diff --git a/pom.xml b/pom.xml
index 02913fa..b477e48 100644
--- a/pom.xml
+++ b/pom.xml
@@ -14,7 +14,7 @@
     <parent>
         <groupId>ca.uhn.hapi.fhir</groupId>
         <artifactId>hapi-fhir</artifactId>
-            <version>6.9.9-SNAPSHOT</version>
+            <version>6.9.10-SNAPSHOT</version>
     </parent>
 
     <artifactId>hapi-fhir-jpaserver-starter</artifactId>
diff --git a/src/main/java/ca/uhn/fhir/jpa/starter/cr/BaseCrConfig.java b/src/main/java/ca/uhn/fhir/jpa/starter/cr/BaseCrConfig.java
new file mode 100644
index 0000000..1e08b33
--- /dev/null
+++ b/src/main/java/ca/uhn/fhir/jpa/starter/cr/BaseCrConfig.java
@@ -0,0 +1,85 @@
+package ca.uhn.fhir.jpa.starter.cr;
+
+import ca.uhn.fhir.context.FhirContext;
+import ca.uhn.fhir.cr.common.CodeCacheResourceChangeListener;
+import ca.uhn.fhir.cr.common.ElmCacheResourceChangeListener;
+import ca.uhn.fhir.jpa.api.dao.DaoRegistry;
+import ca.uhn.fhir.jpa.cache.IResourceChangeListenerCacheRefresher;
+import ca.uhn.fhir.jpa.cache.IResourceChangeListenerRegistry;
+import ca.uhn.fhir.jpa.cache.ResourceChangeListenerCacheFactory;
+import ca.uhn.fhir.jpa.cache.ResourceChangeListenerCacheRefresherImpl;
+import ca.uhn.fhir.jpa.cache.ResourceChangeListenerRegistryImpl;
+import ca.uhn.fhir.jpa.cache.ResourceChangeListenerRegistryInterceptor;
+import ca.uhn.fhir.jpa.searchparam.SearchParameterMap;
+import ca.uhn.fhir.jpa.searchparam.matcher.InMemoryResourceMatcher;
+import org.cqframework.cql.cql2elm.model.CompiledLibrary;
+import org.cqframework.cql.cql2elm.model.Model;
+import org.hl7.cql.model.ModelIdentifier;
+import org.hl7.elm.r1.VersionedIdentifier;
+import org.opencds.cqf.cql.engine.runtime.Code;
+import org.opencds.cqf.fhir.cql.EvaluationSettings;
+import org.springframework.context.annotation.Bean;
+import org.springframework.context.annotation.Configuration;
+
+import java.util.List;
+import java.util.Map;
+import java.util.concurrent.ConcurrentHashMap;
+
+@Configuration
+public class BaseCrConfig {
+	@Bean
+	public Map<VersionedIdentifier, CompiledLibrary> globalLibraryCache() {
+		return new ConcurrentHashMap<>();
+	}
+
+	@Bean
+	public Map<ModelIdentifier, Model> globalModelCache() {
+		return new ConcurrentHashMap<>();
+	}
+
+	@Bean
+	public Map<String, List<Code>> globalValueSetCache() {
+		return new ConcurrentHashMap<>();
+	}
+
+
+	@Bean
+	public ElmCacheResourceChangeListener elmCacheResourceChangeListener(
+		IResourceChangeListenerRegistry theResourceChangeListenerRegistry,
+		DaoRegistry theDaoRegistry,
+		EvaluationSettings theEvaluationSettings) {
+		ElmCacheResourceChangeListener listener =
+			new ElmCacheResourceChangeListener(theDaoRegistry, theEvaluationSettings.getLibraryCache());
+		theResourceChangeListenerRegistry.registerResourceResourceChangeListener(
+			"Library", SearchParameterMap.newSynchronous(), listener, 1000);
+		return listener;
+	}
+
+	@Bean
+	public CodeCacheResourceChangeListener codeCacheResourceChangeListener(
+		IResourceChangeListenerRegistry theResourceChangeListenerRegistry,
+		EvaluationSettings theEvaluationSettings,
+		DaoRegistry theDaoRegistry) {
+
+		CodeCacheResourceChangeListener listener = new CodeCacheResourceChangeListener(theDaoRegistry, theEvaluationSettings.getValueSetCache());
+		//registry
+		theResourceChangeListenerRegistry.registerResourceResourceChangeListener(
+			"ValueSet", SearchParameterMap.newSynchronous(), listener,1000);
+
+		return listener;
+	}
+
+	@Bean
+	public IResourceChangeListenerRegistry resourceChangeListenerRegistry(InMemoryResourceMatcher theInMemoryResourceMatcher, FhirContext theFhirContext, ResourceChangeListenerCacheFactory theResourceChangeListenerCacheFactory) {
+		return new ResourceChangeListenerRegistryImpl(theFhirContext, theResourceChangeListenerCacheFactory, theInMemoryResourceMatcher);
+	}
+
+	@Bean
+	IResourceChangeListenerCacheRefresher resourceChangeListenerCacheRefresher() {
+		return new ResourceChangeListenerCacheRefresherImpl();
+	}
+	@Bean
+	public ResourceChangeListenerRegistryInterceptor resourceChangeListenerRegistryInterceptor() {
+		return new ResourceChangeListenerRegistryInterceptor();
+	}
+}
diff --git a/src/main/java/ca/uhn/fhir/jpa/starter/cr/CrR4Config.java b/src/main/java/ca/uhn/fhir/jpa/starter/cr/CrR4Config.java
index 4713bdb..07cc7cc 100644
--- a/src/main/java/ca/uhn/fhir/jpa/starter/cr/CrR4Config.java
+++ b/src/main/java/ca/uhn/fhir/jpa/starter/cr/CrR4Config.java
@@ -17,7 +17,6 @@ import ca.uhn.fhir.cr.r4.activitydefinition.ActivityDefinitionApplyProvider;
 import ca.uhn.fhir.cr.r4.cqlexecution.CqlExecutionOperationProvider;
 import ca.uhn.fhir.cr.r4.measure.CareGapsOperationProvider;
 import ca.uhn.fhir.cr.r4.measure.MeasureOperationsProvider;
-import ca.uhn.fhir.cr.r4.measure.MeasureService;
 import ca.uhn.fhir.cr.r4.measure.SubmitDataProvider;
 import ca.uhn.fhir.cr.r4.plandefinition.PlanDefinitionApplyProvider;
 import ca.uhn.fhir.cr.r4.plandefinition.PlanDefinitionPackageProvider;
@@ -31,6 +30,7 @@ import org.opencds.cqf.fhir.cr.cql.r4.R4CqlExecutionService;
 import org.opencds.cqf.fhir.cr.measure.CareGapsProperties;
 import org.opencds.cqf.fhir.cr.measure.MeasureEvaluationOptions;
 import org.opencds.cqf.fhir.cr.measure.r4.R4CareGapsService;
+import org.opencds.cqf.fhir.cr.measure.r4.R4MeasureService;
 import org.opencds.cqf.fhir.cr.measure.r4.R4SubmitDataService;
 import org.opencds.cqf.fhir.cr.plandefinition.r4.PlanDefinitionProcessor;
 import org.opencds.cqf.fhir.cr.questionnaire.r4.QuestionnaireProcessor;
@@ -49,8 +49,8 @@ public class CrR4Config {
 
 	@Bean
 	IMeasureServiceFactory r4MeasureServiceFactory(
-			IRepositoryFactory theRepositoryFactory, MeasureEvaluationOptions theEvaluationOptions) {
-		return rd -> new MeasureService(theRepositoryFactory.create(rd), theEvaluationOptions);
+		IRepositoryFactory theRepositoryFactory, MeasureEvaluationOptions theEvaluationOptions) {
+		return rd -> new R4MeasureService(theRepositoryFactory.create(rd), theEvaluationOptions);
 	}
 
 	@Bean
@@ -60,7 +60,7 @@ public class CrR4Config {
 
 	@Bean
 	ICqlExecutionServiceFactory r4CqlExecutionServiceFactory(
-			IRepositoryFactory theRepositoryFactory, EvaluationSettings theEvaluationSettings) {
+		IRepositoryFactory theRepositoryFactory, EvaluationSettings theEvaluationSettings) {
 		return rd -> new R4CqlExecutionService(theRepositoryFactory.create(rd), theEvaluationSettings);
 	}
 
@@ -71,16 +71,16 @@ public class CrR4Config {
 
 	@Bean
 	ICareGapsServiceFactory careGapsServiceFactory(
-			IRepositoryFactory theRepositoryFactory,
-			CareGapsProperties theCareGapsProperties,
-			MeasureEvaluationOptions theMeasureEvaluationOptions,
-			@Qualifier("cqlExecutor") Executor theExecutor) {
+		IRepositoryFactory theRepositoryFactory,
+		CareGapsProperties theCareGapsProperties,
+		MeasureEvaluationOptions theMeasureEvaluationOptions,
+		@Qualifier("cqlExecutor") Executor theExecutor) {
 		return rd -> new R4CareGapsService(
-				theCareGapsProperties,
-				theRepositoryFactory.create(rd),
-				theMeasureEvaluationOptions,
-				theExecutor,
-				rd.getFhirServerBase());
+			theCareGapsProperties,
+			theRepositoryFactory.create(rd),
+			theMeasureEvaluationOptions,
+			theExecutor,
+			rd.getFhirServerBase());
 	}
 
 	@Bean
@@ -100,30 +100,30 @@ public class CrR4Config {
 
 	@Bean
 	IActivityDefinitionProcessorFactory r4ActivityDefinitionProcessorFactory(
-			IRepositoryFactory theRepositoryFactory, EvaluationSettings theEvaluationSettings) {
+		IRepositoryFactory theRepositoryFactory, EvaluationSettings theEvaluationSettings) {
 		return rd -> new ActivityDefinitionProcessor(
-				theRepositoryFactory.create(rd), theEvaluationSettings);
+			theRepositoryFactory.create(rd), theEvaluationSettings);
 	}
 
 	@Bean
 	IPlanDefinitionProcessorFactory r4PlanDefinitionProcessorFactory(
-			IRepositoryFactory theRepositoryFactory, EvaluationSettings theEvaluationSettings) {
+		IRepositoryFactory theRepositoryFactory, EvaluationSettings theEvaluationSettings) {
 		return rd -> new PlanDefinitionProcessor(
-				theRepositoryFactory.create(rd), theEvaluationSettings);
+			theRepositoryFactory.create(rd), theEvaluationSettings);
 	}
 
 	@Bean
 	IQuestionnaireProcessorFactory r4QuestionnaireProcessorFactory(
-			IRepositoryFactory theRepositoryFactory, EvaluationSettings theEvaluationSettings) {
+		IRepositoryFactory theRepositoryFactory, EvaluationSettings theEvaluationSettings) {
 		return rd -> new QuestionnaireProcessor(
-				theRepositoryFactory.create(rd), theEvaluationSettings);
+			theRepositoryFactory.create(rd), theEvaluationSettings);
 	}
 
 	@Bean
 	IQuestionnaireResponseProcessorFactory r4QuestionnaireResponseProcessorFactory(
-			IRepositoryFactory theRepositoryFactory, EvaluationSettings theEvaluationSettings) {
+		IRepositoryFactory theRepositoryFactory, EvaluationSettings theEvaluationSettings) {
 		return rd -> new QuestionnaireResponseProcessor(
-				theRepositoryFactory.create(rd), theEvaluationSettings);
+			theRepositoryFactory.create(rd), theEvaluationSettings);
 	}
 
 	@Bean
@@ -138,7 +138,7 @@ public class CrR4Config {
 
 	@Bean
 	QuestionnaireResponseExtractProvider
-			r4QuestionnaireResponseExtractProvider() {
+	r4QuestionnaireResponseExtractProvider() {
 		return new QuestionnaireResponseExtractProvider();
 	}
 
@@ -159,24 +159,24 @@ public class CrR4Config {
 
 	@Bean
 	public ProviderLoader r4PdLoader(
-			ApplicationContext theApplicationContext, FhirContext theFhirContext, RestfulServer theRestfulServer) {
+		ApplicationContext theApplicationContext, FhirContext theFhirContext, RestfulServer theRestfulServer) {
 
 		var selector = new ProviderSelector(
-				theFhirContext,
-				Map.of(
-						FhirVersionEnum.R4,
-						Arrays.asList(
-								MeasureOperationsProvider.class,
-								SubmitDataProvider.class,
-								CareGapsOperationProvider.class,
-								CqlExecutionOperationProvider.class,
-								ActivityDefinitionApplyProvider.class,
-								PlanDefinitionApplyProvider.class,
-								QuestionnaireResponseExtractProvider.class,
-								QuestionnairePackageProvider.class,
-								PlanDefinitionPackageProvider.class,
-								QuestionnairePopulateProvider.class)));
+			theFhirContext,
+			Map.of(
+				FhirVersionEnum.R4,
+				Arrays.asList(
+					MeasureOperationsProvider.class,
+					SubmitDataProvider.class,
+					CareGapsOperationProvider.class,
+					CqlExecutionOperationProvider.class,
+					ActivityDefinitionApplyProvider.class,
+					PlanDefinitionApplyProvider.class,
+					QuestionnaireResponseExtractProvider.class,
+					QuestionnairePackageProvider.class,
+					PlanDefinitionPackageProvider.class,
+					QuestionnairePopulateProvider.class)));
 
 		return new ProviderLoader(theRestfulServer, theApplicationContext, selector);
 	}
-}
+}
\ No newline at end of file
diff --git a/src/main/java/ca/uhn/fhir/jpa/starter/cr/StarterCrDstu3Config.java b/src/main/java/ca/uhn/fhir/jpa/starter/cr/StarterCrDstu3Config.java
index 6afcbc3..58c731f 100644
--- a/src/main/java/ca/uhn/fhir/jpa/starter/cr/StarterCrDstu3Config.java
+++ b/src/main/java/ca/uhn/fhir/jpa/starter/cr/StarterCrDstu3Config.java
@@ -15,6 +15,7 @@ import org.cqframework.cql.cql2elm.model.Model;
 import org.hl7.cql.model.ModelIdentifier;
 import org.hl7.elm.r1.VersionedIdentifier;
 import org.opencds.cqf.cql.engine.execution.CqlEngine;
+import org.opencds.cqf.cql.engine.runtime.Code;
 import org.opencds.cqf.fhir.cql.EvaluationSettings;
 import org.opencds.cqf.fhir.cr.measure.MeasureEvaluationOptions;
 import org.opencds.cqf.fhir.utility.ValidationProfile;
@@ -23,6 +24,7 @@ import org.slf4j.LoggerFactory;
 import org.springframework.context.annotation.*;
 
 import java.util.EnumSet;
+import java.util.List;
 import java.util.Map;
 import java.util.Set;
 import java.util.concurrent.ConcurrentHashMap;
@@ -33,7 +35,7 @@ import java.util.concurrent.ConcurrentHashMap;
 	ApplyOperationConfig.class,
 	ExtractOperationConfig.class,
 	PackageOperationConfig.class,
-	PopulateOperationConfig.class})
+	PopulateOperationConfig.class, BaseCrConfig.class})
 public class StarterCrDstu3Config {
 	private static final Logger ourLogger = LoggerFactory.getLogger(StarterCrDstu3Config.class);
 
@@ -52,7 +54,8 @@ public class StarterCrDstu3Config {
 	public EvaluationSettings evaluationSettings(
 		AppProperties theAppProperties,
 		Map<VersionedIdentifier, CompiledLibrary> theGlobalLibraryCache,
-		Map<ModelIdentifier, Model> theGlobalModelCache) {
+		Map<ModelIdentifier, Model> theGlobalModelCache,
+		Map<String, List<Code>> theGlobalValueSetCache) {
 		var evaluationSettings = EvaluationSettings.getDefault();
 		var cqlOptions = evaluationSettings.getCqlOptions();
 
@@ -120,19 +123,10 @@ public class StarterCrDstu3Config {
 		cqlOptions.setCqlCompilerOptions(cqlCompilerOptions);
 		evaluationSettings.setLibraryCache(theGlobalLibraryCache);
 		evaluationSettings.setModelCache(theGlobalModelCache);
+		evaluationSettings.setValueSetCache(theGlobalValueSetCache);
 		return evaluationSettings;
 	}
 
-	@Bean
-	public Map<VersionedIdentifier, CompiledLibrary> globalLibraryCache() {
-		return new ConcurrentHashMap<>();
-	}
-
-	@Bean
-	public Map<ModelIdentifier, Model> globalModelCache() {
-		return new ConcurrentHashMap<>();
-	}
-
 	@Bean
 	public PostInitProviderRegisterer postInitProviderRegisterer(RestfulServer theRestfulServer,
 																					 ResourceProviderFactory theResourceProviderFactory) {
diff --git a/src/main/java/ca/uhn/fhir/jpa/starter/cr/StarterCrR4Config.java b/src/main/java/ca/uhn/fhir/jpa/starter/cr/StarterCrR4Config.java
index 09e37b7..46e4abe 100644
--- a/src/main/java/ca/uhn/fhir/jpa/starter/cr/StarterCrR4Config.java
+++ b/src/main/java/ca/uhn/fhir/jpa/starter/cr/StarterCrR4Config.java
@@ -1,13 +1,9 @@
 package ca.uhn.fhir.jpa.starter.cr;
 
-
-import ca.uhn.fhir.cr.repo.HapiFhirRepository;
 import ca.uhn.fhir.jpa.starter.annotations.OnR4Condition;
 import ca.uhn.fhir.rest.server.RestfulServer;
 import ca.uhn.fhir.rest.server.provider.ResourceProviderFactory;
 import ca.uhn.fhir.cr.common.CqlThreadFactory;
-import ca.uhn.fhir.cr.common.IRepositoryFactory;
-import ca.uhn.fhir.jpa.api.dao.DaoRegistry;
 import ca.uhn.fhir.jpa.starter.AppProperties;
 import org.cqframework.cql.cql2elm.CqlCompilerOptions;
 import org.cqframework.cql.cql2elm.model.CompiledLibrary;
@@ -15,6 +11,7 @@ import org.cqframework.cql.cql2elm.model.Model;
 import org.hl7.cql.model.ModelIdentifier;
 import org.hl7.elm.r1.VersionedIdentifier;
 import org.opencds.cqf.cql.engine.execution.CqlEngine;
+import org.opencds.cqf.cql.engine.runtime.Code;
 import org.opencds.cqf.fhir.cql.EvaluationSettings;
 import org.opencds.cqf.fhir.cr.measure.CareGapsProperties;
 import org.opencds.cqf.fhir.cr.measure.MeasureEvaluationOptions;
@@ -25,15 +22,15 @@ import org.springframework.context.annotation.*;
 import org.springframework.security.concurrent.DelegatingSecurityContextExecutorService;
 
 import java.util.EnumSet;
+import java.util.List;
 import java.util.Map;
 import java.util.Set;
-import java.util.concurrent.ConcurrentHashMap;
 import java.util.concurrent.ExecutorService;
 import java.util.concurrent.Executors;
 
 @Configuration
 @Conditional({ OnR4Condition.class, CrConfigCondition.class })
-@Import(CrR4Config.class)
+@Import({BaseCrConfig.class, CrR4Config.class})
 public class StarterCrR4Config {
 	private static final Logger ourLogger = LoggerFactory.getLogger(StarterCrR4Config.class);
 
@@ -72,7 +69,8 @@ public class StarterCrR4Config {
 	public EvaluationSettings evaluationSettings(
 		AppProperties theAppProperties,
 		Map<VersionedIdentifier, CompiledLibrary> theGlobalLibraryCache,
-		Map<ModelIdentifier, Model> theGlobalModelCache) {
+		Map<ModelIdentifier, Model> theGlobalModelCache,
+		Map<String, List<Code>> theGlobalValueSetCache) {
 		var evaluationSettings = EvaluationSettings.getDefault();
 		var cqlOptions = evaluationSettings.getCqlOptions();
 
@@ -140,19 +138,10 @@ public class StarterCrR4Config {
 		cqlOptions.setCqlCompilerOptions(cqlCompilerOptions);
 		evaluationSettings.setLibraryCache(theGlobalLibraryCache);
 		evaluationSettings.setModelCache(theGlobalModelCache);
+		evaluationSettings.setValueSetCache(theGlobalValueSetCache);
 		return evaluationSettings;
 	}
 
-	@Bean
-	public Map<VersionedIdentifier, CompiledLibrary> globalLibraryCache() {
-		return new ConcurrentHashMap<>();
-	}
-
-	@Bean
-	public Map<ModelIdentifier, Model> globalModelCache() {
-		return new ConcurrentHashMap<>();
-	}
-
 	@Bean
 	public PostInitProviderRegisterer postInitProviderRegisterer(RestfulServer theRestfulServer,
 																					 ResourceProviderFactory theResourceProviderFactory) {