library OpioidCDSREC10OrderSignCRD version '2022.1.0'
using FHIR version '4.0.1'
include FHIRHelpers version '4.0.1' called FHIRHelpers
/*
** Recommendation #10
** When prescribing opioids for subacute or chronic pain, clinicians should consider the benefits
** and risks of toxicology testing to assess for prescribed medications as well as other prescribed
** and nonprescribed controlled substances (recommendation category: B; evidence type: 4).
**
** When
** Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting:
** Prescription is for treating subacute and/or chronic pain.
** Opioid review is useful for this patient:
** Patient is 18 or over
** Patient does not have evidence of sickle cell disease
** 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 office visits within the past 12 months with an oncology specialist present, or
** Patient has had at least 2 office visits within the past 12 months with a CDC malignant cancer condition diagnosis
** Patient does not have conditions likely terminal for opioid prescribing present
** Nonopioid drug urine screening has not been performed in last 12 months or
** Opioid drug urine screening has not been performed in last 12 months
** Then
** Consider the benefits and risks of conducting a urine toxicology screen:
** Document - Order toxicology screen
** Document risks outweigh benefits
** Snooze - N/A see comment, snooze 3 months
** When
** Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting:
** Prescription is for treating subacute and/or chronic pain.
** Opioid review is useful for this patient:
** Patient is 18 or over
** Patient does not have evidence of sickle cell disease
** 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 office visits within the past 12 months with an oncology specialist present, or
** Patient has had at least 2 office visits within the past 12 months with a CDC malignant cancer condition diagnosis
** Patient does not have conditions likely terminal for opioid prescribing present
** Nonopioid drug urine screening has been performed in last 12 months and
** Opioid drug urine screening has been performed in last 12 months and
** Positive result for synthetic opioid in the past year and not currently prescribed synthetic opioid or
** Positive result for phencyclidine(PCP) in the past year or
** Positive result for fentanyl in the past year and not currently prescribed fentanyl or
** Positive result for cocaine in the past year or
** Positive result for amphetamine in the past year and not currently prescribed amphetamine or
** Positive result for tetrahydrocannabinol (THC) in the past year and not currently prescribed tetrahydrocannabinol (THC) or
** Positive result for opiate in the past year and not currently prescribed natural opiate or
** Positive result for alcohol in the past year or
** Positive result for methadone in the past year and not currently prescribed methadone
** Then
** Patient may have unexpected toxicology test results:
** Document - Will repeat urine drug screening more frequently
** Document - Will assess patient for substance use disorder
** Snooze - Patient's test results were expected, snooze for 3 months
** Snooze - N/A snooze for 3 months
**
*/
// META: Plan Definition: http://fhir.org/guides/cdc/opioid-cds-r4/PlanDefinition/opioid-cds-10-order-sign
parameter ContextPrescriptions List<MedicationRequest>
context Patient
define "Do the CRD thing?": true
define "Get Coverage Extension":
FHIR.Extension {
url: FHIR.url { value: 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information' },
extension: {
FHIR.Extension {
url: FHIR.url { value: 'coverage' },
value: FHIR.Reference {
reference: FHIR.string { value: 'http://example.org/fhir/Coverage/example' }
}
},
FHIR.Extension {
url: FHIR.url { value: 'covered' },
value: FHIR.code { value: 'covered' }
},
FHIR.Extension {
url: FHIR.url { value: 'pa-needed' },
value: FHIR.code { value: 'satisfied' }
},
FHIR.Extension {
url: FHIR.url { value: 'billingCode' },
value: FHIR.Coding {
system: FHIR.uri { value: 'http://www.ama-assn.org/go/cpt' },
code: FHIR.code { value: '77065' }
}
},
FHIR.Extension {
url: FHIR.url { value: 'billingCode' },
value: FHIR.Coding {
system: FHIR.uri { value: 'http://www.ama-assn.org/go/cpt' },
code: FHIR.code { value: '77066' }
}
},
FHIR.Extension {
url: FHIR.url { value: 'billingCode' },
value: FHIR.Coding {
system: FHIR.uri { value: 'http://www.ama-assn.org/go/cpt' },
code: FHIR.code { value: '77067' }
}
},
FHIR.Extension {
url: FHIR.url { value: 'reason' },
value: FHIR.CodeableConcept { text: FHIR.string { value: 'In-network required unless exigent circumstances' } }
}
}
}
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