define "Initial Population":
  "Inpatient Encounters With An Opioid Or Benzodiazepine At Discharge"

define "Denominator":
  "Initial Population"

/*
@description: Excludes encounters of patients with cancer pain or who are receiving palliative or hospice care at the time of the encounter or who receive treatment for opioid use disorder, have sickle cell disease, or who are discharged to another inpatient care facility or discharged against medical advice, or expire during the inpatient stay.
*/


define "Denominator Exclusion":
  "Denominator" InpatientEncounter
    where exists ( ["ConditionProblemsHealthConcerns": "Cancer Related Pain"] CancerPain
        where CancerPain.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
          and CancerPain.isVerified ( )
    )
      or exists ( "Inpatient Encounter With Encounter Diagnosis Of Cancer Pain" )
      or exists ( ["ConditionProblemsHealthConcerns": "Sickle Cell Disease with and without Crisis"] SickleCellDisease
          where SickleCellDisease.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
            and SickleCellDisease.isVerified ( )
      )
      or exists ( "Treatment For Opioid Use Disorders" OUDTreatment
          where OUDTreatment.authoredOn during day of InpatientEncounter.period
      )
      or exists ( "Intervention Palliative Or Hospice Care" PalliativeOrHospiceCare
          where Coalesce(start of PalliativeOrHospiceCare.performed.toInterval(), PalliativeOrHospiceCare.authoredOn) during InpatientEncounter.hospitalizationWithObservation ( )
      )
      or ( InpatientEncounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Patient Expired"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
      )

/*
@description: Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge.
*/


define "Numerator":
  "Denominator" InpatientEncounter
    where ( Count("Opioid At Discharge" OpioidMedications
          where OpioidMedications.authoredOn during day of InpatientEncounter.period
          return distinct OpioidMedications.medication
      ) >= 2
    )
      or ( exists "Opioid At Discharge" OpioidDischargeMedications
          where OpioidDischargeMedications.authoredOn during day of InpatientEncounter.period
            and exists ( "Benzodiazepine At Discharge" BenzodiazepineDischargeMedication
                where BenzodiazepineDischargeMedication.authoredOn during day of InpatientEncounter.period
            )
      )

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 "Inpatient Encounter With Age Greater Than Or Equal To 18":
  CQMCommon."Inpatient Encounter" InpatientHospitalEncounter
    where AgeInYearsAt(date from start of InpatientHospitalEncounter.period) >= 18

define "Opioid At Discharge":
  ["MedicationRequest": "Schedule II, III and IV Opioid Medications"] OpioidMedications
    where ( OpioidMedications.isCommunity ( )
        or OpioidMedications.isDischarge ( )
    )
      and OpioidMedications.status in { 'active', 'completed' }
      and OpioidMedications.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "Benzodiazepine At Discharge":
  ["MedicationRequest": "Schedule IV Benzodiazepines"] BenzoMedications
    where ( BenzoMedications.isCommunity ( )
        or BenzoMedications.isDischarge ( )
    )
      and BenzoMedications.status in { 'active', 'completed' }
      and BenzoMedications.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

/*
@description: Captures encounters of patients with an opioid and/or benzodiazepine at discharge.
*/


define "Inpatient Encounters With An Opioid Or Benzodiazepine At Discharge":
  "Inpatient Encounter With Age Greater Than Or Equal To 18" InpatientEncounter
    with ( "Opioid At Discharge"
      union "Benzodiazepine At Discharge" ) OpioidOrBenzodiazepineAtDischarge
      such that OpioidOrBenzodiazepineAtDischarge.authoredOn during day of InpatientEncounter.period

define "Initial Population":
  "Inpatient Encounters With An Opioid Or Benzodiazepine At Discharge"

define "Denominator":
  "Initial Population"

/*
@description: Encounters of patients prescribed two or more opioids or an opioid and benzodiazepine at discharge.
*/


define "Numerator":
  "Denominator" InpatientEncounter
    where ( Count("Opioid At Discharge" OpioidMedications
          where OpioidMedications.authoredOn during day of InpatientEncounter.period
          return distinct OpioidMedications.medication
      ) >= 2
    )
      or ( exists "Opioid At Discharge" OpioidDischargeMedications
          where OpioidDischargeMedications.authoredOn during day of InpatientEncounter.period
            and exists ( "Benzodiazepine At Discharge" BenzodiazepineDischargeMedication
                where BenzodiazepineDischargeMedication.authoredOn during day of InpatientEncounter.period
            )
      )

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

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

define "Inpatient Encounter With Encounter Diagnosis Of Cancer Pain":
  "Denominator" QualifyingEncounter
    where QualifyingEncounter.reasonCode in "Cancer Related Pain"
      or QualifyingEncounter.encounterDiagnosis ( ).code in "Cancer Related Pain"

define "Medications For Opioid Use Disorder":
  ["MedicationRequest": "Medications for Opioid Use Disorder (MOUD)"] DischargeMedication
    where ( DischargeMedication.isCommunity ( )
        or DischargeMedication.isDischarge ( )
    )
      and DischargeMedication.status in { 'active', 'completed' }
      and DischargeMedication.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }

define "Treatment For Opioid Use Disorders":
  ( "Medications For Opioid Use Disorder" MedicationTreatment
      with ["Procedure": "Opioid Medication Assisted Treatment (MAT)"] MAT
        such that MedicationTreatment.authoredOn during day of MAT.performed.toInterval ( )
          and MedicationTreatment.authoredOn during day of "Measurement Period"
          and MAT.status in { 'completed', 'in-progress' }
  )
    union ( "Medications For Opioid Use Disorder" MedicationTreatment
        with ["ConditionProblemsHealthConcerns": "Opioid Use Disorder"] OUD
          such that MedicationTreatment.authoredOn during day of OUD.prevalenceInterval ( )
            and OUD.prevalenceInterval ( ) overlaps day of "Measurement Period"
            and OUD.isVerified ( )
    )

define "Intervention Palliative Or Hospice Care":
  ( ["ServiceRequest": "Palliative or Hospice Care"] PalliativeOrHospiceCareOrder
      where PalliativeOrHospiceCareOrder.status in { 'active', 'completed', 'on-hold' }
  )
    union ( ["Procedure": "Palliative or Hospice Care"] PalliativeOrHospiceCarePerformed
        where PalliativeOrHospiceCarePerformed.status in { 'completed', 'in-progress' }
    )

/*
@description: Excludes encounters of patients with cancer pain or who are receiving palliative or hospice care at the time of the encounter or who receive treatment for opioid use disorder, have sickle cell disease, or who are discharged to another inpatient care facility or discharged against medical advice, or expire during the inpatient stay.
*/


define "Denominator Exclusion":
  "Denominator" InpatientEncounter
    where exists ( ["ConditionProblemsHealthConcerns": "Cancer Related Pain"] CancerPain
        where CancerPain.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
          and CancerPain.isVerified ( )
    )
      or exists ( "Inpatient Encounter With Encounter Diagnosis Of Cancer Pain" )
      or exists ( ["ConditionProblemsHealthConcerns": "Sickle Cell Disease with and without Crisis"] SickleCellDisease
          where SickleCellDisease.prevalenceInterval ( ) overlaps day of InpatientEncounter.period
            and SickleCellDisease.isVerified ( )
      )
      or exists ( "Treatment For Opioid Use Disorders" OUDTreatment
          where OUDTreatment.authoredOn during day of InpatientEncounter.period
      )
      or exists ( "Intervention Palliative Or Hospice Care" PalliativeOrHospiceCare
          where Coalesce(start of PalliativeOrHospiceCare.performed.toInterval(), PalliativeOrHospiceCare.authoredOn) during InpatientEncounter.hospitalizationWithObservation ( )
      )
      or ( InpatientEncounter.hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Patient Expired"
          or InpatientEncounter.hospitalization.dischargeDisposition in "Left Against Medical Advice"
      )

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

/*
@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(condition Choice<QICore.ConditionProblemsHealthConcerns, QICore.ConditionEncounterDiagnosis>):
  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 MedicationRequest has a category of Community
*/
define fluent function isCommunity(medicationRequest Choice<MedicationRequest, MedicationNotRequested>):
  exists (medicationRequest.category C
    where C ~ Community
  )

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

/*
@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: 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

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]