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Exact Dx synthetic data · demonstration

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Replay LRUN-00007 criteria library

Live recomputation (nothing written): identical hash

Stored replay hash
7e6a5c327d655f67cae18db3201bb6cbad79f2833fd4a97b5bebf59141b476f1
Recomputed replay hash
7e6a5c327d655f67cae18db3201bb6cbad79f2833fd4a97b5bebf59141b476f1
Measurement-side replay hash
5e2f3de03361dff98039794a44291dc78aa9dab4946c884423a3ea75f1267d37
Inputs intact
yes
Engine and default set
library-engine 1.0 · library_default_set@1.0
Trigger
seed · Fri Nov 13, 2026 04:55 PM · after kidney check RUN-00007
Definition versions used (each file hash must still match for a replay)
DefinitionFile sha256
ada2026_diabetes@1.0e6a402d238eabf94…
ada2026_hypoglycaemia@1.046bd77ec8ba977e0…
ada2026_prediabetes@1.0af2c23fe63c64897…
aha2018_severe_hypercholesterolaemia@1.007ac207b49ba33e7…
atp3_ldl@1.0984f30f535df92c4…
berlin2012_ards_pf@1.0f6d9be0dcd8cd4f8…
cdc_adult_bmi@1.014a2ac45496eea31…
esc2024_office_bp@1.0f507c6c22d66becc…
ese2014_hyponatraemia@1.080cb82e9b02b3fc8…
global2024_ards_intubated_pf@1.064bbc3f7fa5c4c0c…
gold2026_copd_airflow@1.05fe646eb07866c22…
nhlbi_bp_categories@1.017c10323497aaed9…
sepsis3_septic_shock_lactate@1.0349d2d1b41e02f6a…
uhf2021_hf_ef_category@1.0d056531cd58ff1c1…
ukka2026_hyperkalaemia@1.052e59d35a9e19548…
who1994_osteoporosis@1.0285f666b9d1cbe75…
who2020_iron_deficiency_ferritin@1.01cf50051fb66f445…
who2024_anaemia@1.0f2ece42ed4d73490…
who_adult_bmi@1.0de4e41b72636521d…
Stored inputs (exactly what the definitions read)
{
  "as_of": "2026-11-13T16:55:00-05:00",
  "context": {},
  "encounter": {
    "admit_dt": "2026-11-10T11:00:00-05:00",
    "discharge_dt": "2026-11-10T11:40:00-05:00",
    "encounter_id": "KE-P07",
    "setting": "outpatient"
  },
  "entered": [
    {
      "code": "J44.9",
      "description": "Chronic obstructive pulmonary disease, unspecified",
      "dx_id": "LD-P07-1",
      "source": "visit diagnosis list (synthetic)"
    }
  ],
  "measurements": [
    {
      "analyte": "fev1_fvc_ratio_post_bd",
      "flags": [],
      "measurement_id": "LM-P07-01",
      "ref_high": null,
      "ref_low": null,
      "time": "2026-09-11T10:00:00-04:00",
      "unit": "ratio",
      "value": 0.58
    },
    {
      "analyte": "fev1_pct_predicted_post_bd",
      "flags": [],
      "measurement_id": "LM-P07-02",
      "ref_high": null,
      "ref_low": null,
      "time": "2026-09-11T10:00:00-04:00",
      "unit": "%",
      "value": 62.0
    }
  ],
  "note": {
    "note_id": "KN-P07-1",
    "reading": {
      "default_status": "silent",
      "families": {
        "blood_pressure": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "bmi": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "bone_density": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "copd_airflow": {
          "faults": [],
          "spans": [
            {
              "assertion": "affirmed",
              "categories": [],
              "end": 4,
              "family": "copd_airflow",
              "general": true,
              "origin": "both",
              "quote": "COPD",
              "start": 0,
              "words": []
            },
            {
              "assertion": "affirmed",
              "categories": [],
              "end": 133,
              "family": "copd_airflow",
              "general": true,
              "origin": "both",
              "quote": "COPD",
              "start": 129,
              "words": []
            }
          ],
          "status": "stated"
        },
        "diabetes": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "ferritin": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "haemoglobin": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "heart_failure_ef": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "hypoglycaemia": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "lactate": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "ldl": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "oxygenation": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "potassium": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "prediabetes": {
          "faults": [],
          "spans": [],
          "status": "silent"
        },
        "sodium": {
          "faults": [],
          "spans": [],
          "status": "silent"
        }
      },
      "lexicon": "library-lexicon 1.0",
      "model_status": "ok",
      "reader": "lexicon+model",
      "text_sha256": "7a0b24ceda859fa2ffea522ebd11fed04463642eecb47e66f0dc3ab04f6a8cd4"
    }
  },
  "patient": {
    "birth_date": "1954-11-15",
    "patient_id": "P07",
    "sex": "M"
  },
  "settings": {
    "ctcae_grading": false
  }
}
Stored output
{
  "coder_rows": [
    {
      "assessment": "cannot_assess",
      "assessment_label": "Cannot be assessed",
      "category": "gold_2",
      "category_label": "GOLD 2 (moderate): 50% \u2264 FEV1 <80% predicted",
      "condition": "Chronic obstructive pulmonary disease (airflow component)",
      "definition": "gold2026_copd_airflow@1.0",
      "detail": "judgement tier: the record shows these values; the condition needs clinical judgement",
      "entered": [
        {
          "code": "J44.9",
          "description": "Chronic obstructive pulmonary disease, unspecified",
          "dx_id": "LD-P07-1",
          "source": "visit diagnosis list (synthetic)"
        }
      ],
      "expected_codes": [],
      "family": "copd_airflow",
      "note": {
        "mentions": [
          {
            "assertion": "affirmed",
            "quote": "COPD"
          },
          {
            "assertion": "affirmed",
            "quote": "COPD"
          }
        ],
        "quotes": [
          "COPD",
          "COPD"
        ],
        "status": "stated"
      },
      "open": false,
      "query_available": false,
      "reasons": [],
      "specificity_distinguished": "COPD with acute lower respiratory infection, with acute exacerbation, bronchiolitis obliterans, other specified, unspecified; the code set does not distinguish GOLD grades",
      "state": "met",
      "supported": {
        "category": "gold_2",
        "earlier": false,
        "time": "2026-11-13T16:55:00-05:00",
        "values": [
          {
            "analyte": "fev1_fvc_ratio_post_bd",
            "measurement_id": "LM-P07-01",
            "time": "2026-09-11T10:00:00-04:00",
            "unit": "ratio",
            "value": 0.58
          },
          {
            "analyte": "fev1_pct_predicted_post_bd",
            "measurement_id": "LM-P07-02",
            "time": "2026-09-11T10:00:00-04:00",
            "unit": "%",
            "value": 62.0
          }
        ]
      },
      "tier": "judgement",
      "values": [
        {
          "analyte": "fev1_fvc_ratio_post_bd",
          "measurement_id": "LM-P07-01",
          "time": "2026-09-11T10:00:00-04:00",
          "unit": "ratio",
          "value": 0.58
        },
        {
          "analyte": "fev1_pct_predicted_post_bd",
          "measurement_id": "LM-P07-02",
          "time": "2026-09-11T10:00:00-04:00",
          "unit": "%",
          "value": 62.0
        }
      ]
    }
  ],
  "config": "library_default_set@1.0",
  "definitions": {
    "ada2026_diabetes@1.0": "e6a402d238eabf948e24e0c1a768094b2a8eab1534d0208b533bcf624a7c56a7",
    "ada2026_hypoglycaemia@1.0": "46bd77ec8ba977e0a1f201d4ef02d934accd0ab454ed12ef6d6c7f189f56a9a0",
    "ada2026_prediabetes@1.0": "af2c23fe63c64897f2f72242153b81971f32dba4ad55ac279abf2a2991d0e112",
    "aha2018_severe_hypercholesterolaemia@1.0": "07ac207b49ba33e7c341f45bd1e6652460273e35b8ccb6e9882ce4e14506f24b",
    "atp3_ldl@1.0": "984f30f535df92c4f68bcb7331a079e98e17980f6cba9e3e3ca40f3dda5eee03",
    "berlin2012_ards_pf@1.0": "f6d9be0dcd8cd4f86bcc8ecd1bd12854e408cc9e25db8f136564584b9c202d77",
    "cdc_adult_bmi@1.0": "14a2ac45496eea318a30ab4841e1635efe3b8051355ff920c39b471475a3fa80",
    "esc2024_office_bp@1.0": "f507c6c22d66beccef76705f376bfcd942d7852733727916e8e70c9b78ef9f4c",
    "ese2014_hyponatraemia@1.0": "80cb82e9b02b3fc8c2af10544ac52733b115d2a2436f871ddd9f56276c4fd90b",
    "global2024_ards_intubated_pf@1.0": "64bbc3f7fa5c4c0c445d87883b20d22351bdb59ba670062bb4807a1bc924b89f",
    "gold2026_copd_airflow@1.0": "5fe646eb07866c220b55269655e680c559148e99cda65c6dd5faf3198d549e93",
    "nhlbi_bp_categories@1.0": "17c10323497aaed97bf08b4f9db27dc328068eccd4fd0fccf11af416207b76d3",
    "sepsis3_septic_shock_lactate@1.0": "349d2d1b41e02f6a8ad26bd1df917967ec1b78539948f165c14d29e427e8d6aa",
    "uhf2021_hf_ef_category@1.0": "d056531cd58ff1c18dba497a2ed8f8373ed9f9583c3a072a8b525d6a67eb61c3",
    "ukka2026_hyperkalaemia@1.0": "52e59d35a9e19548932d6bf551f322dbcd68e1e05aab0ba68e346d81eaf35c73",
    "who1994_osteoporosis@1.0": "285f666b9d1cbe759d9b827772316840002f5b2439b71ed10aedcb437a089014",
    "who2020_iron_deficiency_ferritin@1.0": "1cf50051fb66f445ab663519fb2ec6e5d60dc73f96a9ee96a86becd424e10ad1",
    "who2024_anaemia@1.0": "f2ece42ed4d7349094e3066f58b4bd9aece49873b33aa458945093e29ad4cede",
    "who_adult_bmi@1.0": "de4e41b72636521df138a3846f673cb8d1f1bb3695ace4d31b592352a719668e"
  },
  "engine": "library-engine 1.0",
  "findings": [
    {
      "checks": [
        "judgement_tier"
      ],
      "citation": {
        "code_reference": {
          "categories": [
            {
              "billable_codes_fy2027": 5,
              "category": "J44",
              "cms_hcc_v28": {
                "codes_mapping": 5,
                "hccs": [
                  "280"
                ]
              },
              "ms_drg_v44": {
                "codes_with_cc": 2,
                "codes_with_mcc": 0,
                "summary": "some codes in this category are CC"
              },
              "note": null,
              "source": "data/code_reference_fy2027.json (CDC/NCHS ICD-10-CM FY2027 order file; CMS FY2027 Tables 6I/6J; CMS 2027 Initial ICD-10-CM Mappings)",
              "specificity_distinguished": "COPD with acute lower respiratory infection, with acute exacerbation, bronchiolitis obliterans, other specified, unspecified; the code set does not distinguish GOLD grades",
              "title": "Other chronic obstructive pulmonary disease"
            }
          ],
          "icd10cm_fiscal_year": "FY2027 (effective 2026-10-01)",
          "null_reason": null,
          "use": "reference for coders \u2014 the software never assigns or suggests a code"
        },
        "condition": "Chronic obstructive pulmonary disease (spirometric grade)",
        "confirmation": null,
        "contested": {
          "is_contested": true,
          "why": "The fixed ratio 0.7 is contested against the lower limit of normal (z-score) approach used by ATS/ERS interpretation standards (not opened); the fixed ratio over-diagnoses in older and under-diagnoses in younger adults."
        },
        "edition": {
          "checked_at": "https://goldcopd.org/2026-gold-report/",
          "checked_on": "2026-11-14",
          "edition": "2026 report",
          "is_current": true,
          "note": "The GOLD site shows the 2026 Report and Pocket Guide as current.",
          "year": 2026
        },
        "id": "gold2026_copd_airflow",
        "inputs": [
          {
            "analyte": "fev1_fvc_ratio_post_bd",
            "key": "ratio",
            "select": "latest",
            "source_units": [
              "ratio"
            ],
            "unit": "ratio"
          },
          {
            "analyte": "fev1_pct_predicted_post_bd",
            "key": "fev1pp",
            "select": "latest",
            "source_units": [
              "%"
            ],
            "unit": "%"
          }
        ],
        "interpretation_notes": [
          "Ratio and FEV1 % predicted must come from the same test (same time).",
          "FEV1/FVC accepted as a fraction or per cent (70 % = 0.70)."
        ],
        "kind": "executable definition",
        "not_encoded": [
          "COPD also needs the appropriate clinical context (symptoms, exposures); the grade describes airflow obstruction only and never says COPD is present.",
          "Symptom and exacerbation assessment (GOLD ABE groups, mMRC, CAT) is not encoded.",
          "Pre-COPD and PRISm are not encoded.",
          "Whether the test was post-bronchodilator is asserted by the sender through the analyte name."
        ],
        "population": "any patient (the source states no population limit)",
        "primary_source": {
          "accessed": "2026-11-14",
          "body": "Global Initiative for Chronic Obstructive Lung Disease (GOLD)",
          "edition": "2026 (pocket guide v1.1, 20 Nov 2025)",
          "locator": "Figure 2.10 (PDF page 20); key points (PDF page 11)",
          "quote": "In patients with COPD (FEV1/FVC < 0.7): GOLD 1: Mild FEV1 \u2265 80% predicted; GOLD 2: Moderate 50% \u2264 FEV1 < 80% predicted; GOLD 3: Severe 30% \u2264 FEV1 < 50% predicted; GOLD 4: Very Severe FEV1 < 30% predicted",
          "title": "Global Strategy for Prevention, Diagnosis and Management of COPD: 2026 Report \u2014 Pocket Guide",
          "url": "https://goldcopd.org/wp-content/uploads/2026/01/GOLD-Pocket-Guide-2026-v1.1-20Nov2025_WMV2.pdf",
          "year": 2026
        },
        "second_source": null,
        "second_source_note": "No independent second source (e.g. ATS/ERS) was opened.",
        "second_source_status": "not found",
        "status": "draft \u2014 requires clinical and coding review",
        "thresholds": [
          {
            "categories": [
              {
                "condition_present": false,
                "id": "no_obstruction",
                "label": "FEV1/FVC 0.7 or above: no airflow obstruction by the fixed ratio",
                "rule": "ratio \u2265 0.7 ratio"
              },
              {
                "condition_present": true,
                "id": "gold_4",
                "label": "GOLD 4 (very severe): FEV1 <30% predicted",
                "rule": "ratio < 0.7 ratio and fev1pp < 30 %"
              },
              {
                "condition_present": true,
                "id": "gold_3",
                "label": "GOLD 3 (severe): 30% \u2264 FEV1 <50% predicted",
                "rule": "ratio < 0.7 ratio and fev1pp \u2265 30 % and fev1pp < 50 %"
              },
              {
                "condition_present": true,
                "id": "gold_2",
                "label": "GOLD 2 (moderate): 50% \u2264 FEV1 <80% predicted",
                "rule": "ratio < 0.7 ratio and fev1pp \u2265 50 % and fev1pp < 80 %"
              },
              {
                "condition_present": true,
                "id": "gold_1",
                "label": "GOLD 1 (mild): FEV1 \u226580% predicted",
                "rule": "ratio < 0.7 ratio and fev1pp \u2265 80 %"
              }
            ],
            "variant": "all",
            "variant_label": "all patients in the population"
          }
        ],
        "tier": 1,
        "title": "COPD airflow obstruction grade by post-bronchodilator spirometry (GOLD 2026)",
        "version": "1.0"
      },
      "contested": true,
      "contested_note": "The fixed ratio 0.7 is contested against the lower limit of normal (z-score) approach used by ATS/ERS interpretation standards (not opened); the fixed ratio over-diagnoses in older and under-diagnoses in younger adults.",
      "definition": "gold2026_copd_airflow@1.0",
      "direction": "JUDGEMENT",
      "draft": true,
      "family": "copd_airflow",
      "family_order": 11,
      "id": "gold2026_copd_airflow",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": true,
        "category": "gold_2",
        "category_label": "GOLD 2 (moderate): 50% \u2264 FEV1 <80% predicted",
        "clinician_label": "FEV1/FVC below 0.7 with FEV1 50 to below 80% predicted (grade 2)",
        "condition_threshold": "FEV1/FVC below 0.7 with FEV1 below 30% predicted (grade 4) (FEV1/FVC < 0.7 and FEV1 % predicted < 30 %); FEV1/FVC below 0.7 with FEV1 30 to below 50% predicted (grade 3) (FEV1/FVC < 0.7 and FEV1 % predicted \u2265 30 % and FEV1 % predicted < 50 %); FEV1/FVC below 0.7 with FEV1 50 to below 80% predicted (grade 2) (FEV1/FVC < 0.7 and FEV1 % predicted \u2265 50 % and FEV1 % predicted < 80 %); FEV1/FVC below 0.7 with FEV1 80% predicted or more (grade 1) (FEV1/FVC < 0.7 and FEV1 % predicted \u2265 80 %)",
        "confirmation": null,
        "contested": true,
        "contested_note": "The fixed ratio 0.7 is contested against the lower limit of normal (z-score) approach used by ATS/ERS interpretation standards (not opened); the fixed ratio over-diagnoses in older and under-diagnoses in younger adults.",
        "definition": "gold2026_copd_airflow@1.0",
        "edition_current": true,
        "family": "copd_airflow",
        "has_data": true,
        "id": "gold2026_copd_airflow",
        "missing_context": [],
        "notes": [],
        "reason_code": null,
        "reasons": [],
        "result": "met",
        "scan": [
          {
            "category": "gold_2",
            "confirmed": true,
            "result": "met",
            "time": "2026-09-11T10:00:00-04:00",
            "values": [
              {
                "analyte": "fev1_fvc_ratio_post_bd",
                "measurement_id": "LM-P07-01",
                "time": "2026-09-11T10:00:00-04:00",
                "unit": "ratio",
                "value": 0.58
              },
              {
                "analyte": "fev1_pct_predicted_post_bd",
                "measurement_id": "LM-P07-02",
                "time": "2026-09-11T10:00:00-04:00",
                "unit": "%",
                "value": 62.0
              }
            ]
          }
        ],
        "state": "met",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": {
          "category": "gold_2",
          "earlier": false,
          "time": "2026-11-13T16:55:00-05:00",
          "values": [
            {
              "analyte": "fev1_fvc_ratio_post_bd",
              "measurement_id": "LM-P07-01",
              "time": "2026-09-11T10:00:00-04:00",
              "unit": "ratio",
              "value": 0.58
            },
            {
              "analyte": "fev1_pct_predicted_post_bd",
              "measurement_id": "LM-P07-02",
              "time": "2026-09-11T10:00:00-04:00",
              "unit": "%",
              "value": 62.0
            }
          ]
        },
        "threshold": "FEV1/FVC < 0.7 and FEV1 % predicted \u2265 50 % and FEV1 % predicted < 80 %",
        "tier": "judgement",
        "values": [
          {
            "analyte": "fev1_fvc_ratio_post_bd",
            "measurement_id": "LM-P07-01",
            "time": "2026-09-11T10:00:00-04:00",
            "unit": "ratio",
            "value": 0.58
          },
          {
            "analyte": "fev1_pct_predicted_post_bd",
            "measurement_id": "LM-P07-02",
            "time": "2026-09-11T10:00:00-04:00",
            "unit": "%",
            "value": 62.0
          }
        ],
        "variant": "all",
        "version": "1.0",
        "window": {
          "days": 1095,
          "from": "2023-11-14T21:55:00",
          "n": 2,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": true,
        "window_met": true
      },
      "note": {
        "faults": [],
        "spans": [
          {
            "assertion": "affirmed",
            "categories": [],
            "end": 4,
            "family": "copd_airflow",
            "general": true,
            "origin": "both",
            "quote": "COPD",
            "start": 0,
            "words": []
          },
          {
            "assertion": "affirmed",
            "categories": [],
            "end": 133,
            "family": "copd_airflow",
            "general": true,
            "origin": "both",
            "quote": "COPD",
            "start": 129,
            "words": []
          }
        ],
        "status": "stated"
      },
      "optional_set": null,
      "priority": [
        5,
        11,
        "copd_airflow"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "judgement",
      "topic": "Lung function after bronchodilator",
      "version": "1.0",
      "why": ""
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": true,
      "contested_note": "Cut-offs are 5th percentiles of mostly higher-income populations (WHO's own remark); the men's 130 g/L cut-off and severity percentages were debated by the guideline group; CTCAE and laboratory reference ranges use other limits; older adults (>65) are not covered.",
      "definition": "who2024_anaemia@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "haemoglobin",
      "family_order": 0,
      "id": "who2024_anaemia",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "'severe' band (haemoglobin < 70 g/L); 'moderate' band (haemoglobin \u2265 70 g/L and haemoglobin < 100 g/L); 'mild' band (haemoglobin \u2265 100 g/L and haemoglobin < 110 g/L)",
        "confirmation": null,
        "contested": true,
        "contested_note": "Cut-offs are 5th percentiles of mostly higher-income populations (WHO's own remark); the men's 130 g/L cut-off and severity percentages were debated by the guideline group; CTCAE and laboratory reference ranges use other limits; older adults (>65) are not covered.",
        "definition": "who2024_anaemia@1.0",
        "edition_current": true,
        "family": "haemoglobin",
        "has_data": false,
        "id": "who2024_anaemia",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "outside the population the source defines: individuals aged 6 months to 65 years (Table 2 covers no other ages); pregnancy by trimester"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 30,
          "from": "2026-10-14T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        0,
        "haemoglobin"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "Haemoglobin",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": false,
      "contested_note": "The <135 mmol/L definition is widely shared; CTCAE uses the laboratory LLN instead.",
      "definition": "ese2014_hyponatraemia@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "sodium",
      "family_order": 1,
      "id": "ese2014_hyponatraemia",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "below 135 mmol/L (sodium < 135 mmol/L)",
        "confirmation": null,
        "contested": false,
        "contested_note": "The <135 mmol/L definition is widely shared; CTCAE uses the laboratory LLN instead.",
        "definition": "ese2014_hyponatraemia@1.0",
        "edition_current": null,
        "family": "sodium",
        "has_data": false,
        "id": "ese2014_hyponatraemia",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable sodium_serum measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 14,
          "from": "2026-10-30T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        1,
        "sodium"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "Sodium",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": true,
      "contested_note": "The guideline itself says 'There is no universally accepted definition of hyperkalaemia'; it adopts the ERC threshold of 5.5 mmol/L. CTCAE grades differ (see ctcae6_hyperkalaemia).",
      "definition": "ukka2026_hyperkalaemia@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "potassium",
      "family_order": 2,
      "id": "ukka2026_hyperkalaemia",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "'severe' band (6.5 mmol/L or more) (potassium \u2265 6.5 mmol/L); 'moderate' band (6.0 to 6.4 mmol/L) (potassium \u2265 6 mmol/L and potassium < 6.5 mmol/L); 'mild' band (5.5 to 5.9 mmol/L) (potassium \u2265 5.5 mmol/L and potassium < 6 mmol/L)",
        "confirmation": null,
        "contested": true,
        "contested_note": "The guideline itself says 'There is no universally accepted definition of hyperkalaemia'; it adopts the ERC threshold of 5.5 mmol/L. CTCAE grades differ (see ctcae6_hyperkalaemia).",
        "definition": "ukka2026_hyperkalaemia@1.0",
        "edition_current": true,
        "family": "potassium",
        "has_data": false,
        "id": "ukka2026_hyperkalaemia",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable potassium_serum measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 14,
          "from": "2026-10-30T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        2,
        "potassium"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "Potassium",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": false,
      "contested_note": "ADA thresholds match long-standing WHO thresholds for A1C and FPG, but WHO's current text was not opened; the A1C criterion is less sensitive in some populations (ADA text).",
      "definition": "ada2026_diabetes@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "diabetes",
      "family_order": 3,
      "id": "ada2026_diabetes",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "two results at or above the diagnostic thresholds (number of qualifying results \u2265 2); random glucose 200 mg/dL or more with typical symptoms (random glucose \u2265 200 mg/dL and a recorded clinical item); one result at or above a diagnostic threshold (number of qualifying results \u2265 1)",
        "confirmation": null,
        "contested": false,
        "contested_note": "ADA thresholds match long-standing WHO thresholds for A1C and FPG, but WHO's current text was not opened; the A1C criterion is less sensitive in some populations (ADA text).",
        "definition": "ada2026_diabetes@1.0",
        "edition_current": true,
        "family": "diabetes",
        "has_data": false,
        "id": "ada2026_diabetes",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "none of hba1c, glucose_fasting_plasma, glucose_ogtt_2h_plasma, glucose_random_plasma has a usable measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 730,
          "from": "2024-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        3,
        "diabetes"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "Glucose and HbA1c",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": true,
      "contested_note": "Other bodies (for example WHO) are understood to use a different impaired fasting glucose range and not to use an A1C prediabetes range; those texts were not opened, so no other thresholds are recorded. Review item.",
      "definition": "ada2026_prediabetes@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "prediabetes",
      "family_order": 4,
      "id": "ada2026_prediabetes",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "intermediate range (HbA1c 5.7 to 6.4%, fasting glucose 100 to 125 mg/dL, or 2-hour glucose 140 to 199 mg/dL) (HbA1c \u2265 5.7 % and HbA1c < 6.5 % or fasting glucose \u2265 100 mg/dL and fasting glucose < 126 mg/dL or 2-hour glucose \u2265 140 mg/dL and 2-hour glucose < 200 mg/dL)",
        "confirmation": null,
        "contested": true,
        "contested_note": "Other bodies (for example WHO) are understood to use a different impaired fasting glucose range and not to use an A1C prediabetes range; those texts were not opened, so no other thresholds are recorded. Review item.",
        "definition": "ada2026_prediabetes@1.0",
        "edition_current": true,
        "family": "prediabetes",
        "has_data": false,
        "id": "ada2026_prediabetes",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "none of hba1c, glucose_fasting_plasma, glucose_ogtt_2h_plasma has a usable measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 365,
          "from": "2025-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        4,
        "prediabetes"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "Glucose and HbA1c (intermediate range)",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": true,
      "contested_note": "The International Hypoglycaemia Study Group (2017) sets level 1 at 'a glucose alert value of 3.9 mmol/l (70 mg/dl) or less', i.e. it includes exactly 70 mg/dL; ADA 2026 uses '<70'. CTCAE uses other cut-offs.",
      "definition": "ada2026_hypoglycaemia@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "hypoglycaemia",
      "family_order": 5,
      "id": "ada2026_hypoglycaemia",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "level 3 (severe event needing assistance) (a recorded clinical item); level 2 (glucose below 54 mg/dL) (glucose < 54 mg/dL); level 1 (glucose 54 to below 70 mg/dL) (glucose \u2265 54 mg/dL and glucose < 70 mg/dL)",
        "confirmation": null,
        "contested": true,
        "contested_note": "The International Hypoglycaemia Study Group (2017) sets level 1 at 'a glucose alert value of 3.9 mmol/l (70 mg/dl) or less', i.e. it includes exactly 70 mg/dL; ADA 2026 uses '<70'. CTCAE uses other cut-offs.",
        "definition": "ada2026_hypoglycaemia@1.0",
        "edition_current": true,
        "family": "hypoglycaemia",
        "has_data": false,
        "id": "ada2026_hypoglycaemia",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "needed to decide whether the definition applies: context 'has_diabetes' not provided"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 14,
          "from": "2026-10-30T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        5,
        "hypoglycaemia"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "Low glucose values",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": true,
      "contested_note": "BMI cut-offs are population-specific (WHO 2004 expert consultation proposed lower action points for Asian populations; not opened) and BMI does not measure adiposity directly; the CDC page applies the categories 'regardless of age, sex, or race' for adults.",
      "definition": "cdc_adult_bmi@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "bmi",
      "family_order": 6,
      "id": "cdc_adult_bmi",
      "measurement": {
        "adjustments": [],
        "alternatives": [
          {
            "category": null,
            "category_label": null,
            "clinician_label": null,
            "definition": "who_adult_bmi@1.0",
            "id": "who_adult_bmi",
            "optional_set": null,
            "reason_code": "no_value",
            "reasons": [
              "no usable bmi measurement"
            ],
            "result": "not_assessable",
            "version": "1.0"
          }
        ],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "40 or more band (class 3) (body-mass index \u2265 40 kg/m2); 35 to below 40 band (class 2) (body-mass index \u2265 35 kg/m2 and body-mass index < 40 kg/m2); 30 to below 35 band (class 1) (body-mass index \u2265 30 kg/m2 and body-mass index < 35 kg/m2); 25 to below 30 band (body-mass index \u2265 25 kg/m2 and body-mass index < 30 kg/m2); below 18.5 band (body-mass index < 18.5 kg/m2)",
        "confirmation": null,
        "contested": true,
        "contested_note": "BMI cut-offs are population-specific (WHO 2004 expert consultation proposed lower action points for Asian populations; not opened) and BMI does not measure adiposity directly; the CDC page applies the categories 'regardless of age, sex, or race' for adults.",
        "definition": "cdc_adult_bmi@1.0",
        "edition_current": true,
        "family": "bmi",
        "has_data": false,
        "id": "cdc_adult_bmi",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable bmi measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 365,
          "from": "2025-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        6,
        "bmi"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "Body-mass index",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": true,
      "contested_note": "European guidelines define hypertension at 140/90 (ESC 2024, encoded separately as esc2024_office_bp) while AHA/ACC use 130/80.",
      "definition": "nhlbi_bp_categories@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "blood_pressure",
      "family_order": 7,
      "id": "nhlbi_bp_categories",
      "measurement": {
        "adjustments": [],
        "alternatives": [
          {
            "category": null,
            "category_label": null,
            "clinician_label": null,
            "definition": "esc2024_office_bp@1.0",
            "id": "esc2024_office_bp",
            "optional_set": null,
            "reason_code": "no_value",
            "reasons": [
              "no reading with all of bp_systolic_office, bp_diastolic_office recorded at the same time",
              "no usable bp_diastolic_office measurement",
              "no usable bp_systolic_office measurement"
            ],
            "result": "not_assessable",
            "version": "1.0"
          }
        ],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "range above 180 systolic or above 120 diastolic (systolic > 180 mmHg or diastolic > 120 mmHg); stage 2 range (140 or more systolic, or 90 or more diastolic) (systolic \u2265 140 mmHg or diastolic \u2265 90 mmHg); stage 1 range (130 to 139 systolic, or 80 to 89 diastolic) (systolic \u2265 130 mmHg and systolic < 140 mmHg or diastolic \u2265 80 mmHg and diastolic < 90 mmHg); elevated range (120 to 129 systolic and below 80 diastolic) (systolic \u2265 120 mmHg and systolic < 130 mmHg and diastolic < 80 mmHg)",
        "confirmation": null,
        "contested": true,
        "contested_note": "European guidelines define hypertension at 140/90 (ESC 2024, encoded separately as esc2024_office_bp) while AHA/ACC use 130/80.",
        "definition": "nhlbi_bp_categories@1.0",
        "edition_current": true,
        "family": "blood_pressure",
        "has_data": false,
        "id": "nhlbi_bp_categories",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no reading with all of bp_systolic_office, bp_diastolic_office recorded at the same time",
          "no usable bp_diastolic_office measurement",
          "no usable bp_systolic_office measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 365,
          "from": "2025-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        7,
        "blood_pressure"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "Blood pressure readings",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": false,
      "contested_note": "Same 190 mg/dL boundary as ATP III 'very high'.",
      "definition": "aha2018_severe_hypercholesterolaemia@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "ldl",
      "family_order": 8,
      "id": "aha2018_severe_hypercholesterolaemia",
      "measurement": {
        "adjustments": [],
        "alternatives": [
          {
            "category": null,
            "category_label": null,
            "clinician_label": null,
            "definition": "atp3_ldl@1.0",
            "id": "atp3_ldl",
            "optional_set": null,
            "reason_code": "no_value",
            "reasons": [
              "no usable ldl_cholesterol measurement"
            ],
            "result": "not_assessable",
            "version": "1.0"
          }
        ],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "LDL 190 mg/dL or more (LDL \u2265 190 mg/dL)",
        "confirmation": null,
        "contested": false,
        "contested_note": "Same 190 mg/dL boundary as ATP III 'very high'.",
        "definition": "aha2018_severe_hypercholesterolaemia@1.0",
        "edition_current": true,
        "family": "ldl",
        "has_data": false,
        "id": "aha2018_severe_hypercholesterolaemia",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable ldl_cholesterol measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 730,
          "from": "2024-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        8,
        "ldl"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "LDL cholesterol",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": true,
      "contested_note": "Ferritin cut-offs for iron deficiency vary widely between bodies and studies (the guideline's own review cites thresholds from <12 to <30 \u00b5g/L in pregnancy); WHO's are low (high specificity). Other bodies (e.g. gastroenterology guidance) use higher values; those texts were not opened.",
      "definition": "who2020_iron_deficiency_ferritin@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "ferritin",
      "family_order": 9,
      "id": "who2020_iron_deficiency_ferritin",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "band below the ferritin cut-off for this group (ferritin < 15 ug/L)",
        "confirmation": null,
        "contested": true,
        "contested_note": "Ferritin cut-offs for iron deficiency vary widely between bodies and studies (the guideline's own review cites thresholds from <12 to <30 \u00b5g/L in pregnancy); WHO's are low (high specificity). Other bodies (e.g. gastroenterology guidance) use higher values; those texts were not opened.",
        "definition": "who2020_iron_deficiency_ferritin@1.0",
        "edition_current": true,
        "family": "ferritin",
        "has_data": false,
        "id": "who2020_iron_deficiency_ferritin",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable ferritin_serum measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 180,
          "from": "2026-05-17T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        9,
        "ferritin"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "Ferritin",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "contradiction",
        "not_stated"
      ],
      "citation": null,
      "contested": true,
      "contested_note": "T-score categories were defined for postmenopausal (white) women; their use in men and other populations relies on later bodies (e.g. ISCD), which were not opened; the report itself calls cut-off values 'somewhat arbitrary'.",
      "definition": "who1994_osteoporosis@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "bone_density",
      "family_order": 10,
      "id": "who1994_osteoporosis",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "T-score below -2.5 with a fragility fracture (T-score < -2.5 SD and a recorded clinical item); T-score -2.5 or lower band (T-score \u2264 -2.5 SD); T-score between -1 and -2.5 band (T-score > -2.5 SD and T-score < -1 SD)",
        "confirmation": null,
        "contested": true,
        "contested_note": "T-score categories were defined for postmenopausal (white) women; their use in men and other populations relies on later bodies (e.g. ISCD), which were not opened; the report itself calls cut-off values 'somewhat arbitrary'.",
        "definition": "who1994_osteoporosis@1.0",
        "edition_current": null,
        "family": "bone_density",
        "has_data": false,
        "id": "who1994_osteoporosis",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "outside the population the source defines: postmenopausal women (the report's categories are stated 'in women' in the context of postmenopausal osteoporosis)"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 1095,
          "from": "2023-11-14T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        10,
        "bone_density"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "measured",
      "topic": "Bone density T-score",
      "version": "1.0",
      "why": "no measurement in the window"
    },
    {
      "checks": [
        "judgement_tier"
      ],
      "citation": null,
      "contested": false,
      "contested_note": "The same cut-offs appear in the co-published Eur J Heart Fail and J Card Fail versions; some guidelines describe HFmrEF differently in wording only (not opened).",
      "definition": "uhf2021_hf_ef_category@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "heart_failure_ef",
      "family_order": 12,
      "id": "uhf2021_hf_ef_category",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "improved category (from 40% or below to above 40%, a rise of 10 points or more) (earliest ejection fraction \u2264 40 % and ejection fraction > 40 % and change in ejection fraction \u2265 10); 40% or below (ejection fraction \u2264 40 %); 41 to 49% (ejection fraction > 40 % and ejection fraction < 50 %); 50% or above (ejection fraction \u2265 50 %)",
        "confirmation": null,
        "contested": false,
        "contested_note": "The same cut-offs appear in the co-published Eur J Heart Fail and J Card Fail versions; some guidelines describe HFmrEF differently in wording only (not opened).",
        "definition": "uhf2021_hf_ef_category@1.0",
        "edition_current": null,
        "family": "heart_failure_ef",
        "has_data": false,
        "id": "uhf2021_hf_ef_category",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "needed to decide whether the definition applies: context 'heart_failure' not provided"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "judgement",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 730,
          "from": "2024-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        12,
        "heart_failure_ef"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "judgement",
      "topic": "Ejection fraction",
      "version": "1.0",
      "why": ""
    },
    {
      "checks": [
        "judgement_tier"
      ],
      "citation": null,
      "contested": false,
      "contested_note": "The CMS SEP-1 measure and the Surviving Sepsis Campaign use lactate thresholds for other purposes (for example \u22654 mmol/L); those documents were not opened for this entry.",
      "definition": "sepsis3_septic_shock_lactate@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "lactate",
      "family_order": 13,
      "id": "sepsis3_septic_shock_lactate",
      "measurement": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "lactate above 2 mmol/L (lactate > 2 mmol/L)",
        "confirmation": null,
        "contested": false,
        "contested_note": "The CMS SEP-1 measure and the Surviving Sepsis Campaign use lactate thresholds for other purposes (for example \u22654 mmol/L); those documents were not opened for this entry.",
        "definition": "sepsis3_septic_shock_lactate@1.0",
        "edition_current": true,
        "family": "lactate",
        "has_data": false,
        "id": "sepsis3_septic_shock_lactate",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable lactate_serum measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "judgement",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 7,
          "from": "2026-11-06T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        13,
        "lactate"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "judgement",
      "topic": "Lactate",
      "version": "1.0",
      "why": ""
    },
    {
      "checks": [
        "judgement_tier"
      ],
      "citation": null,
      "contested": false,
      "contested_note": "Bands unchanged from Berlin for intubated patients.",
      "definition": "global2024_ards_intubated_pf@1.0",
      "direction": "NOT_ASSESSED",
      "draft": true,
      "family": "oxygenation",
      "family_order": 14,
      "id": "global2024_ards_intubated_pf",
      "measurement": {
        "adjustments": [],
        "alternatives": [
          {
            "category": null,
            "category_label": null,
            "clinician_label": null,
            "definition": "berlin2012_ards_pf@1.0",
            "id": "berlin2012_ards_pf",
            "optional_set": null,
            "reason_code": "no_value",
            "reasons": [
              "no reading with all of pao2, fio2 recorded at the same time",
              "no usable fio2 measurement",
              "no usable pao2 measurement"
            ],
            "result": "not_assessable",
            "version": "1.0"
          }
        ],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "PaO2/FiO2 \u2264 100; PaO2/FiO2 > 100 and PaO2/FiO2 \u2264 200; PaO2/FiO2 > 200 and PaO2/FiO2 \u2264 300",
        "confirmation": null,
        "contested": false,
        "contested_note": "Bands unchanged from Berlin for intubated patients.",
        "definition": "global2024_ards_intubated_pf@1.0",
        "edition_current": true,
        "family": "oxygenation",
        "has_data": false,
        "id": "global2024_ards_intubated_pf",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "needed to decide whether the definition applies: context 'intubated' not provided"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "judgement",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 7,
          "from": "2026-11-06T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "note": {
        "faults": [],
        "spans": [],
        "status": "silent"
      },
      "optional_set": null,
      "priority": [
        8,
        14,
        "oxygenation"
      ],
      "status_text": "draft \u2014 requires clinical and coding review",
      "tier": "judgement",
      "topic": "Oxygenation (PaO2/FiO2)",
      "version": "1.0",
      "why": ""
    }
  ],
  "measurement": {
    "config": "library_default_set@1.0",
    "context_used": {
      "age_years": 71,
      "sex": "male"
    },
    "engine": "library-engine 1.0",
    "families": {
      "blood_pressure": {
        "adjustments": [],
        "alternatives": [
          {
            "category": null,
            "category_label": null,
            "clinician_label": null,
            "definition": "esc2024_office_bp@1.0",
            "id": "esc2024_office_bp",
            "optional_set": null,
            "reason_code": "no_value",
            "reasons": [
              "no reading with all of bp_systolic_office, bp_diastolic_office recorded at the same time",
              "no usable bp_diastolic_office measurement",
              "no usable bp_systolic_office measurement"
            ],
            "result": "not_assessable",
            "version": "1.0"
          }
        ],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "range above 180 systolic or above 120 diastolic (systolic > 180 mmHg or diastolic > 120 mmHg); stage 2 range (140 or more systolic, or 90 or more diastolic) (systolic \u2265 140 mmHg or diastolic \u2265 90 mmHg); stage 1 range (130 to 139 systolic, or 80 to 89 diastolic) (systolic \u2265 130 mmHg and systolic < 140 mmHg or diastolic \u2265 80 mmHg and diastolic < 90 mmHg); elevated range (120 to 129 systolic and below 80 diastolic) (systolic \u2265 120 mmHg and systolic < 130 mmHg and diastolic < 80 mmHg)",
        "confirmation": null,
        "contested": true,
        "contested_note": "European guidelines define hypertension at 140/90 (ESC 2024, encoded separately as esc2024_office_bp) while AHA/ACC use 130/80.",
        "definition": "nhlbi_bp_categories@1.0",
        "edition_current": true,
        "family": "blood_pressure",
        "has_data": false,
        "id": "nhlbi_bp_categories",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no reading with all of bp_systolic_office, bp_diastolic_office recorded at the same time",
          "no usable bp_diastolic_office measurement",
          "no usable bp_systolic_office measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 365,
          "from": "2025-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "bmi": {
        "adjustments": [],
        "alternatives": [
          {
            "category": null,
            "category_label": null,
            "clinician_label": null,
            "definition": "who_adult_bmi@1.0",
            "id": "who_adult_bmi",
            "optional_set": null,
            "reason_code": "no_value",
            "reasons": [
              "no usable bmi measurement"
            ],
            "result": "not_assessable",
            "version": "1.0"
          }
        ],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "40 or more band (class 3) (body-mass index \u2265 40 kg/m2); 35 to below 40 band (class 2) (body-mass index \u2265 35 kg/m2 and body-mass index < 40 kg/m2); 30 to below 35 band (class 1) (body-mass index \u2265 30 kg/m2 and body-mass index < 35 kg/m2); 25 to below 30 band (body-mass index \u2265 25 kg/m2 and body-mass index < 30 kg/m2); below 18.5 band (body-mass index < 18.5 kg/m2)",
        "confirmation": null,
        "contested": true,
        "contested_note": "BMI cut-offs are population-specific (WHO 2004 expert consultation proposed lower action points for Asian populations; not opened) and BMI does not measure adiposity directly; the CDC page applies the categories 'regardless of age, sex, or race' for adults.",
        "definition": "cdc_adult_bmi@1.0",
        "edition_current": true,
        "family": "bmi",
        "has_data": false,
        "id": "cdc_adult_bmi",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable bmi measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 365,
          "from": "2025-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "bone_density": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "T-score below -2.5 with a fragility fracture (T-score < -2.5 SD and a recorded clinical item); T-score -2.5 or lower band (T-score \u2264 -2.5 SD); T-score between -1 and -2.5 band (T-score > -2.5 SD and T-score < -1 SD)",
        "confirmation": null,
        "contested": true,
        "contested_note": "T-score categories were defined for postmenopausal (white) women; their use in men and other populations relies on later bodies (e.g. ISCD), which were not opened; the report itself calls cut-off values 'somewhat arbitrary'.",
        "definition": "who1994_osteoporosis@1.0",
        "edition_current": null,
        "family": "bone_density",
        "has_data": false,
        "id": "who1994_osteoporosis",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "outside the population the source defines: postmenopausal women (the report's categories are stated 'in women' in the context of postmenopausal osteoporosis)"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 1095,
          "from": "2023-11-14T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "copd_airflow": {
        "adjustments": [],
        "alternatives": [],
        "any_history": true,
        "category": "gold_2",
        "category_label": "GOLD 2 (moderate): 50% \u2264 FEV1 <80% predicted",
        "clinician_label": "FEV1/FVC below 0.7 with FEV1 50 to below 80% predicted (grade 2)",
        "condition_threshold": "FEV1/FVC below 0.7 with FEV1 below 30% predicted (grade 4) (FEV1/FVC < 0.7 and FEV1 % predicted < 30 %); FEV1/FVC below 0.7 with FEV1 30 to below 50% predicted (grade 3) (FEV1/FVC < 0.7 and FEV1 % predicted \u2265 30 % and FEV1 % predicted < 50 %); FEV1/FVC below 0.7 with FEV1 50 to below 80% predicted (grade 2) (FEV1/FVC < 0.7 and FEV1 % predicted \u2265 50 % and FEV1 % predicted < 80 %); FEV1/FVC below 0.7 with FEV1 80% predicted or more (grade 1) (FEV1/FVC < 0.7 and FEV1 % predicted \u2265 80 %)",
        "confirmation": null,
        "contested": true,
        "contested_note": "The fixed ratio 0.7 is contested against the lower limit of normal (z-score) approach used by ATS/ERS interpretation standards (not opened); the fixed ratio over-diagnoses in older and under-diagnoses in younger adults.",
        "definition": "gold2026_copd_airflow@1.0",
        "edition_current": true,
        "family": "copd_airflow",
        "has_data": true,
        "id": "gold2026_copd_airflow",
        "missing_context": [],
        "notes": [],
        "reason_code": null,
        "reasons": [],
        "result": "met",
        "scan": [
          {
            "category": "gold_2",
            "confirmed": true,
            "result": "met",
            "time": "2026-09-11T10:00:00-04:00",
            "values": [
              {
                "analyte": "fev1_fvc_ratio_post_bd",
                "measurement_id": "LM-P07-01",
                "time": "2026-09-11T10:00:00-04:00",
                "unit": "ratio",
                "value": 0.58
              },
              {
                "analyte": "fev1_pct_predicted_post_bd",
                "measurement_id": "LM-P07-02",
                "time": "2026-09-11T10:00:00-04:00",
                "unit": "%",
                "value": 62.0
              }
            ]
          }
        ],
        "state": "met",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": {
          "category": "gold_2",
          "earlier": false,
          "time": "2026-11-13T16:55:00-05:00",
          "values": [
            {
              "analyte": "fev1_fvc_ratio_post_bd",
              "measurement_id": "LM-P07-01",
              "time": "2026-09-11T10:00:00-04:00",
              "unit": "ratio",
              "value": 0.58
            },
            {
              "analyte": "fev1_pct_predicted_post_bd",
              "measurement_id": "LM-P07-02",
              "time": "2026-09-11T10:00:00-04:00",
              "unit": "%",
              "value": 62.0
            }
          ]
        },
        "threshold": "FEV1/FVC < 0.7 and FEV1 % predicted \u2265 50 % and FEV1 % predicted < 80 %",
        "tier": "judgement",
        "values": [
          {
            "analyte": "fev1_fvc_ratio_post_bd",
            "measurement_id": "LM-P07-01",
            "time": "2026-09-11T10:00:00-04:00",
            "unit": "ratio",
            "value": 0.58
          },
          {
            "analyte": "fev1_pct_predicted_post_bd",
            "measurement_id": "LM-P07-02",
            "time": "2026-09-11T10:00:00-04:00",
            "unit": "%",
            "value": 62.0
          }
        ],
        "variant": "all",
        "version": "1.0",
        "window": {
          "days": 1095,
          "from": "2023-11-14T21:55:00",
          "n": 2,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": true,
        "window_met": true
      },
      "diabetes": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "two results at or above the diagnostic thresholds (number of qualifying results \u2265 2); random glucose 200 mg/dL or more with typical symptoms (random glucose \u2265 200 mg/dL and a recorded clinical item); one result at or above a diagnostic threshold (number of qualifying results \u2265 1)",
        "confirmation": null,
        "contested": false,
        "contested_note": "ADA thresholds match long-standing WHO thresholds for A1C and FPG, but WHO's current text was not opened; the A1C criterion is less sensitive in some populations (ADA text).",
        "definition": "ada2026_diabetes@1.0",
        "edition_current": true,
        "family": "diabetes",
        "has_data": false,
        "id": "ada2026_diabetes",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "none of hba1c, glucose_fasting_plasma, glucose_ogtt_2h_plasma, glucose_random_plasma has a usable measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 730,
          "from": "2024-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "ferritin": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "band below the ferritin cut-off for this group (ferritin < 15 ug/L)",
        "confirmation": null,
        "contested": true,
        "contested_note": "Ferritin cut-offs for iron deficiency vary widely between bodies and studies (the guideline's own review cites thresholds from <12 to <30 \u00b5g/L in pregnancy); WHO's are low (high specificity). Other bodies (e.g. gastroenterology guidance) use higher values; those texts were not opened.",
        "definition": "who2020_iron_deficiency_ferritin@1.0",
        "edition_current": true,
        "family": "ferritin",
        "has_data": false,
        "id": "who2020_iron_deficiency_ferritin",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable ferritin_serum measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 180,
          "from": "2026-05-17T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "haemoglobin": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "'severe' band (haemoglobin < 70 g/L); 'moderate' band (haemoglobin \u2265 70 g/L and haemoglobin < 100 g/L); 'mild' band (haemoglobin \u2265 100 g/L and haemoglobin < 110 g/L)",
        "confirmation": null,
        "contested": true,
        "contested_note": "Cut-offs are 5th percentiles of mostly higher-income populations (WHO's own remark); the men's 130 g/L cut-off and severity percentages were debated by the guideline group; CTCAE and laboratory reference ranges use other limits; older adults (>65) are not covered.",
        "definition": "who2024_anaemia@1.0",
        "edition_current": true,
        "family": "haemoglobin",
        "has_data": false,
        "id": "who2024_anaemia",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "outside the population the source defines: individuals aged 6 months to 65 years (Table 2 covers no other ages); pregnancy by trimester"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 30,
          "from": "2026-10-14T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "heart_failure_ef": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "improved category (from 40% or below to above 40%, a rise of 10 points or more) (earliest ejection fraction \u2264 40 % and ejection fraction > 40 % and change in ejection fraction \u2265 10); 40% or below (ejection fraction \u2264 40 %); 41 to 49% (ejection fraction > 40 % and ejection fraction < 50 %); 50% or above (ejection fraction \u2265 50 %)",
        "confirmation": null,
        "contested": false,
        "contested_note": "The same cut-offs appear in the co-published Eur J Heart Fail and J Card Fail versions; some guidelines describe HFmrEF differently in wording only (not opened).",
        "definition": "uhf2021_hf_ef_category@1.0",
        "edition_current": null,
        "family": "heart_failure_ef",
        "has_data": false,
        "id": "uhf2021_hf_ef_category",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "needed to decide whether the definition applies: context 'heart_failure' not provided"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "judgement",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 730,
          "from": "2024-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "hypoglycaemia": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "level 3 (severe event needing assistance) (a recorded clinical item); level 2 (glucose below 54 mg/dL) (glucose < 54 mg/dL); level 1 (glucose 54 to below 70 mg/dL) (glucose \u2265 54 mg/dL and glucose < 70 mg/dL)",
        "confirmation": null,
        "contested": true,
        "contested_note": "The International Hypoglycaemia Study Group (2017) sets level 1 at 'a glucose alert value of 3.9 mmol/l (70 mg/dl) or less', i.e. it includes exactly 70 mg/dL; ADA 2026 uses '<70'. CTCAE uses other cut-offs.",
        "definition": "ada2026_hypoglycaemia@1.0",
        "edition_current": true,
        "family": "hypoglycaemia",
        "has_data": false,
        "id": "ada2026_hypoglycaemia",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "needed to decide whether the definition applies: context 'has_diabetes' not provided"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 14,
          "from": "2026-10-30T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "lactate": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "lactate above 2 mmol/L (lactate > 2 mmol/L)",
        "confirmation": null,
        "contested": false,
        "contested_note": "The CMS SEP-1 measure and the Surviving Sepsis Campaign use lactate thresholds for other purposes (for example \u22654 mmol/L); those documents were not opened for this entry.",
        "definition": "sepsis3_septic_shock_lactate@1.0",
        "edition_current": true,
        "family": "lactate",
        "has_data": false,
        "id": "sepsis3_septic_shock_lactate",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable lactate_serum measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "judgement",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 7,
          "from": "2026-11-06T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "ldl": {
        "adjustments": [],
        "alternatives": [
          {
            "category": null,
            "category_label": null,
            "clinician_label": null,
            "definition": "atp3_ldl@1.0",
            "id": "atp3_ldl",
            "optional_set": null,
            "reason_code": "no_value",
            "reasons": [
              "no usable ldl_cholesterol measurement"
            ],
            "result": "not_assessable",
            "version": "1.0"
          }
        ],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "LDL 190 mg/dL or more (LDL \u2265 190 mg/dL)",
        "confirmation": null,
        "contested": false,
        "contested_note": "Same 190 mg/dL boundary as ATP III 'very high'.",
        "definition": "aha2018_severe_hypercholesterolaemia@1.0",
        "edition_current": true,
        "family": "ldl",
        "has_data": false,
        "id": "aha2018_severe_hypercholesterolaemia",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable ldl_cholesterol measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 730,
          "from": "2024-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "oxygenation": {
        "adjustments": [],
        "alternatives": [
          {
            "category": null,
            "category_label": null,
            "clinician_label": null,
            "definition": "berlin2012_ards_pf@1.0",
            "id": "berlin2012_ards_pf",
            "optional_set": null,
            "reason_code": "no_value",
            "reasons": [
              "no reading with all of pao2, fio2 recorded at the same time",
              "no usable fio2 measurement",
              "no usable pao2 measurement"
            ],
            "result": "not_assessable",
            "version": "1.0"
          }
        ],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "PaO2/FiO2 \u2264 100; PaO2/FiO2 > 100 and PaO2/FiO2 \u2264 200; PaO2/FiO2 > 200 and PaO2/FiO2 \u2264 300",
        "confirmation": null,
        "contested": false,
        "contested_note": "Bands unchanged from Berlin for intubated patients.",
        "definition": "global2024_ards_intubated_pf@1.0",
        "edition_current": true,
        "family": "oxygenation",
        "has_data": false,
        "id": "global2024_ards_intubated_pf",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "needed to decide whether the definition applies: context 'intubated' not provided"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "judgement",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 7,
          "from": "2026-11-06T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "potassium": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "'severe' band (6.5 mmol/L or more) (potassium \u2265 6.5 mmol/L); 'moderate' band (6.0 to 6.4 mmol/L) (potassium \u2265 6 mmol/L and potassium < 6.5 mmol/L); 'mild' band (5.5 to 5.9 mmol/L) (potassium \u2265 5.5 mmol/L and potassium < 6 mmol/L)",
        "confirmation": null,
        "contested": true,
        "contested_note": "The guideline itself says 'There is no universally accepted definition of hyperkalaemia'; it adopts the ERC threshold of 5.5 mmol/L. CTCAE grades differ (see ctcae6_hyperkalaemia).",
        "definition": "ukka2026_hyperkalaemia@1.0",
        "edition_current": true,
        "family": "potassium",
        "has_data": false,
        "id": "ukka2026_hyperkalaemia",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable potassium_serum measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 14,
          "from": "2026-10-30T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "prediabetes": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "intermediate range (HbA1c 5.7 to 6.4%, fasting glucose 100 to 125 mg/dL, or 2-hour glucose 140 to 199 mg/dL) (HbA1c \u2265 5.7 % and HbA1c < 6.5 % or fasting glucose \u2265 100 mg/dL and fasting glucose < 126 mg/dL or 2-hour glucose \u2265 140 mg/dL and 2-hour glucose < 200 mg/dL)",
        "confirmation": null,
        "contested": true,
        "contested_note": "Other bodies (for example WHO) are understood to use a different impaired fasting glucose range and not to use an A1C prediabetes range; those texts were not opened, so no other thresholds are recorded. Review item.",
        "definition": "ada2026_prediabetes@1.0",
        "edition_current": true,
        "family": "prediabetes",
        "has_data": false,
        "id": "ada2026_prediabetes",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "none of hba1c, glucose_fasting_plasma, glucose_ogtt_2h_plasma has a usable measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 365,
          "from": "2025-11-13T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      },
      "sodium": {
        "adjustments": [],
        "alternatives": [],
        "any_history": false,
        "category": null,
        "category_label": null,
        "clinician_label": null,
        "condition_threshold": "below 135 mmol/L (sodium < 135 mmol/L)",
        "confirmation": null,
        "contested": false,
        "contested_note": "The <135 mmol/L definition is widely shared; CTCAE uses the laboratory LLN instead.",
        "definition": "ese2014_hyponatraemia@1.0",
        "edition_current": null,
        "family": "sodium",
        "has_data": false,
        "id": "ese2014_hyponatraemia",
        "missing_context": [],
        "notes": [],
        "reason_code": "no_value",
        "reasons": [
          "no usable sodium_serum measurement"
        ],
        "result": "not_assessable",
        "scan": [],
        "state": "no_data",
        "status_text": "draft \u2014 requires clinical and coding review",
        "supported": null,
        "threshold": null,
        "tier": "measured",
        "values": [],
        "variant": null,
        "version": "1.0",
        "window": {
          "days": 14,
          "from": "2026-10-30T21:55:00",
          "n": 0,
          "to": "2026-11-13T21:55:00"
        },
        "window_assessable": false,
        "window_met": false
      }
    }
  },
  "measurement_sha256": "c1f0426c64da40eed19fbc090db7d1f24413d26da58439653f45cf281545c17e",
  "reader": {
    "lexicon": "library-lexicon 1.0",
    "model_status": "ok",
    "reader": "lexicon+model"
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}