library CMS50FHIRReceiptofSpecialistReport version '1.0.000'

using QICore version '6.0.0'

include FHIRHelpers version '4.4.000' called FHIRHelpers
include SupplementalDataElements version '5.1.000' called SDE
include QICoreCommon version '4.0.000' called QICoreCommon
include Status version '1.15.000' called Status

codesystem "CPT": 'http://www.ama-assn.org/go/cpt'

valueset "Behavioral/Neuropsych Assessment": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1023'
valueset "Consultant Report": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.121.12.1006'
valueset "Office Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001'
valueset "Ophthalmological Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285'
valueset "Preventive Care Services Established Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025'
valueset "Preventive Care Services, Initial Office Visit, 0 to 17": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022'
valueset "Preventive Care Services Initial Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023'
valueset "Preventive Care, Established Office Visit, 0 to 17": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024'
valueset "Psych Visit Diagnostic Evaluation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492'
valueset "Referral": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1046'

code "Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour": '96112' from "CPT" display 'Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour'
code "Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)": '96156' from "CPT" display 'Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)'
code "Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes": '96136' from "CPT" display 'Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes'
code "Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes": '96138' from "CPT" display 'Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes'
code "Psychotherapy for crisis; first 60 minutes": '90839' from "CPT" display 'Psychotherapy for crisis; first 60 minutes'

parameter "Measurement Period" Interval<DateTime>
  default Interval[@2026-01-01T00:00:00.000Z, @2027-01-01T00:00:00.000Z)

context Patient

define "Denominator":
  "Initial Population"

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

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

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

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

define "Initial Population":
  ( "Has Encounter during Measurement Period"
      or "Has Intervention during Measurement Period"
  )
    and "First Referral during First 10 Months of Measurement Period" is not null

define "Has Encounter during Measurement Period":
  exists ( ( ["Encounter": "Office Visit"]
      union ["Encounter": "Ophthalmological Services"]
      union ["Encounter": "Preventive Care Services Established Office Visit, 18 and Up"]
      union ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"]
      union ["Encounter": "Preventive Care Services Initial Office Visit, 18 and Up"]
      union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"] ) ValidEncounter
      where ValidEncounter.status = 'finished'
        and ValidEncounter.period during day of "Measurement Period"
  )

define "Has Intervention during Measurement Period":
  exists ( ( ( ["Procedure": "Behavioral/Neuropsych Assessment"]
        union ["Procedure": "Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)"]
        union ["Procedure": "Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes"]
        union ["Procedure": "Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes"]
        union ["Procedure": "Psychotherapy for crisis; first 60 minutes"]
        union ["Procedure": "Psych Visit Diagnostic Evaluation"]
        union ["Procedure": "Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour"]
    ).isProcedurePerformed ( ) ) ValidIntervention
      where ValidIntervention.performed.toInterval ( ) during day of "Measurement Period"
  )

define "First Referral during First 10 Months of Measurement Period":
  First([ServiceRequest: "Referral"] ReferralOrder
      where ReferralOrder.status in { 'active', 'completed' }
        and ReferralOrder.intent = 'order'
        and ReferralOrder.authoredOn during day of Interval[start of "Measurement Period", Date(year from start of "Measurement Period", 10, 31)]
      sort by authoredOn ascending
  )

define "Numerator":
  "Referring Clinician Receives Consultant Report to Close Referral Loop"

define "Referring Clinician Receives Consultant Report to Close Referral Loop":
  exists ( [Task: QICoreCommon."Fulfill"] ConsultantReportObtained
      with "First Referral during First 10 Months of Measurement Period" FirstReferral
        // TODO: discuss with vendors .focus vs .basedOn
        
        such that ( ConsultantReportObtained.focus.references ( FirstReferral )
            or ConsultantReportObtained.basedOn.references ( FirstReferral )
        )
          and ConsultantReportObtained.executionPeriod ends after FirstReferral.authoredOn
          and ConsultantReportObtained.executionPeriod ends during day of "Measurement Period"
          and ConsultantReportObtained.status = 'completed'
          and ConsultantReportObtained.reasonCode in "Consultant Report"
            /*
            TODO: discuss usage of Composition resource for "Consultant Report"
            NOTE: the following does not currently work due to "Composition" missing a profile in QICore
            and exists(
              ConsultantReportObtained.output.value OV 
                with ([Composition] ReportComposition where ReportComposition.type in "Consultant Report") ConsultantReportComposition 
                  such that (OV as Reference).references(ConsultantReportComposition)
            )
            */
  
  )

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