define "Initial Population":
  "ED Evaluation and Management"
    union "ED Triage Excluding Those Prior To ED Encounters"

define "Denominator":
  "Initial Population"

define "Numerator":
  "Time to Treatment Room Greater Than 60 Minutes"
    union "ED Arrival Left Without Being Seen"
    union "Boarded Time Greater Than 240 Minutes and No Observation Stay"
    union "ED Length of Stay Greater Than 480 Minutes and No Observation Stay"

define "Stratification 1":
  "Pediatric With No Mental Health Diagnosis"

define "Stratification 2":
  "Adult With No Mental Health Diagnosis"

define "Stratification 3":
  "Pediatric With Mental Health Diagnosis"

define "Stratification 4":
  "Adult With Mental Health Diagnosis"

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 "ED Evaluation and Management":
  [Encounter: "Emergency Department Evaluation and Management Visit"] EDEvalManagementVisit
    where EDEvalManagementVisit.period ends during day of "Measurement Period"
      and EDEvalManagementVisit.status = 'finished'

define "ED Triage":
  ( [Encounter: "Triage"] EDTriage
      where EDTriage.period ends during day of "Measurement Period"
        and EDTriage.status in { 'finished', 'triaged' }
  )

define "ED Triage Excluding Those Prior To ED Encounters":
  "ED Triage" EDTriageinMP
    where not exists ( "ED Evaluation and Management" EDEvalManagementInMP
        where ( ( EDTriageinMP.period overlaps before EDEvalManagementInMP.period )
            or ( EDTriageinMP.period during EDEvalManagementInMP.period )
            or ( EDEvalManagementInMP.period during EDTriageinMP.period )
            or ( EDTriageinMP.period ends 120 minutes or less before start of EDEvalManagementInMP.period )
        )
    )

define "Initial Population":
  "ED Evaluation and Management"
    union "ED Triage Excluding Those Prior To ED Encounters"

define "Denominator":
  "Initial Population"

define "ED Triage Before Evaluation Management":
  "ED Triage" EDTriageinMP
    with "Denominator" EDEncounter
      such that ( ( EDTriageinMP.period overlaps before EDEncounter.period )
          or ( EDTriageinMP.period during EDEncounter.period )
          or ( EDEncounter.period during EDTriageinMP.period )
          or ( EDTriageinMP.period ends 120 minutes or less before start of EDEncounter.period )
      )

define "ED Triage and Evaluation Management":
  "Denominator"
    union "ED Triage Before Evaluation Management"

define "Time to Treatment Room Greater Than 60 Minutes":
  "ED Evaluation and Management" EDEvalManagementInMP
    where EDEvalManagementInMP.edArrivalTime ( ) 61 minutes or more before EDEvalManagementInMP.edTreatmentRoomTimeArrivalTime ( )

define "ED Arrival Left Without Being Seen":
  "Denominator" EDEncounter
    where EDEncounter.hospitalization.dischargeDisposition ~ "Patient left without being seen (finding)"

define "ED To Inpatient Order":
  [ServiceRequest: "Decision to Admit to Hospital Inpatient"] AdmitIPOrder
    where AdmitIPOrder.status in { 'active', 'completed' }

define "Decision to Admit Encounter Order":
  "Denominator" EDEncounter
    with CQMCommon."Inpatient Encounter" EncounterInpatient
      such that EncounterInpatient.admitDecisionUsingEncounterOrder ( ) 241 minutes or more before EDEncounter.edDepartureTime ( )

define "Assessment In ED":
  ["ObservationClinicalResult": "Emergency Department Evaluation"]
    union ["SimpleObservation": "Emergency Department Evaluation"] ObsInED
      where ObsInED.value as Concept in "Admit Inpatient"

define "Decision to Admit Using Assessment":
  "Denominator" EDEncounter
    with CQMCommon."Inpatient Encounter" EncounterInpatient
      such that EncounterInpatient.admitDecisionUsingAssessment ( ) 241 minutes or more before EDEncounter.edDepartureTime ( )

define "Inpatient Or Bed Assignment Encounter Order":
  ( [ServiceRequest: "Encounter Inpatient"]
    union [ServiceRequest: "Patient bed assigned (finding)"] ) IPRequest
    where IPRequest.status in { 'active', 'completed' }

define "Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes":
  "Denominator" EDEncounter
    with CQMCommon."Inpatient Encounter" InpatientEncounter
      such that InpatientEncounter.admitInpatientOrBedAssignmentEncounterOrder ( ) 241 minutes or more before EDEncounter.edDepartureTime ( )

define "Admitted to Inpatient 241 Minutes or More Before Departure":
  "Denominator" EDEncounter
    with CQMCommon."Inpatient Encounter" Inpatient
      such that Inpatient.holdingInEDAfterAdmission ( ) 241 minutes or more before EDEncounter.edDepartureTime ( )

define "Boarded Time Greater Than 240 Minutes":
  "Decision to Admit Encounter Order"
    union "Decision to Admit Using Assessment"
    union "Time of Admit Order Or Bed Assignment to Departure Greater Than 241 Minutes"
    union "Admitted to Inpatient 241 Minutes or More Before Departure"

define "ED Observation Status":
  [Encounter: "Observation Services"] EDObsEncounter
    with "Denominator" EDEncounter
      such that EDObsEncounter.period during EDEncounter.period
        and EDObsEncounter.status = 'finished'

define "Boarded Time Greater Than 240 Minutes and No Observation Stay":
  ( "Boarded Time Greater Than 240 Minutes" Boarding
      where not exists ( "ED Observation Status" EDObs
          where ( EDObs.period during Boarding.period )
      )
  )

define "ED Length of Stay Greater Than 480 Minutes":
  "Denominator" EDEncounter
    where EDEncounter.edArrivalTime ( ) 481 minutes or more before EDEncounter.edDepartureTime ( )

define "ED Length of Stay Greater Than 480 Minutes and No Observation Stay":
  ( "ED Length of Stay Greater Than 480 Minutes" EDStay
      where not exists ( "ED Observation Status" EDObs
          where ( EDObs.period during EDStay.period )
      )
  )

define "Numerator":
  "Time to Treatment Room Greater Than 60 Minutes"
    union "ED Arrival Left Without Being Seen"
    union "Boarded Time Greater Than 240 Minutes and No Observation Stay"
    union "ED Length of Stay Greater Than 480 Minutes and No Observation Stay"

define "ED Encounter or Triage of Patients 18 Years and Older":
  "Denominator" EDEncounter
    where AgeInYearsAt(date from start of "Measurement Period") >= 18

define "Adult With Mental Health Diagnosis":
  ( "ED Encounter or Triage of Patients 18 Years and Older" AdultEDEncounters
      where ( AdultEDEncounters.hasPrincipalDiagnosisOf ( "Mental Health Diagnosis without Substance Use Disorders" ) )
  )

define "Stratification 4":
  "Adult With Mental Health Diagnosis"

define "ED Encounter or Triage of Patients Less Than 18 Years":
  "Denominator" EDEncounter
    where AgeInYearsAt(date from start of "Measurement Period") < 18

define "Pediatric With Mental Health Diagnosis":
  ( "ED Encounter or Triage of Patients Less Than 18 Years" PediatricEDEncounters
      where ( PediatricEDEncounters.hasPrincipalDiagnosisOf ( "Mental Health Diagnosis without Substance Use Disorders" ) )
  )

define "Stratification 3":
  "Pediatric With Mental Health Diagnosis"

define "Adult With No Mental Health Diagnosis":
  ( "ED Encounter or Triage of Patients 18 Years and Older" AdultEDEncounters
      where not ( AdultEDEncounters.hasPrincipalDiagnosisOf ( "Mental Health Diagnosis without Substance Use Disorders" ) )
  )

define "Stratification 2":
  "Adult With No Mental Health Diagnosis"

define "Pediatric With No Mental Health Diagnosis":
  ( "ED Encounter or Triage of Patients Less Than 18 Years" PediatricEDEncounters
      where not ( PediatricEDEncounters.hasPrincipalDiagnosisOf ( "Mental Health Diagnosis without Substance Use Disorders" ) )
  )

define "Stratification 1":
  "Pediatric With No Mental Health Diagnosis"

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

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

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

define fluent function "edArrivalTime"(EDEncounter Encounter):
  Last("ED Triage and Evaluation Management".location Location
      where exists((Location.location.getLocation().type) LocationType
          where(LocationType in "Emergency Department Location"
              or LocationType ~ "Emergency room"
              or LocationType ~ "Emergency trauma unit"
          )
      )
        and start of Location.period is not null
        and(Location.period ends 120 minutes or less before start of EDEncounter.period
            or Location.period overlaps before EDEncounter.period
            or EDEncounter.period overlaps before Location.period
            or Location.period starts same as start of EDEncounter.period
        )
      return start of Location.period
      sort ascending
  )

define fluent function "edTreatmentRoomTimeArrivalTime"(EDEncounter Encounter):
  First(EDEncounter.location Location
      where Location.location.getLocation().type in "Emergency Department Treatment Location"
        and start of Location.period is not null
      return start of Location.period
      sort ascending
  )

define fluent function "admitDecisionUsingEncounterOrder"(EncounterInpatient Encounter):
  Last("ED To Inpatient Order" AdmitOrder
      let LastEDVisit: EncounterInpatient.lastEDEncounter()
      where AdmitOrder.authoredOn during LastEDVisit.period
        and AdmitOrder.intent ~ 'order'
      return AdmitOrder.authoredOn
      sort ascending
  )

define fluent function "lastEDEncounter"(EncounterInpatient Encounter):
  Last("ED Evaluation and Management" EDEvalManagementInMP
      where EDEvalManagementInMP.period starts 1 day or less before or on start of EncounterInpatient.period
        and EDEvalManagementInMP.period starts before start of EncounterInpatient.period
        and EDEvalManagementInMP.period during day of "Measurement Period"
        and EDEvalManagementInMP.status = 'finished'
      sort by 
      end of period ascending
  )

define fluent function "edDepartureTime"(EDEncounter Encounter):
  Last("ED Triage and Evaluation Management".location Location
      where exists((Location.location.getLocation().type) LocationType
          where(LocationType in "Emergency Department Location"
              or LocationType ~ "Emergency room"
              or LocationType ~ "Emergency trauma unit"
          )
      )
        and 
        end of Location.period is not null
        and(Location.period ends 120 minutes or less before start of EDEncounter.period
            or Location.period overlaps before EDEncounter.period
            or EDEncounter.period overlaps before Location.period
            or Location.period starts same as start of EDEncounter.period
        )
      return 
      end of Location.period
      sort ascending
  )

define fluent function "admitDecisionUsingAssessment"(EncounterInpatient Encounter):
  Last("Assessment In ED" EDEvaluation
      let LastEDVisit: EncounterInpatient.lastEDEncounter()
      where EDEvaluation.effective.toInterval() starts during LastEDVisit.period
        and EDEvaluation.status in { 'final', 'amended', 'corrected' }
      return start of EDEvaluation.effective.toInterval()
      sort ascending
  )

define fluent function "admitInpatientOrBedAssignmentEncounterOrder"(Encounter Encounter):
  Last(("Inpatient Or Bed Assignment Encounter Order") AdmitInpatientOrder
      let LastEDVisit: Encounter.lastEDEncounter()
      where AdmitInpatientOrder.authoredOn during LastEDVisit.period
      return AdmitInpatientOrder.authoredOn
      sort ascending
  )

define fluent function holdingInEDAfterAdmission(InpatientEncounter Encounter):
  Last(CQMCommon."Inpatient Encounter" AdmittedInpatient
      let LastEDVisit: InpatientEncounter.lastEDEncounter()
      where start of AdmittedInpatient.period during LastEDVisit.period
      return start of AdmittedInpatient.period
      sort ascending
  )

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

/*
@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 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)

/*
@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, '/'))