value: cdc-opioid-guidance

system: http://terminology.hl7.org/CodeSystem/plan-definition-type

code: eca-rule

display: ECA Rule

define "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
  ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
    where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription )
      and Routines."Acute Pain Prescription Greater Than 7 Days?"(AmbulatoryOpioidPrescription)

define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain":
  exists( "Acute 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

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"
      or "Has Active Cancer Diagnosis on Problem List"
  else false

define "Conditions Likely Terminal for Opioid Prescribing":
  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 "Is Active Cancer Treatment?"
    and not "Conditions Likely Terminal for Opioid Prescribing"

define "Order is for Long-Acting Opioid":
  exists (
    "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" AmbulatoryOpioidPrescription
      where AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential"
        or Common.GetDurationInDays( AmbulatoryOpioidPrescription.dispenseRequest.expectedSupplyDuration ) > 7 days
  )

define "Inclusion Criteria":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain"
    and Routines."Is Opioid Review Useful?"
    and "Order is for Long-Acting Opioid"

define "Exclusion Criteria":
  false

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

define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>):
  ("Get MedicationRequest Medication as Code"(value)) Rx
    where Rx.medication in "Opioid analgesics with ambulatory misuse potential" 
      and Rx.category in "Community"

define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>):
  value Rx
    let Med: 
      if Rx.medication is Reference then singleton from (
        [Medication] M
          where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))
      ) else null
    return 
      MedicationRequest {
        id: Rx.id,
        status: Rx.status,
        intent: Rx.intent,
        category: Rx.category,
        medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,
        subject: Rx.subject,
        authoredOn: Rx.authoredOn,
        recorder: Rx.recorder,
        dosageInstruction: Rx.dosageInstruction,
        dispenseRequest: Rx.dispenseRequest
      }

define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

// End of For Subacute or Chronic Pain Routine

/*
**  Routine #5
**  For Acute Pain Routine
**
**  Definition                  | Answer to Proceed   | Details                                        | Data (Terminology) Requirement
**  -----------------------------------------------------------------------------------------------------------------------------------
**  Order for opioid analgesics | Yes                 | Look for an existing prescription (order) for  | Opioid analgesics with
**  with ambulatory misuse      |                     | opioid analgesics with ambulatory abuse        | ambulatory misuse potential
**  potential of duration < 28  |                     | potential of duration < 28 days                |
**  days                        |                     |                                                |
**  -----------------------------------------------------------------------------------------------------------------------------------
**
*/

// should allow DateTime precision, but not working in the Ruler specifically
define function "Is Acute Pain Prescription?"(prescription FHIR.MedicationRequest):
  prescription.dispenseRequest is not null
    and prescription.dispenseRequest.expectedSupplyDuration is not null
    and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days

define function GetDurationInDays(value FHIR.Duration):
  if value is null then null
  else
    case
      when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' }
      when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' }
      when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' }
      when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' }
      when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' }
      when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' }
      when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' }
      when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' }
      when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null')
      else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value)
end

// should allow DateTime precision, but not working in the Ruler specifically
define function "Acute Pain Prescription Greater Than 7 Days?"(prescription FHIR.MedicationRequest):
      prescription.dispenseRequest is not null
    and prescription.dispenseRequest.expectedSupplyDuration is not null
    and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) > 7 days
    and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days

Documentation

• 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain