value: cdc-opioid-guidance

system: PlanDefinitionType

code: eca-rule

display: ECA Rule

define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
  ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
    where Routines."Is Subacute or Chronic 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 "Patient Age Less Than 18":
  if (Config."Age Less than 18 Years Is Enabled") then
    AgeInYearsAt(Today()) < 18
  else
    false

define "Condition Positive for Sickle Cell":
      if (Config."Sickle Cell Check Enabled") then
        exists(
            Common."Positive Sickle Cell Condition"
        )  else
        false

// 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 "Conditions Indicating End Of Life Present":
  exists (
    Common."US Core-Categorized Conditions" LLEC
      where LLEC.code in Common."Limited life expectancy conditions"
        and LLEC.clinicalStatus in Common."Active Condition"
  )

define "Is Active Cancer Treatment?":
  if (Config."Active Cancer Treatment Encounters Condition Is Enabled") then
      "Has Two or More Encounters with Cancer Diagnosis During Encounter Period"
    else
      false

define "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present":
  if (Config."End-Stage Disease Criteria Enabled") then
    exists (
      Common."US Core-Categorized Conditions" EOLC
        where EOLC.code in Common."Conditions likely terminal for opioid prescribing"
          and EOLC.clinicalStatus in Common."Active Condition"
    )
  else
    false

define "Is Opioid Review Useful?":
  not "Patient Age Less Than 18"
    and not "Condition Positive for Sickle Cell"
    and not "Conditions Indicating End Of Life Present"
    and not "Is Active Cancer Treatment?"
    and not "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present"

define "Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days":
    if (Config."Opioid Naive Prescription Condition Is Enabled") then
      exists ("Opioid RX with Ambulatory Abuse Potential In Past 90 Days")
    else
      false

define "Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days":
  if (Config."Opioid Naive Prescription Condition Is Enabled") then
    exists ("Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days")
  else
    false

// NOTE: MedicationStatement-dependent logic comment out due to bug in Publisher not supporting MedicationStatement in AllTypes.
define "Is Opioid Naive?":
    not ("Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days")
    /* and not ("Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days") */
    and not ("Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days")

// Recommendation 2
define "Opioid Treatment Plan Verification Enabled":
  true

define "Treatment Plan Lookback Period":
  Interval[Today() - 90 days, Today()]

define "Opioid Treatment Plan Creation or Update in Past 90 Days":
  [CarePlan: category in Common."Pain treatment plan"] PainTreatmentPlan
    where PainTreatmentPlan.status in { 'active', 'completed' }
      and (
        FHIRHelpers.ToDateTime( PainTreatmentPlan.created ) during day of "Treatment Plan Lookback Period"
          or PainTreatmentPlan.meta.lastUpdated during day of "Treatment Plan Lookback Period"
      )
      and exists(
        "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions".recorder Recorder
          where Recorder ~ PainTreatmentPlan.author
      )

define "Had Opioid Treatment Plan Reviewed in Past 90 Days":
  exists (
    [Procedure: Common."Pain management procedure"] PainManagementProcedure
      where PainManagementProcedure.performed during day of "Treatment Plan Lookback Period"
        and exists (
          PainManagementProcedure.performer Performer
            with "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ChronicPainScript
            such that Performer.actor ~ ChronicPainScript.recorder
        )
  )

define "No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?":
  Config."Opioid Treatment Plan Verification Enabled"
    and not (
      exists ( "Opioid Treatment Plan Creation or Update in Past 90 Days" )
        or "Had Opioid Treatment Plan Reviewed in Past 90 Days"
    )

define "Inclusion Criteria":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
    and Routines."Is Opioid Review Useful?"
    and Routines."Is Opioid Naive?"
    and "No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?"

define "Is Recommendation Applicable?":
  "Inclusion Criteria"

Documentation

• 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain