value: cdc-opioid-guidance

system: PlanDefinitionType

code: eca-rule

display: ECA Rule

define "Get Summary":
  if "Is Recommendation Applicable?"
    then 'Recommend opioid agonist or partial agonist treatment with methadone maintenance therapy or buprenorphine'/* and/or behavioral therapy' */
  else null

// Opioid Review Useful
define "Age Less than 18 Years Is Enabled":
  true

define "Patient 18 or Older?":
  Config."Age Less than 18 Years Is Enabled"
    and AgeInYears() >= 18

// Recommendation 12
define "Evidence Based Treatment Criteria For Opioid Use Disorder":
  true

define "Not Receiving Evidence-Based Treatment for Opioid Use Disorder":
  Config."Evidence Based Treatment Criteria For Opioid Use Disorder"
    and not (
        if Config."Can the implementing EHR support queries for past medications by date range?" then
          exists (
            [MedicationRequest: Common."Buprenorphine and methadone medications"] MR
              where MR.status in { 'active', 'completed' }
                and date from MR.authoredOn during day of "Opioid Use Disorder Lookback Period"
          )
        else
            true
    /* update 2022 removes "behavioral therapy condition"
      or exists (
        [Procedure: Common."Substance misuse behavioral counseling"] P
          where P.status ~ 'completed'
            and (
              case
                when P.performed is FHIR.dateTime then
                  Interval[FHIRHelpers.ToDateTime(P.performed as FHIR.dateTime), FHIRHelpers.ToDateTime(P.performed as FHIR.dateTime)]
                when P.performed is FHIR.Period then
                  FHIRHelpers.ToInterval(P.performed as FHIR.Period)
                else
                  null as Interval<DateTime>
                end
            ) during day of "Opioid Use Disorder Lookback Period"
      )*/
    )

// 3. Medications indicating end of life
    /* or exists (
      "Medications Indicating End of Life"
    ) */
define "US Core-Categorized Conditions":
  [Condition: category in "Encounter Diagnosis Condition Category"]
    union [Condition: category in "Problem List Condition Category"]
    union [Condition: category in "US Core Health Concern Condition Category"]

define "Opioid Use Disorder Lookback Period":
  Interval[Today() - 90 days, Today()]

define "Presence of Diagnosis of Opioid Use Disorder":
  exists (
    Common."US Core-Categorized Conditions" C
      where C.code in Common."Opioid misuse disorders"
        and C.clinicalStatus in Common."Active Condition"
        and date from C.recordedDate during day of "Opioid Use Disorder Lookback Period"
    )

define "Positive Result from Opioid Use Disorder Evaluation Tool":
  true

define "Inclusion Criteria":
  Common."Patient 18 or Older?"
    and "Not Receiving Evidence-Based Treatment for Opioid Use Disorder"
    and "Presence of Diagnosis of Opioid Use Disorder"
    and "Positive Result from Opioid Use Disorder Evaluation Tool"

define "Exclusion Criteria":
  false

define "Is Recommendation Applicable?":
  "Inclusion Criteria"
    and not "Exclusion Criteria"

define "Get Detail":
  if "Is Recommendation Applicable?"
    then null
  else null

define "Get Indicator":
  if "Is Recommendation Applicable?"
    then 'warning'
  else null

Documentation

• 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain