Proportion

Process

Increased score indicates improvement

define "Initial Population":
  "Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1"
    and "Has Qualifying Encounter"

define "Denominator":
  "Initial Population"

define "Denominator Exclusion":
  exists "Acute Tuberculosis Diagnosis"
    or exists "Immunosuppressive Drugs"
    or exists "Cystectomy Done"
    or "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"
    or "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging"

define "Numerator":
  "First BCG Administered" is not null

/*
@commentedOut: exists "BCG Not Available Within 6 Months After Bladder Cancer Staging"
@commentedOutReason: 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 this population added 'false' as a 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 "Bladder Cancer Diagnosis":
  [Condition: "Bladder Cancer for Urology Care"] BladderCancer
    where BladderCancer.prevalenceInterval ( ) starts before end of "Measurement Period"
      and BladderCancer.isConfirmedActiveDiagnosis ( )

define "First Bladder Cancer Staging Procedure":
  First([Procedure: "Tumor staging (tumor staging)"] BladderCancerStaging
      with "Bladder Cancer Diagnosis" BladderCancer
        such that BladderCancerStaging.performed.toInterval() starts on or before day of start of BladderCancer.prevalenceInterval()
      where BladderCancerStaging.status = 'completed'
      sort by start of performed.toInterval()
  )

define "First BCG Administered":
  First([MedicationAdministration: "BCG Bacillus Calmette Guerin for Urology Care"] BCG
      with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
        such that BCG.effective.toInterval() starts 6 months or less after start of FirstBladderCancerStaging.performed.toInterval()
          and BCG.effective.toInterval() starts during "Measurement Period"
      where BCG.status in { 'in-progress', 'completed' }
      sort by start of effective.toInterval()
  )

define "Numerator":
  "First BCG Administered" is not null

/*
@commentedOut: exists "BCG Not Available Within 6 Months After Bladder Cancer Staging"
@commentedOutReason: 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 this population added 'false' as a placeholder.
*/


define "Denominator Exception":
    //placeholder
  
  false

define "July 1 of Year Prior to the Measurement Period":
  DateTime((year from start of "Measurement Period" - 1), 7, 1, 0, 0, 0, 0, 0)

define "June 30 of the Measurement Period":
  DateTime((year from start of "Measurement Period"), 6, 30, 23, 59, 59, 0, 0)

define "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period":
  "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
    where FirstBladderCancerStaging.performed.toInterval ( ) during day of Interval["July 1 of Year Prior to the Measurement Period", "June 30 of the Measurement Period"]

/*Ta High Grade only to be included.  Ta low grade is to be excluded from this measure.*/


define "Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1":
  exists ( [Observation] StagingObservation
      where StagingObservation.getStagingProcedure ( ) is not null
        and ( StagingObservation.value as Concept ~ "American Joint Committee on Cancer cT1 (qualifier value)"
            or StagingObservation.value as Concept ~ "American Joint Committee on Cancer cTis (qualifier value)"
            or StagingObservation.value as Concept ~ "American Joint Committee on Cancer cTa (qualifier value)"
            or StagingObservation.value as Concept ~ "Carcinoma in situ of bladder"
        )
        and StagingObservation.status in { 'final', 'amended', 'corrected' }
  )

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

define "Initial Population":
  "Has Most Recent Bladder Cancer Tumor Staging is Ta HG, Tis, T1"
    and "Has Qualifying Encounter"

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 "Acute Tuberculosis Diagnosis":
  [Condition: "Active Tuberculosis for Urology Care"] ActiveTuberculosis
    with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
      such that ActiveTuberculosis.prevalenceInterval ( ) overlaps after day of FirstBladderCancerStaging.performed.toInterval ( )
    where ActiveTuberculosis.isConfirmedActiveDiagnosis ( )

define "Immunosuppressive Drugs":
  [MedicationRequest: "Immunosuppressive Drugs for Urology Care"] ImmunosuppressiveDrugs
    let firstMedicationPeriod: First((collapse(ImmunosuppressiveDrugs.dosageInstruction.timing.repeat.bounds DoseTime
          return DoseTime.toInterval()
      )) DrugPeriods
        sort by start of $this
    ),
        //get the very first event
    
    firstMedicationEvent: First((ImmunosuppressiveDrugs.dosageInstruction.timing dosageTiming
                                      //returns first event for the specific dosageTiming
        
        return First(dosageTiming.event dosageTimingEvents
            sort ascending
        )) firstEvents
        sort ascending
    ),
    medicationPeriod: Coalesce(firstMedicationEvent.toInterval(), firstMedicationPeriod)
    with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
      such that medicationPeriod starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )
    where ImmunosuppressiveDrugs.status in { 'active', 'completed' }
      and ImmunosuppressiveDrugs.intent = 'order'

define "Cystectomy Done":
  [Procedure: "Cystectomy for Urology Care"] Cystectomy
    with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
      such that Cystectomy.performed.toInterval ( ) 6 months or less before start of FirstBladderCancerStaging.performed.toInterval ( )
    where Cystectomy.status = 'completed'

define "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging":
  exists ( ( [Condition: "HIV"]
      union [Condition: "Immunocompromised Conditions"]
      union [Condition: "Mixed histology urothelial cell carcinoma for Urology Care"] ) ExclusionDiagnosis
      with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
        such that ExclusionDiagnosis.prevalenceInterval ( ) starts on or before day of start of FirstBladderCancerStaging.performed.toInterval ( )
      where ExclusionDiagnosis.isConfirmedActiveDiagnosis ( )
  )

define "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging":
  exists ( ( [MedicationRequest: "Chemotherapy Agents for Advanced Cancer"] ExclusionMed
        let firstMedicationPeriod: First((collapse(ExclusionMed.dosageInstruction.timing.repeat.bounds DoseTime
              return DoseTime.toInterval()
          )) DrugPeriods
            sort by start of $this
        )
        with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
          such that firstMedicationPeriod starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )
        where ExclusionMed.status in { 'active', 'completed' }
          and ExclusionMed.intent = 'order'
    )
      union ( [Procedure: "Combined radiotherapy (procedure)"] ExclusionProcedure
          with "First Bladder Cancer Staging Procedure" FirstBladderCancerStaging
            such that ExclusionProcedure.performed.toInterval ( ) starts 6 months or less before FirstBladderCancerStaging.performed.toInterval ( )
          where ExclusionProcedure.status = 'completed'
      )
  )

define "Denominator Exclusion":
  exists "Acute Tuberculosis Diagnosis"
    or exists "Immunosuppressive Drugs"
    or exists "Cystectomy Done"
    or "Has Excluding HIV, Immunocompromised Conditions or Mixed Histology Before Staging"
    or "Has Excluding Chemotherapy or Radiotherapy Procedure Before Staging"

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

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

/*
@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]

/*
@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 Condition):
	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>

define fluent function isConfirmedActiveDiagnosis(Condition Condition):
  Condition.isActive ( )
    and Condition.verificationStatus ~ QICoreCommon."confirmed"

/* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
  condition.clinicalStatus ~ "active"
    or condition.clinicalStatus ~ "recurrence"
    or condition.clinicalStatus ~ "relapse"

define fluent function getStagingProcedure(StagingObservation Observation):
  StagingObservation.partOf StagingReference
    return "First Bladder Cancer Staging Procedure during 6 Months Prior to Measurement Period through the First 6 Months of Measurement Period" FirstBladderCancerStagingMP
      where FirstBladderCancerStagingMP.id = StagingReference.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: 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]

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: 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