Proportion

Process

increase

define "Initial Population 1":
  AgeInYearsAt(date from start of "Intake Period") >= 6
    and AgeInYearsAt(date from 
      end of "Intake Period"
    ) <= 12
    and exists "Qualifying Encounter"
    and "First ADHD Medication Prescribed During Intake Period" is not null
    and not exists "Inpatient Stay with Qualifying Diagnosis During Initiation Phase"

define "Denominator 1":
  "Initial Population 1"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( "Narcolepsy Exclusion" )

define "Numerator 1":
  exists ( "Encounter During Initiation Phase" )

Proportion

Process

increase

define "Initial Population 2":
  AgeInYearsAt(date from start of "Intake Period") >= 6
    and AgeInYearsAt(date from 
      end of "Intake Period"
    ) <= 12
    and exists "Qualifying Encounter"
    and "First ADHD Medication Prescribed During Intake Period" is not null
    and "Has ADHD Cumulative Medication Duration Greater Than or Equal to 210 Days"
    and not exists "Inpatient Stay with Qualifying Diagnosis During Continuation and Maintenance Phase"

define "Denominator 2":
  "Initial Population 2"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( "Narcolepsy Exclusion" )

define "Numerator 2":
  exists ( "Encounter During Initiation Phase" )
    and ( ( "Two or More Encounters 31 to 300 Days into Continuation and Maintenance Phase" )
        or ( exists ( "Encounter 31 to 300 Days into Continuation and Maintenance Phase" Encounter1
              with "Virtual Encounter 31 to 300 Days into Continuation and Maintenance Phase" Encounter2
                such that Encounter1 is not null
                  and Encounter2 is not null
                  and Encounter1 !~ Encounter2
          )
        )
    )

define "March 1 of Year Prior to Measurement Period":
  DateTime((year from start of "Measurement Period" - 1), 3, 1, 0, 0, 0, 0, 0)

define "Last Calendar Day of February of Measurement Period":
  ( DateTime(year from start of "Measurement Period", 3, 1, 23, 59, 59, 0, 0) ) - 1 day

define "Intake Period":
  Interval["March 1 of Year Prior to Measurement Period", "Last Calendar Day of February of Measurement Period"]

define "ADHD Medication Prescribed During Intake Period and Not Previously on ADHD Medication":
  ( ( ( ( [MedicationRequest: "Atomoxetine"]
      union [MedicationRequest: "Clonidine"]
      union [MedicationRequest: "Dexmethylphenidate"]
      union [MedicationRequest: "Dextroamphetamine"]
      union [MedicationRequest: "Lisdexamfetamine"]
      union [MedicationRequest: "methamphetamine hydrochloride 5 MG Oral Tablet"]
      union [MedicationRequest: "Methylphenidate"]
      union [MedicationRequest: "Guanfacine Medications"]
  ).isMedicationOrder ( ) ) ADHDMedications
    where ADHDMedications.medicationRequestPeriod ( ) starts during "Intake Period" ) ADHDMedicationOrder
    without ( ( [MedicationRequest: "Atomoxetine"]
        union [MedicationRequest: "Clonidine"]
        union [MedicationRequest: "Dexmethylphenidate"]
        union [MedicationRequest: "Dextroamphetamine"]
        union [MedicationRequest: "Lisdexamfetamine"]
        union [MedicationRequest: "methamphetamine hydrochloride 5 MG Oral Tablet"]
        union [MedicationRequest: "Methylphenidate"]
        union [MedicationRequest: "Guanfacine Medications"]
    ).isMedicationActive ( ) ) ActiveADHDMedication
      such that ActiveADHDMedication.medicationRequestPeriod ( ) overlaps Interval[date from start of ADHDMedicationOrder.medicationRequestPeriod ( ) - 120 days, date from start of ADHDMedicationOrder.medicationRequestPeriod ( ) ) ) QualifyingMed
    return all {
      startDate: start of QualifyingMed.medicationRequestPeriod ( )
    }
    sort by startDate asc

define "First ADHD Medication Prescribed During Intake Period":
  First("ADHD Medication Prescribed During Intake Period and Not Previously on ADHD Medication".startDate)

/*Index Prescription Start Date (IPSD)*/


define "IPSD":
  "First ADHD Medication Prescribed During Intake Period"

define "Qualifying Encounter":
  ( ( [Encounter: "Office Visit"]
      union [Encounter: "Home Healthcare Services"]
      union [Encounter: "Preventive Care, Established Office Visit, 0 to 17"]
      union [Encounter: "Preventive Care Services, Initial Office Visit, 0 to 17"]
  ).isEncounterPerformed ( ) ) ValidEncounters
    where CQMCommon."ToDateInterval" ( ValidEncounters.period.toInterval ( ) ) during day of Interval["IPSD" - 6 months, "IPSD"]

define "ADHD Medications Taken on IPSD or During Continuation and Maintenance Phase":
  ( ( ( ( ( ( [MedicationRequest: "Atomoxetine"] ).isMedicationOrder ( ) ) AtomoxetineMed
          return all {
            period: AtomoxetineMed.medicationRequestPeriod ( ),
            periodStart: start of AtomoxetineMed.medicationRequestPeriod ( )
          }
          sort by periodStart
      ).period
    ).rolloutIntervals ( )
  )
    union ( ( ( ( ( [MedicationRequest: "Clonidine"] ).isMedicationOrder ( ) ) ClonidineMed
            return all {
              period: ClonidineMed.medicationRequestPeriod ( ),
              periodStart: start of ClonidineMed.medicationRequestPeriod ( )
            }
            sort by periodStart
        ).period
      ).rolloutIntervals ( )
    )
    union ( ( ( ( ( [MedicationRequest: "Dexmethylphenidate"] ).isMedicationOrder ( ) ) DexmethylphenidateMed
            return all {
              period: DexmethylphenidateMed.medicationRequestPeriod ( ),
              periodStart: start of DexmethylphenidateMed.medicationRequestPeriod ( )
            }
            sort by periodStart
        ).period
      ).rolloutIntervals ( )
    )
    union ( ( ( ( ( [MedicationRequest: "Dextroamphetamine"] ).isMedicationOrder ( ) ) DextroamphetamineMed
            return all {
              period: DextroamphetamineMed.medicationRequestPeriod ( ),
              periodStart: start of DextroamphetamineMed.medicationRequestPeriod ( )
            }
            sort by periodStart
        ).period
      ).rolloutIntervals ( )
    )
    union ( ( ( ( ( [MedicationRequest: "Lisdexamfetamine"] ).isMedicationOrder ( ) ) LisdexamfetamineMed
            return all {
              period: LisdexamfetamineMed.medicationRequestPeriod ( ),
              periodStart: start of LisdexamfetamineMed.medicationRequestPeriod ( )
            }
            sort by periodStart
        ).period
      ).rolloutIntervals ( )
    )
    union ( ( ( ( ( [MedicationRequest: "Methylphenidate"] ).isMedicationOrder ( ) ) MethylphenidateMed
            return all {
              period: MethylphenidateMed.medicationRequestPeriod ( ),
              periodStart: start of MethylphenidateMed.medicationRequestPeriod ( )
            }
            sort by periodStart
        ).period
      ).rolloutIntervals ( )
    )
    union ( ( ( ( ( [MedicationRequest: "Guanfacine Medications"] ).isMedicationOrder ( ) ) GuanfacineMed
            return all {
              period: GuanfacineMed.medicationRequestPeriod ( ),
              periodStart: start of GuanfacineMed.medicationRequestPeriod ( )
            }
            sort by periodStart
        ).period
      ).rolloutIntervals ( )
    )
    union ( ( ( ( ( [MedicationRequest: "methamphetamine hydrochloride 5 MG Oral Tablet"] ).isMedicationOrder ( ) ) MethamphetamineMed
            return all {
              period: MethamphetamineMed.medicationRequestPeriod ( ),
              periodStart: start of MethamphetamineMed.medicationRequestPeriod ( )
            }
            sort by periodStart
        ).period
      ).rolloutIntervals ( )
    ) ) ADHDMedication
    let IPSDAndContinuationMaintenancePhase: Interval["IPSD", "IPSD" + 300 days]
    return all ADHDMedication
      intersect IPSDAndContinuationMaintenancePhase

define "ADHD Cumulative Medication Duration":
  ( "ADHD Medications Taken on IPSD or During Continuation and Maintenance Phase" ).cumulativeDuration ( )

define "Has ADHD Cumulative Medication Duration Greater Than or Equal to 210 Days":
  "ADHD Cumulative Medication Duration" >= 210

define "Inpatient Stay with Qualifying Diagnosis":
  ( ( [Encounter: "Encounter Inpatient"] ).isEncounterPerformed ( ) ) InpatientStay
    where InpatientStay.principalDiagnosis ( ).code in "Mental Behavioral and Neurodevelopmental Disorders"

define "Inpatient Stay with Qualifying Diagnosis During Continuation and Maintenance Phase":
  "Inpatient Stay with Qualifying Diagnosis" InpatientStay
    where CQMCommon."ToDateInterval" ( InpatientStay.period.toInterval ( ) ) starts 300 days or less after day of "IPSD"

define "Initial Population 2":
  AgeInYearsAt(date from start of "Intake Period") >= 6
    and AgeInYearsAt(date from 
      end of "Intake Period"
    ) <= 12
    and exists "Qualifying Encounter"
    and "First ADHD Medication Prescribed During Intake Period" is not null
    and "Has ADHD Cumulative Medication Duration Greater Than or Equal to 210 Days"
    and not exists "Inpatient Stay with Qualifying Diagnosis During Continuation and Maintenance Phase"

define "Denominator 2":
  "Initial Population 2"

define "Qualifying Numerator Encounter":
  ( [Encounter: "Office Visit"]
      union [Encounter: "Preventive Care Services Group Counseling"]
      union [Encounter: "Behavioral Health Follow up Visit"]
      union [Encounter: "Preventive Care Services Individual Counseling"]
      union ( [Encounter: "Psychotherapy and Pharmacologic Management"] PsychPharmManagement
          where exists ( PsychPharmManagement.location Location
              where CQMCommon."GetLocation" ( Location.location ).type in "Ambulatory"
          )
      )
      union [Encounter: "Outpatient Consultation"]
      union [Encounter: "Home Healthcare Services"]
      union [Encounter: "Preventive Care Services, Initial Office Visit, 0 to 17"]
      union [Encounter: "Preventive Care, Established Office Visit, 0 to 17"]
      union [Encounter: "Psych Visit Diagnostic Evaluation"]
      union [Encounter: "Psych Visit Psychotherapy"]
      union [Encounter: "Telephone Visits"]
  )

define "Encounter During Initiation Phase":
  ( "Qualifying Numerator Encounter".isEncounterPerformed ( ) ) ValidNumeratorEncounter
    where CQMCommon."ToDateInterval" ( ValidNumeratorEncounter.period.toInterval ( ) ) starts 30 days or less after day of "IPSD"

define "Numerator 1":
  exists ( "Encounter During Initiation Phase" )

define "Encounter 31 to 300 Days into Continuation and Maintenance Phase":
  ( "Qualifying Numerator Encounter".isEncounterPerformed ( ) ) ValidNumeratorEncounter
    where CQMCommon."ToDateInterval" ( ValidNumeratorEncounter.period.toInterval ( ) ) starts during day of Interval["IPSD" + 31 days, "IPSD" + 300 days]
    return date from start of ValidNumeratorEncounter.period

define "Two or More Encounters 31 to 300 Days into Continuation and Maintenance Phase":
  Count("Encounter 31 to 300 Days into Continuation and Maintenance Phase") >= 2

define "Virtual Encounter 31 to 300 Days into Continuation and Maintenance Phase":
  ( ( [Encounter: "Virtual Encounter"] ).isEncounterPerformed ( ) ) VirtualEnc
    where CQMCommon."ToDateInterval" ( VirtualEnc.period.toInterval ( ) ) starts during day of Interval["IPSD" + 31 days, "IPSD" + 300 days]
    return date from start of VirtualEnc.period

define "Numerator 2":
  exists ( "Encounter During Initiation Phase" )
    and ( ( "Two or More Encounters 31 to 300 Days into Continuation and Maintenance Phase" )
        or ( exists ( "Encounter 31 to 300 Days into Continuation and Maintenance Phase" Encounter1
              with "Virtual Encounter 31 to 300 Days into Continuation and Maintenance Phase" Encounter2
                such that Encounter1 is not null
                  and Encounter2 is not null
                  and Encounter1 !~ Encounter2
          )
        )
    )

define "Inpatient Stay with Qualifying Diagnosis During Initiation Phase":
  "Inpatient Stay with Qualifying Diagnosis" InpatientStay
    where CQMCommon."ToDateInterval" ( InpatientStay.period.toInterval ( ) ) starts 30 days or less after day of "IPSD"

define "Initial Population 1":
  AgeInYearsAt(date from start of "Intake Period") >= 6
    and AgeInYearsAt(date from 
      end of "Intake Period"
    ) <= 12
    and exists "Qualifying Encounter"
    and "First ADHD Medication Prescribed During Intake Period" is not null
    and not exists "Inpatient Stay with Qualifying Diagnosis During Initiation Phase"

define "Has Hospice Services":
  exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
      where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
          or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
      )
        and InpatientEncounter.period.toInterval() ends during day of "Measurement Period"
  )
    or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
        where HospiceEncounter.period.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([Observation: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
        where HospiceAssessment.value ~ "Yes (qualifier value)"
          and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
    )
    or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
        where HospiceOrder.authoredOn.toInterval() during day of "Measurement Period"
        // and HospiceOrder.doNotPerform is not true
        // https://oncprojectracking.healthit.gov/support/browse/CQLIT-447
    )
    or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
        where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
    )
    or exists (([Condition: "Hospice Diagnosis"]) HospiceCareDiagnosis
        where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
    )

define "Narcolepsy Exclusion":
  [Condition: "Narcolepsy"] Narcolepsy
    where Narcolepsy.prevalenceInterval ( ) starts on or before end of "Measurement Period"

define "Denominator Exclusions":
  Hospice."Has Hospice Services"
    or exists ( "Narcolepsy Exclusion" )

define "Denominator 1":
  "Initial Population 1"

//Encounter, Performed
//General usage unless required otherwise by measure intent (e.g., follow-up encounters)
define fluent function isEncounterPerformed(Enc List<Encounter>):
  Enc E
    where E.status in {'finished', 'arrived', 'triaged', 'in-progress', 'onleave'}

/*
@description: Returns an interval of date values extracted from the input interval of date-time values
@comment: This function returns an interval constructed using the `date from` extractor on the start
and end values of the input date-time interval. Note that using a precision specifier such as `day of`
as part of a timing phrase is preferred to communicate intent to perform day-level comparison, as well
as for general readability.
*/
define function "ToDateInterval"(period Interval<DateTime>):
  Interval[date from start of period, date from 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

//Medication, Order: active and completed only
define fluent function isMedicationOrder(MedicationRequest List<MedicationRequest>):
  MedicationRequest M
    where M.status in { 'active', 'completed' }
      and M.intent = 'order'

define fluent function medicationRequestPeriod(Request "MedicationRequest"):
  Request R
    let
      dosage: singleton from R.dosageInstruction,
      doseAndRate: singleton from dosage.doseAndRate,
      timing: dosage.timing,
      frequency: Coalesce(timing.repeat.frequencyMax, timing.repeat.frequency),
      period: Quantity(timing.repeat.period, timing.repeat.periodUnit),
      doseRange: doseAndRate.dose,
      doseQuantity: doseAndRate.dose,
      dose: Coalesce(end of doseRange, doseQuantity),
      dosesPerDay: Coalesce(ToDaily(frequency, period), Count(timing.repeat.timeOfDay), 1.0),
      boundsPeriod: timing.repeat.bounds as Interval<DateTime>,
      daysSupply: (convert R.dispenseRequest.expectedSupplyDuration to days).value,
      quantity: R.dispenseRequest.quantity,
      refills: Coalesce(R.dispenseRequest.numberOfRepeatsAllowed, 0),
      startDate:
        Coalesce(
          date from start of boundsPeriod,
          date from R.authoredOn,
          date from start of R.dispenseRequest.validityPeriod
        ),
      totalDaysSupplied: Coalesce(daysSupply, quantity.value / (dose.value * dosesPerDay)) * (1 + refills)
    return
      if startDate is not null and totalDaysSupplied is not null then
        Interval[startDate, startDate + Quantity(totalDaysSupplied - 1, 'day') ]
      else if startDate is not null and boundsPeriod."high" is not null then
        Interval[startDate, date from end of boundsPeriod]
      else
        null

/**********************************************************************/
/* Functions in this region are copied from opioid-mme-r4             */
/**********************************************************************/

define function Quantity(value Decimal, unit String):
  if value is not null then
    System.Quantity { value: value, unit: unit }
  else
    null

/*
 Goal is to get to number of days
 Two broad approaches to the calculation:
  1) Based on supply and frequency, calculate the number of expected days the medication will cover/has covered
  2) Based on relevant period, determine a covered interval and calculate the length of that interval in days
This topic covers several use cases and illustrates how to calculate Cumulative
Medication Duration for each type of medication resource using the supply and
frequency approach.
*/

/*
  For the first approach, we need to get from frequency to a frequency/day
  So we define ToDaily
*/

/*
  Calculates daily frequency given frequency within a period
*/
define function ToDaily(frequency System.Integer, period System.Quantity):
  case period.unit
    when 'h' then frequency * (24.0 / period.value)
    when 'min' then frequency * (24.0 / period.value) * 60
    when 's' then frequency * (24.0 / period.value) * 60 * 60
    when 'd' then frequency * (24.0 / period.value) / 24
    when 'wk' then frequency * (24.0 / period.value) / (24 * 7)
    when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    when 'hour' then frequency * (24.0 / period.value)
    when 'minute' then frequency * (24.0 / period.value) * 60
    when 'second' then frequency * (24.0 / period.value) * 60 * 60
    when 'day' then frequency * (24.0 / period.value) / 24
    when 'week' then frequency * (24.0 / period.value) / (24 * 7)
    when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    when 'hours' then frequency * (24.0 / period.value)
    when 'minutes' then frequency * (24.0 / period.value) * 60
    when 'seconds' then frequency * (24.0 / period.value) * 60 * 60
    when 'days' then frequency * (24.0 / period.value) / 24
    when 'weeks' then frequency * (24.0 / period.value) / (24 * 7)
    when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */
    when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */
    else Message(null, true, 'CMDLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit)
  end

//Medication, Active
define fluent function isMedicationActive(MedicationRequest List<MedicationRequest>):
  MedicationRequest M
    where M.status = 'active'
      and M.intent = 'order'

/*
Now that we have functions for determining the medication period for individual
prescriptions, administrations, and dispenses, we can combine those using
an overall cumulative medication duration calculation.
There are two broad approaches to calculating cumulative duration, one that _collapses_
overlapping intervals so that calculations are not duplicated, and one that _rolls out_
overlapping intervals so that the durations are laid end-to-end.
First, we define a function that simply calculates CumulativeDuration of a set of
intervals:
*/
define fluent function cumulativeDuration(Intervals List<Interval<Date>>):
   if Intervals is not null then ( Sum((collapse Intervals per day)X
        return all(difference in days between start of X and 
          end of X
        )+ 1
    )
  ) 
    else null

/*
Next, we define a function that rolls out intervals:
*/
define fluent function rolloutIntervals(intervals List<Interval<Date>>):
 intervals I aggregate all R starting ( null as List<Interval<Date>>): R
    union ( { I X
        let S: Max({ 
          end of Last(R)+ 1 day, start of X }
        ),
        E: S + Quantity(Coalesce(duration in days of X, 0), 'day')
        return Interval[S, E]}
    )

/*
@description: Returns the condition that is specified as the principal diagnosis for the encounter
*/
define fluent function principalDiagnosis(Encounter Encounter ):
	singleton from ((Encounter.diagnosis D where D.rank = 1 and D.use ~ "Billing") PD
      return singleton from ([Condition] C where C.id = PD.condition.reference.getId())
	)

/*
@description: Returns the tail of the given uri (i.e. everything after the last slash in the URI).
@comment: This function can be used to determine the logical id of a given resource. It can be used in
a single-server environment to trace references. However, this function does not attempt to resolve
or distinguish the base of the given url, and so cannot be used safely in multi-server environments.
*/
define fluent function getId(uri String):
  Last(Split(uri, '/'))

/*
@description: Returns the Location resource specified by the given reference
@deprecated: This function is deprecated. Use the fluent function `getLocation()` instead.
*/
define function "GetLocation"(reference Reference ):
  singleton from (
    [Location] L where L.id = reference.reference.getId()
  )

/*
@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
        }

//This library contains functions that are based on QDM 5.6 to QICore 4.1.1 March 2023 (https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns---QICore-v4.1.1). The functions may appear similar to some QICoreCommon functions but different in that they have constraints that are relevant for measures authored by NCQA.

//Assessment, Performed
define fluent function isAssessmentPerformed(Obs List<Observation>):
  Obs O
    where O.status in { 'final', 'amended', 'corrected' }
          and exists ( O.category ObservationCategory
          where ( ObservationCategory ) ~ "survey"
      )

//Intervention, Order: active and completed only    
define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
  ServiceRequest S
    where S.status in { 'active', 'completed' }
      and S.intent = 'order'

//Intervention, Performed
define fluent function isInterventionPerformed(Proc List<Procedure>):
  Proc P
    where P.status ~ 'completed'

/*
@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]