from Lab" Reports
        return SharedResource.DiagnosticReportLabResource(Reports,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-diagnosticreport-lab'}})

    //return the RSV DiagnosticReport based on the result pre admission
    define "SDE RSV DiagnosticReport Result from Lab":
      "RSV DiagnosticReport Result from Lab" Reports
        return SharedResource.DiagnosticReportLabResource(Reports,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-diagnosticreport-lab'}})

    define "SDE ACH Daily ServiceRequest":
      ([ServiceRequest: "COVID_19 (Tests for SARS_CoV_2 Nucleic Acid)"]
      union  [ServiceRequest: "COVID_19 (Tests for SARS_CoV_2 Antigen)"]
      union  [ServiceRequest: "Influenza (Tests for influenza A or B virus Nucleic Acid)"]
      union  [ServiceRequest: "Influenza (Tests for influenza A or B virus Antigen)"]
      union  [ServiceRequest: "RSV (Tests for RSV Nucleic Acid)"]
      union  [ServiceRequest: "RSV (Tests for RSV Antigen)"]
      ) ServiceRequests
        where ServiceRequests.intent ~ 'order'
          and ServiceRequests.status ~ 'completed'
          and exists("Initial Population")
      return SharedResource.ServiceRequestResource(ServiceRequests,
      {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-servicerequest'}})

    define "SDE Isolation Precautions Implemented":
      [Procedure: "Transmission Based Precaution Types"] IsolationPrecautions
        where NHSNHelpers."Normalize Interval"(IsolationPrecautions.performed) during "Measurement Period"
        and exists("Initial Population")
      return SharedResource.ProcedureResource(IsolationPrecautions,
      {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-procedure'}})

    define "SDE Covid or Influenza Medication Administered":
      [MedicationAdministration] RPSMedAdmin
        let Meds: GetMedicationCode(RPSMedAdmin.medication)
       where (Meds in "Anakinra"
                or Meds in "Bamlanivimab"
                or Meds in "Baloxavir"
                or Meds in "Baricitinib"
                or Meds in "Bebtelovimab"
                or Meds in "Casirivimab"
                or Meds in "Casirivimab / Imdevimab"
                or Meds in "COVID19 RxNorm Value Set for Tocilizumab"
                or Meds in "Etesevimab"
                or Meds in "Imdevimab"
                or Meds in "Molnupiravir"
                or Meds in "Nirmatrelvir / Ritonavir"
                or Meds in "Oseltamivir"
                or Meds in "Peramivir"
                or Meds in "Remdesivir"
                or Meds in "Sarilumab"
                or Meds in "Sotrovimab"
                or Meds in "Tofacitinib"
                or Meds in "Zanamivir")
          and RPSMedAdmin.status ~ 'completed'
          and exists("Initial Population")
          and NHSNHelpers."Normalize Interval"(RPSMedAdmin.effective) during "Measurement Period"
        return SharedResource.MedicationAdministrationResource(RPSMedAdmin,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-medicationadministration'}})

    define "SDE Covid or Influenza Medication Ordered":
      [MedicationRequest] RPSMedRequest
        let Meds: GetMedicationCode(RPSMedRequest.medication)
        where (Meds in "Anakinra"
                or Meds in "Baloxavir"
                or Meds in "Bamlanivimab"
                or Meds in "Baricitinib"
                or Meds in "Bebtelovimab"
                or Meds in "Casirivimab"
                or Meds in "Casirivimab / Imdevimab"
                or Meds in "COVID19 RxNorm Value Set for Tocilizumab"
                or Meds in "Etesevimab"
                or Meds in "Imdevimab"
                or Meds in "Molnupiravir"
                or Meds in "Nirmatrelvir / Ritonavir"
                or Meds in "Oseltamivir"
                or Meds in "Peramivir"
                or Meds in "Remdesivir"
                or Meds in "Sarilumab"
                or Meds in "Sotrovimab"
                or Meds in "Tofacitinib"
                or Meds in "Zanamivir")
          and exists("Initial Population")
          and NHSNHelpers."Normalize Interval"(RPSMedRequest.authoredOn) during "Measurement Period"
        return SharedResource.MedicationRequestResource(RPSMedRequest,
        {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-medicationrequest'}})

    define "SDE Medication":
      ("SDE Covid or Influenza Medication Ordered"
      union "SDE Covid or Influenza Medication Administered") MedReqOrAdmin
      where MedReqOrAdmin.medication is FHIR.Reference
      return SharedResource.MedicationResource(GetMedicationFrom(MedReqOrAdmin.medication),
      {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-medication'}})

    //To catch all isolation precautions
    define "SDE All Observations":
      "Observations" O
      where exists("Initial Population")
      return SharedResource.ObservationLabResource(O,
      {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-observation'}})

    //To catch all isolation precautions
    define "SDE All ServiceRequests":
      [ServiceRequest] SR
      where exists("Initial Population")
      return SharedResource.ServiceRequestResource(SR,
      {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-servicerequest'}})

    //To catch all isolation precautions
    define "SDE All Procedures":
      [Procedure] P
      where exists("Initial Population")
      return SharedResource.ProcedureResource(P,
      {FHIR.canonical{value: 'http://www.cdc.gov/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-daily-procedure'}})

    //-----------------------------------------------------
    //functions
    //-----------------------------------------------------
    define function "CheckIP"(encounter Encounter):
      exists("Initial Population" IP
      where encounter.id = IP.id)

    define function "GetMedication"(reference Reference ):
      singleton from (
        [Medication: id in {NHSNHelpers.GetId(reference.reference)}]
      )

    define function "GetMedicationCode"(choice Choice<FHIR.CodeableConcept, FHIR.Reference>):
      case
        when choice is FHIR.CodeableConcept then
          choice as FHIR.CodeableConcept
        when choice is FHIR.Reference then
          GetMedication(choice as FHIR.Reference).code
        else
          null as FHIR.CodeableConcept
      end

    define function "GetMedicationFrom"(choice Choice<FHIR.CodeableConcept, FHIR.Reference>):
      case
        when choice is FHIR.Reference then
          GetMedication(choice as FHIR.Reference)
        else
          null
      end

    define function "GetSpecimen"(reference FHIR.Reference):
      singleton from (
        [Specimen] Specimens
        where Specimens.id = NHSNHelpers.GetId(reference.reference)
      )

    define function "GetEncounter"(reference FHIR.Reference):
      singleton from (
        "Encounters" Encounters
        where Encounters.id = NHSNHelpers.GetId(reference.reference)
      )

    define fluent function references(reference FHIR.Reference, resource FHIR.Resource):
      resource.id = Last(Split(reference.reference, '/'))

    define fluent function references(references List<FHIR.Reference>, resource FHIR.Resource):
      exists(references R where R.references(resource))

    //Common Retrievals
    define "Encounters":
      [Encounter]

    define "Observations":
      [Observation]

    define "DiagnosticReports":
      [DiagnosticReport]