define "Initial Population":   Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[50, 75]       and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":   "Initial Population"

define "Denominator Exclusion":   Hospice."Has Hospice"       or exists "Malignant Neoplasm"       or exists "Total Colectomy Performed"       or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"         and Frailty."Long Term Care Periods Longer Than 90 Consecutive Days"

define "Numerator":   exists "Colonoscopy Performed"       or exists "Fecal Occult Blood Test Performed"       or exists "Flexible Sigmoidoscopy Performed"       or exists "Fecal Immunochemical Test DNA"       or exists "CT Colonography Performed"

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"]   ) ValidEncounter   where ValidEncounter.period during "Measurement Period"     and ValidEncounter.status  = 'finished'

define "Has Hospice":  exists (     [Encounter: "Encounter Inpatient"] DischargeHospice    where DischargeHospice.status = 'finished'       and (          DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"         or DischargeHospice.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"       )     and DischargeHospice.period ends during "Measurement Period"  )     or exists (       [ServiceRequest: "Hospice care ambulatory"] HospiceOrder         where HospiceOrder.intent = 'order'             and HospiceOrder.authoredOn in "Measurement Period"     )     or exists (       [Procedure: "Hospice care ambulatory"] HospicePerformed         where HospicePerformed.status = 'completed'           and Global."Normalize Interval"(HospicePerformed.performed) overlaps "Measurement Period"     )

define "Has Criteria Indicating Frailty":   //Ask Bryn about devices        exists ( [DeviceRequest: "Frailty Device"] FrailtyDeviceOrder          where FrailtyDeviceOrder.authoredOn during "Measurement Period"        )           // DeviceUseStatement has a known issue with the publication tooling           // so it is removed to allow this IG to publish until that is fixed         //or exists ( [DeviceUseStatement: "Frailty Device"] FrailtyDeviceUse         //  where Global."Normalize Interval"(FrailtyDeviceUse.timing) overlaps "Measurement Period"         //)         or exists ( [Condition: "Frailty Diagnosis"] FrailtyDiagnosis           where Global."Prevalence Period"(FrailtyDiagnosis) overlaps "Measurement Period"         )         or exists ( [Encounter: "Frailty Encounter"] FrailtyEncounter           where FrailtyEncounter.period overlaps "Measurement Period"         )         or exists ( [Observation: "Frailty Symptom"] FrailtySymptomObservation           where Global."Normalize Interval"(FrailtySymptomObservation.effective) overlaps "Measurement Period"         )

define "Outpatient Encounters with Advanced Illness":   ( [Encounter: "Outpatient"]         union [Encounter: "Observation"]         union [Encounter: "ED"]         union [Encounter: "Nonacute Inpatient"] ) OutpatientEncounter          with [Condition: "Advanced Illness"] AdvancedIllnessDiagnosis                   such that exists (                       OutpatientEncounter.diagnosis.condition EncounterDiagnosis                           where EndsWith(EncounterDiagnosis.reference, AdvancedIllnessDiagnosis.id)                   )                   and OutpatientEncounter.period starts 2 years or less on or before          end of "Measurement Period"

define "Inpatient Encounter with Advanced Illness":   [Encounter: "Acute Inpatient"] InpatientEncounter         with [Condition: "Advanced Illness"] AdvancedIllnessDiagnosis                   such that exists (                       InpatientEncounter.diagnosis.condition EncounterDiagnosis                           where EndsWith(EncounterDiagnosis.reference, AdvancedIllnessDiagnosis.id)                   )          and InpatientEncounter.period starts 2 years or less on or before          end of "Measurement Period"

define "Dementia Medications In Year Before or During Measurement Period":   ["MedicationDispense": "Dementia Medications"] DementiaMed         where DementiaMed.whenHandedOver during Interval[                   ( start of "Measurement Period" - 1 year ), end of "Measurement Period"               ]

define "Advanced Illness and Frailty Exclusion Not Including Over Age 80":   //If the measure does NOT include populations age 80 and older, then use this logic:        Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period")>= 65               and "Has Criteria Indicating Frailty"               and ( Count("Outpatient Encounters with Advanced Illness")>= 2                   or exists ( "Inpatient Encounter with Advanced Illness" )                   or exists "Dementia Medications In Year Before or During Measurement Period"               )

// start here  define "Long Term Care Periods During Measurement Period":   ( [Encounter: "Care Services in Long-Term Residential Facility"]                 union [Encounter: "Nursing Facility Visit"] ) LongTermFacilityEncounter                 where LongTermFacilityEncounter.period overlaps "Measurement Period"                 return LongTermFacilityEncounter.period                  intersect "Measurement Period"

define "Long Term Care Periods Longer Than 90 Consecutive Days":   exists ( "Long Term Care Periods During Measurement Period" LongTermCareDuringMP         where duration in days of LongTermCareDuringMP > 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 Payer":   [Coverage: type in "Payer"] Payer         return {           code: Payer.type,           period: Payer.period         }

define "SDE Ethnicity":   (flatten (       Patient.extension Extension         where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity'           return Extension.extension     )) E       where E.url = 'ombCategory'         or E.url = 'detailed'       return E.value as Coding

define "SDE Race":   (flatten (       Patient.extension Extension         where Extension.url = 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-race'           return Extension.extension     )) E       where E.url = 'ombCategory'         or E.url = 'detailed'       return E.value as Coding

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

define "Colonoscopy Performed":   [Procedure: "Colonoscopy"] Colonoscopy       where Colonoscopy.status = 'completed'         and Global."Normalize Interval" ( Colonoscopy.performed ) ends 10 years or less on or before         end of "Measurement Period"

define "Fecal Occult Blood Test Performed":   [Observation: "Fecal Occult Blood Test (FOBT)"] FecalOccultResult       where FecalOccultResult.status in { 'final', 'amended', 'corrected', 'preliminary' }         and FecalOccultResult.value is not null         and Global."Normalize Interval" ( FecalOccultResult.effective ) during day of "Measurement Period"

define "Flexible Sigmoidoscopy Performed":   [Procedure: "Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy       where FlexibleSigmoidoscopy.status = 'completed'         and Global."Normalize Interval" ( FlexibleSigmoidoscopy.performed ) ends 5 years or less on or before         end of "Measurement Period"

define "Fecal Immunochemical Test DNA":   [Observation: "FIT DNA"] FitDNA       where FitDNA.status in { 'final', 'amended', 'corrected', 'preliminary' }         and FitDNA.value is not null         and Global."Normalize Interval" ( FitDNA.effective ) occurs 3 years or less on or before day of         end of "Measurement Period"

define "CT Colonography Performed":   [Procedure: "CT Colonography"] Colonography       where Colonography.status = 'completed'         and Global."Normalize Interval" ( Colonography.performed ) ends 5 years or less on or before         end of "Measurement Period"

define "Numerator":   exists "Colonoscopy Performed"       or exists "Fecal Occult Blood Test Performed"       or exists "Flexible Sigmoidoscopy Performed"       or exists "Fecal Immunochemical Test DNA"       or exists "CT Colonography Performed"

define "Initial Population":   Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[50, 75]       and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":   "Initial Population"

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

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

define "Malignant Neoplasm":   [Condition: "Malignant Neoplasm of Colon"] ColorectalCancer       where Global."Prevalence Period" ( ColorectalCancer ) starts on or before       end of "Measurement Period"

define "Total Colectomy Performed":   [Procedure: "Total Colectomy"] Colectomy       where Colectomy.status = 'completed'         and Global."Normalize Interval" ( Colectomy.performed ) starts on or before         end of "Measurement Period"

define "Denominator Exclusion":   Hospice."Has Hospice"       or exists "Malignant Neoplasm"       or exists "Total Colectomy Performed"       or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"         and Frailty."Long Term Care Periods Longer Than 90 Consecutive Days"

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

define function "CalendarAgeInYearsAt"(BirthDateTime DateTime, AsOf DateTime):  years between ToDate(BirthDateTime)and ToDate(AsOf)

define function "ToDate"(Value DateTime):  DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)

define function "Prevalence Period"(condition Condition):   Interval[start of "Normalize Interval"(condition.onset), end of "Normalize Abatement"(condition))

define function "Normalize Abatement"(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, '1', 'Error', 'Cannot compute an interval from a String value')  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 "Normalize Interval"(condition.onset), condition.recordedDate)  else null

define function ToString(value AdministrativeGender): value.value

define function ToString(value ProcedureStatus): value.value

define function ToString(value ObservationStatus): value.value

define function ToDate(value date): 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 ToString(value EncounterStatus): 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 ToString(value ServiceRequestIntent): value.value

define function ToDateTime(value dateTime): 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 string): value.value