feat(measure): promote CMS125 + CMS122 to Active with full CQL

backend/src/main/java/com/workwell/compile/CqlEvaluationService.java

@@ -566,6 +566,29 @@ private MeasureSeedSpec measureSeedSpecFor(String measureName) {
                     "urn:workwell:vs:ldl-labs",
                     false
             );
+            case "Breast Cancer Screening" -> new MeasureSeedSpec(
+                    "cms125",
+                    "cms125-eligible",
+                    "urn:workwell:vs:cms125-eligible",
+                    "cms125-excluded",
+                    "urn:workwell:vs:cms125-excluded",
+                    "mammogram",
+                    "urn:workwell:vs:cms125-mammogram",
+                    false,
+                    820
+            );
+            case "Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)" -> new MeasureSeedSpec(
+                    "cms122",
+                    "cms122-diabetes",
+                    "urn:workwell:vs:cms122-diabetes",
+                    "cms122-excluded",
+                    "urn:workwell:vs:cms122-excluded",
+                    "hba1c-obs",
+                    "urn:workwell:vs:cms122-hba1c",
+                    false,
+                    365,
+                    true
+            );
             default -> null;
         };
     }
@@ -576,14 +599,36 @@ private SeededInput input(
             SeededOutcome targetOutcome
     ) {
         int window = spec.complianceWindowDays();
+        boolean hasWaiver = targetOutcome == SeededOutcome.EXCLUDED;
+
+        // Observation-based measures (e.g. CMS122 HbA1c) derive compliance from a
+        // numeric value, not a recency window. Use observationValue; daysSinceLastExam
+        // is set to a recent value so the observation has a timestamp.
+        if (spec.observationBased()) {
+            Float observationValue = switch (targetOutcome) {
+                case COMPLIANT -> 7.5f;
+                case OVERDUE -> 10.5f;
+                case MISSING_DATA, DUE_SOON -> null;
+                case EXCLUDED -> 7.5f;
+            };
+            Integer daysAgo = observationValue != null ? 30 : null;
+            SyntheticFhirBundleBuilder.ExamConfig config = new SyntheticFhirBundleBuilder.ExamConfig(
+                    daysAgo, hasWaiver, true,
+                    spec.enrollmentCode(), spec.enrollmentVs(),
+                    spec.waiverCode(), spec.waiverVs(),
+                    spec.examCode(), spec.examVs(), false,
+                    observationValue
+            );
+            return new SeededInput(employee, config, targetOutcome.name());
+        }
+
         Integer daysSinceLastExam = switch (targetOutcome) {
             case COMPLIANT -> window / 3;
             case DUE_SOON -> window - 10;
             case OVERDUE -> window + 60;
             case MISSING_DATA -> null;
             case EXCLUDED -> window + 150;
         };
-        boolean hasWaiver = targetOutcome == SeededOutcome.EXCLUDED;
         SyntheticFhirBundleBuilder.ExamConfig config = new SyntheticFhirBundleBuilder.ExamConfig(
                 daysSinceLastExam,
                 hasWaiver,
@@ -629,13 +674,21 @@ private record MeasureSeedSpec(
             String examCode,
             String examVs,
             boolean useImmunization,
-            int complianceWindowDays
+            int complianceWindowDays,
+            boolean observationBased
     ) {
         MeasureSeedSpec(String rateKey, String enrollmentCode, String enrollmentVs,
                         String waiverCode, String waiverVs, String examCode, String examVs,
                         boolean useImmunization) {
             this(rateKey, enrollmentCode, enrollmentVs, waiverCode, waiverVs,
-                    examCode, examVs, useImmunization, 365);
+                    examCode, examVs, useImmunization, 365, false);
+        }
+
+        MeasureSeedSpec(String rateKey, String enrollmentCode, String enrollmentVs,
+                        String waiverCode, String waiverVs, String examCode, String examVs,
+                        boolean useImmunization, int complianceWindowDays) {
+            this(rateKey, enrollmentCode, enrollmentVs, waiverCode, waiverVs,
+                    examCode, examVs, useImmunization, complianceWindowDays, false);
         }
     }
 }

backend/src/main/java/com/workwell/compile/SyntheticFhirBundleBuilder.java

@@ -10,8 +10,10 @@
 import org.hl7.fhir.r4.model.Enumerations;
 import org.hl7.fhir.r4.model.HumanName;
 import org.hl7.fhir.r4.model.Immunization;
+import org.hl7.fhir.r4.model.Observation;
 import org.hl7.fhir.r4.model.Patient;
 import org.hl7.fhir.r4.model.Procedure;
+import org.hl7.fhir.r4.model.Quantity;
 import org.hl7.fhir.r4.model.Reference;
 
 public class SyntheticFhirBundleBuilder {
@@ -49,7 +51,31 @@ public Bundle buildBundle(
             ));
         }
 
-        if (config.daysSinceLastExam() != null) {
+        if (config.observationValue() != null) {
+            Observation observation = new Observation();
+            observation.setId(employee.externalId() + "-observation");
+            observation.setStatus(Observation.ObservationStatus.FINAL);
+            observation.setSubject(new Reference("Patient/" + employee.externalId()));
+            observation.getCode().addCoding()
+                    .setSystem(config.examValueSet())
+                    .setCode(config.examCode())
+                    .setDisplay(config.examCode());
+            if (config.daysSinceLastExam() != null) {
+                String effectiveDateTime = evaluationDate
+                        .minusDays(config.daysSinceLastExam())
+                        .atStartOfDay()
+                        .format(DateTimeFormatter.ISO_LOCAL_DATE_TIME);
+                observation.setEffective(new org.hl7.fhir.r4.model.DateTimeType(effectiveDateTime));
+            }
+            observation.setValue(new Quantity()
+                    .setValue(java.math.BigDecimal.valueOf(config.observationValue()))
+                    .setUnit("%")
+                    .setSystem("http://unitsofmeasure.org")
+                    .setCode("%"));
+            bundle.addEntry().setResource(observation);
+        }
+
+        if (config.daysSinceLastExam() != null && config.observationValue() == null) {
             String performedDateTime = evaluationDate
                     .minusDays(config.daysSinceLastExam())
                     .atStartOfDay()
@@ -106,7 +132,17 @@ public record ExamConfig(
             String waiverValueSet,
             String examCode,
             String examValueSet,
-            boolean useImmunization
+            boolean useImmunization,
+            Float observationValue
     ) {
+        public ExamConfig(Integer daysSinceLastExam, boolean hasWaiver, boolean programEnrolled,
+                          String programEnrollmentCode, String programEnrollmentValueSet,
+                          String waiverCode, String waiverValueSet,
+                          String examCode, String examValueSet, boolean useImmunization) {
+            this(daysSinceLastExam, hasWaiver, programEnrolled,
+                    programEnrollmentCode, programEnrollmentValueSet,
+                    waiverCode, waiverValueSet, examCode, examValueSet,
+                    useImmunization, null);
+        }
     }
 }

backend/src/main/java/com/workwell/measure/MeasureService.java

@@ -127,6 +127,8 @@ private void ensureInstanceSeeds() {
             ensureDiabetesHbA1cSeed();
             ensureObesityBmiSeed();
             ensureCholesterolLdlSeed();
+            ensureCms125Seed();
+            ensureCms122Seed();
             ensureCmsEcqmCatalogSeed();
         }
     }
@@ -1151,6 +1153,127 @@ private void ensureCmsEcqmCatalogSeed() {
         }
     }
 
+    private void ensureCms125Seed() {
+        // CMS125 — Breast Cancer Screening (mammogram within 27 months / 820 days).
+        // We seed this as Active with full CQL BEFORE ensureCmsEcqmCatalogSeed() runs.
+        // Because that method skips existing v1.0 versions, the Active record persists.
+        // policy_ref must start with "CMS125v" so the catalog seed can match by prefix.
+        UUID measureId;
+        try {
+            measureId = jdbcTemplate.queryForObject(
+                    "SELECT id FROM measures WHERE policy_ref LIKE 'CMS125v%'",
+                    UUID.class
+            );
+        } catch (EmptyResultDataAccessException ex) {
+            measureId = UUID.randomUUID();
+            jdbcTemplate.update(
+                    "INSERT INTO measures (id, name, policy_ref, owner, tags, created_at, updated_at) VALUES (?, ?, ?, ?, ?::text[], NOW(), NOW())",
+                    measureId,
+                    "Breast Cancer Screening",
+                    "CMS125v14",
+                    "WorkWell Studio",
+                    "{ecqm,cms,cancer-screening,preventive}"
+            );
+        }
+
+        Integer existing = jdbcTemplate.queryForObject(
+                "SELECT COUNT(*) FROM measure_versions WHERE measure_id = ? AND version = ?",
+                Integer.class, measureId, "v1.0"
+        );
+        if (existing != null && existing > 0) {
+            jdbcTemplate.update(
+                    "UPDATE measure_versions SET cql_text = ?, compile_status = 'COMPILED', compile_result = ?::jsonb WHERE measure_id = ? AND version = ?",
+                    loadSeedCql("cms125.cql"),
+                    toJson(Map.of("status", "COMPILED", "warnings", List.of(), "errors", List.of())),
+                    measureId, "v1.0"
+            );
+            return;
+        }
+
+        Map<String, Object> spec = new LinkedHashMap<>();
+        spec.put("description", "Breast Cancer Screening (CMS125v14 / MIPS 112): women 50–74 who had a mammogram in the measurement period or 26 months prior.");
+        spec.put("eligibilityCriteria", Map.of(
+                "roleFilter", "All",
+                "siteFilter", "All Sites",
+                "programEnrollmentText", "Breast Cancer Screening Eligible"
+        ));
+        spec.put("exclusions", List.of(Map.of("label", "Clinical Exclusion", "criteriaText", "Bilateral mastectomy or history of breast cancer — documented exclusion on file")));
+        spec.put("complianceWindow", "27 months (820 days)");
+        spec.put("requiredDataElements", List.of("Last mammogram date", "Eligible population flag", "Exclusion status"));
+        spec.put("testFixtures", List.of());
+        spec.put("cmsEcqmId", "CMS125v14");
+        spec.put("mipsQualityId", "112");
+
+        jdbcTemplate.update(
+                "INSERT INTO measure_versions (id, measure_id, version, status, spec_json, cql_text, compile_status, compile_result, change_summary, approved_by, activated_at, created_at) VALUES (?, ?, ?, ?, ?::jsonb, ?, ?, ?::jsonb, ?, ?, NOW(), NOW())",
+                UUID.randomUUID(), measureId, "v1.0", "Active",
+                toJson(spec), loadSeedCql("cms125.cql"), "COMPILED",
+                toJson(Map.of("status", "COMPILED", "warnings", List.of(), "errors", List.of())),
+                "CMS125v14 Breast Cancer Screening — Active seed with full CQL (27-month mammogram window)",
+                "system"
+        );
+    }
+
+    private void ensureCms122Seed() {
+        // CMS122 — Diabetes: HbA1c Poor Control (> 9%).
+        // Numeric Observation-based measure. An HbA1c value > 9% → OVERDUE (poor control).
+        // policy_ref must start with "CMS122v" so the catalog seed can match by prefix.
+        UUID measureId;
+        try {
+            measureId = jdbcTemplate.queryForObject(
+                    "SELECT id FROM measures WHERE policy_ref LIKE 'CMS122v%'",
+                    UUID.class
+            );
+        } catch (EmptyResultDataAccessException ex) {
+            measureId = UUID.randomUUID();
+            jdbcTemplate.update(
+                    "INSERT INTO measures (id, name, policy_ref, owner, tags, created_at, updated_at) VALUES (?, ?, ?, ?, ?::text[], NOW(), NOW())",
+                    measureId,
+                    "Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)",
+                    "CMS122v14",
+                    "WorkWell Studio",
+                    "{ecqm,cms,diabetes}"
+            );
+        }
+
+        Integer existing = jdbcTemplate.queryForObject(
+                "SELECT COUNT(*) FROM measure_versions WHERE measure_id = ? AND version = ?",
+                Integer.class, measureId, "v1.0"
+        );
+        if (existing != null && existing > 0) {
+            jdbcTemplate.update(
+                    "UPDATE measure_versions SET cql_text = ?, compile_status = 'COMPILED', compile_result = ?::jsonb WHERE measure_id = ? AND version = ?",
+                    loadSeedCql("cms122.cql"),
+                    toJson(Map.of("status", "COMPILED", "warnings", List.of(), "errors", List.of())),
+                    measureId, "v1.0"
+            );
+            return;
+        }
+
+        Map<String, Object> spec = new LinkedHashMap<>();
+        spec.put("description", "Diabetes: HbA1c Poor Control (CMS122v14 / MIPS 1): patients 18–75 with diabetes whose most recent HbA1c result is > 9% (poor control). OVERDUE indicates intervention is needed.");
+        spec.put("eligibilityCriteria", Map.of(
+                "roleFilter", "All",
+                "siteFilter", "All Sites",
+                "programEnrollmentText", "Diabetes Diagnosis"
+        ));
+        spec.put("exclusions", List.of(Map.of("label", "Clinical Exclusion", "criteriaText", "Hospice care, advanced illness, or other clinical exclusion")));
+        spec.put("complianceWindow", "Annual — based on HbA1c value, not recency");
+        spec.put("requiredDataElements", List.of("Most recent HbA1c lab value", "Diabetes diagnosis", "Exclusion status"));
+        spec.put("testFixtures", List.of());
+        spec.put("cmsEcqmId", "CMS122v14");
+        spec.put("mipsQualityId", "1");
+
+        jdbcTemplate.update(
+                "INSERT INTO measure_versions (id, measure_id, version, status, spec_json, cql_text, compile_status, compile_result, change_summary, approved_by, activated_at, created_at) VALUES (?, ?, ?, ?, ?::jsonb, ?, ?, ?::jsonb, ?, ?, NOW(), NOW())",
+                UUID.randomUUID(), measureId, "v1.0", "Active",
+                toJson(spec), loadSeedCql("cms122.cql"), "COMPILED",
+                toJson(Map.of("status", "COMPILED", "warnings", List.of(), "errors", List.of())),
+                "CMS122v14 Diabetes HbA1c Poor Control — Active seed with numeric Observation CQL",
+                "system"
+        );
+    }
+
     private void ensureHypertensionSeed() {
         UUID measureId;
         try {

backend/src/main/resources/measures/cms122.cql

@@ -0,0 +1,67 @@
+library DiabetesHbA1cPoorControlCQL version '1.0.0'
+using FHIR version '4.0.1'
+include FHIRHelpers version '4.0.1' called FHIRHelpers
+
+valueset "HbA1c Lab Tests": 'urn:workwell:vs:cms122-hba1c'
+valueset "Diabetes Diagnosis": 'urn:workwell:vs:cms122-diabetes'
+valueset "CMS122 Exclusions": 'urn:workwell:vs:cms122-excluded'
+
+parameter "Measurement Period" Interval<DateTime>
+context Patient
+
+define "Has Diabetes Diagnosis":
+  exists([Condition] C
+    where exists(C.code.coding x where x.system = 'urn:workwell:vs:cms122-diabetes' and x.code = 'cms122-diabetes'))
+
+define "Has Exclusion":
+  exists([Condition] C
+    where exists(C.code.coding x where x.system = 'urn:workwell:vs:cms122-excluded' and x.code = 'cms122-excluded'))
+
+define "Most Recent HbA1c Observation":
+  Last(
+    [Observation] O
+      where exists(O.code.coding C where C.system = 'urn:workwell:vs:cms122-hba1c' and C.code = 'hba1c-obs')
+      sort by (effective as FHIR.dateTime)
+  )
+
+define "Most Recent HbA1c Value":
+  "Most Recent HbA1c Observation".value as FHIR.Quantity
+
+define "HbA1c Poor Control":
+  "Most Recent HbA1c Value".value > 9
+
+define "Has Recent HbA1c Result":
+  "Most Recent HbA1c Observation" is not null
+
+define "Compliant":
+  "Has Diabetes Diagnosis"
+    and not "Has Exclusion"
+    and "Has Recent HbA1c Result"
+    and not "HbA1c Poor Control"
+
+define "Due Soon":
+  false
+
+define "Overdue":
+  "Has Diabetes Diagnosis"
+    and not "Has Exclusion"
+    and "Has Recent HbA1c Result"
+    and "HbA1c Poor Control"
+
+define "Missing Data":
+  "Has Diabetes Diagnosis"
+    and not "Has Exclusion"
+    and not "Has Recent HbA1c Result"
+
+define "Excluded":
+  "Has Exclusion"
+
+define "Initial Population":
+  "Has Diabetes Diagnosis" or "Has Exclusion"
+
+define "Outcome Status":
+  if "Excluded" then 'EXCLUDED'
+  else if "Missing Data" then 'MISSING_DATA'
+  else if "Overdue" then 'OVERDUE'
+  else if "Compliant" then 'COMPLIANT'
+  else 'MISSING_DATA'