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Id: library-OpioidCDSREC10PatientView
Type: Logic Library
Status: active

type: depends-on

reference: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers

type: depends-on

reference: http://fhir.org/guides/cdc/opioid-cds/Library/library-OpioidCDSCommon

type: depends-on

reference: http://fhir.org/guides/cdc/opioid-cds/Library/library-OpioidCDSRoutines

Data Requirements:

type: Observation

code filter:
path: code
valueset: org.hl7.fhir.dstu3.model.Reference@49768664

type: Observation

code filter:
path: code
valueset: org.hl7.fhir.dstu3.model.Reference@698745b8

Content: type: text/cql
library OpioidCDSREC10PatientView version '1.2.2'

using FHIR version '3.0.0'

include FHIRHelpers version '3.0.0' called FHIRHelpers
include OpioidCDSCommon version '1.2.2' called Common
include OpioidCDSRoutines version '1.2.2' called Routines

code "Urine Drug Screening": '310627008' from Common.SNOMED display 'Urine drug screening (procedure)'

**  Recommendation #10
**    When prescribing opioids for chronic pain, providers should use urine drug
**    testing before starting opioid therapy and consider urine drug testing at
**    least annually to assess for prescribed medications as well as other controlled
**    prescription drugs and illicit drugs (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 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
**    Urine drug screening has not been performed in last 12 months
**  Then
**    Recommend urine drug screening
**      Will perform urine screening
**      Not for chronic pain management, snooze 3 months
**      N/A - see comment, snooze 3 months

// META: Plan Definition: http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioid-cds-10-patient-view

context Patient

define "Lookback Year":
  Interval[Today() - 12 months - 1 days, Today() - 1 day]

define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
  exists (
    Common."Active Ambulatory Opioid Rx" AmbulatoryOpioidPrescription
      where Routines."Is Chronic Pain Prescription?"(AmbulatoryOpioidPrescription)

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 "Patient had Urine Screening in Last 12 Months"

define "Exclusion Criteria":

define "Patient had Urine Screening in Last 12 Months":
  exists( "Urine Screenings during the Last 12 Months" )

define "Urine Screenings during the Last 12 Months":
    [Observation: "code" in Common."Non-opioid illicit drug urine screening"] IllicitDrugScreen
      where date from IllicitDrugScreen.effective in day of "Lookback Year"
        and not (IllicitDrugScreen.status.value in { 'unknown', 'entered-in-error', 'cancelled' })
    [Observation: "code" in Common."Opioid drug urine screening"] OpioidDrugScreen
      where date from OpioidDrugScreen.effective in day of "Lookback Year"
        and not (OpioidDrugScreen.status.value in { 'unknown', 'entered-in-error', 'cancelled' })

define "No Screening In Last 12 Months Indicator":
  if "Is Recommendation Applicable?"
    then 'warning'
  else null

define "No Screening In Last 12 Months Summary":
  if "Is Recommendation Applicable?"
    then 'Annual Urine Screening Check'
  else null

define "No Screening In Last 12 Months Detail":
  if "Is Recommendation Applicable?"
    then 'Patients on opioid therapy should have a urine drug test performed every 12 months.'
  else null

// Service Request - Urine Screening
define "Urine Drug Screening Request":
  ProcedureRequest {
    definition: { FHIR.Reference { reference: FHIR.string { value: 'http://fhir.org/guides/cdc/activitydefinition/urine-screening-request' } } },
    status: FHIR.RequestStatus { value: 'draft' },
    intent: FHIR.RequestIntent { value: 'proposal' },
    priority: FHIR.RequestPriority { value: 'routine' },
    code: FHIR.CodeableConcept { coding: { ToCoding("Urine Drug Screening") } },
    subject: FHIR.Reference { reference: FHIR.string { value: 'Patient/' + Patient.id } },
    occurrence: FHIR.Period { start: FHIR.dateTime { value: Today() }, end: FHIR.dateTime { value: Today() + 7 days } },
    authoredOn: FHIR.dateTime { value: Now() },
    reasonCode: { FHIR.CodeableConcept { text: FHIR.string { value: "No Screening In Last 12 Months Detail" } } }
    // doesn't really work, need a relatedArtifact here...
    //reasonCode: { FHIR.CodeableConcept { text: FHIR.string { value: 'https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm#10_When_prescribing_opioids' } } }

define function ToCoding(code System.Code):
  FHIR.Coding {
    code: FHIR.code { value: code.code },
    system: FHIR.uri { value: code.system },
    version: FHIR.string { value: code.version },
    display: FHIR.string { value: code.display }