define "Initial Population":
  "Inpatient Encounters With An Opioid Or Benzodiazepine At Discharge"

define "Denominator":
  "Initial Population"

/*
@description: Excludes encounters of patients with cancer pain or who are receiving palliative or hospice care at the time of the encounter or who receive treatment for opioid use disorder, have sickle cell disease, or who are discharged to another inpatient care facility or discharged against medical advice, or expire during the inpatient stay.
*/


define "Denominator Exclusion":
  "Denominator" InpatientEncounter
    where exists ( ["ConditionProblemsHealthConcerns": "Cancer Related Pain"] CancerPain
        where CancerPain.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
          and CancerPain.isVerified ( )
    )
      or exists ( "Inpatient Encounter With Encounter Diagnosis Of Cancer Pain" )
      or exists ( ["ConditionProblemsHealthConcerns": "Sickle Cell Disease with and without Crisis"] SickleCellDisease
          where SickleCellDisease.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
            and SickleCellDisease.isVerified ( )
      )
      or exists ( "Treatment For Opioid Use Disorders" OUDTreatment
          where OUDTreatment.authoredOn during day of InpatientEncounter.period
      )
      or exists ( "Intervention Palliative Or Hospice Care" PalliativeOrHospiceCare
          where Coalesce(start of PalliativeOrHospiceCare.performed.toInterval(), PalliativeOrHospiceCare.authoredOn) during InpatientEncounter.hospitalizationWithObservation ( )
      )
      or ( InpatientEncounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Patient Expired"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
      )

/*
@description: Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge.
*/


define "Numerator":
  "Denominator" InpatientEncounter
    where ( Count("Opioid At Discharge" OpioidMedications
          where OpioidMedications.authoredOn during day of InpatientEncounter.period
          return distinct OpioidMedications.medication
      ) >= 2
    )
      or ( exists "Opioid At Discharge" OpioidDischargeMedications
          where OpioidDischargeMedications.authoredOn during day of InpatientEncounter.period
            and exists ( "Benzodiazepine At Discharge" BenzodiazepineDischargeMedication
                where BenzodiazepineDischargeMedication.authoredOn during day of InpatientEncounter.period
            )
      )

define "SDE Sex":
  case
    when Patient.sex() = '248153007' then "Male (finding)"
    when Patient.sex() = '248152002' then "Female (finding)"
    else null
  end

define "SDE Payer":
  [USQualityCore.Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

define "SDE Ethnicity":
  (Patient.ethnicity()) E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

define "SDE Race":
  (Patient.race()) R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

define "SDE Sex":
  SDE."SDE Sex"

define "Inpatient Encounter With Age Greater Than Or Equal To 18":
  CQMCommon."Inpatient Encounter" InpatientHospitalEncounter
    where AgeInYearsAt(date from start of InpatientHospitalEncounter.period) >= 18

define "Opioid At Discharge":
  ["MedicationRequest": "Schedule II, III and IV Opioid Medications"] OpioidMedications
    where ( OpioidMedications.isCommunity ( )
        or OpioidMedications.isDischarge ( )
    )
      and OpioidMedications.status in { 'active', 'completed' }
      and OpioidMedications.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "Benzodiazepine At Discharge":
  ["MedicationRequest": "Schedule IV Benzodiazepines"] BenzoMedications
    where ( BenzoMedications.isCommunity ( )
        or BenzoMedications.isDischarge ( )
    )
      and BenzoMedications.status in { 'active', 'completed' }
      and BenzoMedications.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

/*
@description: Captures encounters of patients with an opioid and/or benzodiazepine at discharge.
*/


define "Inpatient Encounters With An Opioid Or Benzodiazepine At Discharge":
  "Inpatient Encounter With Age Greater Than Or Equal To 18" InpatientEncounter
    with ( "Opioid At Discharge"
      union "Benzodiazepine At Discharge" ) OpioidOrBenzodiazepineAtDischarge
      such that OpioidOrBenzodiazepineAtDischarge.authoredOn during day of InpatientEncounter.period

define "Initial Population":
  "Inpatient Encounters With An Opioid Or Benzodiazepine At Discharge"

define "Denominator":
  "Initial Population"

/*
@description: Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge.
*/


define "Numerator":
  "Denominator" InpatientEncounter
    where ( Count("Opioid At Discharge" OpioidMedications
          where OpioidMedications.authoredOn during day of InpatientEncounter.period
          return distinct OpioidMedications.medication
      ) >= 2
    )
      or ( exists "Opioid At Discharge" OpioidDischargeMedications
          where OpioidDischargeMedications.authoredOn during day of InpatientEncounter.period
            and exists ( "Benzodiazepine At Discharge" BenzodiazepineDischargeMedication
                where BenzodiazepineDischargeMedication.authoredOn during day of InpatientEncounter.period
            )
      )

define "SDE Payer":
  SDE."SDE Payer"

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

define "Inpatient Encounter With Encounter Diagnosis Of Cancer Pain":
  "Denominator" QualifyingEncounter
    where QualifyingEncounter.reasonCode in "Cancer Related Pain"
      or QualifyingEncounter.encounterDiagnosis ( ).code in "Cancer Related Pain"

define "Medications For Opioid Use Disorder":
  ["MedicationRequest": "Medications for Opioid Use Disorder (MOUD)"] DischargeMedication
    where ( DischargeMedication.isCommunity ( )
        or DischargeMedication.isDischarge ( )
    )
      and DischargeMedication.status in { 'active', 'completed' }
      and DischargeMedication.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "Treatment For Opioid Use Disorders":
  ( "Medications For Opioid Use Disorder" MedicationTreatment
      with ["Procedure": "Opioid Medication Assisted Treatment (MAT)"] MAT
        such that MedicationTreatment.authoredOn during day of MAT.performed.toInterval ( )
          and MedicationTreatment.authoredOn during day of "Measurement Period"
          and MAT.status in { 'completed', 'in-progress' }
  )
    union ( "Medications For Opioid Use Disorder" MedicationTreatment
        with ["ConditionProblemsHealthConcerns": "Opioid Use Disorder"] OUD
          such that MedicationTreatment.authoredOn during day of OUD.prevalenceInterval ( )
            and OUD.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and OUD.isVerified ( )
    )

define "Intervention Palliative Or Hospice Care":
  ( ["ServiceRequest": "Palliative or Hospice Care"] PalliativeOrHospiceCareOrder
      where PalliativeOrHospiceCareOrder.status in { 'active', 'completed', 'on-hold' }
  )
    union ( ["Procedure": "Palliative or Hospice Care"] PalliativeOrHospiceCarePerformed
        where PalliativeOrHospiceCarePerformed.status in { 'completed', 'in-progress' }
    )

/*
@description: Excludes encounters of patients with cancer pain or who are receiving palliative or hospice care at the time of the encounter or who receive treatment for opioid use disorder, have sickle cell disease, or who are discharged to another inpatient care facility or discharged against medical advice, or expire during the inpatient stay.
*/


define "Denominator Exclusion":
  "Denominator" InpatientEncounter
    where exists ( ["ConditionProblemsHealthConcerns": "Cancer Related Pain"] CancerPain
        where CancerPain.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
          and CancerPain.isVerified ( )
    )
      or exists ( "Inpatient Encounter With Encounter Diagnosis Of Cancer Pain" )
      or exists ( ["ConditionProblemsHealthConcerns": "Sickle Cell Disease with and without Crisis"] SickleCellDisease
          where SickleCellDisease.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
            and SickleCellDisease.isVerified ( )
      )
      or exists ( "Treatment For Opioid Use Disorders" OUDTreatment
          where OUDTreatment.authoredOn during day of InpatientEncounter.period
      )
      or exists ( "Intervention Palliative Or Hospice Care" PalliativeOrHospiceCare
          where Coalesce(start of PalliativeOrHospiceCare.performed.toInterval(), PalliativeOrHospiceCare.authoredOn) during InpatientEncounter.hospitalizationWithObservation ( )
      )
      or ( InpatientEncounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Patient Expired"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
      )

define "SDE Race":
  SDE."SDE Race"

/*
@description: Returns true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/


define fluent function isVerified(condition Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ Status."confirmed"
      or condition.verificationStatus ~ Status."unconfirmed"
      or condition.verificationStatus ~ Status."provisional"
      or condition.verificationStatus ~ Status."differential"
  )

/*
@description: Returns the single extension (if present) on the given resource with the specified url.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given resource with the specified url.
*/
define fluent function ext(domainResource DomainResource, url String):
  singleton from domainResource.exts(url)

/*
@description: Returns any extensions defined on the given resource with the specified url
*/
define fluent function exts(domainResource DomainResource, url String):
  domainResource.extension E
    where E.url = url
    return E

/*
@description: Returns true if the given MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest MedicationRequest):
  exists (medicationRequest.category C
    where C ~ Community
  )

/*
@description: Returns true if the given MedicationRequest has a category of Discharge
*/
define fluent function isDischarge(medicationRequest MedicationRequest):
  exists (medicationRequest.category C
    where C ~ Discharge
  )

/*
@description: Returns the single extension (if present) on the given element with the specified url.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given element with the specified url.
*/
define fluent function ext(element Element, url String):
  singleton from element.exts(url)

/*
@description: Returns any extensions defined on the given element with the specified url.
*/
define fluent function exts(element Element, url String):
  element.extension E
    where E.url = url
    return E

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition resource.
@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
  (end of condition.abatementInterval()) abatementDate
    return 
	  if abatementDate is null then
        Interval[start of condition.onset.toInterval(), abatementDate)
      else
        Interval[start of condition.onset.toInterval(), abatementDate]

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in FHIR, allowing this function to be used across any resource.

The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.
If the input is a Period, the result is a DateTime Interval.
If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.
If the input is an instant, the result is a DateTime Interval beginning and ending on that instant.
If the input is a string, an error is raised indicating a single interval cannot be computed from a string.
If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,
and ending immediately prior to when the patient was the given Age plus one year.
If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given
by the low end of the Range, and ending immediately prior to when the patient was the Age given by the
high end of the Range plus one year.

NOTE: Due to the
complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used
with a Timing or String.
*/
define fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):
  case
    when choice is FHIR.dateTime then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]
    when choice is FHIR.Period then
      FHIRHelpers.ToInterval(choice as FHIR.Period)
    when choice is FHIR.instant then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]
    when choice is FHIR.Age then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)
    when choice is FHIR.Range then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)
    when choice is FHIR.Timing then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')
    when choice is FHIR.string then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
    else
      null as Interval<DateTime>
  end

/*
@description: Returns an interval representing the normalized Abatement of a given Condition resource.
@comment: @comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.

NOTE: Due to the complexity of determining an interval from a String, this function will throw
a run-time exception if used with a Condition instance that has a String as the abatement value.
*/
define fluent function abatementInterval(condition Condition):
  if condition.abatement is FHIR.dateTime then
    Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]
  else if condition.abatement is FHIR.Period then
    FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)
  else if condition.abatement is FHIR.string then
    Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
  else if condition.abatement is FHIR.Age then
    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),
      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)
  else if condition.abatement is FHIR.Range then
    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),
      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)
  else if condition.abatement is FHIR.boolean then
    Interval[end of condition.onset.toInterval(), condition.recordedDate)
  else 
    null

/*
@description: Returns true if the given reference is to the given resourceId
@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference FHIR.Reference, resourceId String):
  resourceId = Last(Split(reference.reference, '/'))

define function ToString(value string): value.value

define function ToString(value uri): value.value

define function ToString(value EncounterStatus): value.value

/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

define function ToDate(value date): value.value

/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }

define function ToString(value MedicationRequestStatus): value.value

define function ToString(value MedicationRequestIntent): value.value

define function ToDateTime(value dateTime): value.value

define function ToDateTime(value instant): value.value

/*
@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) 
value to a CQL Quantity
@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity
has a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)
an error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.
@seealso: ToCalendarUnit
*/
define function ToQuantity(quantity FHIR.Quantity):
    case
        when quantity is null then null
        when quantity.value is null then null
        when quantity.comparator is not null then
            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')
        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'
              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then
            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }
        else
            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')
    end

/*
@description: Converts a UCUM definite duration unit to a CQL calendar duration
unit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) 
topic of the CQL specification.
@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate
*/
define function ToCalendarUnit(unit System.String):
    case unit
        when 'ms' then 'millisecond'
        when 's' then 'second'
        when 'min' then 'minute'
        when 'h' then 'hour'
        when 'd' then 'day'
        when 'wk' then 'week'
        when 'mo' then 'month'
        when 'a' then 'year'
        else unit
    end

define function ToString(value ProcedureStatus): value.value

define function ToString(value ServiceRequestStatus): value.value

define "Inpatient Encounter":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.status = 'finished'
      and EncounterInpatient.period ends during day of "Measurement Period"

/*  
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.reasonReference D
    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))

/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
*/
define fluent function hospitalizationWithObservation(TheEncounter Encounter ):
  TheEncounter Visit
  		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
  				where LastObs.status = 'finished'
            and LastObs.period ends 1 hour or less on or before start of Visit.period
  				sort by end of period
  			),
  			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
  			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
  				where LastED.status = 'finished'
            and LastED.period ends 1 hour or less on or before VisitStart
  				sort by end of period
  			)
  		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]

/*
@description: Returns the sex element as defined for the USCore patient profile
*/
define fluent function sex(patient Patient):
  patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code

define fluent function ethnicity(patient Patient):
  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E
    return {
      ombCategory: E.ext('ombCategory').value as FHIR.Coding,
      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,
      text: E.ext('text').value as FHIR.string
    }

define fluent function race(patient Patient):
  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E
    return {
      ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,
      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,
      text: E.ext('text').value as FHIR.string
    }