Proportion

Process

increase

define "Initial Population":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions"

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Encounter Less Than 2 Days"
    union "Encounter with ICU Location Stay 1 Day or More"
    union "Encounter with Principal Diagnosis of Mental Disorder or Stroke"
    union "Encounter with Principal Procedure of SCIP VTE Selected Surgery"
    union "Encounter with Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission"
    union "Encounter with Intervention Comfort Measures on Day of or Day After Procedure"

define "Numerator":
  "Encounter with VTE Prophylaxis Received From Day of Start of Hospitalization To Day After Admission or Procedure"
    union ( "Encounter with Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"
        intersect ( "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Prior Diagnosis of VTE"
            union "Encounter with Prior or Present Procedure of Hip or Knee Replacement Surgery"
        )
    )
    union "Encounter with Low Risk for VTE or Anticoagulant Administered"
    union "Encounter with No VTE Prophylaxis Due to Medical Reason"
    union "Encounter with No VTE Prophylaxis Due to Patient Refusal"

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 "Inpatient Encounter":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
		where EncounterInpatient.status = 'finished'
		and EncounterInpatient.period ends during day of "Measurement Period"

define "Admission without VTE or Obstetrical Conditions":
  CQMCommon."Inpatient Encounter" InpatientEncounter
   where not (exists (InpatientEncounter.encounterDiagnosis()) EncDx
                 where (EncDx.code in "Obstetrical or Pregnancy Related Conditions" 
                      or EncDx.code in "Venous Thromboembolism"
          				or EncDx.code in "Obstetrics VTE"
          			         )
                     )

define "Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions":
 ( CQMCommon."Inpatient Encounter" InpatientEncounter
     where AgeInYearsAt(date from start of InpatientEncounter.period) >= 18 )
    intersect "Admission without VTE or Obstetrical Conditions"

define "Pharmacological or Mechanical VTE Prophylaxis Received":
  ( ["MedicationAdministration": "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
      where VTEMedication.status = 'completed'
        and VTEMedication.dosage.route in "Subcutaneous route"
  )
    union ( ["MedicationAdministration": "Low Molecular Weight Heparin for VTE Prophylaxis"] LMWH
        where LMWH.status = 'completed'
    )
    union ( ["MedicationAdministration": "Injectable Factor Xa Inhibitor for VTE Prophylaxis"] FactorXa
        where FactorXa.status = 'completed'
    )
    union ( ["MedicationAdministration": "Warfarin"] Warfarin
        where Warfarin.status = 'completed'
    )
    union ( ["MedicationAdministration": "Rivaroxaban for VTE Prophylaxis"] Rivaroxaban
        where Rivaroxaban.status = 'completed'
    )
    union ( ( ["Procedure": "Application of Intermittent Pneumatic Compression Devices"]
        union ["Procedure": "Application of Venous Foot Pumps"]
        union ["Procedure": "Application of Graduated Compression Stockings"] ) DeviceApplied
        where DeviceApplied.status = 'completed'
    )

define "Encounter with VTE Prophylaxis Received From Day of Start of Hospitalization To Day After Admission or Procedure":
  ( from
      VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
      "Pharmacological or Mechanical VTE Prophylaxis Received" VTEProphylaxis
      where Coalesce(VTEProphylaxis.effective.toInterval(), VTEProphylaxis.performed.toInterval()) starts during day of QualifyingEncounter.FromDayOfStartOfHospitalizationToDayAfterAdmission ( )
      return QualifyingEncounter
  )
    union ( from
        VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
        ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
        "Pharmacological or Mechanical VTE Prophylaxis Received" VTEProphylaxis
        where AnesthesiaProcedure.status = 'completed'
          and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
          and Coalesce(VTEProphylaxis.effective.toInterval(), VTEProphylaxis.performed.toInterval()) starts during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
        return QualifyingEncounter
    )

define "Encounter with Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure":
  ( from
      VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
      ["MedicationAdministration": "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
      where FactorXaMedication.status = 'completed'
        and FactorXaMedication.effective.toInterval ( ) starts during day of ( start of QualifyingEncounter.period ).CalendarDayOfOrDayAfter ( )
      return QualifyingEncounter
  )
    union ( from
        VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
        ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
        ["MedicationAdministration": "Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment"] FactorXaMedication
        where FactorXaMedication.status = 'completed'
          and AnesthesiaProcedure.status = 'completed'
          and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
          and FactorXaMedication.effective.toInterval ( ) starts during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
        return QualifyingEncounter
    )

define "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Prior Diagnosis of VTE":
  ( VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
      with ["Condition": "Atrial Fibrillation or Flutter"] AtrialFibrillation
        such that AtrialFibrillation.isActive ( )
          and AtrialFibrillation.verificationStatus is not null
          and AtrialFibrillation.verificationStatus ~ QICoreCommon."confirmed"
          and AtrialFibrillation.onset.toInterval ( ) starts on or before end of QualifyingEncounter.period
  )
    union ( VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
        where QualifyingEncounter.encounterDiagnosis ( ).code in "Atrial Fibrillation or Flutter"
    )
    union ( VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
        with ["Condition": "Venous Thromboembolism"] VTEDiagnosis
          such that ( VTEDiagnosis.clinicalStatus ~ QICoreCommon."inactive"
              or VTEDiagnosis.clinicalStatus ~ QICoreCommon."remission"
              or VTEDiagnosis.clinicalStatus ~ QICoreCommon."resolved"
          )
            and VTEDiagnosis.verificationStatus is not null
            and VTEDiagnosis.verificationStatus ~ QICoreCommon."confirmed"
            and VTEDiagnosis.onset.toInterval ( ) before start of QualifyingEncounter.period
    )

define "Encounter with Prior or Present Procedure of Hip or Knee Replacement Surgery":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    with ( ["Procedure": "Hip Replacement Surgery"]
      union ["Procedure": "Knee Replacement Surgery"] ) HipKneeProcedure
      such that HipKneeProcedure.status = 'completed'
        and HipKneeProcedure.performed.toInterval ( ) starts on or before end of QualifyingEncounter.period

define "Low Risk Indicator For VTE":
  ( ["Observation": "Risk for venous thromboembolism"] VTERiskAssessment
      where VTERiskAssessment.value as Concept in "Low Risk"
        and VTERiskAssessment.status in { 'final', 'amended', 'corrected' }
      return {
        id: VTERiskAssessment.id,
        LowRiskDatetime: VTERiskAssessment.effective.earliest ( )
      }
  )
    union ( ["US Core Laboratory Result Observation Profile": "INR"] INRLabTest
        where INRLabTest.value as Quantity > 3.0
          and INRLabTest.status in { 'final', 'amended', 'corrected' }
        return {
          id: INRLabTest.id,
          LowRiskDatetime: INRLabTest.issued
        }
    )
    union ( ( ( ["MedicationAdministration": "Unfractionated Heparin"] UnfractionatedHeparin
          where UnfractionatedHeparin.dosage.route in "Intravenous route"
      )
        union ["MedicationAdministration": "Direct Thrombin Inhibitor"]
        union ["MedicationAdministration": "Glycoprotein IIb/IIIa Inhibitors"] ) AnticoagulantMedication
        where AnticoagulantMedication.status = 'completed'
        return {
          id: AnticoagulantMedication.id,
          LowRiskDatetime: start of AnticoagulantMedication.effective.toInterval ( )
        }
    )

define "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    with "Low Risk Indicator For VTE" LowRiskForVTE
      such that LowRiskForVTE.LowRiskDatetime during day of QualifyingEncounter.FromDayOfStartOfHospitalizationToDayAfterAdmission ( )

define "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure":
  from
    VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "Low Risk Indicator For VTE" LowRiskForVTE
    where AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
      and LowRiskForVTE.LowRiskDatetime during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
    return QualifyingEncounter

define "Encounter with Low Risk for VTE or Anticoagulant Administered":
  "Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission"
    union "Low Risk for VTE or Anticoagulant Administered on Day of or Day After Procedure"

define "No VTE Prophylaxis Medication Administered or Ordered":
  ( ( [MedicationAdministrationNotDone: "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
      union [MedicationAdministrationNotDone: "Low Molecular Weight Heparin for VTE Prophylaxis"]
      union [MedicationAdministrationNotDone: "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
      union [MedicationAdministrationNotDone: "Warfarin"]
      union [MedicationAdministrationNotDone: "Rivaroxaban for VTE Prophylaxis"] ) NoMedicationAdm
      return {
        id: NoMedicationAdm.id,
        MedicationStatusReason: NoMedicationAdm.statusReason,
        authoredOn: NoMedicationAdm.recorded
      }
  )
    union ( ( ["MedicationNotRequested": "Low Dose Unfractionated Heparin for VTE Prophylaxis"]
        union ["MedicationNotRequested": "Low Molecular Weight Heparin for VTE Prophylaxis"]
        union ["MedicationNotRequested": "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
        union ["MedicationNotRequested": "Warfarin"]
        union ["MedicationNotRequested": "Rivaroxaban for VTE Prophylaxis"] ) NoMedicationOrder
        where NoMedicationOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        return {
          id: NoMedicationOrder.id,
          MedicationStatusReason: NoMedicationOrder.reasonCode,
          authoredOn: NoMedicationOrder.authoredOn
        }
    )

define "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    with "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
      such that NoVTEMedication.MedicationStatusReason in "Medical Reason For Not Providing Treatment"
        and NoVTEMedication.authoredOn during day of QualifyingEncounter.FromDayOfStartOfHospitalizationToDayAfterAdmission ( )

define "No Mechanical VTE Prophylaxis Performed or Ordered":
  ( ( [ServiceNotRequested: "Venous foot pumps"]
      union [ServiceNotRequested: "Intermittent pneumatic compression devices"]
      union [ServiceNotRequested: "Graduated compression stockings"] ) DeviceNotOrder
      where DeviceNotOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
      return {
        id: DeviceNotOrder.id,
        requestStatusReason: DeviceNotOrder.reasonRefused,
        authoredOn: DeviceNotOrder.authoredOn
      }
  )
    union ( ( [ProcedureNotDone: "Application of Intermittent Pneumatic Compression Devices"]
        union [ProcedureNotDone: "Application of Venous Foot Pumps"]
        union [ProcedureNotDone: "Application of Graduated Compression Stockings"] ) DeviceNotApplied
        let DeviceNotDoneTiming: DeviceNotApplied.recorded
        return {
          id: DeviceNotApplied.id,
          requestStatusReason: DeviceNotApplied.statusReason,
          authoredOn: DeviceNotDoneTiming
        }
    )

define "No Mechanical VTE Prophylaxis Due to Medical Reason From Day of Start of Hospitalization To Day After Admission":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    with "No Mechanical VTE Prophylaxis Performed or Ordered" NoVTEDevice
      such that NoVTEDevice.requestStatusReason in "Medical Reason For Not Providing Treatment"
        and NoVTEDevice.authoredOn during day of QualifyingEncounter.FromDayOfStartOfHospitalizationToDayAfterAdmission ( )

define "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure":
  from
    VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
    where NoVTEMedication.MedicationStatusReason in "Medical Reason For Not Providing Treatment"
      and AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
      and NoVTEMedication.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
    return QualifyingEncounter

define "No Mechanical VTE Prophylaxis Due to Medical Reason on Day of or Day After Procedure":
  from
    VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "No Mechanical VTE Prophylaxis Performed or Ordered" NoVTEDevice
    where NoVTEDevice.requestStatusReason in "Medical Reason For Not Providing Treatment"
      and AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
      and NoVTEDevice.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
    return QualifyingEncounter

define "Encounter with No VTE Prophylaxis Due to Medical Reason":
  ( "No VTE Prophylaxis Medication Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
      intersect "No Mechanical VTE Prophylaxis Due to Medical Reason From Day of Start of Hospitalization To Day After Admission"
  )
    union ( "No VTE Prophylaxis Medication Due to Medical Reason on Day of or Day After Procedure"
        intersect "No Mechanical VTE Prophylaxis Due to Medical Reason on Day of or Day After Procedure"
    )

define "No Mechanical or Pharmacological VTE Prophylaxis Due to Patient Refusal":
  ( "No VTE Prophylaxis Medication Administered or Ordered" NoVTEMedication
      where NoVTEMedication.MedicationStatusReason in "Patient Refusal"
  )
    union ( "No Mechanical VTE Prophylaxis Performed or Ordered" NoVTEDevice
        where NoVTEDevice.requestStatusReason in "Patient Refusal"
    )

define "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    with "No Mechanical or Pharmacological VTE Prophylaxis Due to Patient Refusal" PatientRefusal
      such that PatientRefusal.authoredOn during day of QualifyingEncounter.FromDayOfStartOfHospitalizationToDayAfterAdmission ( )

define "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure":
  from
    VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "No Mechanical or Pharmacological VTE Prophylaxis Due to Patient Refusal" PatientRefusal
    where AnesthesiaProcedure.status = 'completed'
      and QICoreCommon."ToInterval" ( AnesthesiaProcedure.performed ) ends 1 day after day of start of QualifyingEncounter.period
      and PatientRefusal.authoredOn during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
    return QualifyingEncounter

define "Encounter with No VTE Prophylaxis Due to Patient Refusal":
  "No VTE Prophylaxis Due to Patient Refusal From Day of Start of Hospitalization To Day After Admission"
    union "No VTE Prophylaxis Due to Patient Refusal on Day of or Day After Procedure"

define "Numerator":
  "Encounter with VTE Prophylaxis Received From Day of Start of Hospitalization To Day After Admission or Procedure"
    union ( "Encounter with Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"
        intersect ( "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Prior Diagnosis of VTE"
            union "Encounter with Prior or Present Procedure of Hip or Knee Replacement Surgery"
        )
    )
    union "Encounter with Low Risk for VTE or Anticoagulant Administered"
    union "Encounter with No VTE Prophylaxis Due to Medical Reason"
    union "Encounter with No VTE Prophylaxis Due to Patient Refusal"

define "Initial Population":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions"

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 "Encounter Less Than 2 Days":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    where QualifyingEncounter.period.lengthInDays ( ) < 2

define "Encounter with ICU Location Stay 1 Day or More":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    where exists ( QualifyingEncounter.location Location
        where Location.location.getLocation ( ).type in "Intensive Care Unit"
          and Location.period.lengthInDays ( ) >= 1
          and Location.period starts on or after start of QualifyingEncounter.period
          and date from ( start of Location.period ) during ( start of QualifyingEncounter.period ).CalendarDayOfOrDayAfter ( )
    )

define "Encounter with Principal Diagnosis of Mental Disorder or Stroke":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    where QualifyingEncounter.principalDiagnosis ( ).code in "Mental Health Diagnoses"
      or QualifyingEncounter.principalDiagnosis ( ).code in "Hemorrhagic Stroke"
      or QualifyingEncounter.principalDiagnosis ( ).code in "Ischemic Stroke"

define "SCIP VTE Selected Surgery":
  ( ["Procedure": "General Surgery"]
    union ["Procedure": "Gynecological Surgery"]
    union ["Procedure": "Hip Fracture Surgery"]
    union ["Procedure": "Hip Replacement Surgery"]
    union ["Procedure": "Intracranial Neurosurgery"]
    union ["Procedure": "Knee Replacement Surgery"]
    union ["Procedure": "Urological Surgery"] ) Procedure
    where Procedure.status = 'completed'

define "Encounter with Principal Procedure of SCIP VTE Selected Surgery":
  from
    VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
    "SCIP VTE Selected Surgery" SelectedProcedure
    let EncounterProcedure: singleton from ( QualifyingEncounter.procedure P
        where P.rank = 1
    )
    where EncounterProcedure.procedure.reference.getId ( ) = SelectedProcedure.id
      and end of SelectedProcedure.performed.toInterval ( ) during QualifyingEncounter.period
    return QualifyingEncounter

define "Intervention Comfort Measures":
  ( ["ServiceRequest": "Comfort Measures"] InterventionRequest
      where InterventionRequest.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and InterventionRequest.status in { 'active', 'on-hold', 'completed' }
        and InterventionRequest.doNotPerform is not true
  )
    union ( ["Procedure": "Comfort Measures"] InterventionPerformed
        where InterventionPerformed.status in { 'completed', 'in-progress' }
    )

define "Encounter with Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission":
  VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter
    with "Intervention Comfort Measures" ComfortMeasure
      such that Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of QualifyingEncounter.FromDayOfStartOfHospitalizationToDayAfterAdmission ( )

define "Encounter with Intervention Comfort Measures on Day of or Day After Procedure":
  from
    VTE."Encounter with Age Range and without VTE Diagnosis or Obstetrical Conditions" QualifyingEncounter,
    ["Procedure": "General or Neuraxial Anesthesia"] AnesthesiaProcedure,
    "Intervention Comfort Measures" ComfortMeasure
    where AnesthesiaProcedure.status = 'completed'
      and AnesthesiaProcedure.performed.toInterval ( ) ends 1 day after day of start of QualifyingEncounter.period
      and Coalesce(start of ComfortMeasure.performed.toInterval(), ComfortMeasure.authoredOn) during day of ( end of AnesthesiaProcedure.performed.toInterval ( ) ).CalendarDayOfOrDayAfter ( )
    return QualifyingEncounter

define "Denominator Exclusions":
  "Encounter Less Than 2 Days"
    union "Encounter with ICU Location Stay 1 Day or More"
    union "Encounter with Principal Diagnosis of Mental Disorder or Stroke"
    union "Encounter with Principal Procedure of SCIP VTE Selected Surgery"
    union "Encounter with Intervention Comfort Measures From Day of Start of Hospitalization To Day After Admission"
    union "Encounter with Intervention Comfort Measures on Day of or Day After Procedure"

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 the Condition resources referenced by the diagnosis element of the Encounter
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.diagnosis D
    return singleton from ([Condition] C where C.id = D.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, '/'))

define fluent function "FromDayOfStartOfHospitalizationToDayAfterAdmission"(Encounter Encounter ):
	Interval[ date from (start of Encounter.hospitalizationWithObservation()), date from (start of Encounter.period) + 1 days]

/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
*/
define fluent function hospitalizationWithObservation(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
  			)
  		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]

define fluent function CalendarDayOfOrDayAfter(StartValue DateTime):
  Interval [date from (StartValue), date from (StartValue) + 1 day]

/* 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"

/*
@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: 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
        }

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: 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: Returns the Location resource specified by the given reference.
*/
define fluent function getLocation(reference Reference ):
  singleton from (
    [Location] L where L.id = reference.reference.getId()
  )

/*
@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())
	)