library BreastCancerScreeningFHIR version '0.0.001'

using QICore version '4.1.1'

include FHIRHelpers version '4.4.000' called FHIRHelpers
include SupplementalDataElements version '3.5.000' called SDE
include QICoreCommon version '2.1.000' called QICoreCommon
include AdultOutpatientEncounters version '4.10.000' called AdultOutpatientEncounters
include Hospice version '6.10.000' called Hospice
include Status version '1.7.000' called Status
include PalliativeCare version '1.10.000' called PalliativeCare
include AdvancedIllnessandFrailty version '1.13.000' called AIFrailLTCF

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

valueset "Bilateral Mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1005' 
valueset "History of bilateral mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1068' 
valueset "Mammography": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1018' 
valueset "Status Post Left Mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1069' 
valueset "Status Post Right Mastectomy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1070' 
valueset "Unilateral Mastectomy Left": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1133' 
valueset "Unilateral Mastectomy Right": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1134' 
valueset "Unilateral Mastectomy, Unspecified Laterality": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1071'

code "Female": 'F' from "AdministrativeGender" display 'Female'
code "Left (qualifier value)": '7771000' from "SNOMEDCT" display 'Left (qualifier value)'
code "Right (qualifier value)": '24028007' from "SNOMEDCT" display 'Right (qualifier value)'

parameter "Measurement Period" Interval<DateTime>

context Patient

define "Initial Population":
                 AgeInYearsAt(date from 
                     end of "Measurement Period"
                  )in Interval[52, 74]
                  and Patient.gender = 'female'
                  and exists AdultOutpatientEncounters."Qualifying Encounters"
               
define "Denominator":
  "Initial Population"
  
define "Denominator Exclusions":
             Hospice."Has Hospice Services"
                  or ( ( 
                  exists ( "Right Mastectomy Diagnosis" )
                         or exists ( "Right Mastectomy Procedure" )
                     )
                      and (
                      exists ( "Left Mastectomy Diagnosis" )
                          or exists ( "Left Mastectomy Procedure" )
                      )
                  )
                  or exists "Bilateral Mastectomy Diagnosis"
                  or exists "Bilateral Mastectomy Procedure"
                  or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty"
                  or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
                  or PalliativeCare."Has Palliative Care in the Measurement Period"
                  
define "Right Mastectomy Diagnosis":
             ( [Condition: "Status Post Right Mastectomy"] RightMastectomyProcedure
                  union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis
                    where "Right (qualifier value)" in UnilateralMastectomyDiagnosis.bodySite
                    // where exists (UnilateralMastectomyDiagnosis.bodySite S where S ~ "Right (qualifier value)")
                  ) ) RightMastectomy
                  where RightMastectomy.prevalenceInterval() starts on or before 
                  end of "Measurement Period"
                  
define "Right Mastectomy Procedure":
             (([Procedure: "Unilateral Mastectomy Right"]).isProcedurePerformed()) UnilateralMastectomyRightPerformed
                  where UnilateralMastectomyRightPerformed.performed.toInterval() ends on or before 
                  end of "Measurement Period"
                
define "Left Mastectomy Diagnosis":
             ( [Condition: "Status Post Left Mastectomy"]
                  union ( [Condition: "Unilateral Mastectomy, Unspecified Laterality"] UnilateralMastectomyDiagnosis
                      where "Left (qualifier value)" in UnilateralMastectomyDiagnosis.bodySite
                    // where exists (UnilateralMastectomyDiagnosis.bodySite S where S ~ "Left (qualifier value)")
                  ) ) LeftMastectomy
                  where LeftMastectomy.prevalenceInterval() starts on or before 
                  end of "Measurement Period"
                  
define "Left Mastectomy Procedure":
             (([Procedure: "Unilateral Mastectomy Left"]).isProcedurePerformed()) UnilateralMastectomyLeftPerformed
                  where UnilateralMastectomyLeftPerformed.performed.toInterval() ends on or before 
                  end of "Measurement Period"
                
define "Bilateral Mastectomy Diagnosis":
             [Condition: "History of bilateral mastectomy"] BilateralMastectomyHistory
                  where BilateralMastectomyHistory.prevalenceInterval() starts on or before
                  end of "Measurement Period"
          
define "Bilateral Mastectomy Procedure":
            (([Procedure: "Bilateral Mastectomy"]).isProcedurePerformed()) BilateralMastectomyPerformed
                  where BilateralMastectomyPerformed.performed.toInterval() ends on or before 
                  end of "Measurement Period"
                  
define "Numerator":
             exists ((([Observation: "Mammography"]).isDiagnosticStudyPerformed()) Mammogram
                     where Mammogram.effective.toInterval() ends during day of Interval["October 1 Two Years Prior to the Measurement Period", 
                      end of "Measurement Period"]
                     )
          
define "October 1 Two Years Prior to the Measurement Period":
             DateTime((year from start of "Measurement Period" - 2), 10, 1, 0, 0, 0, 0, 0)
             
define "SDE Ethnicity":
  SDE."SDE Ethnicity"

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

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

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