/*
NOTE: For use by March 2026 US Realm Connectathon participants for internal use only. Not for use or distribution in commercial products.
*/
library CMS816FHIRHHHypo version '1.1.000'

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.USCoreCommon version '2.0.0-ballot' called USCoreCommon
include hl7.fhir.us.cql.USCoreElements version '2.0.0-ballot' called USCoreElements

include CQMCommon version '5.1.000' called CQMCommon
include USQualityCoreCommon version '0.1.0-cibuild' called USQualityCoreCommon
include SupplementalDataElements version '6.1.000' called SDE
include Status version '2.1.000' called Status

valueset "Encounter Inpatient": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307'
valueset "Glucose Lab Test Mass Per Volume": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1248.34'
valueset "Hypoglycemics Severe Hypoglycemia": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1196.393'
valueset "Positive Pregnancy Status": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.24'

parameter "Measurement Period" Interval<DateTime>
  default Interval[@2026-01-01T00:00:00.000Z, @2027-01-01T00:00:00.000Z)

context Patient

define "Denominator":
  "Initial Population"

define "Encounter With Severe Hypoglycemic Harm Event":
  from
    "Denominator" InpatientHospitalization,
    "Severe Hypoglycemic Harm Event" HypoglycemicEvent
    let GlucoseTestTime: HypoglycemicEvent.effective.earliest ( ),
    HospitalizationInterval: InpatientHospitalization.hospitalizationWithObservation ( )
    where GlucoseTestTime during HospitalizationInterval
    return InpatientHospitalization

define "Glucose Test With Result Less Than 40":
  from
    "Denominator" InpatientHospitalization,
    "Hypoglycemic Medication Administration" HypoglycemicMedication,
    ["LaboratoryResultObservation": "Glucose Lab Test Mass Per Volume"] GlucoseTest
    let HospitalizationInterval: InpatientHospitalization.hospitalizationWithObservation ( ),
    HypoglycemicMedicationStart: HypoglycemicMedication.effective.toInterval ( ),
    GlucoseTestTime: GlucoseTest.effective.earliest ( )
    where GlucoseTestTime during HospitalizationInterval
      and GlucoseTest.status in { 'final', 'amended', 'corrected' }
      and GlucoseTest.value < 40 'mg/dL'
      and HypoglycemicMedicationStart starts 24 hours or less before or on GlucoseTestTime
    return GlucoseTest

define "Hypoglycemic Medication Administration":
  ["MedicationAdministration": "Hypoglycemics Severe Hypoglycemia"] HypoMedication
    where HypoMedication.status = 'completed'

define "Initial Population":
  "Encounter With Hypoglycemic Medication Administration"

define "Numerator":
  "Encounter With Severe Hypoglycemic Harm Event"

define "Qualifying Encounter":
  ["Encounter": "Encounter Inpatient"] InpatientEncounter
    where AgeInYearsAt(date from start of InpatientEncounter.period) >= 18
      and InpatientEncounter.period ends during day of "Measurement Period"
      and InpatientEncounter.status = 'finished'

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 "Encounter With Hypoglycemic Medication Administration":
  "Qualifying Encounter" InpatientHospitalization
    with "Hypoglycemic Medication Administration" HypoglycemicMedication
      such that HypoglycemicMedication.effective.toInterval ( ) starts during InpatientHospitalization.hospitalizationWithObservation ( )

define "Low Glucose Test Followed By Glucose Test Result Greater Than 80":
  from
    "Denominator" InpatientHospitalization,
    "Glucose Test With Result Less Than 40" LowGlucoseTest,
    ["LaboratoryResultObservation": "Glucose Lab Test Mass Per Volume"] FollowupGlucoseTest
    let GlucoseTestTime: LowGlucoseTest.effective.earliest ( ),
    FollowupGlucoseTestTime: FollowupGlucoseTest.effective.earliest ( )
    where FollowupGlucoseTestTime 5 minutes or less after GlucoseTestTime
      and GlucoseTestTime during InpatientHospitalization.hospitalizationWithObservation ( )
      and FollowupGlucoseTestTime during InpatientHospitalization.hospitalizationWithObservation ( )
      and FollowupGlucoseTest.id !~ LowGlucoseTest.id
      and FollowupGlucoseTest.status in { 'final', 'amended', 'corrected' }
      and FollowupGlucoseTest.value > 80 'mg/dL'
    return LowGlucoseTest

define "Severe Hypoglycemic Harm Event":
  "Glucose Test With Result Less Than 40" LowGlucoseTest
    where not ( LowGlucoseTest.id in "Low Glucose Test Followed By Glucose Test Result Greater Than 80".id )