define "Initial Population":
  PCMaternal."Delivery Encounter With Age Range"

define "Denominator":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation"

define "Numerator":
  "Delivery Encounters With Severe Obstetric Complications"

define "Initial Population":
  PCMaternal."Delivery Encounter With Age Range"

define "Denominator":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation"

define "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only":
  "Delivery Encounters With Severe Obstetric Complications"
    intersect "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions"

define "SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC":
  ( "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
      where exists ( ( SOCExcludingTransfusion.encounterDiagnosis ( ) ) EncounterDiagnoses
          where EncounterDiagnoses.code in "Placenta Increta or Percreta"
      )
        and ( exists "Delivery Encounters With Blood Transfusion"
            or exists "Delivery Encounters With Hysterectomy"
        )
  )
	
	//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
          where SOCExcludingTransfusion.isDiagnosisPresentOnAdmission ( "Severe Maternal Morbidity Diagnoses", "Present on Admission is No or Unable To Determine" )
      )
        union "Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures"
        union "Delivery Encounters With Expiration"
    )

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

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

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

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

define "Encounter With Age Range":
 CQMCommon."Inpatient Encounter" InpatientEncounter
                      where AgeInYearsAt(date from start of InpatientEncounter.period) in Interval[ 8, 65 )

define "Delivery Encounter With Age Range":
  "Encounter With Age Range" EncounterWithAge
                with ["Procedure": "Delivery Procedures"] DeliveryProcedure
                such that DeliveryProcedure.status = 'completed'
                and DeliveryProcedure.performed.toInterval  ( ) starts during EncounterWithAge.hospitalizationWithEDOBTriageObservation ()

define "Variable Calculated Gestational Age":
 "Delivery Encounter With Age Range" DeliveryEncounter
    let CGA: DeliveryEncounter.calculatedGestationalAge()
    return {
      EncounterID: DeliveryEncounter.id,
      CalculatedCGA: CGA
    }

define fluent function hospitalizationWithEDOBTriageObservation (TheEncounter Encounter ):
  /*hospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter*/
  TheEncounter Visit
    let ObsVisit: Last(["Encounter": "Observation Services"] LastObs
        where LastObs.period ends 1 hour or less on or before start of Visit.period
          and LastObs.status = 'finished'
        sort by 
        end of period
    ),
    VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
    EDOBTriageVisit: Last(["Encounter": "ED Visit and OB Triage"] LastEDOBTriage
        where LastEDOBTriage.period ends 1 hour or less on or before VisitStart
          and LastEDOBTriage.status = 'finished'
        sort by 
        end of period
    )
    return Interval[Coalesce(start of EDOBTriageVisit.period, VisitStart), 
    end of Visit.period]

define fluent function calculatedGestationalAge (TheEncounter Encounter ):
  //Gestational Age = (280 -(Estimated Delivery Date minus Reference Date/Delivery Date))/7
 ( 280 - ( difference in days between TheEncounter.lastTimeOfDelivery () and TheEncounter.lastEstimatedDeliveryDate( )) ) div 7

define fluent function lastTimeOfDelivery (TheEncounter Encounter ):
  Last(["SimpleObservation": "Date and time of obstetric delivery"] TimeOfDelivery
      where TimeOfDelivery.value as DateTime is not null
        and TimeOfDelivery.status in { 'final', 'amended', 'corrected' }
        and TimeOfDelivery.effective.earliest () during TheEncounter.hospitalizationWithEDOBTriageObservation ()
        and TimeOfDelivery.value as DateTime during TheEncounter.hospitalizationWithEDOBTriageObservation()
      sort by effective.earliest()
  ).value as DateTime

define fluent function lastEstimatedDeliveryDate (TheEncounter Encounter ):
  /*This function identifies the last time the EDD was assessed 42 weeks or less prior to or on delivery and stores the result of that assessment.*/
  Last(["SimpleObservation": "Delivery date Estimated"] EstimatedDateOfDelivery
      where EstimatedDateOfDelivery.value as DateTime is not null
        and EstimatedDateOfDelivery.status in { 'final', 'amended', 'corrected' }
        and EstimatedDateOfDelivery.effective.earliest ( ) 42 weeks or less before or on TheEncounter.lastTimeOfDelivery ()
      sort by effective.earliest ( )
  ).value as DateTime

define fluent function lastEstimatedGestationalAge (TheEncounter Encounter ):
  Last(["SimpleObservation": "Estimated Gestational Age at Delivery"] EstimatedGestationalAge
  let EGATiming:  EstimatedGestationalAge.effective.earliest() where 
  (EGATiming 24 hours or less before or on TheEncounter.lastTimeOfDelivery () 
  and EstimatedGestationalAge.value is not null 
  and EstimatedGestationalAge.status in { 'final', 'amended', 'corrected' }) or 
      (EGATiming same day as TheEncounter.lastTimeOfDelivery () 
      and EGATiming during TheEncounter.hospitalizationWithEDOBTriageObservation() 
      and EstimatedGestationalAge.value is not null)
 sort by effective.earliest ())
         .value as Quantity

/*
@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

/*
@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
  )

/*
@description: Returns true if the given reference is to the given resourceId
@comment: Returns true if the `resourceId` parameter exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resourceId String):
  resourceId = Last(Split(reference.reference, '/'))

/*
@description: Returns true if any of the given references are to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(references List<Reference>, resource Resource):
  exists (references R where R.references(resource))

/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))

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

/*  
@description: Returns the Condition resources referenced by the diagnosis element of the Encounter  
*/
define fluent function encounterDiagnosis(Encounter Encounter ):
  Encounter.reasonReference D
    return singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where D.references(C.id))

/*
 @description: Returns true if the given diagnosis is present on admission, based on the given poaValueSet
 @comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
 */
 define fluent function isDiagnosisPresentOnAdmission(encounter Encounter, diagnosisValueSet ValueSet, poaValueSet ValueSet):
   exists (
     (encounter.claimDiagnosis()) CD
       where CD.onAdmission in poaValueSet
         and (
           CD.diagnosis in diagnosisValueSet
             or CD.diagnosis.getCondition().code in diagnosisValueSet
         )
   )

/*
@description: Returns the claim diagnosis elements for the given encounter
@comment: See the QICore 6 Authoring Patterns discussion on [Principal Diagnosis and Present on Admission](https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/wiki/Authoring-Patterns-QICore-v6.0.0#conditions-present-on-admission-and-principal-diagnoses) for more information
*/
define fluent function claimDiagnosis(encounter Encounter):
  encounter E
    let 
      claim: ([Claim] C where C.status = 'active' and C.use = 'claim' and exists (C.item I where I.encounter.references(E))),
      claimItem: (claim.item I where I.encounter.references(E))
    return claim.diagnosis D where D.sequence in claimItem.diagnosisSequence

/*
@description: Returns the Condition resource for the given reference
*/
define fluent function getCondition(reference Reference):
  singleton from (([ConditionEncounterDiagnosis] union [ConditionProblemsHealthConcerns]) C where reference.references(C.id))

/*
@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: 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 "Delivery Encounters With Calculated Gestational Age Greater Than Or Equal To 20 Weeks":
  PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
    where DeliveryEncounter.calculatedGestationalAge ( ) >= 20

define "Delivery Encounters With Estimated Gestational Age Assessment Greater Than Or Equal To 20 Weeks":
  PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
    where DeliveryEncounter.calculatedGestationalAge ( ) is null
      and ( DeliveryEncounter.lastEstimatedGestationalAge ( ) >= 20 weeks )

define "Delivery Encounters With Gestational Age Greater Than Or Equal To 20 Weeks Based On Coding":
  PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
    let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
    EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
    where CGA is null
      and EGA is null
      and exists ( ( DeliveryEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
          where EncounterDiagnosis.code in "20 to 42 Plus Weeks Gestation"
      )

define "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation":
  "Delivery Encounters With Calculated Gestational Age Greater Than Or Equal To 20 Weeks"
    union "Delivery Encounters With Estimated Gestational Age Assessment Greater Than Or Equal To 20 Weeks"
    union "Delivery Encounters With Gestational Age Greater Than Or Equal To 20 Weeks Based On Coding"

define "Risk Variable Asthma":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Acute or Persistent Asthma", "Present On Admission is Yes or Exempt" )

define "Risk Variable Placental Accreta Spectrum":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Placenta Accreta", "Present On Admission is Yes or Exempt" )
      or TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Placenta Increta or Percreta", "Present On Admission is Yes or Exempt" )

define "Risk Variable Hypertension":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Hypertension", "Present On Admission is Yes or Exempt" )

define "Risk Variable Preterm Birth":
/*  CGA = Calculated Gestational Age.  EGA = Estimated Gestational Age. */
  
  ( PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
      let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
      EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
      where CGA in Interval[20, 36]
        or ( CGA is null
            and ( EGA >= 20 weeks
                and EGA <= 36 weeks
            )
        )
  )
    union ( PCMaternal."Delivery Encounter With Age Range" DeliveryEncounter
        let CGA: DeliveryEncounter.calculatedGestationalAge ( ),
        EGA: DeliveryEncounter.lastEstimatedGestationalAge ( )
        where CGA is null
          and EGA is null
          and /*DeliveryEncounter.isDiagnosisPresentOnAdmission("Preterm Birth","Present On Admission is Yes or Exempt")*/
                
                /*where DeliveryEncounter.isDiagnosisPresentOnAdmission("Preterm Birth","Present On Admission is Yes or Exempt")*/
          
          exists ( ( DeliveryEncounter.claimDiagnosis ( ) ) D
              where D.onAdmission ~ "POA-Y"
                and ( D.diagnosis in "Preterm Birth"
                    or D.diagnosis.getCondition ( ).code in "Preterm Birth"
                )
          )
    )

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

define "Risk Variable Placental Abruption":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Placental Abruption", "Present On Admission is Yes or Exempt" )

define "Risk Variable Morbid Obesity":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Morbid or Severe Obesity", "Present On Admission is Yes or Exempt" )

define "Risk Variable Preexisting Diabetes":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Preexisting Diabetes", "Present On Admission is Yes or Exempt" )

define "Risk Variable Bariatric Surgery":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Bariatric Surgery", "Present On Admission is Yes or Exempt" )

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

define "Risk Variable Placenta Previa":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Placenta Previa", "Present On Admission is Yes or Exempt" )

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

define "Risk Variable Bleeding Disorder":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Bleeding Disorder", "Present On Admission is Yes or Exempt" )

//First resulted value 24 hours prior to start of encounter and before time of delivery
 //Report white blood cell count as 10*3/uL



define "Risk Variable First White Blood Cell Count Lab Test":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstWBC: First(["LaboratoryResultObservation": "White blood cells count lab test"] WBC
        where WBC.issued during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]
          and WBC.status in { 'final', 'amended', 'corrected' }
          and WBC.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstWBCResult: FirstWBC.value as Quantity,
      Timing: FirstWBC.issued
    }

//First resulted value 24 hours prior to start of encounter and before time of delivery
 //Report hematocrit as %



define "Risk Variable First Hematocrit Lab Test":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstHematocrit: First(["LaboratoryResultObservation": "Hematocrit lab test"] Hematocrit
        where Hematocrit.issued during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]
          and Hematocrit.status in { 'final', 'amended', 'corrected' }
          and Hematocrit.value is not null
        sort by issued.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstHematocritResult: FirstHematocrit.value as Quantity,
      Timing: FirstHematocrit.issued
    }

define "Risk Variable Anemia":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Anemia", "Present On Admission is Yes or Exempt" )

define "Risk Variable Severe Preeclampsia":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Severe Preeclampsia", "Present On Admission is Yes or Exempt" )

define "Risk Variable Cardiac Disease":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Cardiac Disease", "Present On Admission is Yes or Exempt" )

define "Risk Variable Long Term Anticoagulant Use":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Long Term Anticoagulant Use", "Present On Admission is Yes or Exempt" )

define "Delivery Encounters With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Severe Maternal Morbidity Diagnoses", "Present on Admission is No or Unable To Determine" )
      or ( exists ( ["Procedure": "Severe Maternal Morbidity Procedures"] SMMProcedures
            where SMMProcedures.status = 'completed'
              and SMMProcedures.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )
        )
      )

define "Delivery Encounters With Expiration":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.hospitalization.dischargeDisposition in "Patient Expired"

define "Delivery Encounters With Blood Transfusion":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with ["Procedure": "Blood Transfusion"] BloodTransfusion
      such that BloodTransfusion.status = 'completed'
        and BloodTransfusion.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )

define "Delivery Encounters With Severe Obstetric Complications":
  "Delivery Encounters With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion"
    union "Delivery Encounters With Expiration"
    union "Delivery Encounters With Blood Transfusion"

define "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions":
  "Delivery Encounters With Severe Obstetric Complications Diagnosis Or Procedure Excluding Blood Transfusion"
    union "Delivery Encounters With Expiration"

define "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only":
  "Delivery Encounters With Severe Obstetric Complications"
    intersect "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions"

define "Delivery Encounters With Hysterectomy":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with ["Procedure": "Hysterectomy"] Hysterectomy
      such that Hysterectomy.status = 'completed'
        and Hysterectomy.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )

define "Cardiac Conversion, Tracheostomy Or Ventilation Procedures":
  ["Procedure": "Conversion of Cardiac Rhythm"]
    union ["Procedure": "Tracheostomy"]
    union ["Procedure": "Ventilation"]

define "Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    with "Cardiac Conversion, Tracheostomy Or Ventilation Procedures" ConvTrachVentProcedures
      such that ConvTrachVentProcedures.status = 'completed'
        and ConvTrachVentProcedures.performed.toInterval ( ) starts during TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation ( )

define "SOC Excluding Blood Transfusions Only With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC":
  ( "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
      where exists ( ( SOCExcludingTransfusion.encounterDiagnosis ( ) ) EncounterDiagnoses
          where EncounterDiagnoses.code in "Placenta Increta or Percreta"
      )
        and ( exists "Delivery Encounters With Blood Transfusion"
            or exists "Delivery Encounters With Hysterectomy"
        )
  )
	
	//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounters With Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
          where SOCExcludingTransfusion.isDiagnosisPresentOnAdmission ( "Severe Maternal Morbidity Diagnoses", "Present on Admission is No or Unable To Determine" )
      )
        union "Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures"
        union "Delivery Encounters With Expiration"
    )

//First resulted value 24 hours prior to start of encounter and before time of delivery
//Report systolic blood pressure as mm[Hg]
//Systolic blood pressure value cannot be null per QICore profile requirement.




define "Risk Variable Systolic Blood Pressure":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstSystolicBP: First(["USCoreBloodPressureProfile"] BP
        where BP.effective.earliest() during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]
          and BP.status in { 'final', 'amended', 'corrected' }
          and BP.component.value is not null
        sort by effective.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstSBPResult: FirstSystolicBP.component C
        where C.code ~ "Systolic blood pressure"
        return C.value as Quantity,
      Timing: FirstSystolicBP.effective.earliest ( )
    }

define "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC":
  ( "Delivery Encounters With Severe Obstetric Complications" SOCEncounter
      where exists ( ( SOCEncounter.encounterDiagnosis ( ) ) EncounterDiagnosis
          where EncounterDiagnosis.code in "Placenta Increta or Percreta"
      )
        and ( exists "Delivery Encounters With Blood Transfusion"
            or exists "Delivery Encounters With Hysterectomy"
        )
  )
	//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy
    
    except ( ( "Delivery Encounters With Severe Obstetric Complications" SOCEncounter
          where SOCEncounter.isDiagnosisPresentOnAdmission ( "Severe Maternal Morbidity Diagnoses", "Present on Admission is No or Unable To Determine" )
      )
        union "Delivery Encounters With Cardiac Conversion, Tracheostomy Or Ventilation Procedures"
        union "Delivery Encounters With Expiration"
    )

define "SDE Delivery Encounters With Severe Obstetric Complication Diagnosis":
  ( "Delivery Encounters With Severe Obstetric Complications"
    except "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC" ) Encounter
    where Encounter.isDiagnosisPresentOnAdmission ( "Severe Maternal Morbidity Diagnoses", "Present on Admission is No or Unable To Determine" )

define "SDE SOC Diagnoses Detail":
  "SDE Delivery Encounters With Severe Obstetric Complication Diagnosis" Encounter
    let complication: Encounter.pOAIsNoOrUTD ( )
    return {
      id: Encounter.id,
      code: Encounter.type,
      complications: complication C
        where C in "Severe Maternal Morbidity Diagnoses"
          or C.getCondition ( ).code in "Severe Maternal Morbidity Diagnoses"
        return {
          code: C,
          SOCDxCategory: C.sOCDxCategory ( )
        }
    }

define "Risk Variable Substance Abuse":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Substance Abuse", "Present On Admission is Yes or Exempt" )

define "Risk Variable Renal Disease":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Renal Disease", "Present On Admission is Yes or Exempt" )

define "SDE Variable Calculated Gestational Age":
  //This definition establishes a variable of CGA (Calculated Gestational Age).  CGA is a supplemental data element to store the calculated gestational age result from the "CalculatedGestationalAge" function.  The data element enables the capturing and saving of the CGA for data analysis post data receipt. Hospitals do not need to submit any additional data to comply with this definition. 
  
  PCMaternal."Variable Calculated Gestational Age"

define "Risk Variable Gastrointestinal Disease":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Gastrointestinal Disease", "Present On Admission is Yes or Exempt" )

define "Risk Variable Pulmonary Hypertension":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Pulmonary Hypertension", "Present On Admission is Yes or Exempt" )

define "SDE Delivery Encounters With Severe Obstetric Complication Procedures":
  ( "Delivery Encounters With Severe Obstetric Complications"
    except "SOC With Hysterectomy Or Blood Transfusion With Placenta Increta Or Placenta Percreta Without Additional SOC" ) Encounter
    where exists ( ["Procedure": "Severe Maternal Morbidity Procedures"]
      union ["Procedure": "Blood Transfusion"] ) SMMProcedures
      where SMMProcedures.status = 'completed'
        and SMMProcedures.performed.toInterval ( ) starts during Encounter.hospitalizationWithEDOBTriageObservation ( )

define "Risk Variable Other Preeclampsia":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Mild or Moderate Preeclampsia", "Present On Admission is Yes or Exempt" )

define "Risk Variable Thyrotoxicosis":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Thyrotoxicosis", "Present On Admission is Yes or Exempt" )

define "Initial Population":
  PCMaternal."Delivery Encounter With Age Range"

define "Risk Variable Neuromuscular Disease":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Neuromuscular Disease", "Present On Admission is Yes or Exempt" )

define "Risk Variable Economic Housing Instability":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Economic Housing Instability", "Present On Admission is Yes or Exempt" )

define "Risk Variable HIV":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "HIV in Pregnancy Childbirth and Puerperium", "Present On Admission is Yes or Exempt" )

define "Risk Variable Maternal Age":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let MaternalAge: AgeInYearsAt(date from start of TwentyWeeksPlusEncounter.period)
    return { TwentyWeeksPlusEncounter, MaternalAge }

//First resulted value 24 hours prior to start of encounter and before time of delivery
 //Report heart rate as beats/min
 //Heart rate value cannot be null per QICore profile requirement.




define "Risk Variable Heart Rate":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    let FirstHeartRate: First([USCoreHeartRateProfile] HeartRate
        where HeartRate.effective.earliest() during Interval[start of TwentyWeeksPlusEncounter.hospitalizationWithEDOBTriageObservation() - 1440 minutes, TwentyWeeksPlusEncounter.lastTimeOfDelivery()]
          and HeartRate.status in { 'final', 'amended', 'corrected' }
        sort by effective.earliest()
    )
    return {
      EncounterId: TwentyWeeksPlusEncounter.id,
      FirstHRResult: FirstHeartRate.value as Quantity,
      Timing: FirstHeartRate.effective.earliest ( )
    }

define "Risk Variable Mental Health Disorder":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Mental Health Disorder", "Present On Admission is Yes or Exempt" )

define "Risk Variable Obstetrical VTE":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Venous Thromboembolism in Pregnancy", "Present On Admission is Yes or Exempt" )

define "Risk Variable Autoimmune Disease":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Autoimmune Disease", "Present On Admission is Yes or Exempt" )

define "Risk Variable Previous Cesarean":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Previous Cesarean", "Present On Admission is Yes or Exempt" )

define "Risk Variable Gestational Diabetes":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Gestational Diabetes", "Present On Admission is Yes or Exempt" )

define "SDE SOC Procedure Detail":
  "SDE Delivery Encounters With Severe Obstetric Complication Procedures" Encounter
    let procedure: Encounter.sOCProcedures ( )
    return {
      id: Encounter.id,
      code: Encounter.type,
      procedures: procedure P
        return {
          code: P,
          SOCProcedureCategory: P.sOCProcedureCategory ( )
        }
    }

define "Numerator":
  "Delivery Encounters With Severe Obstetric Complications"

define "Risk Variable Multiple Pregnancy":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation" TwentyWeeksPlusEncounter
    where TwentyWeeksPlusEncounter.isDiagnosisPresentOnAdmission ( "Multiple Pregnancy", "Present On Admission is Yes or Exempt" )

define "Denominator":
  "Delivery Encounters At Greater Than Or Equal To 20 Weeks Gestation"

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

define fluent function pOAIsNoOrUTD(TheEncounter Encounter):
  ( TheEncounter.claimDiagnosis ( ) ) CDiagnoses
    where CDiagnoses.onAdmission in "Present on Admission is No or Unable To Determine"
    return CDiagnoses.diagnosis

define fluent function sOCDxCategory(Dx Concept):
  case
    when Dx in "Acute Heart Failure" then 'Acute Heart Failure'
    when Dx in "Acute Myocardial Infarction" then 'Acute Myocardial Infarction'
    when Dx in "Acute Renal Failure" then 'Acute Renal Failure'
    when Dx in "Acute Respiratory Distress Syndrome" then 'Acute Respiratory Distress Syndrome'
    when Dx in "Air and Thrombotic Embolism" then 'Air and Thrombotic Embolism'
    when Dx in "Amniotic Fluid Embolism" then 'Amniotic Fluid Embolism'
    when Dx in "Aortic Aneurysm" then 'Aortic Aneurysm'
    when Dx in "Cardiac Arrest Ventricular Fibrillation" then 'Cardiac Arrest Ventricular Fibrillation'
    when Dx in "Disseminated Intravascular Coagulation" then 'Disseminated Intravascular Coagulation'
    when Dx in "Eclampsia" then 'Eclampsia'
    when Dx in "Heart Failure Cardiac Arrest Related to Procedure or Surgery" then 'Heart Failure Cardiac Arrest Related to Procedure or Surgery'
    when Dx in "Puerperal Cerebrovascular Disorder" then 'Puerperal Cerebrovascular Disorder'
    when Dx in "Pulmonary Edema" then 'Pulmonary Edema'
    when Dx in "Sepsis" then 'Sepsis'
    when Dx in "Severe Anesthesia Complications" then 'Severe Anesthesia Complications'
    when Dx in "Shock" then 'Shock'
    when Dx in "Sickle Cell Disease with Crisis" then 'Sickle Cell Disease with Crisis' 
    else null end

define fluent function sOCProcedures(TheEncounter Encounter):
  ( ["Procedure": "Severe Maternal Morbidity Procedures"]
    union ["Procedure": "Blood Transfusion"] ) SMMProcedures
    where SMMProcedures.status = 'completed'
      and SMMProcedures.performed.toInterval ( ) starts during TheEncounter.hospitalizationWithEDOBTriageObservation ( )

define fluent function sOCProcedureCategory(TheProcedure Procedure):
  case
    when TheProcedure.code in "Blood Transfusion" then 'Blood Transfusion'
    when TheProcedure.code in "Conversion of Cardiac Rhythm" then 'Conversion of cardiac rhythm'
    when TheProcedure.code in "Hysterectomy" then 'Hysterectomy'
    when TheProcedure.code in "Tracheostomy" then 'Tracheostomy'
    when TheProcedure.code in "Ventilation" then 'Ventilation' 
    else null end