define "Initial Population":
  exists "Qualifying Encounter during Day of Measurement Period" QualifyingEncounter
    where "AgeInYearsAt"(date from start of QualifyingEncounter.period) >= 18

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or PalliativeCare."Has Palliative Care in the Measurement Period"
    or exists "Pregnancy"

define "Numerator":
  exists "High BMI and Follow up Provided"
    or exists "Low BMI and Follow up Provided"
    or "Has Normal BMI"

define "Denominator Exceptions":
  exists "Medical Reason for Not Documenting a Follow up Plan for Low or High BMI"
    or exists "Medical Reason or Patient Reason for Not Performing BMI Exam"

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 "BMI during Measurement Period":
  ["observation-bmi"] BMI
    where BMI.value > 0 'kg/m2'
      and BMI.status in { 'final', 'amended', 'corrected' }
      and BMI.effective.toInterval ( ) during day of "Measurement Period"

define "Documented High BMI during Measurement Period":
  "BMI during Measurement Period" BMI
    where BMI.effective.toInterval ( ) during day of "Measurement Period"
      and BMI.value >= 25 'kg/m2'

define "High BMI Interventions Ordered":
  ( ( [ServiceRequest: "Follow Up for Above Normal BMI"]
      union [ServiceRequest: "Referrals Where Weight Assessment May Occur"]
      union [MedicationRequest: "Medications for Above Normal BMI"] ) HighInterventionsOrdered
      where HighInterventionsOrdered.reasonCode in "Overweight or Obese"
        or ( exists [Condition: "Overweight or Obese"] OverweightObese
            where ( OverweightObese.isProblemListItem ( )
                or OverweightObese.isHealthConcern ( )
            )
              and OverweightObese.isActive ( )
              and OverweightObese.prevalenceInterval ( ) starts before or on day of HighInterventionsOrdered.authoredOn
              and not ( OverweightObese.prevalenceInterval ( ) ends before day of HighInterventionsOrdered.authoredOn )
        )
  )

define "High BMI Interventions Performed":
  ( [Procedure: "Follow Up for Above Normal BMI"] HighInterventionsPerformed
      where HighInterventionsPerformed.reasonCode in "Overweight or Obese"
        and HighInterventionsPerformed.status = 'completed'
        or ( exists [Condition: "Overweight or Obese"] OverweightObese
            where OverweightObese.isHealthConcern ( )
              and OverweightObese.isActive ( )
              and OverweightObese.prevalenceInterval ( ) starts before or on day of HighInterventionsPerformed.performed.toInterval ( )
              and not ( OverweightObese.prevalenceInterval ( ) ends before day of HighInterventionsPerformed.performed.toInterval ( ) )
        )
  )

define "High BMI and Follow up Provided":
  "Documented High BMI during Measurement Period" HighBMI
    with ( "High BMI Interventions Ordered"
      union "High BMI Interventions Performed" ) HighBMIInterventions
      such that Coalesce(HighBMIInterventions.performed.toInterval(), HighBMIInterventions.authoredOn.toInterval()) starts during day of "Measurement Period"

define "Documented Low BMI during Measurement Period":
  "BMI during Measurement Period" BMI
    where BMI.effective.toInterval ( ) during day of "Measurement Period"
      and BMI.value < 18.5 'kg/m2'

define "Low BMI Interventions Ordered":
  ( ( [ServiceRequest: "Follow Up for Below Normal BMI"]
      union [ServiceRequest: "Referrals Where Weight Assessment May Occur"]
      union [MedicationRequest: "Medications for Below Normal BMI"] ) LowInterventionsOrdered
      where LowInterventionsOrdered.reasonCode in "Underweight"
        or ( exists [Condition: "Underweight"] Underweight
            where ( Underweight.isHealthConcern ( ) )
              and Underweight.isActive ( )
              and Underweight.prevalenceInterval ( ) starts before or on day of LowInterventionsOrdered.authoredOn
              and not ( Underweight.prevalenceInterval ( ) ends before day of LowInterventionsOrdered.authoredOn )
              and LowInterventionsOrdered.authoredOn during day of "Measurement Period"
        )
  )

define "Low BMI Interventions Performed":
  ( [Procedure: "Follow Up for Below Normal BMI"] LowInterventionsPerformed
      where LowInterventionsPerformed.reasonCode in "Underweight"
        and LowInterventionsPerformed.status = 'completed'
        or ( exists [Condition: "Underweight"] Underweight
            where ( Underweight.isHealthConcern ( ) )
              and Underweight.isActive ( )
              and Underweight.prevalenceInterval ( ) starts before or on day of LowInterventionsPerformed.performed.toInterval ( )
              and not ( Underweight.prevalenceInterval ( ) ends before day of LowInterventionsPerformed.performed.toInterval ( )
                  and LowInterventionsPerformed.performed.toInterval ( ) during day of "Measurement Period"
              )
        )
  )

define "Low BMI and Follow up Provided":
  ( "Documented Low BMI during Measurement Period" LowBMI
      with ( "Low BMI Interventions Ordered"
        union "Low BMI Interventions Performed" ) LowBMIInterventions
        such that Coalesce(LowBMIInterventions.performed.toInterval(), LowBMIInterventions.authoredOn.toInterval()) starts during day of "Measurement Period"
  )

define "Has Normal BMI":
  exists ( "BMI during Measurement Period" BMI
      where BMI.value in Interval[18.5 'kg/m2', 24.9 'kg/m2']
  )
    and not ( exists "Documented High BMI during Measurement Period"
        or exists "Documented Low BMI during Measurement Period"
    )

define "Numerator":
  exists "High BMI and Follow up Provided"
    or exists "Low BMI and Follow up Provided"
    or "Has Normal BMI"

define "Qualifying Encounter during Day of Measurement Period":
  [Encounter: "Encounter to Evaluate BMI"] BMIEncounter
    where BMIEncounter.period during day of "Measurement Period"
      and BMIEncounter.class !~ "virtual"
      and BMIEncounter.status = 'finished'

define "Initial Population":
  exists "Qualifying Encounter during Day of Measurement Period" QualifyingEncounter
    where "AgeInYearsAt"(date from start of QualifyingEncounter.period) >= 18

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 "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 "Pregnancy":
  [Condition: "Pregnancy or Other Related Diagnoses"] PregnancyDiagnosis
    with "Qualifying Encounter during Day of Measurement Period" QualifyingEncounter
      such that PregnancyDiagnosis.clinicalStatus ~ QICoreCommon."active"
        and PregnancyDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or PalliativeCare."Has Palliative Care in the Measurement Period"
    or exists "Pregnancy"

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

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

define "Medical Reason for Not Documenting a Follow up Plan for Low or High BMI":
  ( ( [ServiceNotRequested: "Referrals Where Weight Assessment May Occur"]
      union [ServiceNotRequested: "Follow Up for Above Normal BMI"]
      union [ServiceNotRequested: "Follow Up for Below Normal BMI"] ) NoBMIFollowUp
      with "Qualifying Encounter during Day of Measurement Period" QualifyingEncounter
        such that NoBMIFollowUp.authoredOn same day as start of QualifyingEncounter.period
      where NoBMIFollowUp.status ~ 'completed'
        and NoBMIFollowUp.reasonRefused in "Medical Reason"
  )
    union ( ( [MedicationNotRequested: "Medications for Above Normal BMI"]
        union [MedicationNotRequested: "Medications for Below Normal BMI"] ) NoBMIFollowUp
        with "Qualifying Encounter during Day of Measurement Period" QualifyingEncounter
          such that NoBMIFollowUp.authoredOn same day as start of QualifyingEncounter.period
        where NoBMIFollowUp.status ~ 'completed'
          and NoBMIFollowUp.reasonCode in "Medical Reason"
    )

define "Medical Reason or Patient Reason for Not Performing BMI Exam":
  [ObservationNotDone: code = "Body mass index (BMI) [Ratio]"] NoBMI
    with "Qualifying Encounter during Day of Measurement Period" QualifyingEncounter
      such that NoBMI.effective.toInterval ( ) ends same day as start of QualifyingEncounter.period
    where NoBMI.status = 'cancelled'
      and ( NoBMI.notDoneReason in "Patient Declined"
          or NoBMI.notDoneReason in "Medical Reason"
      )

define "Denominator Exceptions":
  exists "Medical Reason for Not Documenting a Follow up Plan for Low or High BMI"
    or exists "Medical Reason or Patient Reason for Not Performing BMI Exam"