define "Initial Population":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Encounter Less Than 2 Days"
    union "Encounter With ICU Location Stay 1 Day Or More"
    union "Encounter With Principal Diagnosis Of Mental Disorder Or Stroke"
    union "Encounter With Principal Procedure Of Selected Surgery"
    union "Encounter With Intervention Comfort Measures From Day Of Start Of Hospitalization To Day After Admission"
    union "Encounter With Intervention Comfort Measures On Day Of Or Day After Procedure"

define "Numerator":
  "Encounter With VTE Prophylaxis Received From Day Of Start Of Hospitalization To Day After Admission Or Procedure"
    union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered On Day Of Or Day After Admission Or Procedure"
        intersect ( "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Prior Diagnosis Of VTE"
            union "Encounter With Prior Or Present Procedure Of Hip Or Knee Replacement Surgery"
        )
    )
    union "Encounter With Low Risk For VTE Or Anticoagulant Administered"
    union "Encounter With No VTE Prophylaxis Due To Medical Reason"
    union "Encounter With No VTE Prophylaxis Due To Patient Refusal"

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

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

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

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

define function ToString(value uri): 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]

/*
@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 "SDE Sex":
  SDE."SDE Sex"

define "Pharmacological or Mechanical VTE Prophylaxis Received":
  ( ["MedicationAdministration": "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
      where VTEMedication.status = 'completed'
        and VTEMedication.dosage.route in "Subcutaneous route"
  )
    union ( ["MedicationAdministration": "Low Molecular Weight Heparin for VTE Prophylaxis"] LMWH
        where LMWH.status = 'completed'
    )
    union ( ["MedicationAdministration": "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] FactorXa
        where FactorXa.status = 'completed'
    )
    union ( ["MedicationAdministration": "Warfarin"] WarfarinAdm
        where WarfarinAdm.status = 'completed'
    )
    union ( ["MedicationAdministration": "Rivaroxaban for VTE Prophylaxis"] Rivaroxaban
        where Rivaroxaban.status = 'completed'
    )
    union ( ( ["Procedure": "Application of Intermittent Pneumatic Compression Devices"]
        union ["Procedure": "Application of Venous Foot Pumps"]
        union ["Procedure": "Application of Graduated Compression Stockings"] ) DeviceApplied
        where DeviceApplied.status = 'completed'
    )

define "Encounter With VTE Prophylaxis Received From Day Of Start Of Hospitalization To Day After Admission Or Procedure":
  ( from
      VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter,
      "Pharmacological or Mechanical VTE Prophylaxis Received" VTEProphylaxis
      where Coalesce(VTEProphylaxis.effective.toInterval(), VTEProphylaxis.performed.toInterval()) starts during day of QualifyingEncounter.fromDayOfStartOfHospitalizationToDayAfterAdmission ( )
      return QualifyingEncounter
  )
    union ( from
        VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter,
        ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
        "Pharmacological or Mechanical VTE Prophylaxis Received" VTEProphylaxis
        where AnesthesiaProcedure.status = 'completed'
          and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
          and Coalesce(VTEProphylaxis.effective.toInterval(), VTEProphylaxis.performed.toInterval()) starts during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).calendarDayOfOrDayAfter ( )
        return QualifyingEncounter
    )

define "Encounter With Medication Oral Factor Xa Inhibitor Administered On Day Of Or Day After Admission Or Procedure":
  ( from
      VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter,
      ["MedicationAdministration": "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
      where FactorXaMedication.status = 'completed'
        and FactorXaMedication.effective.toInterval ( ) starts during day of ( start of QualifyingEncounter.period ).calendarDayOfOrDayAfter ( )
      return QualifyingEncounter
  )
    union ( from
        VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter,
        ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
        ["MedicationAdministration": "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
        where FactorXaMedication.status = 'completed'
          and AnesthesiaProcedure.status = 'completed'
          and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
          and FactorXaMedication.effective.toInterval ( ) starts during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).calendarDayOfOrDayAfter ( )
        return QualifyingEncounter
    )

define "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Prior Diagnosis Of VTE":
  ( VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
      with ["ConditionProblemsHealthConcerns": "Atrial Fibrillation or Flutter"] AtrialFibrillation
        such that AtrialFibrillation.verificationStatus is not null implies ( AtrialFibrillation.verificationStatus !~ QICoreCommon."refuted"
            and AtrialFibrillation.verificationStatus !~ QICoreCommon."entered-in-error"
        )
          and AtrialFibrillation.onset.toInterval ( ) starts on or before end of QualifyingEncounter.period
  )
    union ( VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
        where QualifyingEncounter.hasEncDiagnosisOf ( "Atrial Fibrillation or Flutter" )
    )
    union ( VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
        with ["ConditionProblemsHealthConcerns": "Venous Thromboembolism"] VTEDiagnosis
          such that ( VTEDiagnosis.clinicalStatus ~ QICoreCommon."inactive"
              or VTEDiagnosis.clinicalStatus ~ QICoreCommon."remission"
              or VTEDiagnosis.clinicalStatus ~ QICoreCommon."resolved"
          )
            and VTEDiagnosis.verificationStatus is not null implies ( VTEDiagnosis.verificationStatus !~ QICoreCommon."refuted"
              and VTEDiagnosis.verificationStatus !~ QICoreCommon."entered-in-error"
          )
            and VTEDiagnosis.onset.toInterval ( ) before start of QualifyingEncounter.period
    )

define "Encounter With Prior Or Present Procedure Of Hip Or Knee Replacement Surgery":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    with ( ["Procedure": "Hip Replacement Surgery"]
      union ["Procedure": "Knee Replacement Surgery"] ) HipKneeProcedure
      such that HipKneeProcedure.status = 'completed'
        and HipKneeProcedure.performed.toInterval ( ) starts on or before end of QualifyingEncounter.period

define "Low Risk Indicator For VTE":
  ( ["SimpleObservation": "Risk for venous thromboembolism"] VTERiskAssessment
      where VTERiskAssessment.value as Concept in "Low Risk"
        and VTERiskAssessment.status in { 'final', 'amended', 'corrected' }
      return {
        id: VTERiskAssessment.id,
        LowRiskDatetime: VTERiskAssessment.effective.earliest ( )
      }
  )
    union ( ["LaboratoryResultObservation": "INR"] INRLabTest
        where INRLabTest.value as Quantity > 3.0
          and INRLabTest.status in { 'final', 'amended', 'corrected' }
        return {
          id: INRLabTest.id,
          LowRiskDatetime: INRLabTest.issued
        }
    )
    union ( ( ( ["MedicationAdministration": "Unfractionated Heparin"] UnfractionatedHeparin
          where UnfractionatedHeparin.dosage.route in "Intravenous route"
      )
        union ["MedicationAdministration": "Direct Thrombin Inhibitor"]
        union ["MedicationAdministration": "Glycoprotein IIb IIIa Inhibitors"] ) AnticoagulantMedication
        where AnticoagulantMedication.status = 'completed'
        return {
          id: AnticoagulantMedication.id,
          LowRiskDatetime: start of AnticoagulantMedication.effective.toInterval ( )
        }
    )

define "Low Risk For VTE Or Anticoagulant Administered From Day Of Start Of Hospitalization To Day After Admission":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    with "Low Risk Indicator For VTE" LowRiskForVTE
      such that LowRiskForVTE.LowRiskDatetime during day of QualifyingEncounter.fromDayOfStartOfHospitalizationToDayAfterAdmission ( )

define "Low Risk For VTE Or Anticoagulant Administered On Day Of Or Day After Procedure":
  from
    VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "Low Risk Indicator For VTE" LowRiskForVTE
    where AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
      and LowRiskForVTE.LowRiskDatetime during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).calendarDayOfOrDayAfter ( )
    return QualifyingEncounter

define "Encounter With Low Risk For VTE Or Anticoagulant Administered":
  "Low Risk For VTE Or Anticoagulant Administered From Day Of Start Of Hospitalization To Day After Admission"
    union "Low Risk For VTE Or Anticoagulant Administered On Day Of Or Day After Procedure"

define "No VTE Prophylaxis Medication Administered Or Ordered":
  ( ( [MedicationAdministrationNotDone: "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
      union [MedicationAdministrationNotDone: "Low Molecular Weight Heparin for VTE Prophylaxis"]
      union [MedicationAdministrationNotDone: "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
      union [MedicationAdministrationNotDone: "Warfarin"]
      union [MedicationAdministrationNotDone: "Rivaroxaban for VTE Prophylaxis"] ) NoMedicationAdm
      return {
        id: NoMedicationAdm.id,
        medicationStatusReason: NoMedicationAdm.statusReason,
        authoredOn: NoMedicationAdm.recorded
      }
  )
    union ( ( ["MedicationNotRequested": "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
        union ["MedicationNotRequested": "Low Molecular Weight Heparin for VTE Prophylaxis"]
        union ["MedicationNotRequested": "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
        union ["MedicationNotRequested": "Warfarin"]
        union ["MedicationNotRequested": "Rivaroxaban for VTE Prophylaxis"] ) NoMedicationOrder
        where NoMedicationOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
          and NoMedicationOrder.status in { 'active', 'completed' }
        return {
          id: NoMedicationOrder.id,
          medicationStatusReason: NoMedicationOrder.reasonCode,
          authoredOn: NoMedicationOrder.authoredOn
        }
    )
    union ( from
        ( ["MedicationRequest": "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
          union ["MedicationRequest": "Low Molecular Weight Heparin for VTE Prophylaxis"]
          union ["MedicationRequest": "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
          union ["MedicationRequest": "Warfarin"]
          union ["MedicationRequest": "Rivaroxaban for VTE Prophylaxis"] ) MedicationOrderReject,
        [TaskRejected] T
        where T.focus.references ( MedicationOrderReject )
          and T.code ~ QICoreCommon."Fulfill"
          and MedicationOrderReject.status = 'active'
        return {
          id: MedicationOrderReject.id,
          medicationStatusReason: { T.statusReason },
          authoredOn: MedicationOrderReject.authoredOn
        }
    )

define "No VTE Prophylaxis Medication Due To Medical Reason From Day Of Start Of Hospitalization To Day After Admission":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    with "No VTE Prophylaxis Medication Administered Or Ordered" NoVTEMedication
      such that NoVTEMedication.medicationStatusReason in "Medical Reason For Not Providing Treatment"
        and NoVTEMedication.authoredOn during day of QualifyingEncounter.fromDayOfStartOfHospitalizationToDayAfterAdmission ( )

define "No Mechanical VTE Prophylaxis Performed Or Ordered":
  ( ( [ServiceNotRequested: "Venous foot pumps"]
      union [ServiceNotRequested: "Intermittent pneumatic compression devices"]
      union [ServiceNotRequested: "Graduated compression stockings"] ) DeviceNotOrder
      where DeviceNotOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      return {
        id: DeviceNotOrder.id,
        requestStatusReason: DeviceNotOrder.reasonRefused,
        authoredOn: DeviceNotOrder.authoredOn
      }
  )
    union ( from
        ( [ServiceRequest: "Venous foot pumps"]
          union [ServiceRequest: "Intermittent pneumatic compression devices"]
          union [ServiceRequest: "Graduated compression stockings"] ) DeviceOrderReject,
        [TaskRejected] T
        where DeviceOrderReject.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
          and DeviceOrderReject.status = 'active'
          and T.focus.references ( DeviceOrderReject )
          and T.code ~ QICoreCommon."Fulfill"
        return {
          id: DeviceOrderReject.id,
          requestStatusReason: T.statusReason,
          authoredOn: DeviceOrderReject.authoredOn
        }
    )
    union ( ( [ProcedureNotDone: "Application of Intermittent Pneumatic Compression Devices"]
        union [ProcedureNotDone: "Application of Venous Foot Pumps"]
        union [ProcedureNotDone: "Application of Graduated Compression Stockings"] ) DeviceNotApplied
        return {
          id: DeviceNotApplied.id,
          requestStatusReason: DeviceNotApplied.statusReason,
          authoredOn: DeviceNotApplied.recorded
        }
    )

define "No Mechanical VTE Prophylaxis Due To Medical Reason From Day Of Start Of Hospitalization To Day After Admission":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    with "No Mechanical VTE Prophylaxis Performed Or Ordered" NoVTEDevice
      such that NoVTEDevice.requestStatusReason in "Medical Reason For Not Providing Treatment"
        and NoVTEDevice.authoredOn during day of QualifyingEncounter.fromDayOfStartOfHospitalizationToDayAfterAdmission ( )

define "No VTE Prophylaxis Medication Due To Medical Reason On Day Of Or Day After Procedure":
  from
    VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "No VTE Prophylaxis Medication Administered Or Ordered" NoVTEMedication
    where NoVTEMedication.medicationStatusReason in "Medical Reason For Not Providing Treatment"
      and AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
      and NoVTEMedication.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).calendarDayOfOrDayAfter ( )
    return QualifyingEncounter

define "No Mechanical VTE Prophylaxis Due To Medical Reason On Day Of Or Day After Procedure":
  from
    VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "No Mechanical VTE Prophylaxis Performed Or Ordered" NoVTEDevice
    where NoVTEDevice.requestStatusReason in "Medical Reason For Not Providing Treatment"
      and AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
      and NoVTEDevice.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).calendarDayOfOrDayAfter ( )
    return QualifyingEncounter

define "Encounter With No VTE Prophylaxis Due To Medical Reason":
  ( "No VTE Prophylaxis Medication Due To Medical Reason From Day Of Start Of Hospitalization To Day After Admission"
      intersect "No Mechanical VTE Prophylaxis Due To Medical Reason From Day Of Start Of Hospitalization To Day After Admission"
  )
    union ( "No VTE Prophylaxis Medication Due To Medical Reason On Day Of Or Day After Procedure"
        intersect "No Mechanical VTE Prophylaxis Due To Medical Reason On Day Of Or Day After Procedure"
    )

define "No Mechanical Or Pharmacological VTE Prophylaxis Due To Patient Refusal":
  ( "No VTE Prophylaxis Medication Administered Or Ordered" NoVTEMedication
      where exists ( NoVTEMedication.medicationStatusReason MedRsn
          where MedRsn in "Patient Refusal"
      )
  )
    union ( "No Mechanical VTE Prophylaxis Performed Or Ordered" NoVTEDevice
        where NoVTEDevice.requestStatusReason in "Patient Refusal"
    )

define "No VTE Prophylaxis Due To Patient Refusal From Day Of Start Of Hospitalization To Day After Admission":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    with "No Mechanical Or Pharmacological VTE Prophylaxis Due To Patient Refusal" PatientRefusal
      such that PatientRefusal.authoredOn during day of QualifyingEncounter.fromDayOfStartOfHospitalizationToDayAfterAdmission ( )

define "No VTE Prophylaxis Due To Patient Refusal On Day Of Or Day After Procedure":
  from
    VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "No Mechanical Or Pharmacological VTE Prophylaxis Due To Patient Refusal" PatientRefusal
    where AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
      and PatientRefusal.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).calendarDayOfOrDayAfter ( )
    return QualifyingEncounter

define "Encounter With No VTE Prophylaxis Due To Patient Refusal":
  "No VTE Prophylaxis Due To Patient Refusal From Day Of Start Of Hospitalization To Day After Admission"
    union "No VTE Prophylaxis Due To Patient Refusal On Day Of Or Day After Procedure"

define "Numerator":
  "Encounter With VTE Prophylaxis Received From Day Of Start Of Hospitalization To Day After Admission Or Procedure"
    union ( "Encounter With Medication Oral Factor Xa Inhibitor Administered On Day Of Or Day After Admission Or Procedure"
        intersect ( "Encounter With Prior Or Present Diagnosis Of Atrial Fibrillation Or Prior Diagnosis Of VTE"
            union "Encounter With Prior Or Present Procedure Of Hip Or Knee Replacement Surgery"
        )
    )
    union "Encounter With Low Risk For VTE Or Anticoagulant Administered"
    union "Encounter With No VTE Prophylaxis Due To Medical Reason"
    union "Encounter With No VTE Prophylaxis Due To Patient Refusal"

define "Initial Population":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions"

define "Denominator":
  "Initial Population"

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

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

define "Encounter Less Than 2 Days":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    where QualifyingEncounter.period.lengthInDays ( ) < 2

define "Encounter With ICU Location Stay 1 Day Or More":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    where exists ( QualifyingEncounter.location Location
        where Location.location.getLocation ( ).type in "Intensive Care Unit"
          and Location.period.lengthInDays ( ) >= 1
          and Location.period starts on or after start of QualifyingEncounter.period
          and date from ( start of Location.period ) during ( start of QualifyingEncounter.period ).calendarDayOfOrDayAfter ( )
    )

define "Encounter With Principal Diagnosis Of Mental Disorder Or Stroke":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    where QualifyingEncounter.hasPrincipalDiagnosisOf ( "Mental Health Diagnoses" )
      or QualifyingEncounter.hasPrincipalDiagnosisOf ( "Hemorrhagic Stroke" )
      or QualifyingEncounter.hasPrincipalDiagnosisOf ( "Ischemic Stroke" )

define "Encounter With Principal Procedure Of Selected Surgery":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    where QualifyingEncounter.hasPrincipalProcedureOf ( "General Surgery" )
      or QualifyingEncounter.hasPrincipalProcedureOf ( "Gynecological Surgery" )
      or QualifyingEncounter.hasPrincipalProcedureOf ( "Hip Fracture Surgery" )
      or QualifyingEncounter.hasPrincipalProcedureOf ( "Hip Replacement Surgery" )
      or QualifyingEncounter.hasPrincipalProcedureOf ( "Intracranial Neurosurgery" )
      or QualifyingEncounter.hasPrincipalProcedureOf ( "Knee Replacement Surgery" )
      or QualifyingEncounter.hasPrincipalProcedureOf ( "Urological Surgery" )

define "Intervention Comfort Measures":
  ( ["ServiceRequest": "Comfort Measures"] InterventionRequest
      where InterventionRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and InterventionRequest.status in { 'active', 'completed' }
  )
    union ( ["Procedure": "Comfort Measures"] InterventionPerformed
        where InterventionPerformed.status in { 'completed', 'in-progress' }
    )

define "Encounter With Intervention Comfort Measures From Day Of Start Of Hospitalization To Day After Admission":
  VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter
    with "Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of QualifyingEncounter.fromDayOfStartOfHospitalizationToDayAfterAdmission ( )

define "Encounter With Intervention Comfort Measures On Day Of Or Day After Procedure":
  from
    VTE."Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "Intervention Comfort Measures" ComfortMeasure
    where AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
      and Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).calendarDayOfOrDayAfter ( )
    return QualifyingEncounter

define "Denominator Exclusions":
  "Encounter Less Than 2 Days"
    union "Encounter With ICU Location Stay 1 Day Or More"
    union "Encounter With Principal Diagnosis Of Mental Disorder Or Stroke"
    union "Encounter With Principal Procedure Of Selected Surgery"
    union "Encounter With Intervention Comfort Measures From Day Of Start Of Hospitalization To Day After Admission"
    union "Encounter With Intervention Comfort Measures On Day Of Or Day After Procedure"

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

define fluent function "fromDayOfStartOfHospitalizationToDayAfterAdmission"(Encounter Encounter):
  Interval[date from ( start of Encounter.hospitalizationWithObservation ( ) ), date from ( start of Encounter.period ) + 1 days]

define fluent function calendarDayOfOrDayAfter(StartValue DateTime):
  Interval [date from (StartValue), date from (StartValue) + 1 day]

/*
@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: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end

/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasStart"()) then start of period
      else end of period

/*
@description: Given an interval, return true if the interval has a starting boundary specified
(i.e. the start of the interval is not null and not the minimum DateTime value)
*/
define fluent function hasStart(period Interval<DateTime> ):
  not ( start of period is null
      or start of period = minimum DateTime
  )

/*
@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 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 code is in the given codeList
@comment: Returns true if the `code` is equivalent to any of the codes in the given `codeList`, false otherwise.
*/
define fluent function includesCode(codeList List<Concept>, code Code):
  exists (codeList C where C ~ code)

define "Admission Without VTE Or Obstetrical Conditions":
  CQMCommon."Inpatient Encounter" InpatientEncounter
  where not (InpatientEncounter.hasEncDiagnosisOf("Obstetrical or Pregnancy Related Conditions")
             or InpatientEncounter.hasEncDiagnosisOf("Venous Thromboembolism")
             or InpatientEncounter.hasEncDiagnosisOf("Obstetrics VTE")
            )

define "Encounter With Age Range And Without VTE Diagnosis Or Obstetrical Conditions":
 "Admission Without VTE Or Obstetrical Conditions" EncounterWithoutConditions
     where AgeInYearsAt(date from start of EncounterWithoutConditions.period) >= 18

define fluent function hasEncDiagnosisOf(TheEncounter Encounter, DiagnosisValueSet ValueSet):
   TheEncounter E
     return (E.encounterDiagnosis()).code in DiagnosisValueSet
       or E.reasonCode in DiagnosisValueSet

define fluent function hasPrincipalProcedureOf(TheEncounter Encounter, DiagnosisValueSet ValueSet):
   TheEncounter E
   let
        PPx: E.principalProcedure(),
        CPx: singleton from ([Procedure] P where PPx.procedure.references(P.id))
     return PPx.procedure in DiagnosisValueSet
       or CPx.code in DiagnosisValueSet

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

/*  
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.reasonReference D
    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))

/*
@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: 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: Returns the Location resource specified by the given reference.
*/
define fluent function getLocation(reference Reference):
  singleton from (
    [Location] L where reference.references(L)
  )

/*
 @description: Returns the condition that is specified as the principal diagnosis for the encounter and has a code in the given valueSet.
 @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 hasPrincipalDiagnosisOf(encounter Encounter, valueSet ValueSet):
   (encounter.principalDiagnosis()) PD
     return PD.diagnosis in valueSet
       or PD.diagnosis.getCondition().code in valueSet

/*
@description: Returns the claim diagnosis element that is specified as the principal diagnosis for the 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 principalDiagnosis(encounter Encounter):
singleton from (
     (encounter.claimDiagnosis()) CD
       where CD.type.includesCode("Principal Diagnosis")
   )

/*
@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 the claim procedure elements for the given encounter
*/
define fluent function principalProcedure(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),
        princProcedure: singleton from (claim.procedure P where P.sequence in claimItem.procedureSequence and P.type.includesCode("Primary procedure"))
    return princProcedure