define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Encounter During Measurement Period" Encounter1
        with "Qualifying Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Qualifying CAD Encounter"

define "Denominator 1":
  "Initial Population"
    and exists "Qualifying CAD Encounter and History of Moderate or Severe LVSD"

define "Numerator 1":
  "Has Beta Blocker Therapy for LVSD Ordered"
    or "Is Currently Taking Beta Blocker Therapy for LVSD"

define "Denominator Exceptions 1":
  "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
    or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Encounter During Measurement Period" Encounter1
        with "Qualifying Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Qualifying CAD Encounter"

define "Denominator 2":
  "Initial Population"
    and exists "Qualifying CAD Encounter and Prior MI"

define "Numerator 2":
  "Has Beta Blocker Therapy Ordered"
    or "Is Currently Taking Beta Blocker Therapy"

define "Denominator Exceptions 2":
  "Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
    or "Has Asthma with Qualifying CAD Encounter and Prior MI"
    or "Has Bradycardia with Qualifying CAD Encounter and Prior MI"
    or "Has Hypotension with Qualifying CAD Encounter and Prior MI"
    or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
    or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"

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
    }

/*
@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

/*
@description: Returns a union  of the following:
                * Observations where the final, amended or correction ejection fraction result is <= 40
                * Moderate or Severe LVSD conditions where the diagnosis has been confirmed as active
*/
define "Moderate or Severe LVSD Findings":
  ( [ObservationClinicalResult: "Ejection Fraction"] EjectionFraction
      where EjectionFraction.value as Quantity <= 40 '%'
        and EjectionFraction.status in { 'final', 'amended', 'corrected' }
  )
    union ( ( ( [ConditionProblemsHealthConcerns: "Moderate or Severe LVSD"]
          union [ConditionEncounterDiagnosis: "Moderate or Severe LVSD"]
      )
        union ( ( [ConditionProblemsHealthConcerns: "Left ventricular systolic dysfunction (disorder)"]
            union [ConditionEncounterDiagnosis: "Left ventricular systolic dysfunction (disorder)"] ) LVSDDiagnosis
            where LVSDDiagnosis.severity in "Moderate or Severe"
        ) ) ModerateOrSevereLVSD
        where ModerateOrSevereLVSD.isVerified ( )
    )

/*
@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 true if the given condition either has no verification status or has a verification status of confirmed, unconfirmed, provisional, or differential
*/
define fluent function isVerified(AllergyIntolerance AllergyIntolerance):
  AllergyIntolerance.verificationStatus is not null implies ( AllergyIntolerance.verificationStatus ~ QICoreCommon."allergy-confirmed"
      or AllergyIntolerance.verificationStatus ~ QICoreCommon."allergy-unconfirmed"
  )

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 "Qualifying Encounter During Measurement Period":
  ( [Encounter: "Office Visit"]
    union [Encounter: "Outpatient Consultation"]
    union [Encounter: "Nursing Facility Visit"]
    union [Encounter: "Care Services in Long Term Residential Facility"]
    union [Encounter: "Home Healthcare Services"]
    union [Encounter: "Patient Provider Interaction"] ) ValidEncounter
    where ValidEncounter.period during day of "Measurement Period"
      and ValidEncounter.status = 'finished'

define "Outpatient Encounter During Measurement Period":
  ( [Encounter: "Office Visit"]
    union [Encounter: "Outpatient Consultation"]
    union [Encounter: "Care Services in Long Term Residential Facility"]
    union [Encounter: "Home Healthcare Services"]
    union [Encounter: "Nursing Facility Visit"] ) QualifyingEncounter
    where QualifyingEncounter.period during day of "Measurement Period"
      and QualifyingEncounter.status = 'finished'

define "Coronary Artery Disease Encounter":
  "Outpatient Encounter During Measurement Period" ValidQualifyingEncounter
    with ( [ConditionProblemsHealthConcerns: "Coronary Artery Disease No MI"]
      union [ConditionEncounterDiagnosis: "Coronary Artery Disease No MI"] ) CoronaryArteryDisease
      such that CoronaryArteryDisease.overlapsDayOfEncounter ( ValidQualifyingEncounter )

define "History of Cardiac Surgery Prior to Encounter":
  "Outpatient Encounter During Measurement Period" ValidQualifyingEncounter
    with [Procedure: "Cardiac Surgery"] CardiacSurgeryProcedure
      such that CardiacSurgeryProcedure.performed.toInterval ( ) starts before end of ValidQualifyingEncounter.period
        and CardiacSurgeryProcedure.status = 'completed'

define "Qualifying CAD Encounter":
  "Coronary Artery Disease Encounter"
    union "History of Cardiac Surgery Prior to Encounter"

define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists ( "Qualifying Encounter During Measurement Period" Encounter1
        with "Qualifying Encounter During Measurement Period" Encounter2
          such that Encounter2.id !~ Encounter1.id
    )
    and exists "Qualifying CAD Encounter"

define "Qualifying CAD Encounter and Prior MI":
  "Qualifying CAD Encounter" EncounterWithCADProxy
    with ( [ConditionProblemsHealthConcerns: "Myocardial Infarction"]
      union [ConditionEncounterDiagnosis: "Myocardial Infarction"] ) MyocardialInfarction
      such that MyocardialInfarction.prevalenceInterval ( ) starts 3 years or less before day of start of EncounterWithCADProxy.period
        and not exists AHA."Moderate or Severe LVSD Findings"
        and MyocardialInfarction.isVerified ( )

define "Denominator 2":
  "Initial Population"
    and exists "Qualifying CAD Encounter and Prior MI"

define "Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  "Qualifying CAD Encounter" EncounterWithCADProxy
    with AHA."Moderate or Severe LVSD Findings" LVSDFindings
      such that Coalesce(LVSDFindings.prevalenceInterval(), LVSDFindings.effective.toInterval()) starts before end of EncounterWithCADProxy.period

define "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Arrhythmia"] ArrhythmiaDiagnosis
      where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Asthma"] AsthmaDiagnosis
      where AsthmaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Bradycardia"] BradycardiaDiagnosis
      where BradycardiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Hypotension"] HypotensionDiagnosis
      where HypotensionDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

/*
* @code: Heart rate - 8867-4
* @profile: http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate
*/


define "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( from
      ["USCoreHeartRateProfile"] HeartRateExam,
      "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
      let PriorHeartRateExam: Last(["USCoreHeartRateProfile"] MostRecentPriorHeartRateExam
          where MostRecentPriorHeartRateExam.effective.toInterval() during CADEncounterModerateOrSevereLVSD.period
            and MostRecentPriorHeartRateExam.status in { 'final', 'amended', 'corrected' }
            and MostRecentPriorHeartRateExam.effective.toInterval() before HeartRateExam.effective.toInterval()
          sort by start of effective.toInterval()
      )
      where HeartRateExam.effective.toInterval ( ) during CADEncounterModerateOrSevereLVSD.period
        and HeartRateExam.status in { 'final', 'amended', 'corrected' }
        and HeartRateExam.value < 50 '/min'
        and PriorHeartRateExam.value < 50 '/min'
  )

define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
      union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
      where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( ( [ConditionProblemsHealthConcerns: "Allergy to Beta Blocker Therapy"]
      union [ConditionProblemsHealthConcerns: "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
      where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD":
  exists ( [MedicationNotRequested: medication in "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
      with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" LVSDVisit
        such that NoBetaBlockerForLVSDOrdered.authoredOn during day of LVSDVisit.period
      where NoBetaBlockerForLVSDOrdered.status in { 'active', 'completed' }
        and NoBetaBlockerForLVSDOrdered.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and ( NoBetaBlockerForLVSDOrdered.reasonCode in "Medical Reason"
            or NoBetaBlockerForLVSDOrdered.reasonCode in "Patient Reason"
        )
  )

define "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Atrioventricular Block"] AtrioventricularBlock
      where AtrioventricularBlock.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [ConditionProblemsHealthConcerns: "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
      where CardiacPacerDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD":
  exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
      with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
        such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterModerateOrSevereLVSD.period
  )

define "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer":
  "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    and not "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    and not "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and History of Moderate or Severe LVSD"

define "Denominator Exceptions 1":
  "Has Arrhythmia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Asthma with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Bradycardia with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Hypotension with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and History of Moderate or Severe LVSD"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker for LVSD"
    or "Has Atrioventricular Block with Qualifying CAD Encounter and History of Moderate or Severe LVSD without Cardiac Pacer"

define "Has Beta Blocker Therapy for LVSD Ordered":
  exists ( [MedicationRequest: medication in "Beta Blocker Therapy for LVSD"] BetaBlockerForLVSDOrdered
      where BetaBlockerForLVSDOrdered.authoredDuringDayOfEncounter ( "Qualifying CAD Encounter and History of Moderate or Severe LVSD" )
  )

define "Is Currently Taking Beta Blocker Therapy for LVSD":
  exists ( [MedicationRequest: medication in "Beta Blocker Therapy for LVSD"] ActiveBetaBlockerForLVSD
      with "Qualifying CAD Encounter and History of Moderate or Severe LVSD" CADEncounterModerateOrSevereLVSD
        such that First((collapse(ActiveBetaBlockerForLVSD.dosageInstruction.timing.repeat.bounds DoseTime
              return DoseTime.toInterval()
          )) DrugPeriod
            sort by start of $this
        ) overlaps after day of CADEncounterModerateOrSevereLVSD.period
      where ActiveBetaBlockerForLVSD.status in { 'active', 'completed' }
        and ActiveBetaBlockerForLVSD.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
  )

define "Numerator 1":
  "Has Beta Blocker Therapy for LVSD Ordered"
    or "Is Currently Taking Beta Blocker Therapy for LVSD"

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

define "Has Beta Blocker Therapy Ordered":
  exists ( [MedicationRequest: medication in "Beta Blocker Therapy"] BetaBlockerOrdered
      where BetaBlockerOrdered.authoredDuringDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Is Currently Taking Beta Blocker Therapy":
  exists ( [MedicationRequest: medication in "Beta Blocker Therapy"] ActiveBetaBlocker
      with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
        such that First((collapse(ActiveBetaBlocker.dosageInstruction.timing.repeat.bounds DoseTime
              return DoseTime.toInterval()
          )) DrugPeriod
            sort by start of $this
        ) overlaps after day of CADEncounterMI.period
      where ActiveBetaBlocker.status in { 'active', 'completed' }
        and ActiveBetaBlocker.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
  )

define "Numerator 2":
  "Has Beta Blocker Therapy Ordered"
    or "Is Currently Taking Beta Blocker Therapy"

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

define "Has Arrhythmia with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Arrhythmia"] ArrhythmiaDiagnosis
      where ArrhythmiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Asthma with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Asthma"] AsthmaDiagnosis
      where AsthmaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Bradycardia with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Bradycardia"] BradycardiaDiagnosis
      where BradycardiaDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Hypotension with Qualifying CAD Encounter and Prior MI":
  exists ( ( [ConditionProblemsHealthConcerns: "Hypotension"]
      union [ConditionEncounterDiagnosis: "Hypotension"] ) HypotensionDiagnosis
      where HypotensionDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

/*
* @code: Heart rate - 8867-4
* @profile: http://hl7.org/fhir/us/core/StructureDefinition/us-core-heart-rate 
*/


define "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI":
  exists ( from
      ["USCoreHeartRateProfile"] HeartRateExam,
      "Qualifying CAD Encounter and Prior MI" CADEncounterMI
      let PriorHeartRateExam: Last(["USCoreHeartRateProfile"] MostRecentPriorHeartRateExam
          where MostRecentPriorHeartRateExam.effective.toInterval() during CADEncounterMI.period
            and MostRecentPriorHeartRateExam.status in { 'final', 'amended', 'corrected' }
            and MostRecentPriorHeartRateExam.effective.toInterval() before HeartRateExam.effective.toInterval()
          sort by start of effective.toInterval()
      )
      where HeartRateExam.effective.toInterval ( ) during CADEncounterMI.period
        and HeartRateExam.status in { 'final', 'amended', 'corrected' }
        and HeartRateExam.value < 50 '/min'
        and PriorHeartRateExam.value < 50 '/min'
  )

define "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI":
  exists ( ( [AllergyIntolerance: "Beta Blocker Therapy Ingredient"]
      union [AllergyIntolerance: "Substance with beta adrenergic receptor antagonist mechanism of action (substance)"] ) BetaBlockerAllergyIntolerance
      where BetaBlockerAllergyIntolerance.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI":
  exists ( ( [ConditionProblemsHealthConcerns: "Allergy to Beta Blocker Therapy"]
      union [ConditionProblemsHealthConcerns: "Intolerance to Beta Blocker Therapy"] ) BetaBlockerAllergyOrIntoleranceDiagnosis
      where BetaBlockerAllergyOrIntoleranceDiagnosis.overlapsAfterDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy":
  exists ( [MedicationNotRequested: medication in "Beta Blocker Therapy for LVSD"] NoBetaBlockerForLVSDOrdered
      with "Qualifying CAD Encounter and Prior MI" PriorMIVisit
        such that NoBetaBlockerForLVSDOrdered.authoredOn during day of PriorMIVisit.period
      where NoBetaBlockerForLVSDOrdered.status in { 'active', 'completed' }
        and NoBetaBlockerForLVSDOrdered.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and ( NoBetaBlockerForLVSDOrdered.reasonCode in "Medical Reason"
            or NoBetaBlockerForLVSDOrdered.reasonCode in "Patient Reason"
        )
  )

define "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Atrioventricular Block"] AtrioventricularBlockDiagnosis
      where AtrioventricularBlockDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI":
  exists ( [ConditionProblemsHealthConcerns: "Cardiac Pacer in Situ"] CardiacPacerDiagnosis
      where CardiacPacerDiagnosis.overlapsDayOfEncounter ( "Qualifying CAD Encounter and Prior MI" )
  )

define "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI":
  exists ( [Procedure: "Cardiac Pacer"] ImplantedCardiacPacer
      with "Qualifying CAD Encounter and Prior MI" CADEncounterMI
        such that ImplantedCardiacPacer.performed.toInterval ( ) starts before end of CADEncounterMI.period
          and ImplantedCardiacPacer.status = 'completed'
  )

define "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer":
  "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI"
    and not "Has Diagnosis of Cardiac Pacer in Situ with Qualifying CAD Encounter and Prior MI"
    and not "Has Cardiac Pacer Device Implanted with Qualifying CAD Encounter and Prior MI"

define "Denominator Exceptions 2":
  "Has Arrhythmia with Qualifying CAD Encounter and Prior MI"
    or "Has Asthma with Qualifying CAD Encounter and Prior MI"
    or "Has Bradycardia with Qualifying CAD Encounter and Prior MI"
    or "Has Hypotension with Qualifying CAD Encounter and Prior MI"
    or "Has Consecutive Heart Rates Less than 50 with Qualifying CAD Encounter and Prior MI"
    or "Has Allergy or Intolerance to Beta Blocker Therapy Ingredient with Qualifying CAD Encounter and Prior MI"
    or "Has Diagnosis of Allergy or Intolerance to Beta Blocker Therapy with Qualifying CAD Encounter and Prior MI"
    or "Has Medical or Patient Reason for Not Ordering Beta Blocker Therapy"
    or "Has Atrioventricular Block with Qualifying CAD Encounter and Prior MI without Cardiac Pacer"

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

define "Denominator 1":
  "Initial Population"
    and exists "Qualifying CAD Encounter and History of Moderate or Severe LVSD"

define fluent function overlapsDayOfEncounter(Diagnosis ConditionProblemsHealthConcerns, TheEncounter Encounter):
  TheEncounter Visit
    where Diagnosis.isVerified ( )
    return Diagnosis.prevalenceInterval ( ) overlaps day of Visit.period

define fluent function overlapsDayOfEncounter(Diagnosis ConditionProblemsHealthConcerns, EncounterList List<Encounter>):
  AnyTrue(EncounterList Visit
      return Diagnosis.overlapsDayOfEncounter(Visit)
  )

define fluent function overlapsAfterDayOfEncounter(Event Choice<AllergyIntolerance, ConditionProblemsHealthConcerns>, EncounterList List<Encounter>):
  AnyTrue(EncounterList Visit
      return
      case
        when Event is AllergyIntolerance then Interval[start of Event.onset.toInterval(), Event.lastOccurrence]overlaps after day of Visit.period
          and(Event.clinicalStatus is null
              or Event.clinicalStatus ~ QICoreCommon."allergy-active"
          )
          and(Event.verificationStatus is null
              or Event.verificationStatus ~ QICoreCommon."allergy-confirmed"
          )
        when Event is ConditionProblemsHealthConcerns then Event.isVerified()
          and Event.prevalenceInterval() overlaps after day of Visit.period 
        else false 
      end
  )

define fluent function authoredDuringDayOfEncounter(Order Choice<MedicationRequest, MedicationNotRequested>, EncounterList List<Encounter>):
  AnyTrue(EncounterList Visit
      return
      case
        when Order is MedicationRequest then Order.authoredOn during day of Visit.period
          and Order.status in { 'active', 'completed' }
          and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
          and Order.doNotPerform is not true
        when Order is MedicationNotRequested then Order.authoredOn during day of Visit.period
          and Order.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' } 
        else false 
      end
  )