define "Initial Population":
  "ED Encounter with STEMI Diagnosis"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
    union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
    union "Active Exclusion Diagnosis at Start of ED Encounter"
    union "Active use of Anticoagulants"
    union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
    union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"
    union "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
    union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
    union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
    union "ED Encounter with Discharge Disposition as Patient Expired"
    union "ED Encounter with Discharge Disposition as Left Against Medical Advice"
    union "ED Encounter with Hospice Services"
    union "Currently Pregnant"

define "Denominator Exceptions":
  "Received tPA in Another Facility within 24 hours Prior to Admission"
    union "ED Encounter with a Documented Reason for No PCI Performed"
    union "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy"

define "Numerator":
  "Fibrinolytic Therapy Administration within 30 Minutes of Arrival"
    union "PCI within 90 Minutes of Arrival"
    union "ED Departure with Discharge to Acute Care Facility Within 45 Minutes Of Arrival"

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
    }

/*  
@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: Returns the Location resource specified by the given reference.
*/
define fluent function getLocation(reference Reference):
  singleton from (
    [Location] L where reference.references(L)
  )

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

define "ED Encounter During MP":
  ["Encounter": class ~ "EMER"] EDEncounter
    where EDEncounter.type in "Emergency Department Evaluation and Management Visit"
      and EDEncounter.period ends during day of "Measurement Period"
      and EDEncounter.status = 'finished'
      and AgeInYearsAt(date from start of(EDEncounter.period)) >= 18

define "ED Encounter with STEMI Diagnosis":
  "ED Encounter During MP" EDEncounterinMP
    where ( EDEncounterinMP.reasonCode in "STEMI"
        or exists ( ( ( [ConditionProblemsHealthConcerns: "STEMI"]
              union [ConditionEncounterDiagnosis: "STEMI"]
          ).verified ( ) ) DxSTEMI
            where ( EDEncounterinMP.encounterDiagnosis ( ).code in "STEMI"
                or ( DxSTEMI.onset.toInterval ( ) starts during EDEncounterinMP.period )
            )
        )
    )

define "Fibrinolytic Therapy Administration within 30 Minutes of Arrival":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ["MedicationAdministration": "Fibrinolytic Therapy"] Fibrinolytic
      such that Fibrinolytic.status = 'completed'
        and start of ( Fibrinolytic.effective.toInterval ( ) ) 30 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )

define "PCI within 90 Minutes of Arrival":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ["Procedure": "Percutaneous Coronary Intervention"] PCI
      such that PCI.performed.toInterval ( ) starts 90 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
        and PCI.status = 'completed'

define "ED Departure with Discharge to Acute Care Facility Within 45 Minutes Of Arrival":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    where EDwithSTEMI.currentemergencyDepartmentDepartTime ( ) 45 minutes or less after EDwithSTEMI.currentemergencyDepartmentArrivalTime ( )
      and EDwithSTEMI.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"

define "Numerator":
  "Fibrinolytic Therapy Administration within 30 Minutes of Arrival"
    union "PCI within 90 Minutes of Arrival"
    union "ED Departure with Discharge to Acute Care Facility Within 45 Minutes Of Arrival"

define "Initial Population":
  "ED Encounter with STEMI Diagnosis"

define "Denominator":
  "Initial Population"

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

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

define "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwSTEMI
    with ["AllergyIntolerance": "Thrombolytic medications"] ThrombolyticAllergy
      such that ThrombolyticAllergy.clinicalStatus ~ USQualityCoreCommon."allergy-active"
        and ( ThrombolyticAllergy.verificationStatus is not null implies ( ThrombolyticAllergy.verificationStatus ~ USQualityCoreCommon."allergy-confirmed"
              or ThrombolyticAllergy.verificationStatus ~ USQualityCoreCommon."allergy-unconfirmed"
          )
        )
        and ( ThrombolyticAllergy.onset.toInterval ( ) overlaps ( EDwSTEMI.period )
            or ThrombolyticAllergy.onset before end EDwSTEMI.period
        )

define "Adverse Effect to Thrombolytic Medications Before End of ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwSTEMI
    with [AdverseEvent: "Thrombolytics Adverse Event"] ThrombolyticAdverseEvent
      such that Coalesce(ThrombolyticAdverseEvent.date, ThrombolyticAdverseEvent.detected, ThrombolyticAdverseEvent.recordedDate) before end of ( EDwSTEMI.period )
        and ThrombolyticAdverseEvent.actuality = 'actual'

define "Active Exclusion Diagnosis at Start of ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ( ( ["ConditionProblemsHealthConcerns": "Active Bleeding or Bleeding Diathesis, Excluding Menses"]
        union ["ConditionProblemsHealthConcerns": "Malignant Intracranial Neoplasm Group"]
        union ["ConditionProblemsHealthConcerns": "Cerebral Vascular Lesion"]
        union ["ConditionProblemsHealthConcerns": "Dementia and Related Intracranial Pathologies"]
        union ["ConditionProblemsHealthConcerns": "Pregnant State"]
        union ["ConditionProblemsHealthConcerns": "Allergy to thrombolytics"]
    ).verified ( ) ) ActiveExclusionDx
      such that ActiveExclusionDx.prevalenceInterval ( ) overlaps before ( EDwithSTEMI.period )

define "Active Oral Anticoagulant Medication at the Start of ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ["MedicationRequest": "Oral Anticoagulant Medications"] OralAnticoagulant
      such that OralAnticoagulant.status in { 'active', 'completed' }
        and OralAnticoagulant.intent = 'order'
        and OralAnticoagulant.authoredOn 90 days or less before or on start of EDwithSTEMI.period

define "Active Long Term use of Anticoagulants":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ( ( ["ConditionProblemsHealthConcerns": "Long term (current) use of anticoagulants"]
        union ["ConditionEncounterDiagnosis": "Long term (current) use of anticoagulants"]
    ).verified ( ) ) LongTermAnticoagulant
      such that ( LongTermAnticoagulant.onset.toInterval ( ) starts before or on start of EDwithSTEMI.period
          and LongTermAnticoagulant.onset.toInterval ( ) ends on or after start of EDwithSTEMI.period
      )

define "Active use of Anticoagulants":
  "Active Oral Anticoagulant Medication at the Start of ED Encounter"
    union "Active Long Term use of Anticoagulants"

define "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ( ( ["ConditionProblemsHealthConcerns": "Aortic Dissection or Ruptured Aortic Aneurysm"]
        union ["ConditionProblemsHealthConcerns": "Neurologic impairment"]
        union ["ConditionProblemsHealthConcerns": "Angina pectoris with documented spasm"]
        union ["ConditionProblemsHealthConcerns": "Ventricular aneurysm due to and following acute myocardial infarction (disorder)"]
        union ["ConditionProblemsHealthConcerns": "Aneurysm of heart"]
        union ["ConditionProblemsHealthConcerns": "Takotsubo cardiomyopathy (disorder)"]
        union ["ConditionProblemsHealthConcerns": "Takotsubo syndrome"]
        union ["ConditionProblemsHealthConcerns": "Cardiopulmonary Emergency"]
    ).verified ( ) ) ExclusionDiagnosis
      such that ( ( ExclusionDiagnosis.onset.toInterval ( ) starts during EDwithSTEMI.period )
          or ( ExclusionDiagnosis.onset.toInterval ( ) starts 24 hours or less before start of EDwithSTEMI.period )
      )

define "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ["Procedure": "Major Surgical Procedure"] MajorSurgery
      such that ( MajorSurgery.performed.toInterval ( ) starts 21 days or less before start of EDwithSTEMI.period
          or MajorSurgery.performed.toInterval ( ) starts during EDwithSTEMI.period
      )
        and MajorSurgery.status = 'completed'

define "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ( ["Procedure": "Endotracheal Intubation"]
      union ["Procedure": "Mechanical Circulatory Assist Device"] ) AirwayProcedure
      such that ( ( AirwayProcedure.performed.toInterval ( ) starts during ( EDwithSTEMI.period ) )
          or ( AirwayProcedure.performed.toInterval ( ) starts 24 hours or less before start of ( EDwithSTEMI.period ) )
      )
        and AirwayProcedure.status = 'completed'

define "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwSTEMI
    with ( ( ["ConditionProblemsHealthConcerns": "Ischemic Stroke"]
        union ["ConditionProblemsHealthConcerns": "Closed Head and Facial Trauma"]
        union ["ConditionProblemsHealthConcerns": "Active Peptic Ulcer"]
    ).verified ( ) ) ExclusionCondition
      such that ExclusionCondition.prevalenceInterval ( ) starts during Interval[start of ( EDwSTEMI.period ) - 90 days, start of ( EDwSTEMI.period )]

define "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ["Procedure": "Intracranial or Intraspinal surgery"] CranialorSpinalSurgery
      such that CranialorSpinalSurgery.performed.toInterval ( ) starts 90 days or less before start of ( EDwithSTEMI.period )
        and CranialorSpinalSurgery.status = 'completed'

define "ED Encounter with Discharge Disposition as Patient Expired":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    where EDwithSTEMI.hospitalization.dischargeDisposition in "Patient Expired"

define "ED Encounter with Discharge Disposition as Left Against Medical Advice":
  "ED Encounter with STEMI Diagnosis" EDwSTEMI
    where EDwSTEMI.hospitalization.dischargeDisposition in "Left Against Medical Advice"

define "ED Encounter with Hospice Services":
  from
    "ED Encounter with STEMI Diagnosis" EDwSTEMI
    let SixMonthsBeforeToEndOfSTEMI: Interval[start of ( EDwSTEMI.period ) - 6 months, end of ( EDwSTEMI.period )]
    where ( exists ( ( ( [Encounter: "Encounter Inpatient"] ).isEncounterPerformed ( ) ) InpatientEncounter
          where ( InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
              or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
          )
            and InpatientEncounter.period starts before or on start of ( EDwSTEMI.period )
            and InpatientEncounter.period overlaps day of SixMonthsBeforeToEndOfSTEMI
      )
        or exists ( ( ( [Encounter: "Hospice Encounter"] ).isEncounterPerformed ( ) ) HospiceEncounter
            where HospiceEncounter.period starts before or on start of ( EDwSTEMI.period )
              and ( HospiceEncounter.period overlaps day of SixMonthsBeforeToEndOfSTEMI )
        )
        or exists ( ( ( [ObservationScreeningAssessment: "Hospice care [Minimum Data Set]"] ).isAssessmentPerformed ( ) ) HospiceAssessment
            where ( HospiceAssessment as ObservationScreeningAssessment ).value ~ "Yes (qualifier value)"
              and HospiceAssessment.effective.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
              and ( HospiceAssessment.effective.toInterval ( ) overlaps day of SixMonthsBeforeToEndOfSTEMI )
        )
        or exists ( ( ( [ServiceRequest: "Hospice Care Ambulatory"] ).isInterventionOrder ( ) ) HospiceOrder
            where HospiceOrder.authoredOn 6 months or less before start of ( EDwSTEMI.period )
        )
        or exists ( ( ( [Procedure: "Hospice Care Ambulatory"] ).isInterventionPerformed ( ) ) HospicePerformed
            where HospicePerformed.performed.toInterval ( ) starts before or on start of ( EDwSTEMI.period )
              and ( HospicePerformed.performed.toInterval ( ) overlaps day of SixMonthsBeforeToEndOfSTEMI )
        )
        or exists ( ( ( [ConditionProblemsHealthConcerns: "Hospice Diagnosis"] ).verified ( ) ) HospiceCareDiagnosis
            where HospiceCareDiagnosis.onset.toInterval ( ) ends on or after start of ( EDwSTEMI.period )
        )
    )

define "Currently Pregnant":
  "ED Encounter with STEMI Diagnosis" EDwSTEMI
    with ( ["USCore.ObservationPregnancyStatusProfile"] ) PregStatus
      such that PregStatus.status = 'final'
        and ( PregStatus.value in "Pregnant State" )
        and ( PregStatus.effective during EDwSTEMI.period )

define "Denominator Exclusions":
  "Allergy or Intolerance to Thrombolytic Medications Overlaps ED Encounter"
    union "Adverse Effect to Thrombolytic Medications Before End of ED Encounter"
    union "Active Exclusion Diagnosis at Start of ED Encounter"
    union "Active use of Anticoagulants"
    union "Exclusion Diagnosis During ED Encounter or Within 24 Hours of ED Encounter Start"
    union "Major Surgical Procedure 21 Days or Less Before Start of or Starts During ED Encounter"
    union "Intubation or Mechanical Circulatory Assist Device Placement or Removal Procedure During ED Encounter or Within 24 Hours of ED Encounter Start"
    union "Active Exclusion Diagnosis Within 90 Days Before or At the Start of ED Encounter"
    union "Intracranial or Intraspinal Procedure 90 Days or Less Before Start of ED Encounter"
    union "ED Encounter with Discharge Disposition as Patient Expired"
    union "ED Encounter with Discharge Disposition as Left Against Medical Advice"
    union "ED Encounter with Hospice Services"
    union "Currently Pregnant"

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

define "Received tPA in Another Facility within 24 hours Prior to Admission":
  "ED Encounter with STEMI Diagnosis" EDwithSTEMI
    with ( ( ["ConditionProblemsHealthConcerns": "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"]
        union ["ConditionEncounterDiagnosis": "Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility"]
    ).verified ( ) ) TPA
      such that TPA.onset.toInterval ( ) starts during EDwithSTEMI.period

define "ED Encounter with a Documented Reason for No PCI Performed":
  "ED Encounter with STEMI Diagnosis" EDwSTEMI
    with ["ProcedureNotDone": "Percutaneous Coronary Intervention"] PCINotDone
      such that ( PCINotDone.statusReason in "Patient Refusal"
          or PCINotDone.statusReason in "Procedure Not Indicated/Contraindicated"
      )
        and PCINotDone.performed during EDwSTEMI.period

define "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy":
  "ED Encounter with STEMI Diagnosis" EDwSTEMI
    with ["MedicationAdministrationNotDone": "Fibrinolytic Therapy"] FibrinolyticNoMed
      such that ( FibrinolyticNoMed.statusReason in "Patient Refusal"
          or FibrinolyticNoMed.statusReason in "Drug Intervention Not Indicated/Contraindicated"
      )
        and FibrinolyticNoMed.effective during EDwSTEMI.period

define "Denominator Exceptions":
  "Received tPA in Another Facility within 24 hours Prior to Admission"
    union "ED Encounter with a Documented Reason for No PCI Performed"
    union "ED Encounter with a Documented Reason for Not Administering Fibrinolytic Therapy"

define fluent function currentemergencyDepartmentArrivalTime(EDEncounter Encounter):
  First(EDEncounter.location EDLocation
      where exists((EDLocation.location.getLocation().type) LocationType
          where(LocationType in "Emergency Department Visit"
              or LocationType ~ "Emergency room"
              or LocationType ~ "Emergency trauma unit"
          )
            and start of EDLocation.period is not null
      )
      return start of EDLocation.period
      sort ascending
  )

define fluent function currentemergencyDepartmentDepartTime(EDEncounter Encounter):
  Last(EDEncounter.location EDLocation
      where exists((EDLocation.location.getLocation().type) LocationType
          where(LocationType in "Emergency Department Visit"
              or LocationType ~ "Emergency room"
              or LocationType ~ "Emergency trauma unit"
          )
            and 
            end of EDLocation.period is not null
      )
      return 
      end of EDLocation.period
      sort ascending
  )

/*
@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 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, '/'))

/*
@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 true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource 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, resource FHIR.Resource):
  resource.id = Last(Split(reference.reference, '/'))

/*
@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 conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function verified(conditions List<FHIR.Condition>):
  conditions C
    where C.verificationStatus is not null implies
      (C.verificationStatus ~ "confirmed"
        or C.verificationStatus ~ "unconfirmed"
        or C.verificationStatus ~ "provisional"
        or C.verificationStatus ~ "differential"
      )

/*
@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: 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

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
        }

/*
@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 ToString(value EncounterStatus): value.value

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

define function ToString(value ProcedureStatus): value.value

define function ToString(value AdverseEventActuality): value.value

define function ToString(value MedicationRequestStatus): value.value

define function ToString(value MedicationRequestIntent): value.value

define function ToString(value ObservationStatus): value.value

define function ToString(value ServiceRequestStatus): value.value

define function ToString(value ServiceRequestIntent): value.value

// TODO: Deprecate because this is now in FHIRCommon
//Condition
/*
@description: Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential
@deprecated: Use the USCoreCommon verified function insteada
*/
define fluent function verified(conditions List<Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>>):
  conditions C
    where C.verificationStatus is not null implies
      (C.verificationStatus ~ "confirmed"
        or C.verificationStatus ~ "unconfirmed"
        or C.verificationStatus ~ "provisional"
        or C.verificationStatus ~ "differential"
      )

//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<FHIR.Encounter>):
  Enc E
    where E.status = 'finished'

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }

//Intervention, Order
define fluent function isInterventionOrder(ServiceRequest List<FHIR.ServiceRequest>):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}

//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<FHIR.Procedure>):
  Proc P
    where P.status ~ 'completed'

/*
@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
    }