define "Initial Population":
  ( "Patient is Male" )
    and "Has Qualifying Encounter"
    and "Has Qualifying BPH Diagnosis"

define "Denominator":
  "Initial Population"
    and "Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis" is not null
    and "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" is not null

define "Denominator Exclusions":
  exists ( "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis" )
    or ( "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization" is not null )
    or ( "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment" )

define "Numerator":
  "Urinary Symptom Score Improvement Greater Than or Equal To 3"

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 "Documented IPSS Assessment Result":
  [ObservationScreeningAssessment: "International Prostate Symptom Score [IPSS]"] IPSSAssessment
    where IPSSAssessment.status in { 'final', 'amended', 'corrected' }
      and IPSSAssessment.value is not null
    return {
      effectiveDatetime: IPSSAssessment.effective.earliest ( ),
      valueInteger: IPSSAssessment.value as Integer
    }

define "AUA Symptom Index and Quality of Life Assessment Result":
  [ObservationScreeningAssessment: "American Urological Association Symptom Index [AUASI]"] AUASIAssessment
    let LastQOLOnDate: Last([ObservationScreeningAssessment: "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]"] QOLAssessment
        where QOLAssessment.effective.earliest() same day as AUASIAssessment.effective.earliest()
          and QOLAssessment.status in { 'final', 'amended', 'corrected' }
          and QOLAssessment.value is not null
        sort by effective.earliest()
    )
    where AUASIAssessment.status in { 'final', 'amended', 'corrected' }
      and AUASIAssessment.value is not null
    return {
      effectiveDatetime: AUASIAssessment.effective.earliest ( ),
      valueInteger: ( AUASIAssessment.value as Integer ) + ( LastQOLOnDate.value as Integer )
    }

define "Urinary Symptom Score Assessment":
  "Documented IPSS Assessment Result"
    union "AUA Symptom Index and Quality of Life Assessment Result"

define "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period":
  First(([ConditionProblemsHealthConcerns: "Benign prostatic hyperplasia with lower urinary tract symptoms"]
      union [ConditionEncounterDiagnosis: "Benign prostatic hyperplasia with lower urinary tract symptoms"]) NewBPHDiagnosis
      where NewBPHDiagnosis.prevalenceInterval() starts during Interval[start of "Measurement Period" - 6 months, start of "Measurement Period"]
        and NewBPHDiagnosis.verificationStatusIsNotInvalid()
      sort by start of onset.toInterval()
  )

define "Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis":
  First("Urinary Symptom Score Assessment" USSAssessment
      with "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
        such that USSAssessment.effectiveDatetime 1 month or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval()
      sort by effectiveDatetime
  )

define "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis":
  Last("Urinary Symptom Score Assessment" USSAssessment
      with "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
        such that difference in months between start of InitialBPHDiagnosis.prevalenceInterval() and USSAssessment.effectiveDatetime in Interval[6, 12]
      sort by effectiveDatetime
  )

define "Urinary Symptom Score Change":
  from
    "Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis" FirstUSSAssessment,
    "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" FollowUpUSSAssessment
    let USSChange: ( FirstUSSAssessment.valueInteger ) - ( FollowUpUSSAssessment.valueInteger )
    return USSChange

define "Urinary Symptom Score Improvement Greater Than or Equal To 3":
  ( "Urinary Symptom Score Change" USSImprovement
      where USSImprovement >= 3
  ) is not null

define "Numerator":
  "Urinary Symptom Score Improvement Greater Than or Equal To 3"

define "Patient is Male":
  SDE."SDE Sex" ~ SDE."Male (finding)"

define "Has Qualifying Encounter":
  exists ( [Encounter: "Office Visit"] ValidEncounter
      where ValidEncounter.period during day of "Measurement Period"
        and ValidEncounter.class !~ "virtual"
        and ValidEncounter.status = 'finished'
  )

define "Has Qualifying BPH Diagnosis":
  "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" is not null

define "Initial Population":
  ( "Patient is Male" )
    and "Has Qualifying Encounter"
    and "Has Qualifying BPH Diagnosis"

define "Denominator":
  "Initial Population"
    and "Urinary Symptom Score Within 1 Month After Initial BPH Diagnosis" is not null
    and "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" is not null

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

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

define "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis":
  ( [ConditionProblemsHealthConcerns: "Urinary Retention"]
    union [ConditionEncounterDiagnosis: "Urinary Retention"] ) UrinaryRetention
    with "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
      such that UrinaryRetention.prevalenceInterval ( ) starts 1 year or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval ( )
    where UrinaryRetention.verificationStatusIsNotInvalid ( )

define "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization":
  "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
    with [Encounter: "Hospital Services for Urology Care"] UrologyHospitalServices
      such that InitialBPHDiagnosis.prevalenceInterval ( ) starts during Interval[start of UrologyHospitalServices.period, end of UrologyHospitalServices.period + 31 days]
        and UrologyHospitalServices.status = 'finished'

define "Morbid Obesity Diagnosis On or Before Follow Up USS Assessment":
  ( [ConditionProblemsHealthConcerns: "Morbid Obesity"]
    union [ConditionEncounterDiagnosis: "Morbid Obesity"] ) MorbidObesityDiagnosis
    with "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" FollowUpUSSAssessment
      such that MorbidObesityDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period"
        and MorbidObesityDiagnosis.prevalenceInterval ( ) starts on or before FollowUpUSSAssessment.effectiveDatetime
    where MorbidObesityDiagnosis.verificationStatusIsNotInvalid ( )

/*
* @code: Body mass index (BMI) [Ratio] - 39156-5
* @profile: http://hl7.org/fhir/StructureDefinition/bmi
*/


define "BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment":
  exists ( ["USCoreBMIProfile"] BMIExam
      with "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" FollowUpUSSAssessment
        such that BMIExam.value >= 40 'kg/m2'
          and BMIExam.status in { 'final', 'amended', 'corrected' }
          and BMIExam.effective.earliest ( ) during day of "Measurement Period"
          and BMIExam.effective.earliest ( ) on or before FollowUpUSSAssessment.effectiveDatetime
      return BMIExam.effective.earliest ( )
  )

define "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment":
  exists "Morbid Obesity Diagnosis On or Before Follow Up USS Assessment"
    or "BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment"

define "Denominator Exclusions":
  exists ( "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis" )
    or ( "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization" is not null )
    or ( "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment" )

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

/*
@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
  )

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
        }