library OpioidCDSREC07 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 #7
** Clinicians should evaluate benefits and harms with patients within 1 to 4
** weeks of starting opioid therapy for subacute or chronic pain or of dose escalation.
** Clinicians should evaluate benefits and harms of continued therapy with
** patients every 3 months or more frequently. If benefits do not outweigh
** harms of continued opioid therapy, clinicians should optimize other
** therapies and work with patients to taper opioids to lower dosages or to
** taper and discontinue opioids (recommendation category: A, 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
** Patient has not undergone an opioid misuse assessment procedure in the last 90 days
** Then
** Recommend performing opioid misuse assessment
** Will schedule opioid misuse assessment
** Benefits outweigh risks, snooze 3 months
** N/A - see comment, snooze 3 months
**
*/
// META: Plan Definition: http://fhir.org/guides/cdc/opioid-cds-r4/PlanDefinition/opioid-cds-07
parameter ContextPrescriptions List<MedicationRequest>
context Patient
define "Risk Assessment Interval":
Interval[Today() - 91 days, Today() - 1 day]
define "Previous 10 Days Interval":
Interval[Today() - 10 days, Today()]
define "Encounter Interval":
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 exists ( "Opioid Risk Assessment in Past 90 Days" )
and (
"Prescribed Opioids for 7 of Past 10 Days with an Encounter"
or Common."Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months"
)
define "Exclusion Criteria":
Common."End of Life Assessment"
define "Opioid Risk Assessment in Past 90 Days":
[Procedure: Common."Opioid misuse assessment procedure"] riskAssessment
where start of (riskAssessment.performed as FHIR.Period) in day of "Risk Assessment Interval"
define "Prescribed Opioids for 7 of Past 10 Days with an Encounter":
Common."Days on Opioids during Period"( "Previous 10 Days Interval" ) >= 7
and exists (
[Encounter: Common."Office Visit"] AmbulatoryEncounter
where AmbulatoryEncounter.period during "Encounter Interval"
)
define "Get Indicator":
if "Is Recommendation Applicable?"
then 'warning'
else null
define "Get Summary":
if "Is Recommendation Applicable?"
then 'Patients on opioid therapy should be evaluated for benefits and harms within 1 to 4 weeks of starting opioid therapy and every 3 months or more subsequently.'
else null
define "Get Detail":
if "Is Recommendation Applicable?"
then
if Common."Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months"
then 'No evaluation for benefits and harms associated with opioid therapy has been performed for the patient in the past 3 months'
else 'No evaluation for benefits and harms has been performed for the patient starting opioid therapy'
else null
|
