define "Initial Population":   exists ( ["Patient"] BirthDate         where Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( BirthDate.birthDate ), start of "Measurement Period" ) >= 18     )       and ( Count("Office Based Visit During Measurement Period")>= 2           or exists "Preventive Visit During Measurement Period"       )

define "Denominator 1":   "Initial Population"

define "Denominator Exceptions 1":   exists "Medical Reason for Not Screening for Tobacco Use"       or "Has Limited Life Expectancy"

define "Numerator 1":   "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null       or "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

define "Initial Population":   exists ( ["Patient"] BirthDate         where Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( BirthDate.birthDate ), start of "Measurement Period" ) >= 18     )       and ( Count("Office Based Visit During Measurement Period")>= 2           or exists "Preventive Visit During Measurement Period"       )

define "Denominator 2":   "Initial Population"       and "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

define "Denominator Exceptions 2":   exists "Medical Reason for Not Counseling Tobacco User"       or exists "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy"       or "Has Limited Life Expectancy"

define "Numerator 2":   exists "Tobacco Cessation Counseling Given"       or exists "Tobacco Cessation Pharmacotherapy Ordered"

define "Initial Population":   exists ( ["Patient"] BirthDate         where Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( BirthDate.birthDate ), start of "Measurement Period" ) >= 18     )       and ( Count("Office Based Visit During Measurement Period")>= 2           or exists "Preventive Visit During Measurement Period"       )

define "Denominator 3":   "Initial Population"

define "Denominator Exceptions 3":   exists "Medical Reason for Not Screening for Tobacco Use"       or exists "Medical Reason for Not Counseling Tobacco User"       or exists "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy"       or "Has Limited Life Expectancy"

define "Numerator 3":   "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null       or ( "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null           and ( exists "Tobacco Cessation Counseling Given"               or exists "Tobacco Cessation Pharmacotherapy Ordered"               //or exists "Active Pharmacotherapy for Tobacco Cessation"           )       )

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":   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 "Most Recent Tobacco Use Screening Indicates Tobacco Non User":   ( Last(["Observation": "Tobacco Use Screening"] TobaccoUseScreening         where Global."Normalize Interval"(TobaccoUseScreening.effective)overlaps "Measurement Period"         sort by start of Global."Normalize Interval"(effective)     )) MostRecentTobaccoUseScreening       where MostRecentTobaccoUseScreening.value in "Tobacco Non-User"

define "Most Recent Tobacco Use Screening Indicates Tobacco User":   ( Last(["Observation": "Tobacco Use Screening"] TobaccoUseScreening         where Global."Normalize Interval"(TobaccoUseScreening.effective)overlaps "Measurement Period"         sort by start of Global."Normalize Interval"(effective)     )) MostRecentTobaccoUseScreening       where MostRecentTobaccoUseScreening.value in "Tobacco User"

// MedicationStatement is not available in R5, known publication issue //define "Active Pharmacotherapy for Tobacco Cessation": //  ["MedicationStatement": "Tobacco Use Cessation Pharmacotherapy"] TakingCessationPharmacotherapy //      where Global."Normalize Interval" ( TakingCessationPharmacotherapy.effective ) overlaps after "Measurement Period" //        and TakingCessationPharmacotherapy.status in { 'active', 'completed' }  define "Tobacco Cessation Counseling Given":   ["Encounter": "Tobacco Use Cessation Counseling"] TobaccoCessationCounseling       where TobaccoCessationCounseling.period during "Measurement Period"         and TobaccoCessationCounseling.status = 'finished'

define "Tobacco Cessation Pharmacotherapy Ordered":   ["MedicationRequest": "Tobacco Use Cessation Pharmacotherapy"] CessationPharmacotherapyOrdered       where CessationPharmacotherapyOrdered.authoredOn during "Measurement Period"         and CessationPharmacotherapyOrdered.status = 'active'

define "Numerator 3":   "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null       or ( "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null           and ( exists "Tobacco Cessation Counseling Given"               or exists "Tobacco Cessation Pharmacotherapy Ordered"               //or exists "Active Pharmacotherapy for Tobacco Cessation"           )       )

define "Medical Reason for Not Screening for Tobacco Use":   ["Observation": "Tobacco Use Screening"] NoTobaccoUseScreening       where NoTobaccoUseScreening.issued during "Measurement Period"         and "Not Done"(NoTobaccoUseScreening)         and "Not Done Reason in Medical Reason"(NoTobaccoUseScreening)         and NoTobaccoUseScreening.status = 'final'

//or exists "Active Pharmacotherapy for Tobacco Cessation"  define "Has Limited Life Expectancy":   exists ( ["Condition"] LimitedLifeExpectancy         where Global."Prevalence Period" ( LimitedLifeExpectancy ) overlaps after "Measurement Period"           and LimitedLifeExpectancy.clinicalStatus ~ ToConcept(Global."active")     )

define "Denominator Exceptions 1":   exists "Medical Reason for Not Screening for Tobacco Use"       or "Has Limited Life Expectancy"

define "Numerator 1":   "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null       or "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

define "Numerator 2":   exists "Tobacco Cessation Counseling Given"       or exists "Tobacco Cessation Pharmacotherapy Ordered"

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

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

define "Office Based Visit During Measurement Period":   ( ["Encounter": "Health behavior intervention, individual, face-to-face; initial 30 minutes"]       union ["Encounter": "Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)"]       union ["Encounter": "Home Healthcare Services"]       union ["Encounter": "Occupational Therapy Evaluation"]       union ["Encounter": "Office Visit"]       union ["Encounter": "Ophthalmological Services"]       union ["Encounter": "Physical Therapy Evaluation"]       union ["Encounter": "Psych Visit - Diagnostic Evaluation"]       union ["Encounter": "Psych Visit - Psychotherapy"]       union ["Encounter": "Psychoanalysis"]       union ["Encounter": "Speech and Hearing Evaluation"] ) OfficeBasedEncounter       where OfficeBasedEncounter.period during "Measurement Period"         and OfficeBasedEncounter.status = 'finished'

define "Preventive Visit During Measurement Period":   ( ["Encounter": "Annual Wellness Visit"]       union ["Encounter": "Preventive Care Services - Established Office Visit, 18 and Up"]       union ["Encounter": "Preventive Care Services - Group Counseling"]       union ["Encounter": "Preventive Care Services - Other"]       union ["Encounter": "Preventive Care Services-Individual Counseling"]       union ["Encounter": "Preventive Care Services-Initial Office Visit, 18 and Up"] ) PreventiveEncounter       where PreventiveEncounter.period during "Measurement Period"         and PreventiveEncounter.status = 'finished'

define "Initial Population":   exists ( ["Patient"] BirthDate         where Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( BirthDate.birthDate ), start of "Measurement Period" ) >= 18     )       and ( Count("Office Based Visit During Measurement Period")>= 2           or exists "Preventive Visit During Measurement Period"       )

define "Denominator 3":   "Initial Population"

define "Denominator 2":   "Initial Population"       and "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null

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

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

define "Medical Reason for Not Counseling Tobacco User":   ["Procedure": "Tobacco Use Cessation Counseling"] NoTobaccoCessationCounseling       where Global."Normalize Interval" ( NoTobaccoCessationCounseling.performed ) starts during "Measurement Period"         and ( ( NoTobaccoCessationCounseling.status = 'not-done'               and NoTobaccoCessationCounseling.statusReason in "Medical Reason"           )             or ( "Not Done"(NoTobaccoCessationCounseling)                 and "Not Done Reason in Medical Reason"(NoTobaccoCessationCounseling)             )         )

define "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy":   ["MedicationRequest": "Tobacco Use Cessation Pharmacotherapy"] NoCessationPharmacotherapyOrdered       where NoCessationPharmacotherapyOrdered.authoredOn during "Measurement Period"         and NoCessationPharmacotherapyOrdered.status = 'completed'         and ( ( "Not Done"(NoCessationPharmacotherapyOrdered)               and "Not Done Reason in Medical Reason"(NoCessationPharmacotherapyOrdered)           )             or ( NoCessationPharmacotherapyOrdered.doNotPerform = true                 and NoCessationPharmacotherapyOrdered.statusReason in "Medical Reason"             )         )

define "Denominator Exceptions 2":   exists "Medical Reason for Not Counseling Tobacco User"       or exists "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy"       or "Has Limited Life Expectancy"

define "Denominator Exceptions 3":   exists "Medical Reason for Not Screening for Tobacco Use"       or exists "Medical Reason for Not Counseling Tobacco User"       or exists "Medical Reason for Not Ordering Tobacco Cessation Pharmacotherapy"       or "Has Limited Life Expectancy"

define "Denominator 1":   "Initial Population"

define function "Not Done"(res DomainResource ):   if ( res R       where ( "GetModiferExtension"(R, 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDone').value = true )   ) is not null then true     else false

define function "GetModiferExtension"(res DomainResource, url String ):   singleton from "GetModifierExtensions"(res, url)

define function "GetModifierExtensions"(res DomainResource, url String ):   res.modifierExtension E     where E.url = ( url )     return E

define function "Not Done Reason in Medical Reason"(res DomainResource ):   if ( res R       where "GetModiferExtension"(R, 'http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-notDoneReason').value in "Medical Reason"   ) is not null then true     else false

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 "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 ToString(value string): 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

/* @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 ToDateTime(value dateTime): value.value

define function ToString(value MedicationRequestStatus): value.value

define function ToDateTime(value instant): value.value

define function ToBoolean(value boolean): value.value

define function ToString(value uri): value.value

define function ToString(value base64Binary): value.value

define function ToString(value ObservationStatus): value.value

define function ToDate(value date): 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 AdministrativeGender): value.value

define function ToString(value ProcedureStatus): value.value