Library Name | Name | sequence |
OpioidCDSREC09 |
Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions |
0 |
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 )
Library Name | Name | sequence |
OpioidCDSREC09 |
Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential |
1 |
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )
Library Name | Name | sequence |
OpioidCDSCommonConfig |
Age Less than 18 Years Is Enabled |
2 |
// CDC 2022 General Inclusion Criteria
define "Age Less than 18 Years Is Enabled":
true
Library Name | Name | sequence |
OpioidCDSRoutines |
Patient Age Less Than 18 |
3 |
define "Patient Age Less Than 18":
if (Config."Age Less than 18 Years Is Enabled") then
AgeInYearsAt(Today()) < 18
else false
Library Name | Name | sequence |
OpioidCDSCommonConfig |
Sickle Cell Check Enabled |
4 |
// Sickle Cell
define "Sickle Cell Check Enabled":
true
Library Name | Name | sequence |
OpioidCDSCommonConfig |
Sickle Cell Assumed Active |
5 |
define "Sickle Cell Assumed Active":
true
Library Name | Name | sequence |
OpioidCDSCommon |
US Core-Categorized Conditions |
6 |
// 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"]
Library Name | Name | sequence |
OpioidCDSCommon |
Positive Sickle Cell Condition |
7 |
define "Positive Sickle Cell Condition":
if Config."Sickle Cell Check Enabled" and not Config."Sickle Cell Assumed Active"
then (
"US Core-Categorized Conditions" C
where C.code in "Sickle Cell Diseases"
and C.clinicalStatus in "Active Condition"
) else if Config."Sickle Cell Check Enabled" and Config."Sickle Cell Assumed Active"
then (
"US Core-Categorized Conditions" C
where C.code in "Sickle Cell Diseases"
)
else null
Library Name | Name | sequence |
OpioidCDSRoutines |
Condition Positive for Sickle Cell |
8 |
define "Condition Positive for Sickle Cell":
if (Config."Sickle Cell Check Enabled") then
exists(
Common."Positive Sickle Cell Condition"
)
else false
Library Name | Name | sequence |
OpioidCDSCommonConfig |
Active Cancer Treatment Encounters Condition Is Enabled |
9 |
// Active Cancer Treatment
define "Active Cancer Treatment Encounters Condition Is Enabled":
true
Library Name | Name | sequence |
OpioidCDSRoutines |
Encounter Period |
10 |
// End of Opioid Naive Routine
/*
** Routine #3
** Active Cancer Treatment Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** ---------------------------------------------------------------------------------------------------------------------------------
** Two office visits within the | No | Look for a minimum of two distinct | Office Visit
** past 12 months | | encounters within 12 months of the date |
** | | of the current visit for which each of the |
** | | following is true: |
** | | - the encounter diagnosis (primary or |
** | | secondary or co-morbidity diagnosis) |
** | | is listed in the CDC Malignant Cancer |
** | | Conditions value set |
** ---------------------------------------------------------------------------------------------------------------------------------
** Office visits with an | No | The encounter is performed by an | Oncology specialty
** oncology specialist | | oncologist as defined in the oncology | designations (NUCC)
** present | | specialty designations using the |
** | | National Uniform Claim Committee |
** | | (NUCC) classifications |
** ---------------------------------------------------------------------------------------------------------------------------------
** Office visits including CDC | No | The encounter diagnosis (primary or | CDC malignant cancer
** malignant cancer | | secondary or co-morbidity diagnosis) | conditions
** condition | | is listed in the CDC Malignant Cancer |
** | | Conditions value set |
** ----------------------------------------------------------------------------------------------------------------------------------
**
*/
define "Encounter Period":
Interval[Today() - 12 months, Today())
Library Name | Name | sequence |
OpioidCDSCommon |
USCore Encounter Cancer Diagnoses |
11 |
define "USCore Encounter Cancer Diagnoses":
[Condition: category in "Encounter Diagnosis Condition Category"] CancerDiagnoses
where CancerDiagnoses.code in "CDC malignant cancer conditions"
Library Name | Name | sequence |
OpioidCDSRoutines |
Encounters with Cancer Diagnosis During Encounter Period |
12 |
// encounter-diagnosis, problem-list and health-concern Conditions
// define "US Core-Categorized Cancer Diagnoses":
// Common."US Core-Categorized Conditions" C
// where C.code in Common."CDC malignant cancer conditions"
// define "Encounters with Cancer Diagnosis During Encounter Period":
// [Encounter] Encounter
// with "US Core-Categorized Cancer Diagnoses" CancerDiagnosis
// such that date from Encounter.period."start".value in day of "Encounter Period"
// and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id)
define "Encounters with Cancer Diagnosis During Encounter Period":
[Encounter] Encounters
where date from Encounters.period."start" in day of "Encounter Period"
and exists (
Common."USCore Encounter Cancer Diagnoses" CancerDiagnoses
where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id)
)
Library Name | Name | sequence |
OpioidCDSRoutines |
Number of Encounters with Cancer Diagnosis During Encounter Period |
13 |
define "Number of Encounters with Cancer Diagnosis During Encounter Period":
Count ("Encounters with Cancer Diagnosis During Encounter Period")
Library Name | Name | sequence |
OpioidCDSRoutines |
Has Two or More Encounters with Cancer Diagnosis During Encounter Period |
14 |
define "Has Two or More Encounters with Cancer Diagnosis During Encounter Period":
"Number of Encounters with Cancer Diagnosis During Encounter Period" >= 2
Library Name | Name | sequence |
OpioidCDSCommon |
USCore Problem List Cancer Diagnoses |
15 |
define "USCore Problem List Cancer Diagnoses":
[Condition: category in "Problem List Condition Category"] CancerDiagnoses
where CancerDiagnoses.code in "CDC malignant cancer conditions"
Library Name | Name | sequence |
OpioidCDSRoutines |
Has Active Cancer Diagnosis on Problem List |
16 |
define "Has Active Cancer Diagnosis on Problem List":
exists (
Common."USCore Problem List Cancer Diagnoses" CancerDiagnoses
where CancerDiagnoses.category in Common."Problem List Condition Category"
and exists(
CancerDiagnoses.clinicalStatus.coding ClinicalStatus
where ClinicalStatus.code ~ 'active'
)
)
Library Name | Name | sequence |
OpioidCDSRoutines |
Is Active Cancer Treatment? |
17 |
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
Library Name | Name | sequence |
OpioidCDSCommonConfig |
End-Stage Disease Criteria Enabled |
18 |
// CDC 2022 General Inclusion Criteria
define "End-Stage Disease Criteria Enabled":
true
Library Name | Name | sequence |
OpioidCDSRoutines |
Conditions Likely Terminal for Opioid Prescribing |
19 |
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
Library Name | Name | sequence |
OpioidCDSRoutines |
CDC 2022 Guideline General Inclusion Criteria |
20 |
define "CDC 2022 Guideline General Inclusion Criteria":
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"
Library Name | Name | sequence |
OpioidCDSCommonConfig |
PDMP Data Not Reviewed in Past 90 Days Criteria Enabled |
21 |
// Recommendation 9
define "PDMP Data Not Reviewed in Past 90 Days Criteria Enabled":
true
Library Name | Name | sequence |
OpioidCDSREC09 |
Look Back 90 Days |
22 |
define "Look Back 90 Days":
Interval[Today() - 90 days, Today()]
Library Name | Name | sequence |
OpioidCDSREC09 |
PDMP Data Not Reviewed in Past 90 Days |
23 |
define "PDMP Data Not Reviewed in Past 90 Days":
Config."PDMP Data Not Reviewed in Past 90 Days Criteria Enabled"
and not (
exists (
[Procedure: Common."PDMP review procedure"] P
where P.status ~ 'completed'
and P.performed during "Look Back 90 Days"
)
or exists (
[Observation: Common."PDMP data reviewed finding"] O
where O.status in { 'final', 'amended' }
and (
if O.effective is FHIR.Period
then (O.effective as FHIR.Period) during day of "Look Back 90 Days"
else if O.effective is FHIR.dateTime
then date from O.effective in day of "Look Back 90 Days"
else false
)
)
)
Library Name | Name | sequence |
OpioidCDSREC09 |
Inclusion Criteria |
24 |
define "Inclusion Criteria":
"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
and Routines."CDC 2022 Guideline General Inclusion Criteria"
and "PDMP Data Not Reviewed in Past 90 Days"
Library Name | Name | sequence |
OpioidCDSREC09 |
Exclusion Criteria |
25 |
define "Exclusion Criteria":
false
Library Name | Name | sequence |
OpioidCDSREC09 |
Is Recommendation Applicable? |
26 |
define "Is Recommendation Applicable?":
"Inclusion Criteria"
and not "Exclusion Criteria"
Library Name | Name | sequence |
OpioidCDSCommon |
Is Opioid Analgesic with Ambulatory Misuse Potential? |
27 |
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"
Library Name | Name | sequence |
OpioidCDSCommon |
Get MedicationRequest Medication as Code |
28 |
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
}
Library Name | Name | sequence |
FHIRHelpers |
ToString |
29 |
define function ToString(value string): value.value
Library Name | Name | sequence |
FHIRHelpers |
ToConcept |
30 |
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
}
Library Name | Name | sequence |
FHIRHelpers |
ToCode |
31 |
define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}
Library Name | Name | sequence |
OpioidCDSRoutines |
Is Subacute or Chronic Pain Prescription? |
32 |
// End of Active Cancer Treatment Routine
/*
** Routine #4
** For Subacute or Chronic Pain Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** -----------------------------------------------------------------------------------------------------------------------------------
** Order for opioid analgesic | Yes | Order for opioid analgesics with ambulatory | Opioid analgesics with
** with expected supply | | misuse potential with a supply duration of >= | ambulatory misuse potential
** duration >= 28 days | | 28 days |
** | | |
** | | - Subacute definition = order for opioid |
** | | analgesics with ambulatory misuse |
** | | potential with a supply duration of one to |
** | | two months. |
** | | - Chronic pain definition = order for opioid |
** | | analgesics with ambulatory misuse |
** | | potential with a supply duration of >= two |
** | | months. |
** -----------------------------------------------------------------------------------------------------------------------------------
**
*/
define function "Is Subacute or Chronic Pain Prescription?"(prescription FHIR.MedicationRequest):
"Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription)
or "Is Subacute or Chronic Pain Using Validity Period"(prescription)
Library Name | Name | sequence |
OpioidCDSRoutines |
Is Subacute or Chronic Pain Using Expected Supply Duration |
33 |
define function "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription FHIR.MedicationRequest):
(
prescription.dispenseRequest is not null
and prescription.dispenseRequest.expectedSupplyDuration is not null
and (
Common.GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration) >= 28 days
)
)
Library Name | Name | sequence |
OpioidCDSCommon |
GetDurationInDays |
34 |
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
Library Name | Name | sequence |
OpioidCDSRoutines |
Is Subacute or Chronic Pain Using Validity Period |
35 |
define function "Is Subacute or Chronic Pain Using Validity Period"(prescription FHIR.MedicationRequest):
(
prescription.dispenseRequest is not null
and prescription.dispenseRequest.validityPeriod is not null
and (
days between prescription.dispenseRequest.validityPeriod.start and prescription.dispenseRequest.validityPeriod.end >= 28
)
)
Library Name | Name | sequence |
FHIRHelpers |
ToDateTime |
36 |
define function ToDateTime(value dateTime): value.value
Library Name | Name | sequence |
FHIRHelpers |
ToString |
37 |
define function ToString(value ProcedureStatus): value.value
Library Name | Name | sequence |
FHIRHelpers |
ToInterval |
38 |
define function ToInterval(period FHIR.Period):
if period is null then
null
else
if period."start" is null then
Interval(period."start".value, period."end".value]
else
Interval[period."start".value, period."end".value]
Library Name | Name | sequence |
FHIRHelpers |
ToString |
39 |
define function ToString(value ObservationStatus): value.value
Library Name | Name | sequence |
FHIRHelpers |
ToDateTime |
40 |
define function ToDateTime(value instant): value.value
|