define "Initial Population":
  exists "Prostate Cancer Diagnosis"

define "Denominator":
  "Initial Population"
    and "First Prostate Cancer Treatment during day of Measurement Period" is not null
    and "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a" is not null
    and "Most Recent PSA Test Result is Low"
    and "Most Recent Gleason Score is Low"

define "Numerator":
  not exists "Bone Scan Study Performed"

define "Denominator Exceptions":
  "Has Diagnosis of Pain related to Prostate Cancer"
    or "Has Salvage Therapy Performed after Prostate Cancer Diagnosis"
    or "Has Bone Scan Study Performed with Documented Reason"

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 "SDE Sex":
  SDE."SDE Sex"

define "Prostate Cancer Diagnosis":
  [ConditionProblemsHealthConcerns: "Prostate Cancer"] ProstateCancer
    where ProstateCancer.prevalenceInterval ( ) overlaps day of "Measurement Period"
      and ProstateCancer.isVerified ( )

define "Bone Scan Study Performed":
  [ObservationClinicalResult: "Bone Scan"] BoneScan
    with "Prostate Cancer Diagnosis" ActiveProstateCancer
      such that BoneScan.effective.toInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )
    where BoneScan.effective.toInterval ( ) ends during day of "Measurement Period"
      and BoneScan.status in { 'final', 'amended', 'corrected' }

define "Numerator":
  not exists "Bone Scan Study Performed"

define "Initial Population":
  exists "Prostate Cancer Diagnosis"

define "First Prostate Cancer Treatment during day of Measurement Period":
  First([Procedure: "Prostate Cancer Treatment"] ProstateCancerTreatment
      where ProstateCancerTreatment.performed.toInterval() ends during day of "Measurement Period"
        and ProstateCancerTreatment.status = 'completed'
      sort by start of performed.toInterval()
  )

define "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a":
  ( Last(([ObservationClinicalResult: "Tumor staging (tumor staging)"] TumorStaging
    // TODO: determine feasibility of ObservationClinicalResult having basedOn reference to Condition
    // where exists("Prostate Cancer Diagnosis" ActiveProstateCancer where TumorStaging.basedOn.references(ActiveProstateCancer))
    
    ) ProstateCancerStaging
      with "First Prostate Cancer Treatment during day of Measurement Period" FirstProstateCancerTreatment
        such that ProstateCancerStaging.effective.toInterval() starts before start of FirstProstateCancerTreatment.performed.toInterval()
          and ProstateCancerStaging.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ) ) LastProstateCancerStaging
    where ( LastProstateCancerStaging.value ~ "American Joint Committee on Cancer cT1a (qualifier value)"
        or LastProstateCancerStaging.value ~ "American Joint Committee on Cancer cT1b (qualifier value)"
        or LastProstateCancerStaging.value ~ "American Joint Committee on Cancer cT1c (qualifier value)"
        or LastProstateCancerStaging.value ~ "American Joint Committee on Cancer cT2a (qualifier value)"
    )

define "Most Recent PSA Test Result is Low":
  ( Last([LaboratoryResultObservation: "Prostate Specific Antigen Test"] PSATest
      with "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a" MostRecentProstateCancerStaging
        such that PSATest.effective.toInterval() starts before MostRecentProstateCancerStaging.effective.toInterval()
          and PSATest.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ) ) LastPSATest
    return LastPSATest.value as Quantity < 10 'ng/mL'

define "Most Recent Gleason Score is Low":
  ( Last([ObservationClinicalResult: "Gleason score in Specimen Qualitative"] GleasonScore
      with "First Prostate Cancer Treatment during day of Measurement Period" FirstProstateCancerTreatment
        such that GleasonScore.effective.toInterval() starts before start of FirstProstateCancerTreatment.performed.toInterval()
          and GleasonScore.status in { 'final', 'amended', 'corrected' }
      sort by start of effective.toInterval()
  ) ) LastGleasonScore
    return LastGleasonScore.value as Integer <= 6

define "Denominator":
  "Initial Population"
    and "First Prostate Cancer Treatment during day of Measurement Period" is not null
    and "Most Recent Prostate Cancer Staging Tumor Size T1a to T2a" is not null
    and "Most Recent PSA Test Result is Low"
    and "Most Recent Gleason Score is Low"

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

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

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

define "Has Diagnosis of Pain related to Prostate Cancer":
  exists ( ( [ConditionProblemsHealthConcerns: "Pain Warranting Further Investigation for Prostate Cancer"]
      union [ConditionEncounterDiagnosis: "Pain Warranting Further Investigation for Prostate Cancer"] ) ProstateCancerPain
      with "Prostate Cancer Diagnosis" ActiveProstateCancer
        such that ProstateCancerPain.prevalenceInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )
          and ProstateCancerPain.isVerified ( )
  )

define "Has Salvage Therapy Performed after Prostate Cancer Diagnosis":
  exists ( [Procedure: "Salvage Therapy"] SalvageTherapy
      with "Prostate Cancer Diagnosis" ActiveProstateCancer
        such that SalvageTherapy.performed.toInterval ( ) starts after start of ActiveProstateCancer.prevalenceInterval ( )
          and SalvageTherapy.status = 'completed'
  )

define "Has Bone Scan Study Performed with Documented Reason":
  exists "Bone Scan Study Performed" BoneScanAfterDiagnosis
    where BoneScanAfterDiagnosis.value ~ "Procedure reason record (record artifact)"

define "Denominator Exceptions":
  "Has Diagnosis of Pain related to Prostate Cancer"
    or "Has Salvage Therapy Performed after Prostate Cancer Diagnosis"
    or "Has Bone Scan Study Performed with Documented Reason"

/*
@note: When possible, this function should be migrated to QICoreCommon.
@description: Returns true if the given Condition has a verification status of "confirmed", "unconfirmed", "provisional", or "differential"
*/


define fluent function isVerified(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ QICoreCommon."confirmed"
      or condition.verificationStatus ~ QICoreCommon."unconfirmed"
      or condition.verificationStatus ~ QICoreCommon."provisional"
      or condition.verificationStatus ~ QICoreCommon."differential"
  )

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]

/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.
*/
define fluent function abatementInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
	if condition.abatement is DateTime then
	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
	else if condition.abatement is Quantity then
		Interval[Patient.birthDate + (condition.abatement as Quantity),
			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
	else if condition.abatement is Interval<Quantity> then
	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
	else if condition.abatement is Interval<DateTime> then
	  Interval[condition.abatement.low, condition.abatement.high)
	else null as Interval<DateTime>

/*
@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

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 [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
        }