library OpioidCDSREC08 version '2022.1.0'

using FHIR version '4.0.1'

include FHIRHelpers  version '4.0.1' called FHIRHelpers
include OpioidCDSCommon version '2022.1.0' called Common
include OpioidCDSCommonConfig version '2022.1.0' called Config
include OpioidCDSRoutines version '2022.1.0' called Routines
/*include fhir.cdc."opioid-mme-r4".MMECalculator version '3.0.0' called MMECalculator
 */
include MMECalculator version '3.0.0' called MMECalculator

/*
**
**  Recommendation #8
**    Before starting and periodically during continuation of opioid therapy, clinicians should 
**    evaluate risk for opioid-related harms and discuss risk with patients. Clinicians should 
**    work with patients to incorporate into the management plan strategies to mitigate risk, 
**    including offering naloxone (recommendation category: A; evidence type: 4).
**
**  When
**    Order for opioid analgesics with ambulatory misuse potential:
**    CDC 2022 guideline general inclusion criteria met 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
**  Then
**    Incorporate Risk Mitigation Strategies Into Opioid Therapy:
**      Order - Naloxone ordered
**      Document - Verified patient is on Naloxone an has been educated on use, snooze 3 months
**      Document - Naloxone discussed but declined, snooze 3 months
**      Snooze - N/A see comment, snooze 3 months
**
*/

// META: Plan Definition: http://fhir.org/guides/cdc/opioid-cds-r4/PlanDefinition/opioid-cds-08

parameter ContextPrescriptions List<MedicationRequest>

context Patient

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 "Inclusion Criteria":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
    and Routines."CDC 2022 Guideline General Inclusion Criteria"

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

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