define "Initial Population":
  "Has Most Recent Bladder Cancer Tumor Staging is T1, Tis, Ta HG"
    and "Has Qualifying Encounter"

define "Denominator":
  "Initial Population"

define "Denominator Exclusion":
  exists "Acute Tuberculosis Diagnosis"
    or exists "Immunosuppressive Drugs"
    or exists "Cystectomy Done"
    or "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"
    or "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging"

define "Denominator Exception":
  exists "BCG Not Available Within 6 Months After Bladder Cancer Staging"

define "Numerator":
  "First BCG Administered" is not null

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 "Bladder Cancer Diagnosis":
  ( [ConditionProblemsHealthConcerns: "Bladder Cancer for Urology Care"]
    union [ConditionEncounterDiagnosis: "Bladder Cancer for Urology Care"] ) BladderCancer
    where ( BladderCancer.onset.toInterval ( ) starts before day of end of "Measurement Period"
        or BladderCancer.onset.toInterval ( ) before day of end of "Measurement Period"
    )
      and BladderCancer.isVerified ( )

define "First Bladder Cancer Staging Procedure":
  First([Procedure: "Tumor staging (tumor staging)"] BladderCancerStaging
      with "Bladder Cancer Diagnosis" BladderCancer
        such that BladderCancerStaging.performed.toInterval() starts on or before day of start of BladderCancer.onset.toInterval ( )
      where BladderCancerStaging.status = 'completed'
      sort by start of performed.toInterval()
  )

define "First BCG Administered":
  First([MedicationAdministration: "Bacillus Calmette Guerin for Urology Care"] BCG
      with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
        such that BCG.effective.toInterval() starts 6 months or less after day of start of FirstBladderCancerStaging.performed.toInterval()
          and BCG.effective.toInterval() starts during day of "Measurement Period"
      where BCG.status in { 'in-progress', 'completed' }
      sort by start of effective.toInterval()
  )

define "Numerator":
  "First BCG Administered" is not null

define "BCG Not Available Within 6 Months After Bladder Cancer Staging":
  [MedicationAdministrationNotDone: "Bacillus Calmette Guerin for Urology Care"] BCGNotGiven
    with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
      such that BCGNotGiven.effective 6 months or less after day of start of FirstBladderCancerStaging.performed.toInterval ( )
    where BCGNotGiven.statusReason in "Unavailability of Bacillus Calmette Guerin for Urology Care"

define "Denominator Exception":
  exists "BCG Not Available Within 6 Months After Bladder Cancer Staging"

define "July 1 of Year Prior to the Measurement Period":
  Date((year from start of "Measurement Period" - 1), 7, 1)

define "June 30 of the Measurement Period":
  Date((year from start of "Measurement Period"), 6, 30)

define "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period":
  "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
    where FirstBladderCancerStaging.performed.toInterval ( ) during day of Interval["July 1 of Year Prior to the Measurement Period", "June 30 of the Measurement Period"]

/*Ta High Grade only to be included.  Ta low grade is to be excluded from this measure.*/


define "Has Most Recent Bladder Cancer Tumor Staging is T1, Tis, Ta HG":
  exists ( [LaboratoryResultObservation] StagingObservation
      where StagingObservation.getStagingProcedure ( ) is not null
        and ( StagingObservation.value as CodeableConcept ~ "American Joint Committee on Cancer cT1 (qualifier value)"
            or StagingObservation.value as CodeableConcept ~ "American Joint Committee on Cancer cTis (qualifier value)"
            or StagingObservation.value as CodeableConcept ~ "American Joint Committee on Cancer cTa (qualifier value)"
            or StagingObservation.value as CodeableConcept ~ "Carcinoma in situ of bladder"
        )
        and StagingObservation.status in { 'final', 'amended', 'corrected' }
  )

define "Has Qualifying Encounter":
  exists ( [Encounter: "Office Visit"] ValidEncounter
      where ValidEncounter.period during day of "Measurement Period"
        and ValidEncounter.class !~ "virtual"
        and ValidEncounter.status = 'finished'
  )

define "Initial Population":
  "Has Most Recent Bladder Cancer Tumor Staging is T1, Tis, Ta HG"
    and "Has Qualifying Encounter"

define "Denominator":
  "Initial Population"

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

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

define "Acute Tuberculosis Diagnosis":
  ( [ConditionProblemsHealthConcerns: "Tuberculosis for Urology Care"]
    union [ConditionEncounterDiagnosis: "Tuberculosis for Urology Care"] ) ActiveTuberculosis
    with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
      such that ( ( ActiveTuberculosis.onset.toInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( ) )
          or ( ActiveTuberculosis.onset.toInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( )
              and ( ( ActiveTuberculosis.abatement.toInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( ) )
                  or ( ActiveTuberculosis.abatement is null )
              )
          )
      )
    where ActiveTuberculosis.isVerified ( )

define "Immunosuppressive Drugs":
  [MedicationRequest: "Immunosuppressive Drugs for Urology Care"] ImmunosuppressiveDrugs
    let firstMedicationPeriod: First((collapse(ImmunosuppressiveDrugs.dosageInstruction.timing.repeat.bounds DoseTime
          return DoseTime.toInterval()
      )) DrugPeriods
        sort by start of $this
    ),
    //get the very first event
    
    firstMedicationEvent: First((ImmunosuppressiveDrugs.dosageInstruction.timing dosageTiming
        //return first event for the specific dosageTiming
        
        return First(dosageTiming.event dosageTimingEvents
            sort ascending
        )) firstEvents
        sort ascending
    ),
    medicationPeriod: Coalesce(firstMedicationEvent.toInterval(), firstMedicationPeriod)
    with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
      such that medicationPeriod starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )
    where ImmunosuppressiveDrugs.status in { 'active', 'completed' }
      and ImmunosuppressiveDrugs.intent = 'order'

define "Cystectomy Done":
  [Procedure: "Cystectomy for Urology Care"] Cystectomy
    with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
      such that Cystectomy.performed.toInterval ( ) 6 months or less before day of start of FirstBladderCancerStaging.performed.toInterval ( )
    where Cystectomy.status = 'completed'

define "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging":
  exists ( ( ( [ConditionProblemsHealthConcerns: "HIV"]
        union [ConditionEncounterDiagnosis: "HIV"]
    )
      union ( [ConditionProblemsHealthConcerns: "Immunocompromised Conditions"]
          union [ConditionEncounterDiagnosis: "Immunocompromised Conditions"]
      )
      union ( [ConditionProblemsHealthConcerns: "Mixed Histology Urothelial Cell Carcinoma for Urology Care"]
          union [ConditionEncounterDiagnosis: "Mixed Histology Urothelial Cell Carcinoma for Urology Care"]
      ) ) ExclusionDiagnosis
      with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
        such that ( ( ExclusionDiagnosis.onset.toInterval ( ) starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( ) )
            or ( ExclusionDiagnosis.onset.toInterval ( ) starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( ) )
        )
      where ExclusionDiagnosis.isVerified ( )
  )

define "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging":
  exists ( ( [MedicationRequest: "Chemotherapy Agents for Advanced Cancer"] ExclusionMed
        let firstMedicationPeriod: First((collapse(ExclusionMed.dosageInstruction.timing.repeat.bounds DoseTime
              return DoseTime.toInterval()
          )) DrugPeriods
            sort by start of $this
        )
        with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
          such that firstMedicationPeriod starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )
        where ExclusionMed.status in { 'active', 'completed' }
          and ExclusionMed.intent = 'order'
    )
      union ( [Procedure: "Combined radiotherapy (procedure)"] ExclusionProcedure
          with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
            such that ExclusionProcedure.performed.toInterval ( ) starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )
          where ExclusionProcedure.status in { 'completed', 'in-progress' }
      )
  )

define "Denominator Exclusion":
  exists "Acute Tuberculosis Diagnosis"
    or exists "Immunosuppressive Drugs"
    or exists "Cystectomy Done"
    or "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"
    or "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging"

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

define fluent function isVerified(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
  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"
  )

define fluent function getStagingProcedure(StagingObservation LaboratoryResultObservation):
  StagingObservation.partOf StagingReference
    return "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period" FirstBladderCancerStagingMP
      where FirstBladderCancerStagingMP.id = StagingReference.reference.getId ( )

/*
@description: Returns the id of the given uri (i.e. everything after the last slash)
*/
define fluent function getId(uri String):
  Last(Split(uri, '/'))

/*
@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: 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 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

define function ToString(value string): value.value

define function ToString(value uri): 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 ToDateTime(value dateTime): 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 ToDateTime(value instant): value.value

define function ToDate(value date): 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 MedicationAdministrationStatus): value.value

define function ToString(value ObservationStatus): value.value

define function ToString(value EncounterStatus): value.value

define function ToString(value MedicationRequestStatus): value.value

define function ToString(value MedicationRequestIntent): value.value

/*
@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
    }