Process

Increased score indicates improvement

define "Initial Population":
  "Has Qualifying Encounter"
    and exists "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period"

define "Denominator":
  "Initial Population"

define "Numerator":
  "Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT"

/*
@commentedOut: exists ( "No Bone Density Scan Ordered Due to Patient Refusal" ) 
                 or exists ( "No Bone Density Scan Performed Due to Patient Refusal" )
@commmentedOutReason: Negation issue related to https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455. Due to this being the only logic in population, created a 'false' placeholder
*/


define "Denominator Exception":
    //placeholder
  
  false

define "SDE Sex":
  case
    when Patient.gender = 'male' then "M"
    when Patient.gender = 'female' then "F"
    else null
  end

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

define "Androgen Deprivation Therapy for Urology Care Medication Active Start Dates":
  [MedicationRequest: "Androgen deprivation therapy for Urology Care"] ADTActive
    let firstMedicationPeriod: First((collapse(ADTActive.dosageInstruction.timing.repeat.bounds DoseTime
          return DoseTime.toInterval()
      )) DrugPeriods
        sort by start of $this
    ),
         //get the very first event
    
    firstMedicationEvent: First((ADTActive.dosageInstruction.timing dosageTiming
                                      //returns first event for the specific dosageTiming
        
        return First(dosageTiming.event dosageTimingEvents
            sort ascending
        )) firstEvents
        sort ascending
    ),
    medicationDateTime: NormalizeInterval(firstMedicationEvent, firstMedicationPeriod).earliest ( )
    where ADTActive.status in { 'active', 'completed' }
      and ADTActive.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
    return medicationDateTime

define "Androgen Deprivation Therapy for Urology Care Medication Order Start Dates":
  [MedicationRequest: "Androgen deprivation therapy for Urology Care"] ADTOrder
    let firstMedicationPeriod: First((collapse(ADTOrder.dosageInstruction.timing.repeat.bounds DoseTime
          return DoseTime.toInterval()
      )) DrugPeriods
        sort by start of $this
    ),
    medicationDateTime: NormalizeInterval(ADTOrder.authoredOn, firstMedicationPeriod).earliest ( )
    where ADTOrder.status in { 'active', 'completed' }
      and ADTOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
    return medicationDateTime

define "Prostate Cancer Diagnosis":
  [Condition: "Prostate Cancer"] ProstateCancer
    where ProstateCancer.prevalenceInterval ( ) overlaps "Measurement Period"
      and ProstateCancer.clinicalStatus ~ QICoreCommon."active"
      and ProstateCancer.verificationStatus ~ QICoreCommon."confirmed"

define "First ADT in 3 Months Before to 9 Months After Start of Measurement Period":
  First(("Androgen Deprivation Therapy for Urology Care Medication Active Start Dates"
      union "Androgen Deprivation Therapy for Urology Care Medication Order Start Dates") ADTDateTime
      with "Prostate Cancer Diagnosis" ProstateCancer
        such that ADTDateTime during day of ProstateCancer.prevalenceInterval()
          and ADTDateTime during day of Interval[start of "Measurement Period" - 3 months, start of "Measurement Period" + 9 months]
      sort ascending
  )

define "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period":
  [ServiceRequest: "Injection of leuprolide acetate for twelve month period (regime/therapy)"] OrderTwelveMonthADT
    with "First ADT in 3 Months Before to 9 Months After Start of Measurement Period" FirstADTMP
      such that OrderTwelveMonthADT.authoredOn on or after day of FirstADTMP
        and OrderTwelveMonthADT.authoredOn during day of Interval[start of "Measurement Period" - 3 months, start of "Measurement Period" + 9 months]
        and OrderTwelveMonthADT.status in { 'active', 'completed' }
        and OrderTwelveMonthADT.intent = 'order'
        and OrderTwelveMonthADT.doNotPerform is not true

define "Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT":
  exists ( ( [ServiceRequest: "DEXA Dual Energy Xray Absorptiometry, Bone Density for Urology Care"] DEXAOrdered
        with "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period" OrderTwelveMonthsADT
          such that DEXAOrdered.authoredOn 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn
            or DEXAOrdered.authoredOn 2 years or less before day of OrderTwelveMonthsADT.authoredOn
        where DEXAOrdered.status in { 'active', 'completed' }
          and DEXAOrdered.intent = 'order'
          and DEXAOrdered.doNotPerform is not true
    )
      union ( [Observation: "DEXA Dual Energy Xray Absorptiometry, Bone Density for Urology Care"] DEXAPerformed
          with "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period" OrderTwelveMonthsADT
            such that DEXAPerformed.effective.toInterval ( ) 3 months or less on or after day of OrderTwelveMonthsADT.authoredOn
              or DEXAPerformed.effective.toInterval ( ) 2 years or less before day of OrderTwelveMonthsADT.authoredOn
          where DEXAPerformed.status in { 'final', 'amended', 'corrected' }
      )
  )

define "Numerator":
  "Has Baseline DEXA Scan Two Years Prior to the Start of or Less than Three Months After the Start of ADT"

/*
@commentedOut: exists ( "No Bone Density Scan Ordered Due to Patient Refusal" ) 
                 or exists ( "No Bone Density Scan Performed Due to Patient Refusal" )
@commmentedOutReason: Negation issue related to https://github.com/cqframework/cql-execution/issues/296, which is tied to https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1455. Due to this being the only logic in population, created a 'false' placeholder
*/


define "Denominator Exception":
    //placeholder
  
  false

define "Has Qualifying Encounter":
  exists ( ["Encounter": "Office Visit"] OfficeVisit
      where OfficeVisit.period during "Measurement Period"
        and OfficeVisit.status = 'finished'
  )

define "Initial Population":
  "Has Qualifying Encounter"
    and exists "Order for 12 Months of ADT in 3 Months Before to 9 Months After Start of Measurement Period"

define "Denominator":
  "Initial Population"

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

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

define function NormalizeInterval(pointInTime DateTime, dateTimeInterval Interval<DateTime>):
  if pointInTime is not null then Interval[pointInTime, pointInTime]
    else if dateTimeInterval is not null then dateTimeInterval 
    else null as Interval<DateTime>

/*
@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 Condition):
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]

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
        }