library DRCommunicationWithPhysicianManagingDiabetesFHIR version '0.0.003'

using QICore version '4.1.1'

/*This spec aligns with AU2022/PY2023 QDM version*/

include FHIRHelpers version '4.1.000' called FHIRHelpers
include SupplementalDataElements version '3.1.000' called SDE
include CQMCommon version '1.0.000' called CQMCommon 
include QICoreCommon version '1.2.000' called QICoreCommon
include FHIRCommon version '4.1.000' called FHIRCommon

codesystem "SNOMEDCT": 'http://snomed.info/sct' 
codesystem "ActCode": 'http://terminology.hl7.org/CodeSystem/v3-ActCode'  

valueset "Care Services in Long-Term Residential Facility": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014' 
valueset "Diabetic Retinopathy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.327' 
valueset "Level of Severity of Retinopathy Findings": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283'  
valueset "Macular Edema Findings Present": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320' 
valueset "Macular Exam": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1251' 
valueset "Medical Reason": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007' 
valueset "Nursing Facility Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012' 
valueset "Office Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001' 
valueset "Ophthalmological Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285' 
valueset "Outpatient Consultation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008' 
valueset "Patient Reason": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008' 

code "Healthcare professional (occupation)": '223366009' from "SNOMEDCT" display 'Healthcare professional (occupation)'
code "Medical practitioner (occupation)": '158965000' from "SNOMEDCT" display 'Medical practitioner (occupation)'
code "Ophthalmologist (occupation)": '422234006' from "SNOMEDCT" display 'Ophthalmologist (occupation)'
code "Optometrist (occupation)": '28229004' from "SNOMEDCT" display 'Optometrist (occupation)'
code "Physician (occupation)": '309343006' from "SNOMEDCT" display 'Physician (occupation)'
code "virtual": 'VR' from "ActCode" display 'virtual'
code "Macular edema absent (situation)": '428341000124108' from "SNOMEDCT" display 'Macular edema absent (situation)'
code "AMB" : 'AMB' from "ActCode" display 'Ambulatory'

parameter "Measurement Period" Interval<DateTime>

context Patient

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

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

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

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


define "Initial Population":
AgeInYearsAt(date from start of "Measurement Period")>= 18
    and exists "Diabetic Retinopathy Encounter"

define "Denominator":
"Initial Population"
    and exists "Macular Exam Performed"
   
define "Numerator":
exists "Level of Severity of Retinopathy Findings Communicated"
    and ( exists "Macular Edema Absence Communicated"
          or exists "Macular Edema Presence Communicated" )   
  
define "Denominator Exceptions":
exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
    or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
    or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema"
    
define "Qualifying Encounter During Measurement Period":
( ["Encounter": "Office Visit"]
    union ["Encounter": "Ophthalmological Services"]
    union ["Encounter": "Outpatient Consultation"]
    union ["Encounter": "Care Services in Long-Term Residential Facility"]
    union ["Encounter": "Nursing Facility Visit"] ) QualifyingEncounter
    where QualifyingEncounter.period during "Measurement Period"
        and QualifyingEncounter.status = 'finished'
        and QualifyingEncounter.class !~ "virtual"
        and QualifyingEncounter.class ~  "AMB"

define "Diabetic Retinopathy Encounter":
"Qualifying Encounter During Measurement Period" ValidQualifyingEncounter 
    with ["Condition": "Diabetic Retinopathy"] DiabeticRetinopathy
    such that QICoreCommon."ToPrevalenceInterval" ( DiabeticRetinopathy ) overlaps  ValidQualifyingEncounter.period


define "Macular Exam Performed":
["Observation": "Macular Exam"] MacularExam
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
       such that QICoreCommon."ToInterval" (MacularExam.effective) during EncounterDiabeticRetinopathy.period
    where MacularExam.value is not null

define "Results of Dilated Macular or Fundus Exam Communicated":
exists "Level of Severity of Retinopathy Findings Communicated"
    and ( exists "Macular Edema Absence Communicated"
        or exists "Macular Edema Presence Communicated"
      )
      
define "Level of Severity of Retinopathy Findings Communicated":
["Communication": "Level of Severity of Retinopathy Findings"] LevelOfSeverityCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
        such that LevelOfSeverityCommunicated.sent after start of EncounterDiabeticRetinopathy.period
    where LevelOfSeverityCommunicated.status = 'completed'

define "Macular Edema Absence Communicated":
["Communication":  "Macular edema absent (situation)"] MacularEdemaAbsentCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
        such that MacularEdemaAbsentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
    where  MacularEdemaAbsentCommunicated.status = 'completed'

define "Macular Edema Presence Communicated":
["Communication": "Macular Edema Findings Present"] MacularEdemaPresentCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
        such that MacularEdemaPresentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
    where  MacularEdemaPresentCommunicated.status = 'completed'

define "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy":
[CommunicationNotDone: "Level of Severity of Retinopathy Findings"] LevelOfSeverityNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
        such that LevelOfSeverityNotCommunicated.recorded during EncounterDiabeticRetinopathy.period
     where ( LevelOfSeverityNotCommunicated.statusReason in "Medical Reason"
          or LevelOfSeverityNotCommunicated.statusReason in "Patient Reason" 
      ) 

define "Medical or Patient Reason for Not Communicating Presence of Macular Edema":
[CommunicationNotDone: "Macular Edema Findings Present"] MacularEdemaPresentNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
        such that MacularEdemaPresentNotCommunicated.recorded during EncounterDiabeticRetinopathy.period
      where ( MacularEdemaPresentNotCommunicated.statusReason in "Medical Reason"
          or MacularEdemaPresentNotCommunicated.statusReason in "Patient Reason"
      ) 

define "Medical or Patient Reason for Not Communicating Absence of Macular Edema":
[CommunicationNotDone] MacularEdemaAbsentNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaAbsentNotCommunicated.recorded during EncounterDiabeticRetinopathy.period
    where ( MacularEdemaAbsentNotCommunicated.reasonCode = "Macular edema absent (situation)"
        or "Macular edema absent (situation)" in MacularEdemaAbsentNotCommunicated.reasonCode) 
      and (MacularEdemaAbsentNotCommunicated.statusReason in "Medical Reason"
        or MacularEdemaAbsentNotCommunicated.statusReason in "Patient Reason")
/*https://oncprojectracking.healthit.gov/support/browse/BONNIEMAT-1420*/