library OpioidCDSREC10 version '2022.1.0'
using FHIR version '4.0.1'
include FHIRHelpers version '4.0.1' called FHIRHelpers
include OpioidCDSCommon version '2022.1.0' called Common
include OpioidCDSRoutines version '2022.1.0' called Routines
/*
** Recommendation #10
** When prescribing opioids for subacute or chronic pain, providers should use urine drug
** testing before starting opioid therapy and consider urine drug testing at
** least annually to assess for prescribed medications as well as other controlled
** prescription drugs and illicit drugs (recommendation category: B, evidence type: 4)
**
** When
** Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting
** Prescription is for treating chronic pain.
** Opioid review is useful for this patient:
** Patient is 18 or over
** Patient does not have findings indicating limited life expectancy
** Patient does not have orders for therapies indicating end of life care
** Patient is not undergoing active cancer treatment:
** Patient has had at least 2 encounters within the past year with any diagnosis of cancer
** Urine drug screening has not been performed in last 12 months
** Then
** Recommend urine drug screening
** Will perform urine screening
** Not for chronic pain management, snooze 3 months
** N/A - see comment, snooze 3 months
**
*/
// META: Plan Definition: http://fhir.org/guides/cdc/opioid-cds-r4/PlanDefinition/opioid-cds-10
parameter ContextPrescriptions List<MedicationRequest>
context Patient
define "Lookback Year":
Interval[Today() - 12 months - 1 days, Today() - 1 day]
define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription )
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )
define "Is Recommendation Applicable?":
"Inclusion Criteria"
and not "Exclusion Criteria"
define "Inclusion Criteria":
"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
and Routines."Is Opioid Review Useful?"
and not "Patient had Urine Screening in Last 12 Months"
define "Exclusion Criteria":
Common."End of Life Assessment"
define "Patient had Urine Screening in Last 12 Months":
exists( "Urine Screenings during the Last 12 Months" )
define "Urine Screenings during the Last 12 Months":
(
[Observation: "code" in Common."Non-opioid drug urine screening"] IllicitDrugScreen
where date from IllicitDrugScreen.effective in day of "Lookback Year"
)
union
(
[Observation: "code" in Common."Opioid drug urine screening"] OpioidDrugScreen
where date from OpioidDrugScreen.effective in day of "Lookback Year"
)
define "No Screening In Last 12 Months Indicator":
if "Is Recommendation Applicable?"
then 'warning'
else null
define "No Screening In Last 12 Months Summary":
if "Is Recommendation Applicable?"
then 'Annual Urine Screening Check'
else null
define "No Screening In Last 12 Months Detail":
if "Is Recommendation Applicable?"
then 'Patients on opioid therapy should have a urine drug test performed every 12 months.'
else null
|
