define "Initial Population":
  Patient.gender = 'female'
      and Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[51, 74 )
      and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":
  "Initial Population"

define "Denominator Exclusion":
  Hospice."Has Hospice"
      or ( ( exists "Right Mastectomy Diagnosis"
            or exists "Right Mastectomy Procedure"
        )
          and ( exists "Left Mastectomy"
              or exists "Left Mastectomy Procedure"
          )
      )
      or exists "Bilateral Mastectomy Diagnosis"
      or exists "Bilateral Mastectomy Procedure"
      or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"
      or ( Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) >= 65
          and Frailty."Long Term Care Periods Longer Than 90 Consecutive Days"
      )

define "Numerator":
  exists ( [DiagnosticReport: "Mammography"] Mammogram
        where ( Global."Normalize Interval" ( Mammogram.effective ) ends 27 months or less on or before
          end of "Measurement Period"
        )
          and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' }
    )

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 "Numerator":
  exists ( [DiagnosticReport: "Mammography"] Mammogram
        where ( Global."Normalize Interval" ( Mammogram.effective ) ends 27 months or less on or before
          end of "Measurement Period"
        )
          and Mammogram.status in { 'final', 'amended', 'corrected', 'appended' }
    )

define "Initial Population":
  Patient.gender = 'female'
      and Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) in Interval[51, 74 )
      and exists AdultOutpatientEncounters."Qualifying Encounters"

define "Denominator":
  "Initial Population"

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

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

define "Right Mastectomy Diagnosis":
  ( ( [Condition: "Status Post Right Mastectomy"] )
      union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis
          where UnilateralMastectomyDiagnosis.bodySite in "Right"
      ) ) RightMastectomy
      where Global."Normalize Interval" ( RightMastectomy.onset ) starts on or before
      end of "Measurement Period"

define "Right Mastectomy Procedure":
  [Procedure: "Unilateral Mastectomy Right"] UnilateralMastectomyRightPerformed
      where Global."Normalize Interval" ( UnilateralMastectomyRightPerformed.performed ) ends on or before
      end of "Measurement Period"
        and UnilateralMastectomyRightPerformed.status = 'completed'

define "Left Mastectomy":
  ( ( [Condition: "Status Post Left Mastectomy"] )
      union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis
          where UnilateralMastectomyDiagnosis.bodySite in "Left"
      ) ) LeftMastectomy
      where Global."Normalize Interval" ( LeftMastectomy.onset ) starts on or before
      end of "Measurement Period"

define "Left Mastectomy Procedure":
  [Procedure: "Unilateral Mastectomy Left"] UnilateralMastectomyLeftPerformed
      where Global."Normalize Interval" ( UnilateralMastectomyLeftPerformed.performed ) ends on or before
      end of "Measurement Period"
        and UnilateralMastectomyLeftPerformed.status = 'completed'

define "Bilateral Mastectomy Diagnosis":
  [Condition: "History of bilateral mastectomy"] BilateralMastectomyHistory
      where Global."Normalize Interval" ( BilateralMastectomyHistory.onset ) starts on or before
      end of "Measurement Period"

define "Bilateral Mastectomy Procedure":
  [Procedure: "Bilateral Mastectomy"] BilateralMastectomyPerformed
      where Global."Normalize Interval" ( BilateralMastectomyPerformed.performed ) ends on or before
      end of "Measurement Period"
        and BilateralMastectomyPerformed.status = 'completed'

define "Denominator Exclusion":
  Hospice."Has Hospice"
      or ( ( exists "Right Mastectomy Diagnosis"
            or exists "Right Mastectomy Procedure"
        )
          and ( exists "Left Mastectomy"
              or exists "Left Mastectomy Procedure"
          )
      )
      or exists "Bilateral Mastectomy Diagnosis"
      or exists "Bilateral Mastectomy Procedure"
      or Frailty."Advanced Illness and Frailty Exclusion Not Including Over Age 80"
      or ( Global."CalendarAgeInYearsAt" ( FHIRHelpers.ToDate ( Patient.birthDate ), start of "Measurement Period" ) >= 65
          and Frailty."Long Term Care Periods Longer Than 90 Consecutive Days"
      )

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

/*
*
*    CQFMeasures Common Logic
*
*/

define function "Normalize Interval"(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):
  case
	  when choice is FHIR.dateTime then
    	Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]
		when choice is FHIR.Period then
  		FHIRHelpers.ToInterval(choice as FHIR.Period)
		when choice is FHIR.instant then
			Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]
		when choice is FHIR.Age then
		  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),
			  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)
		when choice is FHIR.Range then
		  Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),
			  FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)
		when choice is FHIR.Timing then
		  Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute a single interval from a Timing type')
    when choice is FHIR.string then
      Message(null as Interval<DateTime>, true, '1', 'Error', 'Cannot compute an interval from a String value')
		else
			null as Interval<DateTime>
	end

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 ToDateTime(value dateTime): 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 ToDateTime(value instant): 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 DiagnosticReportStatus): value.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 ToString(value ProcedureStatus): value.value

define function ToString(value string): value.value