/*
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 CCSComponent

using FHIR version '4.0.1'

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

include SupplementalDataElements called SDE
include MATGlobalCommonFunctions called Global
include AdultOutpatientEncounters called AdultOutpatientEncounters
include Hospice called Hospice
include AdvancedIllnessandFrailtyExclusion called Frailty

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 "Annual Wellness Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1240'
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 "Colonoscopy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020'
valueset "CT Colonography": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038'
valueset "Dementia Medications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510'
valueset "Discharged to Health Care Facility for Hospice Care": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.207'
valueset "Discharged to Home for Hospice Care": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.209'
valueset "ED": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1085'
valueset "Encounter Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307'
valueset "Fecal Occult Blood Test (FOBT)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011'
valueset "FIT DNA": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039'
valueset "Flexible Sigmoidoscopy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010'
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 "Home Healthcare Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016'
valueset "Hospice care ambulatory": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1108.15'
valueset "Malignant Neoplasm of Colon": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001'
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 "Office Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001'
valueset "Outpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1087'
valueset "Preventive Care Services - Established Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025'
valueset "Preventive Care Services-Initial Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023'
valueset "Total Colectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019'

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

parameter "Measurement Period" Interval<DateTime>

context Patient

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

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

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

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

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 "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 "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 "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 "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 "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 "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 "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 "Malignant Neoplasm":
  [Condition: "Malignant Neoplasm of Colon"] ColorectalCancer
      where Global."Prevalence Period" ( ColorectalCancer ) 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"

Encoded data 

Encoded data