define "Initial Population":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"

define "Numerator":
  "Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure"
    union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"
    			  intersect ( "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE"
    						    union "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery"
    			            )
          )
    union "Encounter With Low Risk for VTE or Anticoagulant Administered"
    union "Encounter With No VTE Prophylaxis Due to Medical Reason"
    union "Encounter With No VTE Prophylaxis Due to Patient Refusal"

define "Denominator":
      "Initial Population"

define "Denominator Exclusion":
  "Encounter Less Than 2 Days"
     union "Encounter With ICU Location Stay 1 Day or More"
     union "Encounter With Principal Diagnosis of Mental Disorder or Stroke"
     union "Encounter With Principal Procedure of SCIP VTE Selected Surgery"
     union "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission"
     union "Encounter With Intervention Comfort Measures on Day of or Day After Procedure"

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 function "CalendarDayOfOrDayAfter"(StartValue DateTime ):
	Interval(Global."ToDate"(StartValue), Global."ToDate"(StartValue + 2 days))

define function "FromDayOfStartOfHospitalizationToDayAfterAdmission"(Encounter FHIR.Encounter ):
	Interval[Global."ToDate"(start of Global."HospitalizationWithObservation"(Encounter)), Global."ToDate"(start of Encounter.period + 2 days))

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

define "Admission Without VTE or Obstetrical Conditions":
  Global."Inpatient Encounter" InpatientEncounter
    where not exists (
      (Global.EncounterDiagnosis(InpatientEncounter)) EncounterDiagnosis
        where EncounterDiagnosis.code in "Obstetrics"
          or EncounterDiagnosis.code in "Venous Thromboembolism"
          or EncounterDiagnosis.code in "Obstetrics VTE"
    )

// Note: added FHIRHelpers.ToDate() in R4
define "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions":
  ( Global."Inpatient Encounter" InpatientEncounter
        where Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of InpatientEncounter.period) >= 18
  )
    intersect "Admission Without VTE or Obstetrical Conditions"

// 10/29: Replaced DeviceUseStatement with Procedure with a new value set and procedure.usdCode for specifying devices
define "VTE Prophylaxis by Medication Administered or Device Applied":
  ( ["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
      where VTEMedication.status ='completed'
			     and VTEMedication.dosage.route in "Subcutaneous route"
  )
   union (["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"] LMWH where LMWH.status = 'completed')
    union (["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] FactorXa where FactorXa.status = 'completed')
     union (["MedicationAdministration": medication in "Warfarin"] Warfarin where Warfarin.status = 'completed')
      union (
          ["Procedure": "Device Application"] DeviceApplied
          where DeviceApplied.status = 'complete'
                and (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)"
                    or DeviceApplied.usedCode in"Venous foot pumps (VFP)"
                    or DeviceApplied.usedCode in "Graduated compression stockings (GCS)"
                    )
          )

define "Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure":
 	( from
      "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
      "VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis
    where Coalesce(Global."Normalize Interval"(VTEProphylaxis.effective), Global."Normalize Interval"(VTEProphylaxis.performed)) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
    return QualifyingEncounter
 	)
 	union (
    from
      "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
      ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
      "VTE Prophylaxis by Medication Administered or Device Applied" VTEProphylaxis
    where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
      and Coalesce(Global."Normalize Interval"(VTEProphylaxis.effective), Global."Normalize Interval"(VTEProphylaxis.performed)) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
    return QualifyingEncounter
	)

define "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure":
	( from
    		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
  			["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
    where FactorXaMedication.status = 'completed'
      and Global."Normalize Interval"(FactorXaMedication.effective) starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
    return QualifyingEncounter
    )
    union ( from
    				  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
      				["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
      				["MedicationAdministration": medication in "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
      			where FactorXaMedication.status = 'completed'
                and AnesthesiaProcedure.status = 'completed'
      			    and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
      					and Global."Normalize Interval"(FactorXaMedication.effective) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
      			return QualifyingEncounter
      		)

define "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE":
	( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
		with ["Condition": code in "Atrial Fibrillation/Flutter"] AtrialFibrillation
		such that FHIRHelpers.ToConcept(AtrialFibrillation.clinicalStatus) in { Global."active", Global."recurrence", Global."relapse" }
			and Global."Normalize Interval"(AtrialFibrillation.onset) starts on or before end of QualifyingEncounter.period
    )
    union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    				where Global.EncounterDiagnosis(QualifyingEncounter).code in "Atrial Fibrillation/Flutter"
    			)
    union ( "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    				with ["Condition": code in "Venous Thromboembolism"] VTEDiagnosis
    				such that  FHIRHelpers.ToConcept(VTEDiagnosis.clinicalStatus) in { Global."inactive", Global."remission", Global."resolved" }
      					//and VTEDiagnosis.verificationStatus = 'confirmed'
    				and Global."Normalize Interval"(VTEDiagnosis.onset) before start of QualifyingEncounter.period
      		)

define "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery":
	"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
	with ( ["Procedure": "Hip Replacement Surgery"]
    			union ["Procedure": "Knee Replacement Surgery"] ) HipKneeProcedure
	such that HipKneeProcedure.status = 'completed'
	     and Global."Normalize Interval"(HipKneeProcedure.performed) starts on or before end of QualifyingEncounter.period

define "Is In Low Risk for VTE or On Anticoagulant":
	  ( ["Observation": "Risk for venous thromboembolism"] VTERiskAssessment
			  where VTERiskAssessment.value in "Low Risk"
        and VTERiskAssessment.status in {'final','amended', 'corrected'}
	  )
  union ( ["Observation": "INR"] INRLabTest
        where INRLabTest.value as Quantity > 3.0
            and INRLabTest.status in {'final','amended', 'corrected'}
        return "Observation" { id: INRLabTest.id, effective: INRLabTest.issued }
        )
  union ((( ["MedicationAdministration": "Unfractionated Heparin"] UnfractionatedHeparin
          where UnfractionatedHeparin.dosage.route in "Intravenous route"
         )
         union ["MedicationAdministration": "Direct Thrombin Inhibitor"]
         union ["MedicationAdministration": "Glycoprotein IIb/IIIa Inhibitors"] ) AnticoagulantMedication
         where AnticoagulantMedication.status = 'complete'
         return "Observation" { id: AnticoagulantMedication.id, effective: AnticoagulantMedication.effective }
      )

define "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission":
 	"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    with "Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment
    such that Global."Normalize Interval"(VTERiskAssessment.effective) starts during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)

define "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure":
 	from
   		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
   		["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
   		"Is In Low Risk for VTE or On Anticoagulant" VTERiskAssessment
	where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
 			and Global."Normalize Interval"(VTERiskAssessment.effective) starts during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
	return QualifyingEncounter

define "Encounter With Low Risk for VTE or Anticoagulant Administered":
   "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission"
   	 union "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure"

define "No VTE Prophylaxis Medication Administered or Ordered":
   ((	["MedicationAdministration": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
     union
	    ["MedicationAdministration": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"]
     union
	    ["MedicationAdministration": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
     union
	    ["MedicationAdministration": medication in "Warfarin"]
       ) MedicationAdm
       where MedicationAdm.status = 'not-done'
        )
  union
	   ((	["MedicationRequest": medication in "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
  	union
  	 ["MedicationRequest": medication in "Low Molecular Weight Heparin for VTE Prophylaxis"]
    union
    	["MedicationRequest": medication in "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
    union
    	["MedicationRequest": medication in "Warfarin"]
    ) MedicationOrder
    	where	MedicationOrder.doNotPerform is true
        and MedicationOrder.status in {'completed', 'cancelled'}
        //11/5 discussion: all expressions for QI-Core must include a status.
        //Therefore, we need ServiceRequest.status = completed; and MedicationRequest.status = cancelled (or completed, since cancelled indicates it was once ordered but intentionally never filled).
        //So the not done issue is handled by ServiceRequest.doNotPerform = True  Or MedicationRequest.doNotPerform = True
    )

define "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
   	"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
       with	"No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
     	such that Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason"
      			and Coalesce(NoVTEMedication.authoredOn, start of Global."Normalize Interval"(NoVTEMedication.effective)) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)

define "No VTE Prophylaxis Device Applied or Ordered":
  ((
    ["ServiceRequest": "Venous foot pumps (VFP)"]
    union ["ServiceRequest": "Intermittent pneumatic compression devices (IPC)"]
    union ["ServiceRequest": "Graduated compression stockings (GCS)"]
    ) DeviceOrder
    where DeviceOrder.status = 'completed'
        and DeviceOrder.doNotPerform is true
    return {id: DeviceOrder.id, requestStatusReason: GetStatusReason(DeviceOrder), authoredOn: DeviceOrder.authoredOn}
    )
  union
    (
      ["Procedure": "Device Application"] DeviceApplied
      let DeviceNotDoneTiming: Global.GetExtension(DeviceApplied, 'qicore-recorded').value
      where (DeviceApplied.usedCode in "Intermittent pneumatic compression devices (IPC)"
            or DeviceApplied.usedCode in "Venous foot pumps (VFP)"
            or DeviceApplied.usedCode in "Graduated compression stockings (GCS)"
            )
         and  DeviceApplied.status = 'not-done'
         return {id: DeviceApplied.id, requestStatusReason: DeviceApplied.statusReason, authoredOn: DeviceNotDoneTiming}

    )

define "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
  	with "No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
      such that NoVTEDevice.requestStatusReason in "Medical Reason"
        and  NoVTEDevice.authoredOn during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)

define "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure":
	from
  		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
  		["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
  		"No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
	where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Medical Reason"
			and AnesthesiaProcedure.status = 'completed'
			and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
			and Coalesce(NoVTEMedication.authoredOn, start of Global."Normalize Interval"(NoVTEMedication.effective)) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
  return QualifyingEncounter

define "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure":
  from
  		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
  		["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
  		"No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
  where  NoVTEDevice.requestStatusReason in "Medical Reason"
      and AnesthesiaProcedure.status = 'completed'
  		and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
      and NoVTEDevice.authoredOn during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
  return QualifyingEncounter

define "Encounter With No VTE Prophylaxis Due to Medical Reason":
   ( "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
     intersect "No VTE Prophylaxis Device Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
   )
   union ( "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure"
       intersect "No VTE Prophylaxis Device Due to Medical Reason on Day of or Day After Procedure"
       )

define "No VTE Prophylaxis Medication or Device Due to Patient Refusal":
    ( "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
        where Coalesce(NoVTEMedication.statusReason,NoVTEMedication.reasonCode) in "Patient Refusal"
    )
  union ("No VTE Prophylaxis Device Applied or Ordered" NoVTEDevice
           where NoVTEDevice.requestStatusReason in "Patient Refusal"
        )

define "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission":
 	"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
	 with "No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
   such that Coalesce(start of Global."Normalize Interval"(PatientRefusal.effective), PatientRefusal.authoredOn)
         during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)

define "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure":
 	from
   		"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
   		["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
   		"No VTE Prophylaxis Medication or Device Due to Patient Refusal" PatientRefusal
	where Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
 			and Coalesce(start of Global."Normalize Interval"(PatientRefusal.effective), PatientRefusal.authoredOn)
             during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
	return QualifyingEncounter

define "Encounter With No VTE Prophylaxis Due to Patient Refusal":
 "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission"
 	union "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure"

define "Numerator":
  "Encounter With VTE Prophylaxis Received on Day of or Day After Admission or Procedure"
    union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"
    			  intersect ( "Encounter With Prior or Present Diagnosis of Atrial Fibrillation or VTE"
    						    union "Encounter With Prior or Present Procedure of Hip or Knee Replacement Surgery"
    			            )
          )
    union "Encounter With Low Risk for VTE or Anticoagulant Administered"
    union "Encounter With No VTE Prophylaxis Due to Medical Reason"
    union "Encounter With No VTE Prophylaxis Due to Patient Refusal"

define "Initial Population":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions"

define "Denominator":
      "Initial Population"

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

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

define "Encounter Less Than 2 Days":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
  	where Global."LengthInDays"(QualifyingEncounter.period)< 2

define "Encounter With ICU Location Stay 1 Day or More":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    where exists ( QualifyingEncounter.location Location
    		where Global.GetLocation(Location.location).type in "Intensive Care Unit"
    			and Global."LengthInDays"(Location.period)>= 1
    			and Location.period starts during TJC."CalendarDayOfOrDayAfter"(start of QualifyingEncounter.period)
	    )

define "Encounter With Principal Diagnosis of Mental Disorder or Stroke":
  "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    where Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Mental Health Diagnoses"
        or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Hemorrhagic Stroke"
        or Global."PrincipalDiagnosis"(QualifyingEncounter).code in "Ischemic Stroke"

define "SCIP VTE Selected Surgery":
  (	["Procedure": "General Surgery"]
    union ["Procedure": "Gynecological Surgery"]
    union ["Procedure": "Hip Fracture Surgery"]
    union ["Procedure": "Hip Replacement Surgery"]
    union ["Procedure": "Intracranial Neurosurgery"]
    union ["Procedure": "Knee Replacement Surgery"]
    union ["Procedure": "Urological Surgery"] ) Procedure
  where Procedure.status = 'completed'

define "Encounter With Principal Procedure of SCIP VTE Selected Surgery":
  from
    "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
    "SCIP VTE Selected Surgery" SelectedProcedure
  let EncounterProcedure: Global.GetExtension(QualifyingEncounter, 'qicore-encounter-procedure')
  where FHIRHelpers.ToInteger(Global.GetExtension(EncounterProcedure, 'rank').value as FHIR.positiveInt) = 1
    and Global.GetId(FHIRHelpers.ToString((Global.GetExtension(EncounterProcedure, 'procedure').value as FHIR.Reference).reference)) = SelectedProcedure.id
    and Global."Normalize Interval"(SelectedProcedure.performed) during QualifyingEncounter.period

define "Intervention Comfort Measures":
	(["ServiceRequest": "Comfort Measures"] P
    		where P.intent = 'order'
  )
  	union
    	(["Procedure": "Comfort Measures"] InterventionPerformed
      	where InterventionPerformed.status in {'completed', 'in-progress'})

define "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission":
	"Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
		with "Intervention Comfort Measures" ComfortMeasure
		such that Coalesce(start of Global."Normalize Interval"(ComfortMeasure.performed), ComfortMeasure.authoredOn) during VTEICU."FromDayOfStartOfHospitalizationToDayAfterAdmission"(QualifyingEncounter)

define "Encounter With Intervention Comfort Measures on Day of or Day After Procedure":
  from
    "Encounter With Age Range and Without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "Intervention Comfort Measures" ComfortMeasure
  where AnesthesiaProcedure.status = 'completed'
      and Global."Normalize Interval"(AnesthesiaProcedure.performed) ends 1 day after day of start of QualifyingEncounter.period
      and Coalesce(start of Global."Normalize Interval"(ComfortMeasure.performed), ComfortMeasure.authoredOn) during TJC."CalendarDayOfOrDayAfter"(end of Global."Normalize Interval"(AnesthesiaProcedure.performed))
  return QualifyingEncounter

define "Denominator Exclusion":
  "Encounter Less Than 2 Days"
     union "Encounter With ICU Location Stay 1 Day or More"
     union "Encounter With Principal Diagnosis of Mental Disorder or Stroke"
     union "Encounter With Principal Procedure of SCIP VTE Selected Surgery"
     union "Encounter With Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission"
     union "Encounter With Intervention Comfort Measures on Day of or Day After Procedure"

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

//11/5: ServiceRequest not done reason is an extension in QI-Core R4 as ServiceRequest.extension:statusReason
define function GetStatusReason(requestReason ServiceRequest):
      Global.GetBaseExtension(requestReason, 'request-statusReason')

define "Inpatient Encounter":
	[Encounter: "Encounter Inpatient"] EncounterInpatient
		where EncounterInpatient.status = 'finished'
		    and "LengthInDays"(EncounterInpatient.period) <= 120
			and EncounterInpatient.period ends during "Measurement Period"

define function "LengthInDays"(Value Interval<DateTime>):
	difference in days between start of Value and end of Value

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 "EncounterDiagnosis"(Encounter Encounter):
  Encounter.diagnosis D
    return singleton from ([Condition] C where C.id = "GetId"(D.condition.reference))

define function "GetId"(uri String):
	Last(Split(uri, '/'))

define function "HospitalizationWithObservation"(TheEncounter FHIR.Encounter):
	TheEncounter Visit
		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
				where LastObs.period ends 1 hour or less on or before start of Visit.period
				sort by end of period
			),
			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
				where LastED.period ends 1 hour or less on or before VisitStart
				sort by end of period
			)
		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]

define function "GetBaseExtension"(domainResource DomainResource, url String):
  singleton from "GetBaseExtensions"(domainResource, url)

/*
NOTE: Extensions are not the preferred approach, but are used as a way to access
content that is defined by extensions but not yet surfaced in the
CQL model info.
*/
define function "GetBaseExtensions"(domainResource DomainResource, url String):
  domainResource.extension E
	  where E.url = ('http://hl7.org/fhir/StructureDefinition/' + url)
		return E

define function "GetExtension"(domainResource DomainResource, url String):
  singleton from "GetExtensions"(domainResource, url)

/*
NOTE: Extensions are not the preferred approach, but are used as a way to access
content that is defined by extensions but not yet surfaced in the
CQL model info.
*/
define function "GetExtensions"(domainResource DomainResource, url String):
  domainResource.extension E
	  where E.url = ('http://hl7.org/fhir/us/qicore/StructureDefinition/' + url)
		return E

// Returns the location for the given location reference
define function GetLocation(reference Reference):
  singleton from (
    [Location] L where L.id = GetId(reference.reference)
  )

// Returns the condition that is specified as the principal diagnosis for the encounter
// TODO: BTR 2019-07-30: Shouldn't need the FHIRHelpers reference here, investigate
define function "PrincipalDiagnosis"(Encounter Encounter):
	(singleton from (Encounter.diagnosis D where FHIRHelpers.ToInteger(D.rank) = 1)) PD
		return singleton from ([Condition] C where C.id = "GetId"(PD.condition.reference))

define function "GetExtension"(element Element, url String):
  singleton from "GetExtensions"(element, url)

/*
NOTE: Extensions are not the preferred approach, but are used as a way to access
content that is defined by extensions but not yet surfaced in the
CQL model info.
*/
define function "GetExtensions"(element Element, url String):
  element.extension E
	  where E.url = (url)
		return E

define function ToString(value AdministrativeGender): value.value

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

define function ToString(value string): 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 MedicationAdministrationStatus): value.value

define function ToString(value ProcedureStatus): value.value

define function ToString(value ObservationStatus): 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 ToBoolean(value boolean): value.value

define function ToString(value MedicationRequestStatus): value.value

define function ToDateTime(value dateTime): value.value

define function ToString(value ServiceRequestStatus): value.value

define function ToString(value uri): value.value

define function ToDateTime(value instant): value.value

define function ToInteger(value integer): value.value

define function ToString(value ServiceRequestIntent): value.value