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"

// Recommendation 9
define "PDMP Data Not Reviewed in Past 90 Days Criteria Enabled":
  true

define "Look Back 90 Days":
  Interval[Today() - 90 days, Today()]

define "PDMP Data Not Reviewed in Past 90 Days":
  Config."PDMP Data Not Reviewed in Past 90 Days Criteria Enabled"
    and not (
      exists (
        [Procedure: Common."PDMP review procedure"] P
          where P.status ~ 'completed'
            and P.performed during "Look Back 90 Days"
      )
      or exists (
        [Observation: Common."PDMP data reviewed finding"] O
          where O.status in { 'final', 'amended' }
            and (
              if O.effective is FHIR.Period
                then (O.effective as FHIR.Period) during day of "Look Back 90 Days"
                else if O.effective is FHIR.dateTime
                  then date from O.effective in day of "Look Back 90 Days"
                  else false
          )
      )
    )

define "Inclusion Criteria":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
    and Routines."Is Opioid Review Useful?"
    and "PDMP Data Not Reviewed in Past 90 Days"

define "Exclusion Criteria":
  false

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

Documentation

• 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain