define "Initial Population":
  "Qualifying Encounter"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Encounter With A Fall Present On Admission"

define "Numerator":
  "Encounter Where A Fall And Major Injury Occurred Not POA"
    union "Encounter Where A Fall And Moderate Injury Occurred Not POA"

define "Numerator Exclusions":
  "Encounter With A Fall Present On Admission"

define function "Denominator Observation"(QualifyingEncounter Encounter):
  duration in days of QualifyingEncounter.hospitalizationWithObservation ( )

define function "Numerator Observation"(QualifyingEncounter Encounter):
  Count("Numerator" FallsEncounter
      where FallsEncounter.period ends during QualifyingEncounter.hospitalizationWithObservation()
  )

define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end

define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

define "Inpatient Encounter":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.status = 'finished'
      and EncounterInpatient.period ends during day of "Measurement Period"

/*
@description: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
  difference in days between start of Value and end of Value

/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
*/
define fluent function hospitalizationWithObservation(TheEncounter Encounter ):
  TheEncounter Visit
  		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
  				where LastObs.status = 'finished'
            and LastObs.period ends 1 hour or less on or before start of Visit.period
  				sort by end of period
  			),
  			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
  			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
  				where LastED.status = 'finished'
            and LastED.period ends 1 hour or less on or before VisitStart
  				sort by end of period
  			)
  		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]

/*
 @description: Returns true if the given diagnosis is present on admission, based on the given poaValueSet
 @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
 */
 define fluent function isDiagnosisPresentOnAdmission(encounter Encounter, diagnosisValueSet ValueSet, poaValueSet ValueSet):
   exists (
     (encounter.claimDiagnosis()) CD
       where CD.onAdmission in poaValueSet
         and (
           CD.diagnosis in diagnosisValueSet
             or CD.diagnosis.getCondition().code in diagnosisValueSet
         )
   )

/*
@description: Returns the claim diagnosis elements for the given encounter
@comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
*/
define fluent function claimDiagnosis(encounter Encounter):
  encounter E
    let 
      claim: ([Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E))),
      claimItem: (claim.item I where I.encounter.references(E))
    return claim.diagnosis D where D.sequence in claimItem.diagnosisSequence

/*
@description: Returns the Condition resource for the given reference
*/
define fluent function getCondition(reference Reference):
  singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where reference.references(C.id))

/*
@description: Returns true if any of the given references are to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(references List<Reference>, resource Resource):
  exists (references R where R.references(resource))

/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))

/*
@description: Returns true if the given reference is to the given resourceId
@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resourceId String):
  resourceId = Last(Split(reference.reference, '/'))

/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
  Last(Split(uri, '/'))

/*
@description: Returns true if the given MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest Choice<MedicationRequest, MedicationNotRequested>):
  exists (medicationRequest.category C
    where C ~ Community
  )

define fluent function medicationRequestPeriod(Request "MedicationRequest"):
  Request R
    let
      dosage: singleton from R.dosageInstruction,
      doseAndRate: singleton from dosage.doseAndRate,
      timing: dosage.timing,
      frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
      period: Quantity(timing.repeat.period, timing.repeat.periodUnit),
      doseRange: doseAndRate.dose,
      doseQuantity: doseAndRate.dose,
      dose: Coalesce(end of doseRange, doseQuantity),
      dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),
      boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
      daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,
      quantity: R.dispenseRequest.quantity,
      refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
      startDate:
        Coalesce(
          date from start of boundsPeriod,
          date from R.authoredOn,
          date from start of R.dispenseRequest.validityPeriod
        ),
      totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)
    return
      if startDate is not null and totalDaysSupplied is not null then
        Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]
      else if startDate is not null and boundsPeriod."high" is not null then
        Interval[startDate, date from end of boundsPeriod]
      else
        null

/**********************************************************************/
/* Functions in this region are copied from opioid-mme-r4             */
/**********************************************************************/

define function Quantity(value Decimal, unit String):
  if value is not null then
    System.Quantity { value: value, unit: unit }
  else
    null

/*
 Goal is to get to number of days
 Two broad approaches to the calculation:
  1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered
  2) Based on relevant period, determine a covered interval and calculate the length of that interval in days
This topic covers several use cases and illustrates how to calculate Cumulative
Medication Duration for each type of medication resource using the supply and
frequency approach.
*/

/*
  For the first approach, we need to get from frequency to a frequency/day
  So we define ToDaily
*/

/*
  Calculates daily frequency given frequency within a period
*/
define function ToDaily(frequency System.Integer, period System.Quantity):
  case period.unit
    when 'h' then frequency * (24.0 / period.value)
    when 'min' then frequency * (24.0 / period.value) * 60
    when 's' then frequency * (24.0 / period.value) * 60 * 60
    when 'd' then frequency * (24.0 / period.value) / 24
    when 'wk' then frequency * (24.0 / period.value) / (24 * 7)
    when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    when 'hour' then frequency * (24.0 / period.value)
    when 'minute' then frequency * (24.0 / period.value) * 60
    when 'second' then frequency * (24.0 / period.value) * 60 * 60
    when 'day' then frequency * (24.0 / period.value) / 24
    when 'week' then frequency * (24.0 / period.value) / (24 * 7)
    when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    when 'hours' then frequency * (24.0 / period.value)
    when 'minutes' then frequency * (24.0 / period.value) * 60
    when 'seconds' then frequency * (24.0 / period.value) * 60 * 60
    when 'days' then frequency * (24.0 / period.value) / 24
    when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)
    when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)
  end

/*
@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]

/*
@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 uri): value.value

define "Qualifying Encounter":
  CQMCommon."Inpatient Encounter" InpatientEncounter
    where InpatientEncounter.hospitalizationWithObservation ( ).lengthInDays ( ) <= 120
      and AgeInYearsAt(date from start of InpatientEncounter.period) >= 18

define "Risk Variable Encounter with Osteoporosis Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Osteoporosis", "Present on Admission or Clinically Undetermined" )

define "Risk Variable Encounter with Coagulation Disorder Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Coagulation Disorders", "Present on Admission or Clinically Undetermined" )

define "Risk Variable Encounter with Antidepressant Active at Admission":
  "Qualifying Encounter" InpatientEncounter
    with ["MedicationRequest": "Antidepressants"] AntidepressantMed
      such that AntidepressantMed.status in { 'active', 'completed' }
        and ( AntidepressantMed.intent = 'order'
            or ( AntidepressantMed.intent = 'plan'
                and AntidepressantMed.subject.reference.getId ( ) = Patient.id
            )
        )
        and AntidepressantMed.isCommunity ( )
        and AntidepressantMed.medicationRequestPeriod ( ) overlaps before day of InpatientEncounter.period

define "Risk Variable All Encounter Diagnoses with Rank and POA Indication":
  from
    "Qualifying Encounter" InpatientEncounter
    let claim: ( [Claim] C
        where C.status = 'active'
          and C.use = 'claim'
          and exists ( C.item ClaimItem
              where ClaimItem.encounter.references ( InpatientEncounter )
          )
    ),
    claimItem: ( claim.item ClaimItem
        where ClaimItem.encounter.references ( InpatientEncounter )
    )
    return Tuple {
      encounterId: InpatientEncounter.id,
      diagnosis: claim.diagnosis,
      rank: claim.diagnosis.sequence,
      POA: claim.diagnosis Diag
        where Diag.onAdmission in "Present on Admission or Clinically Undetermined"
          or Diag.onAdmission in "Not Present On Admission or Documentation Insufficient to Determine"
    }

define "Risk Variable Encounter with Leukemia or Lymphoma Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Leukemia or Lymphoma", "Present on Admission or Clinically Undetermined" )

define "Risk Variable Encounter with Obesity Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Obesity", "Present on Admission or Clinically Undetermined" )

define "Risk Variable Encounter with Peripheral Neuropathy Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Peripheral Neuropathy", "Present on Admission or Clinically Undetermined" )

define "Risk Variable Encounter with Delirium or Dementia or Other Psychosis Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Delirium, Dementia, and Other Psychoses", "Present on Admission or Clinically Undetermined" )

define "Risk Variable Encounter with Suicide Attempt":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.encountersDiagnosis ( ).code in "Suicide Attempt"

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

define "Risk Variable Encounter with Liver Disease Moderate to Severe Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Liver Disease Moderate to Severe", "Present on Admission or Clinically Undetermined" )

define "Initial Population":
  "Qualifying Encounter"

define "Risk Variable Encounter with Anticoagulant Administration During Encounter":
  "Qualifying Encounter" InpatientEncounter
    with ["MedicationAdministration": "Anticoagulants for All Indications"] Anticoagulants
      such that Anticoagulants.effective.toInterval ( ) starts during InpatientEncounter.hospitalizationWithObservation ( )
        and Anticoagulants.status in { 'in-progress', 'completed' }

define "Risk Variable Encounter with Neurologic Disorder Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Neurologic Movement and Related Disorders", "Present on Admission or Clinically Undetermined" )

define "Risk Variable Encounter with Abnormal Weight Loss or Malnutrition Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Abnormal Weight Loss", "Present on Admission or Clinically Undetermined" )
      or InpatientEncounter.isDiagnosisPresentOnAdmission ( "Malnutrition", "Present on Admission or Clinically Undetermined" )

define "Risk Variable Encounter with Anticoagulant Active at Admission":
  "Qualifying Encounter" InpatientEncounter
    with ["MedicationRequest": "Anticoagulants for All Indications"] Anticoagulants
      such that Anticoagulants.status in { 'active', 'completed' }
        and ( Anticoagulants.intent = 'order'
            or ( Anticoagulants.intent = 'plan'
                and Anticoagulants.subject.reference.getId ( ) = Patient.id
            )
        )
        and Anticoagulants.isCommunity ( )
        and Anticoagulants.medicationRequestPeriod ( ) overlaps before day of InpatientEncounter.period

define "Risk Variable Body Mass Index (BMI)":
  from
    ["USCoreBMIProfile"] BMI
    with "Qualifying Encounter" InpatientEncounter
      such that BMI.effective.toInterval ( ) starts during InpatientEncounter.hospitalizationWithObservation ( )
        and BMI.value is not null
        and BMI.status in { 'final', 'amended', 'corrected' }
    return BMI.value as Quantity

define "Risk Variable Encounter with Depression Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Depression", "Present on Admission or Clinically Undetermined" )

define "Risk Variable Encounter with Epilepsy Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Epilepsy", "Present on Admission or Clinically Undetermined" )

define "Risk Variable Encounter with Diuretic Active at Admission":
  "Qualifying Encounter" InpatientEncounter
    with ["MedicationRequest": "Diuretics"] DiureticMed
      such that DiureticMed.status in { 'active', 'completed' }
        and ( DiureticMed.intent = 'order'
            or ( DiureticMed.intent = 'plan'
                and DiureticMed.subject.reference.getId ( ) = Patient.id
            )
        )
        and DiureticMed.isCommunity ( )
        and DiureticMed.medicationRequestPeriod ( ) overlaps before day of InpatientEncounter.period

define "Risk Variable Encounter with CNS Depressant Active at Admission":
  "Qualifying Encounter" InpatientEncounter
    with ["MedicationRequest": "Central Nervous System Depressants"] CNSMed
      such that CNSMed.status in { 'active', 'completed' }
        and ( CNSMed.intent = 'order'
            or ( CNSMed.intent = 'plan'
                and CNSMed.subject.reference.getId ( ) = Patient.id
            )
        )
        and CNSMed.isCommunity ( )
        and CNSMed.medicationRequestPeriod ( ) overlaps before day of InpatientEncounter.period

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

define "Risk Variable Encounter with Malignant Bone Disease Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Malignant Bone Disease", "Present on Admission or Clinically Undetermined" )

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

define "Risk Variable Encounter with Antihypertensive Active at Admission":
  "Qualifying Encounter" InpatientEncounter
    with ["MedicationRequest": "Antihypertensives"] BPMed
      such that BPMed.status in { 'active', 'completed' }
        and ( BPMed.intent = 'order'
            or ( BPMed.intent = 'plan'
                and BPMed.subject.reference.getId ( ) = Patient.id
            )
        )
        and BPMed.isCommunity ( )
        and BPMed.medicationRequestPeriod ( ) overlaps before day of InpatientEncounter.period

define "Risk Variable Encounter with Opioid Medication Active at Admission":
  "Qualifying Encounter" InpatientEncounter
    with ["MedicationRequest": "Opioids"] OpioidMed
      such that OpioidMed.status in { 'active', 'completed' }
        and ( OpioidMed.intent = 'order'
            or ( OpioidMed.intent = 'plan'
                and OpioidMed.subject.reference.getId ( ) = Patient.id
            )
        )
        and OpioidMed.isCommunity ( )
        and OpioidMed.medicationRequestPeriod ( ) overlaps before day of InpatientEncounter.period

define "Encounter With A Fall Diagnosis":
  "Qualifying Encounter" QualifyingFall
    where QualifyingFall.reasonCode in "Inpatient Falls"
      or QualifyingFall.encountersDiagnosis ( ).code in "Inpatient Falls"

define "Encounter With A Fall Event":
  "Qualifying Encounter" InpatientEncounter
    with [AdverseEvent: "Inpatient Falls"] FallsDocumentation
      such that Coalesce(FallsDocumentation.date, FallsDocumentation.recordedDate) during InpatientEncounter.hospitalizationWithObservation ( )

define "Encounter Where A Fall Occurred":
  "Encounter With A Fall Diagnosis" EncounterFallDiagnosis
    union "Encounter With A Fall Event" EncounterFallEvent

define "Encounter With A Fall Not Present On Admission":
  "Encounter Where A Fall Occurred" EncounterFallDiagnosis
    where EncounterFallDiagnosis.hasDiagnosisNotPresentOnAdmissionOrNull ( "Inpatient Falls" )

define "Encounter Where A Fall And Major Injury Occurred Not POA":
  "Encounter With A Fall Not Present On Admission" FallOccurred
    where exists ( ( FallOccurred.claimDiagnosis ( ) ) MajorFallOccurred
        where ( MajorFallOccurred.onAdmission is null
            or MajorFallOccurred.onAdmission in "Not Present On Admission or Documentation Insufficient to Determine"
        )
          and ( MajorFallOccurred.diagnosis in "Major Injuries"
              or MajorFallOccurred.diagnosis.getCondition ( ).code in "Major Injuries"
          )
    )

define "Encounter Where A Fall And Moderate Injury Occurred Not POA":
  "Encounter With A Fall Not Present On Admission" FallOccurred
    where exists ( ( FallOccurred.claimDiagnosis ( ) ) ModerateFallOccurred
        where ( ModerateFallOccurred.onAdmission is null
            or ModerateFallOccurred.onAdmission in "Not Present On Admission or Documentation Insufficient to Determine"
        )
          and ( ModerateFallOccurred.diagnosis in "Moderate Injuries"
              or ModerateFallOccurred.diagnosis.getCondition ( ).code in "Moderate Injuries"
          )
    )

define "Numerator":
  "Encounter Where A Fall And Major Injury Occurred Not POA"
    union "Encounter Where A Fall And Moderate Injury Occurred Not POA"

define "Denominator":
  "Initial Population"

define "Encounter With A Fall Present On Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Inpatient Falls", "Present on Admission or Clinically Undetermined" )

define "Numerator Exclusions":
  "Encounter With A Fall Present On Admission"

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

define "Denominator Exclusions":
  "Encounter With A Fall Present On Admission"

define "Risk Variable Encounter with Stroke Present on Admission":
  "Qualifying Encounter" InpatientEncounter
    where InpatientEncounter.isDiagnosisPresentOnAdmission ( "Stroke", "Present on Admission or Clinically Undetermined" )

define fluent function encountersDiagnosis(Encounter Encounter):
  Encounter.reasonReference EncDiag
    return singleton from ( ( [ConditionEncounterDiagnosis] ConditionED
        union [ConditionProblemsHealthConcerns] ConditionPHC ) Cond
        where EncDiag.references ( Cond.id )
    )

define function "Denominator Observation"(QualifyingEncounter Encounter):
  duration in days of QualifyingEncounter.hospitalizationWithObservation ( )

define fluent function hasDiagnosisNotPresentOnAdmissionOrNull(encounter Encounter, diagnosisValueSet ValueSet):
  exists ( [Claim] C
      where C.status = 'active'
        and C.use = 'claim'
        and exists ( C.item I
            where I.encounter.references ( encounter )
        )
      return C.diagnosis D
        where exists ( C.item I
            where I.encounter.references ( encounter )
              and D.sequence in I.diagnosisSequence
        )
          and ( D.onAdmission is null
              or D.onAdmission in "Not Present On Admission or Documentation Insufficient to Determine"
          )
          and D.diagnosis in diagnosisValueSet
  )

define function "Numerator Observation"(QualifyingEncounter Encounter):
  Count("Numerator" FallsEncounter
      where FallsEncounter.period ends during QualifyingEncounter.hospitalizationWithObservation()
  )