/*
NOTE: For use by March 2026 US Realm Connectathon participants for internal use only. Not for use or distribution in commercial products.
*/
library AdvancedIllnessandFrailty version '2.1.000'

using USQualityCore version '0.1.0-cibuild'
using USCore version '6.1.0-derived'
using FHIR version '4.0.1'

include hl7.fhir.uv.cql.FHIRHelpers version '4.0.1' called FHIRHelpers
include hl7.fhir.uv.cql.FHIRCommon version '2.0.0' called FHIRCommon
include hl7.fhir.us.cql.CumulativeMedicationDuration version '2.0.0-ballot' called CMD

include Status version '2.1.000' called Status

codesystem "LOINC": 'http://loinc.org'
codesystem "SNOMEDCT": 'http://snomed.info/sct'

valueset "Advanced Illness": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1082'
valueset "Dementia Medications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1510'
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'
 
code "Housing status": '71802-3' from "LOINC" display 'Housing status'
code "Lives in nursing home (finding)": '160734000' from "SNOMEDCT" display 'Lives in nursing home (finding)'
code "Medical equipment used": '98181-1' from "LOINC" display 'Medical equipment used'

parameter "Measurement Period" Interval<DateTime>

context Patient

define "Is Age 66 or Older with Advanced Illness and Frailty":
   AgeInYearsAt(date from end of "Measurement Period") >= 66
    and "Has Criteria Indicating Frailty"
    and ( "Has Advanced Illness in Year Before or During Measurement Period"
        or "Has Dementia Medications in Year Before or During Measurement Period"
    )

define "Is Age 66 to 80 with Advanced Illness and Frailty or Is Age 81 or Older with Frailty":
  ( AgeInYearsAt(date from end of "Measurement Period") in Interval[66, 80]
      and "Has Criteria Indicating Frailty"
      and ( "Has Advanced Illness in Year Before or During Measurement Period"
          or "Has Dementia Medications in Year Before or During Measurement Period"
      )
  )
    or ( AgeInYearsAt(date from end of "Measurement Period")>= 81
        and "Has Criteria Indicating Frailty"
    )

define "Has Criteria Indicating Frailty":
  exists ( (([USQualityCore.DeviceRequest: "Frailty Device"]).isDeviceOrderPersonalUseDevices()) FrailtyDeviceOrder
      where FrailtyDeviceOrder.authoredOn.toInterval() during day of "Measurement Period"
  )
    or exists ( (([ObservationScreeningAssessment: "Medical equipment used"]).isAssessmentPerformed()) EquipmentUsed
        where EquipmentUsed.value as CodeableConcept in "Frailty Device" 
        and EquipmentUsed.effective.toInterval() ends during day of "Measurement Period"
    )
    // TODO: Consider whether to keep this as the union of problems and encounter diagnoses
    or exists ( (([FHIR.Condition: "Frailty Diagnosis"]).verified()) FrailtyDiagnosis
        where FrailtyDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )
    or exists ( (([USQualityCore.Encounter: "Frailty Encounter"]).isEncounterPerformed()) FrailtyEncounter
        where FrailtyEncounter.period overlaps day of "Measurement Period"
    )
    or exists ( (([USQualityCore.SimpleObservation: "Frailty Symptom"]).isSymptom()) FrailtySymptom
        where FrailtySymptom.effective.toInterval() overlaps day of "Measurement Period"
    )

define "Has Advanced Illness in Year Before or During Measurement Period":
// TODO: Consider whether to keep this as the union of problems and encounter diagnoses
exists ((([Condition: "Advanced Illness"]).verified()) AdvancedIllnessDiagnosis
where AdvancedIllnessDiagnosis.prevalenceInterval() starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"])

define "Has Dementia Medications in Year Before or During Measurement Period":
  exists (( ([FHIR.MedicationRequest: "Dementia Medications"]).isMedicationActive()) DementiaMedication
      where DementiaMedication.medicationRequestPeriod() overlaps day of Interval[start of "Measurement Period" - 1 year, 
        end of "Measurement Period"]
  )

define "Is Age 66 or Older Living Long Term in a Nursing Home":
  AgeInYearsAt(date from end of "Measurement Period") >= 66
    and ( ( Last( (([ObservationScreeningAssessment: "Housing status"]).isAssessmentPerformed()) HousingStatus    
          where HousingStatus.effective.toInterval() ends on or before 
          day of end of "Measurement Period"
          sort by 
          end of effective.toInterval() asc
      )) LastHousingStatus
        where LastHousingStatus.value ~ "Lives in nursing home (finding)"
    ) is not null
  

Encoded data 

Encoded data