/*
This example is a work in progress and should not be considered a final specification
or recommendation for guidance. This example will help guide and direct the process
of finding conventions and usage patterns that meet the needs of the various stakeholders
in the measure development community.
*/
library AdvancedIllnessandFrailtyExclusion

using FHIR version '4.0.1'

include hl7.fhir.uv.cql.FHIRHelpers version '4.0.1' called FHIRHelpers

include MATGlobalCommonFunctions called Global

codesystem "LOINC": 'http://loinc.org'

valueset "Acute Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1083'
valueset "Advanced Illness": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082'
valueset "Care Services in Long-Term Residential Facility": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014'
valueset "Dementia Medications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510'
valueset "ED": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1085'
valueset "Frailty Device": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.118.12.1300'
valueset "Frailty Diagnosis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1074'
valueset "Frailty Encounter": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1088'
valueset "Frailty Symptom": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.113.12.1075'
valueset "Nonacute Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1084'
valueset "Nursing Facility Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012'
valueset "Observation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1086'
valueset "Outpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087'

code "Birth date": '21112-8' from "LOINC" display 'Birth date'

parameter "Measurement Period" Interval<DateTime>
  default Interval[@2019-01-01T00:00:00.0, @2020-01-01T00:00:00.0)

context Patient

define "Advanced Illness and Frailty Exclusion Including Over Age 80":
  //If the measure includes populations age 80 and older, then use this logic:
      	(
              Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period")in Interval[66, 80]
                  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"
                  )
      	)
      		or (
                  Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period")>= 81
      			    and "Has Criteria Indicating Frailty"
      		)

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"
              )

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 "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 "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"
      // 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 "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 function "CumulativeDays"(Intervals List<Interval<DateTime>> ):
  Sum((collapse Intervals)CollapsedInterval
  			return all duration in days of CollapsedInterval
  	)

Encoded data 

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