library OpioidCDSREC01 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 #1
** Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred
** for acute pain. Clinicians should consider opioid therapy only if expected
** benefits for both pain and function are anticipated to outweigh risks to the
** patient. If opioids are used, they should be combined with nonpharmacologic
** therapy and nonopioid pharmacologic therapy, as appropriate
** (recommendation category: A, evidence type: 3).
**
** When
** Prescription is for treating acute pain
** Provider is prescribing an opioid with ambulatory misuse potential in the outpatient setting
** 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
** Patient is opioid naive:
** No indication of opioid use in the past 90 days from a prescription, self report (for future implementation), or a dispensing event (for future implementation)
** Then
** Recommend the use of nonpharmacologic therapy and nonopioid pharmacologic therapy as an alternative. Potential actions include:
** Document reason for opioid use
** Document that alternative therapy was attempted, snooze 3 months
** N/A - see comment, snooze 3 months
** Select from order set for alternative therapies
** Remove triggering medication
**
*/
// META: Plan Definition: http://fhir.org/guides/cdc/opioid-cds-r4/PlanDefinition/opioid-cds-01
parameter ContextPrescriptions List<FHIR.MedicationRequest>
context Patient
define "Acute 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 Routines."Is Opioid Naive?"
define "Exclusion Criteria":
false
define "Get Indicator":
if "Is Recommendation Applicable?"
then 'warning'
else null
define "Get Summary":
if "Is Recommendation Applicable?"
// NOTE: Wordsmithing here
then 'Recommend use of nonpharmacologic therapy and nonopioid pharmacologic therapy as alternative'
else null
define "Get Detail":
if "Is Recommendation Applicable?"
then 'Medication requests(s): ' + Combine( flatten( Common.GetMedicationNames( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ) ), ', ' )
else null
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