value: cdc-opioid-guidance

system: PlanDefinitionType

code: eca-rule

display: ECA Rule

define "Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
  Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions )

define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
  exists( "Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )

define "Active Ambulatory Benzodiazepine or CNS Depressant Rx":
    if Config."Can the implementing EHR support queries for past medications by date range?" then
      (
        "Get MedicationRequest Medication as Code"("Active Medication List")
      ) Rx
        where date from Rx.authoredOn 2 years or less on or before Today()
          and Rx.medication in "Benzodiazepine medications"
          or  Rx.medication in "CNS Depressant Medications"
    else
         List<FHIR.MedicationRequest>{}

define "Benzodiazepine or CNS Depressant Prescriptions":
  Common."Is Benzodiazepine or CNS Depressant?"( ContextPrescriptions )

define "Patient Is Being Prescribed Benzodiazepine or CNS Depressant":
  exists( "Benzodiazepine or CNS Depressant Prescriptions" )

define "Active Ambulatory Opioid Rx":
    if Config."Can the implementing EHR support queries for past medications by date range?" then
      (
        "Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest]))
      ) Rx
        where date from Rx.authoredOn 2 years or less on or before Today()
          and Rx.medication in "Opioid analgesics with ambulatory misuse potential"
    else
        List<FHIR.MedicationRequest>{}

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 "Inclusion Criteria":
  (
    (
      "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
        and exists Common."Active Ambulatory Benzodiazepine or CNS Depressant Rx"
    )
      or (
        "Patient Is Being Prescribed Benzodiazepine or CNS Depressant"
          and exists Common."Active Ambulatory Opioid Rx"
      )
  )
    and Routines."Is Opioid Review Useful?"

define "Conditions Indicating End of Life or With Limited Life Expectancy":
  (
    "US Core-Categorized Conditions" C
      where C.code in "Conditions likely terminal for opioid prescribing"
        and C.clinicalStatus in "Active Condition"
  )
  union
  (
    "US Core-Categorized Conditions" C
      where C.code in "Limited life expectancy conditions"
        and C.clinicalStatus in "Active Condition"
  )

define "Admitted/Referred/Discharged to Hospice Care":
  (
    if (Config."Hospice Findings Exclusion Enabled") then
      [Observation: code in "Hospice Finding Codes"] O
        where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })
    else
      {}
  )
  union
  (
    [Encounter] E
      where date from E.period.start 1 year or less on or before Today()
        and (
          if E.hospitalization.dischargeDisposition.coding is null
              or not exists (E.hospitalization.dischargeDisposition.coding)
            then false
          else E.hospitalization.dischargeDisposition in "Hospice Disposition"
        )
        and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }
  )

define "End of Life Assessment":
    // 1. Conditions indicating end of life or with limited life expectancy
    exists (
      "Conditions Indicating End of Life or With Limited Life Expectancy"
    )
    // 2. Admitted/referred/discharged to hospice care
    or exists (
      "Admitted/Referred/Discharged to Hospice Care"
    )

define "Exclusion Criteria":
  Common."End of Life Assessment"

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

Documentation

• 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain