define "Inpatient Encounters":
  [Encounter: "Encounter Inpatient"] InpatientEncounter
    with ( [Coverage: "Medicare FFS payer"]
      union [Coverage: "Medicare Advantage payer"] ) MedicarePayer
      such that ( InpatientEncounter.hospitalizationWithObservationAndOutpatientSurgeryService ( ).lengthInDays ( ) ) < 365
        and InpatientEncounter.status = 'finished'
        and AgeInYearsAt(date from start of InpatientEncounter.period) >= 65
        and InpatientEncounter.period ends during day of "Measurement Period"

define "SDE Encounter With First Creatinine Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstCreatinineLab: First(["LaboratoryResultObservation": "Creatinine lab test"] CreatinineLab
        where CreatinineLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and CreatinineLab.status in { 'final', 'amended', 'corrected' }
          and CreatinineLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstCreatinineLab.value as Quantity,
      Timing: FirstCreatinineLab.issued
    }

define "SDE Encounter With First Systolic Blood Pressure":
  "Inpatient Encounters" EncounterInpatient
    let FirstSystolicBP: First(["USCoreBloodPressureProfile"] BP
        where BP.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and BP.status in { 'final', 'amended', 'corrected' }
          and BP.component.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstSBPResult: FirstSystolicBP.component C
        where C.code ~ "Systolic blood pressure"
        return C.value as Quantity,
      Timing: FirstSystolicBP.effective.earliest ( )
    }

define "SDE Encounter With First White Blood Cells Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstWhiteBloodCellLab: First(["LaboratoryResultObservation": "White blood cells count lab test"] WhiteBloodCellLab
        where WhiteBloodCellLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and WhiteBloodCellLab.status in { 'final', 'amended', 'corrected' }
          and WhiteBloodCellLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstWhiteBloodCellLab.value as Quantity,
      Timing: FirstWhiteBloodCellLab.issued
    }

define "SDE Encounter With First Sodium Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstSodiumLab: First(["LaboratoryResultObservation": "Sodium lab test"] SodiumLab
        where SodiumLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and SodiumLab.status in { 'final', 'amended', 'corrected' }
          and SodiumLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstSodiumLab.value as Quantity,
      Timing: FirstSodiumLab.issued
    }

define "SDE Encounter With First Weight Recorded":
  "Inpatient Encounters" EncounterInpatient
    let FirstWeight: First(["USCoreBodyWeightProfile"] WeightExam
        where WeightExam.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and WeightExam.status in { 'final', 'amended', 'corrected' }
          and WeightExam.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstWeight.value as Quantity,
      Timing: FirstWeight.effective.earliest ( )
    }

define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

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

define "SDE Encounter With First Hematocrit Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstHematocritLab: First(["LaboratoryResultObservation": "Hematocrit lab test"] HematocritLab
        where HematocritLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and HematocritLab.status in { 'final', 'amended', 'corrected' }
          and HematocritLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstHematocritLab.value as Quantity,
      Timing: FirstHematocritLab.issued
    }

define "Initial Population":
  "Inpatient Encounters"

define "SDE Encounter With Oxygen 60 Minutes Or Less Prior To ED Admission Or During ED":
  "Initial Population" EncounterInpatient
    where exists ( ( [ServiceRequest: "Non Invasive Oxygen Therapy by Nasal Cannula or Mask"]
        union [ServiceRequest: "Non Invasive Oxygen Therapy Device Codes"] ) OxygenTherapyOrder
        where ( OxygenTherapyOrder.authoredOn during EncounterInpatient.edVisit ( ).period
            or OxygenTherapyOrder.authoredOn 60 minutes or less before or on start of EncounterInpatient.edVisit ( ).period
        )
          and OxygenTherapyOrder.status in { 'active', 'completed' }
          and OxygenTherapyOrder.intent = 'order'
        return {
          EncounterId: EncounterInpatient.id,
          OrderStatus: OxygenTherapyOrder.status,
          OrderTiming: OxygenTherapyOrder.authoredOn
        }
    )
      or exists ( [Procedure: "Non Invasive Oxygen Therapy by Nasal Cannula or Mask"] OxygenAdminInterv
          where ( OxygenAdminInterv.performed.toInterval ( ) starts during EncounterInpatient.edVisit ( ).period
              or OxygenAdminInterv.performed.toInterval ( ) 60 minutes or less before or on start of EncounterInpatient.edVisit ( ).period
          )
            and OxygenAdminInterv.status = 'completed'
          return {
            EncounterId: EncounterInpatient.id,
            EDEncounterTiming: EncounterInpatient.edVisit ( ).period,
            PerformedStatus: OxygenAdminInterv.status,
            PerformedTiming: OxygenAdminInterv.performed.toInterval ( )
          }
      )

define "SDE Encounter With First Respiratory Rate":
  "Inpatient Encounters" EncounterInpatient
    let FirstRespRate: First([USCoreRespiratoryRateProfile] Respirations
        where Respirations.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and Respirations.status in { 'final', 'amended', 'corrected' }
          and Respirations.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstRespRateResult: FirstRespRate.value as Quantity,
      Timing: FirstRespRate.effective.earliest ( )
    }

define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end

define "SDE Sex":
  SDE."SDE Sex"

define "SDE Encounter With First Heart Rate":
  "Inpatient Encounters" EncounterInpatient
    let FirstHeartRate: First([USCoreHeartRateProfile] HeartRate
        where HeartRate.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and HeartRate.status in { 'final', 'amended', 'corrected' }
          and HeartRate.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstHeartRateResult: FirstHeartRate.value as Quantity,
      Timing: FirstHeartRate.effective.earliest ( )
    }

define "SDE Encounter With First Oxygen Saturation":
  "Inpatient Encounters" EncounterInpatient
    let FirstOxygenSat: First(["USCorePulseOximetryProfile": "Oxygen Saturation by Pulse Oximetry"] O2Saturation
        where O2Saturation.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and O2Saturation.status in { 'final', 'amended', 'corrected' }
          and O2Saturation.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstOxygenSatResult: FirstOxygenSat.value as Quantity,
      Timing: FirstOxygenSat.effective.earliest ( )
    }

define "SDE Encounter With First Potassium Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstPotassiumLab: First(["LaboratoryResultObservation": "Potassium lab test"] PotassiumLab
        where PotassiumLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and PotassiumLab.status in { 'final', 'amended', 'corrected' }
          and PotassiumLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstPotassiumLab.value as Quantity,
      Timing: FirstPotassiumLab.issued
    }

define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

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

define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

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

define "SDE Encounter With First Bicarbonate Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstBicarbonateLab: First(["LaboratoryResultObservation": "Bicarbonate lab test"] bicarbonatelab
        where bicarbonatelab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and bicarbonatelab.status in { 'final', 'amended', 'corrected' }
          and bicarbonatelab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstBicarbonateLab.value as Quantity,
      Timing: FirstBicarbonateLab.issued
    }

define "SDE Encounter With First Body Temperature":
  "Inpatient Encounters" EncounterInpatient
    let FirstTemperature: First([USCoreBodyTemperatureProfile] Temperature
        where Temperature.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and Temperature.status in { 'final', 'amended', 'corrected' }
          and Temperature.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstTemperatureResult: FirstTemperature.value as Quantity,
      Timing: FirstTemperature.effective.earliest ( )
    }

define "SDE Encounter With First Glucose Lab Test":
  "Inpatient Encounters" EncounterInpatient
    let FirstGlucoseLab: First(["LaboratoryResultObservation": "Glucose lab test"] GlucoseLab
        where GlucoseLab.effective.earliest() during EncounterInpatient.hospitalizationWithObservationAndOutpatientSurgeryService()
          and GlucoseLab.status in { 'final', 'amended', 'corrected' }
          and GlucoseLab.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: EncounterInpatient.id,
      FirstResult: FirstGlucoseLab.value as Quantity,
      Timing: FirstGlucoseLab.issued
    }

/*
@description: Calculates the difference in calendar days between the start and end of the given interval.
*/
define fluent function lengthInDays(Value Interval<DateTime> ):
  difference in days between start of Value and end of Value

/*
@description: Hospitalization with Observation and Outpatient Surgery Service returns the total interval from the start of any immediately prior emergency department visit, outpatient surgery visit or observation visit to the discharge of the given encounter.
*/
define fluent function hospitalizationWithObservationAndOutpatientSurgeryService(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
    	),
    	VisitStartWithED: Coalesce(start of EDVisit.period, VisitStart),
    	OutpatientSurgeryVisit: Last([Encounter: "Outpatient Surgery Service"] LastSurgeryOP
			  where LastSurgeryOP.period ends 1 hour or less on or before VisitStartWithED
			  sort by	end of period
    	)
  	return Interval[Coalesce(start of OutpatientSurgeryVisit.period, VisitStartWithED), end of Visit.period]

/*
@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: 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 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
        }

/*
@description: Returns the most recent emergency department visit, if any, that occurs 1 hour or less prior to the given encounter.
*/
define fluent function edVisit(TheEncounter Encounter ):
  Last(
    [Encounter: "Emergency Department Visit"] EDVisit
      where EDVisit.status = 'finished'
        and EDVisit.period ends 1 hour or less on or before start of TheEncounter.period
      sort by end of period
    )

/*
@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