define "Initial Population":
  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[18, 85]
    and exists "Essential Hypertension Diagnosis"
    and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( "Pregnancy or Renal Diagnosis" )
    or exists ( "End Stage Renal Disease Procedures" )
    or exists ( "End Stage Renal Disease Encounter" )
    or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty"
    or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
    or PalliativeCare."Has Palliative Care in the Measurement Period"

define "Numerator":
  "Has Systolic Blood Pressure Less Than 140"
    and "Has Diastolic Blood Pressure Less Than 90"

define "SDE Sex":
  case
      when Patient.gender = 'male' then Code { code: 'M', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Male' }
      when Patient.gender = 'female' then Code { code: 'F', system: 'http://hl7.org/fhir/v3/AdministrativeGender', display: 'Female' }
      else null
    end

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

define "Qualifying Systolic Blood Pressure Reading":
  ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure
    where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) )
      and BloodPressure.effective.latest ( ) during day of "Measurement Period"

define "Qualifying Diastolic Blood Pressure Reading":
  ( ( ["observation-bp"] ).isObservationBP ( ) ) BloodPressure
    where ( not ( ( BloodPressure.encounter.getEncounter ( ) ).class.code in { 'EMER', 'IMP', 'ACUTE', 'NONAC', 'PRENC', 'SS' } ) )
      and BloodPressure.effective.latest ( ) during day of "Measurement Period"

define "Blood Pressure Days":
  ( "Qualifying Diastolic Blood Pressure Reading" DBPExam
      return date from DBPExam.effective.latest ( )
  )
    intersect ( "Qualifying Systolic Blood Pressure Reading" SBPExam
        return date from SBPExam.effective.latest ( )
    )

define "Most Recent Blood Pressure Day":
  Last("Blood Pressure Days" BPDays
      sort asc
  )

define "Lowest Systolic Reading on Most Recent Blood Pressure Day":
  First("Qualifying Systolic Blood Pressure Reading" SBPReading
      where SBPReading.effective.latest() same day as "Most Recent Blood Pressure Day"
      return singleton from(SBPReading.component SBPComponent
          where SBPComponent.code ~ "Systolic blood pressure"
          return SBPComponent.value as Quantity
      )
      sort asc
  )

define "Has Systolic Blood Pressure Less Than 140":
  "Lowest Systolic Reading on Most Recent Blood Pressure Day" < 140 'mm[Hg]'

define "Lowest Diastolic Reading on Most Recent Blood Pressure Day":
  First("Qualifying Diastolic Blood Pressure Reading" DBPReading
      where DBPReading.effective.latest() same day as "Most Recent Blood Pressure Day"
      return singleton from(DBPReading.component DBPComponent
          where DBPComponent.code ~ "Diastolic blood pressure"
          return DBPComponent.value as Quantity
      )
      sort asc
  )

define "Has Diastolic Blood Pressure Less Than 90":
  "Lowest Diastolic Reading on Most Recent Blood Pressure Day" < 90 'mm[Hg]'

define "Numerator":
  "Has Systolic Blood Pressure Less Than 140"
    and "Has Diastolic Blood Pressure Less Than 90"

define "Essential Hypertension Diagnosis":
  ( [Condition: "Essential Hypertension"] ) Hypertension
    where Hypertension.prevalenceInterval ( ) overlaps Interval[start of "Measurement Period", start of "Measurement Period" + 6 months )

define "Qualifying Encounters":
  ( ( [Encounter: "Office Visit"]
    union [Encounter: "Annual Wellness Visit"]
    union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]
    union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]
    union [Encounter: "Home Healthcare Services"]
    union [Encounter: "Online Assessments"]
    union [Encounter: "Telephone Visits"] ).isEncounterPerformed() ) ValidEncounter
    where ValidEncounter.period.toInterval() during day of "Measurement Period"

define "Initial Population":
  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[18, 85]
    and exists "Essential Hypertension Diagnosis"
    and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":
  "Initial Population"

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

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

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

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

define "Has Hospice Services":
  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.toInterval() ends during day of "Measurement Period"
  )
    or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ "Yes (qualifier value)"
          and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"
    )
    or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
    )
    or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )

define "Pregnancy or Renal Diagnosis":
  ( [Condition: "Pregnancy"]
    union [Condition: "End Stage Renal Disease"]
    union [Condition: "Kidney Transplant Recipient"]
    union [Condition: "Chronic Kidney Disease, Stage 5"] ) PregnancyESRDDiagnosis
    where PregnancyESRDDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period"

define "End Stage Renal Disease Procedures":
  ( ( [Procedure: "Kidney Transplant"]
      union [Procedure: "Dialysis Services"]
  ).isProcedurePerformed ( ) ) ESRDProcedure
    where ESRDProcedure.performed.toInterval ( ) ends on or before end of "Measurement Period"

define "End Stage Renal Disease Encounter":
  ( ( [Encounter: "ESRD Monthly Outpatient Services"] ).isEncounterPerformed ( ) ) ESRDEncounter
    where ESRDEncounter.period.toInterval ( ) starts on or before end of "Measurement Period"

define "Has Criteria Indicating Frailty":
  exists ( (([DeviceRequest: "Frailty Device"]).isDeviceOrder()) FrailtyDeviceOrder
      where FrailtyDeviceOrder.doNotPerform() is not true
      and FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period"
  )
    or exists ( (([Observation: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed
        where EquipmentUsed.value as Concept in "Frailty Device" 
        and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period"
    )
    or exists ( ([Condition: "Frailty Diagnosis"]) FrailtyDiagnosis
        where FrailtyDiagnosis.prevalenceInterval() overlaps "Measurement Period"
    )
    or exists ( (([Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter
        where FrailtyEncounter.period.toInterval() overlaps "Measurement Period"
    )
    or exists ( (([Observation: "Frailty Symptom"]).isSymptom()) FrailtySymptom
        where FrailtySymptom.effective.toInterval() overlaps "Measurement Period"
    )

define "Outpatient Encounters with Advanced Illness":
   (( [Encounter: "Outpatient"]
    union [Encounter: "Observation"]
    union [Encounter: "Emergency Department Evaluation and Management Visit"]
    union [Encounter: "Nonacute Inpatient"] ).isEncounterPerformed()) OutpatientEncounter
      where exists ((OutpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in "Advanced Illness")
        and OutpatientEncounter.period.toInterval() starts during day of Interval[start of "Measurement Period" - 1 year, 
        end of "Measurement Period"]

define "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service":
  exists ( from
      "Outpatient Encounters with Advanced Illness" OutpatientEncounter1,
      "Outpatient Encounters with Advanced Illness" OutpatientEncounter2
      where OutpatientEncounter2.period ends 1 day or more after day of 
      end of OutpatientEncounter1.period
      return OutpatientEncounter1
  )

define "Has Inpatient Encounter with Advanced Illness":
  exists ( ( ([Encounter: "Acute Inpatient"]).isEncounterPerformed()) InpatientEncounter
      where exists ((InpatientEncounter.encounterDiagnosis()) Diagnosis where Diagnosis.code in "Advanced Illness")
        and InpatientEncounter.period.toInterval() starts during day of Interval[start of "Measurement Period" - 1 year, 
          end of "Measurement Period"]
  )

define "Has Dementia Medications in Year Before or During Measurement Period":
  exists (( ([MedicationRequest: "Dementia Medications"]).isMedicationActive()) DementiaMedication
      where DementiaMedication.doNotPerform is not true and
      CMD."MedicationRequestPeriod" ( DementiaMedication ) overlaps Interval[start of "Measurement Period" - 1 year, 
        end of "Measurement Period"]
  )

define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty":
  ( AgeInYearsAt(date from end of "Measurement Period")in Interval[66, 80]
      and "Has Criteria Indicating Frailty"
      and ( "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service"
          or "Has Inpatient Encounter with Advanced Illness"
          or "Has Dementia Medications in Year Before or During Measurement Period"
      )
  )
    or ( AgeInYearsAt(date from end of "Measurement Period")>= 81
        and "Has Criteria Indicating Frailty"
    )

define "Is Age 66 or Older Living Long Term in a Nursing Home":
  AgeInYearsAt(date from 
     end of "Measurement Period"
  )>= 66
    and ( ( Last( (([Observation: "Housing status"]).isAssessmentPerformed()) HousingStatus    
          where HousingStatus.effective.toInterval() ends on or before 
          end of "Measurement Period"
          sort by 
          end of effective.toInterval() asc
      )) LastHousingStatus
        where LastHousingStatus.value ~ "Lives in a nursing home (finding)"
    ) is not null

define "Has Palliative Care in the Measurement Period":
  exists ((([Observation: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment
      where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period"
  )
    or exists ([Condition: "Palliative Care Diagnosis"] PalliativeDiagnosis
        where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )
    or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter
        where PalliativeEncounter.period.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention
        where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period"
    )

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( "Pregnancy or Renal Diagnosis" )
    or exists ( "End Stage Renal Disease Procedures" )
    or exists ( "End Stage Renal Disease Encounter" )
    or AIFrailLTCF."Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty"
    or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
    or PalliativeCare."Has Palliative Care in the Measurement Period"

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

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