Id: OMTKLogicMK2020 Url: Library - OMTK Data (2020) Version: 2022.1.0 Name: OMTKLogicMK2020 Title: Library - OMTK Data (2020) Status: active Experimental: true Type: system: http://terminology.hl7.org/CodeSystem/library-type code: logic-library Date: 2025-12-31 04:14:52+0000 Publisher: Centers for Disease Control and Prevention (CDC) Related Artifacts: Dependencies http://fhir.org/guides/cqf/common/Library/FHIR-ModelInfo|4.0.1 Library - OMTK Data (2020)version: null2022.1.0) RxNorm Parameters: Name Type Min Max In/Out Patient Patient 0 1 Out Data Requirements: Type Profile MS Code Filter Patient http://hl7.org/fhir/StructureDefinition/Patient Content: text/cql library OMTKLogicMK2020 version '2022.1.0' /* This version of the OMTKLogic library uses the FHIR MedicationKnowledge Resource as the source for drug ingredient and strength information, rather than the OMTK data source. */ using FHIR version '4.0.1' include OMTKData2020 version '2022.1.0' called OMTKData codesystem RxNorm: 'http://www.nlm.nih.gov/research/umls/rxnorm' context Patient /* Normalizes the input units to UCUM units Note guidance for UCUM presentation of medication units from SNOMED here: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjU3vLpicPTAhWFMGMKHRpOBUAQFggiMAA&url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fattachments%2F17859188%2FExpressing%2520Units%2520of%2520Measure%2520for%2520Medicinal%2520Products.doc%3Fapi%3Dv2&usg=AFQjCNE5sboicqvJDUyXJ2im8VzBpgHE8A The values listed here are the only ones currently present in the OMTK data Based on the HL7 UCUM subset here: http://download.hl7.de/documents/ucum/ucumdata.html */ define function ToUCUM(unit System.String): case unit when 'MG' then 'mg' when 'MG/ACTUAT' then 'mg/{actuat}' when 'MG/HR' then 'mg/h' when 'MG/ML' then 'mg/mL' else 'Error: unknown{' + unit + '}' end /* Calculates daily frequency given frequency within a period */ define function ToDaily(frequency System.Integer, period System.Quantity): case period.unit when 'h' then frequency * (24.0 / period.value) when 'min' then frequency * (24.0 / period.value) * 60 when 's' then frequency * (24.0 / period.value) * 60 * 60 when 'd' then frequency * (24.0 / period.value) / 24 when 'wk' then frequency * (24.0 / period.value) / (24 * 7) when 'mo' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'a' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ else null end /* Returns true if the given dose form is a patch (transdermal system) */ define function IsPatch(doseFormCode System.Code): ToInteger(doseFormCode.code) = 316987 /* Returns the conversion factor for the given ingredient Opioid (strength in mg except where noted) MME Conversion Factor* Buprenorphine, transdermal patch (MCG/HR) 12.6 Buprenorphine, tablet or film 30 Buprenorphine, film (MCG) 0.03 Butorphanol 7 Codeine 0.15 Dihydrocodeine 0.25 Fentanyl, buccal/SL tabet or lozenge/troche (MCG) 0.13 Fentanyl, film or oral spray (MCG) 0.18 Fentanyl, nasal spray (MCG) 0.16 Fentanyl, transdermal patch (MCG/HR) 2.4 Hydrocodone 1 Hydromorphone 4 Levomethadyl acetate 8 Levorphanol tartrate 11 Meperidine 0.1 Methadone 3 1-20 mg/d 4 21-40 mg/d 8 41-60 mg/d 10 61-80 mg/d 12 Morphine 1 Opium 1 // NOTE: Not present as an ingredient in the RxNorm data Oxycodone 1.5 Oxymorphone 3 Pentazocine 0.37 Tapentadol 0.4 Tramadol 0.1 */ define function GetConversionFactor(ingredientCode System.Code, dailyDose System.Quantity, doseFormCode System.Code): case ToInteger(ingredientCode.code) when 161 then 0 /* Acetaminophen */ when 1191 then 0 /* Aspirin */ when 1223 then 0 /* Atropine */ when 1767 then 0 /* Brompheniramine */ when 1819 then ( /* Buprenorphine */ case when ToInteger(doseFormCode.code) = 316987 then 12.6 /* Transdermal system */ else 30 /* Tablet or Film (or Film in MCG) */ end ) when 1841 then 7 /* Butorphanol */ when 1886 then 0 /* Caffeine */ when 2101 then 0 /* Carisoprodol */ when 2354 then 0 /* chlorcyclizine */ when 2400 then 0 /* Chlorpheniramine */ when 2670 then 0.15 /* Codeine */ when 3423 then 4 /* Hydromorphone */ when 3498 then 0 /* Diphenhydramine */ when 4337 then ( /* Fentanyl */ case when ToInteger(doseFormCode.code) in { 970789, 317007, 316992 } then 0.13 /* Buccal Tablet, Sublingual Tablet, Oral Lozenge */ when ToInteger(doseFormCode.code) = 858080 then 0.18 /* Buccal Film */ when ToInteger(doseFormCode.code) in { 126542, 346163 } then 0.16 /* Nasal Spray, Mucosal Spray */ when IsPatch(doseFormCode) then 2.4 /* Transdermal system */ else 1000 /* Really ought to be an error because it represents a previously unencountered dose form.... */ end ) when 5032 then 0 /* Guaifenesin */ when 5489 then 1 /* Hydrocodone */ when 5640 then 0 /* Ibuprofen */ when 6102 then 0 /* Kaolin */ when 6378 then 11 /* Levorphanol (NOTE: Given as Levorphanol tartrate in the CDC conversion table) */ when 6754 then 0.1 /* Meperidine */ when 6813 then ( /* Methadone */ case when dailyDose.value between 1 and 20 then 4 when dailyDose.value between 21 and 40 then 8 when dailyDose.value between 41 and 60 then 10 when dailyDose.value >= 61 then 12 else 1000 /* Really ought to be an error because it represents an unexpected dose range... */ end ) when 7052 then 1 /* Morphine */ when 7242 then 0 /* Naloxone */ when 7243 then 0 /* Naltrexone */ when 7804 then 1.5 /* Oxycodone */ when 7814 then 3 /* Oxymorphone */ when 8001 then 0.37 /* Pentazocine */ when 8163 then 0 /* Phenylephrine */ when 8175 then 0 /* Phenylpropanolamine */ when 8745 then 0 /* Promethazine */ when 8896 then 0 /* Pseudoephedrine */ when 9009 then 0 /* Pyrilamine */ when 10689 then 0.1 /* Tramadol */ when 10849 then 0 /* Triprolidine */ when 19759 then 0 /* bromodiphenhydramine */ when 19860 then 0 /* butalbital */ when 22696 then 0 /* dexbrompheniramine */ when 22697 then 0 /* dexchlorpheniramine */ when 23088 then 0.25 /* dihydrocodeine */ when 27084 then 0 /* homatropine */ when 35780 then 0 /* ropivacaine */ when 237005 then 8 /* Levomethadyl (NOTE: given as Levomethadyl acetate in the CDC conversion table) */ when 636827 then 0 /* guaiacolsulfonate */ when 787390 then 0.4 /* tapentadol */ else 0 end define function EnsureMicrogramQuantity(strength System.Quantity): if strength.value < 0.1 and (PositionOf('mg', strength.unit) = 0) then System.Quantity { value: strength.value * 1000, unit: 'mcg' + Substring(strength.unit, 2) } else strength /* Returns the non-surgical opioid ingredients and their strengths that make up the drug identified by the given rxNormCode as a list of tuples: List<Tuple { rxNormCode Code, doseFormCode Code, doseFormName String, ingredientCode Code, ingredientName String, strength Quantity }> */ /* DrugIngredients: List<{ drugCode Integer, drugName String, doseFormCode Integer, doseFormName String, ingredientCode Integer, ingredientName String, strength String, strengthValue Decimal, strengthUnit String }> */ define function GetIngredients(rxNormCode System.Code): OMTKData.DrugIngredients DI where DI.drugCode = ToInteger(rxNormCode.code) return { rxNormCode: System.Code { code: ToString(DI.drugCode), system: 'http://www.nlm.nih.gov/research/umls/rxnorm', display: DI.drugName }, doseFormCode: System.Code { code: ToString(DI.doseFormCode), system: 'http://www.nlm.nih.gov/research/umls/rxnorm', display: DI.doseFormName }, doseFormName: DI.doseFormName, ingredientCode: System.Code { code: ToString(DI.ingredientCode), system: 'http://www.nlm.nih.gov/research/umls/rxnorm', display: DI.ingredientName }, ingredientName: DI.ingredientName, strength: EnsureMicrogramQuantity( System.Quantity { value: DI.strengthValue, unit: ToUCUM(DI.strengthUnit) } ) } /* define function GetIngredients(rxNormCode Code): flatten ( [MedicationKnowledge: rxNormCode] M return M.ingredient I where I.code in "Opioid Ingredients" // TODO: Need a value set of opioid ingredients return { rxNormCode: M.code, doseFormCode: M.doseForm, // TODO: MedicationKnowledge specifies SNOMED-CT dose forms here, would need to profile to RXNorm doseFormName: M.doseForm.text, ingredientCode: I.item as CodeableConcept, // TODO: Profile to code only ingredientName: (I.item as CodeableConcept).text, strength: EnsureMicrogramQuantity(I.strength.denominator) // TODO: Is this correct? } ) */ /* Calculates daily dose for a specific ingredient based on the ingredient strength, dose form, dose quantity, and daily frequency */ define function GetDailyDose(ingredientCode System.Code, strength System.Quantity, doseFormCode System.Code, doseQuantity System.Quantity, dosesPerDay System.Decimal): case /* if patch --> daily dose = dose value (e.g, number patches with doseQuantity unit = "patch") * per-hour strength */ when IsPatch(doseFormCode) then /* buprenorphine or fentanyl patch */ if ToInteger(ingredientCode.code) in { 1819, 4337 } then System.Quantity { value: dosesPerDay * doseQuantity.value * strength.value, unit: strength.unit } else null /* if dose unit in actual mass units (mg or mcg -- when it's a single med) --> daily dose = numTimesPerDay * dose */ when doseQuantity.unit in { 'mg', 'mcg' } then System.Quantity { value: dosesPerDay * doseQuantity.value, unit: doseQuantity.unit } /* if doseQuantity is in actual volume units (mL) --> daily dose = numTimesPerDay * dose * strength */ when doseQuantity.unit = 'mL' and (PositionOf('/mL', strength.unit) = Length(strength.unit) - 3) then System.Quantity { value: dosesPerDay * doseQuantity.value * strength.value, unit: Substring(strength.unit, 0, PositionOf('/', strength.unit)) } /* if doseQuantity is not in actual units (e.g., 1 tab, 1 spray -- when it's a combo med with a unit of tablet, or it's mg/actuat) --> daily dose = numTimesPerDay * dose value * strength value */ else System.Quantity { value: dosesPerDay * doseQuantity.value * strength.value, unit: Substring(strength.unit, 0, PositionOf('/', strength.unit)) } end define function GetMedicationConceptName(concept Concept): if concept.display is null then First( (concept.codes) C where C.system = 'http://www.nlm.nih.gov/research/umls/rxnorm' return GetMedicationName(C) ) else concept.display define function GetMedicationName(rxNormCode System.Code): if rxNormCode.display is null then SingletonFrom( OMTKData.DrugIngredients DI where DI.drugCode = ToInteger(rxNormCode.code) return DI.drugName ) else rxNormCode.display /* Builds a description for the daily dose for an ingredient */ define function GetDailyDoseDescription(ingredientCode System.Code, ingredientName System.String, strength System.Quantity, doseFormCode System.Code, doseFormName System.String, doseQuantity System.Quantity, dosesPerDay System.Decimal, dailyDose System.Quantity): case /* if patch */ when IsPatch(doseFormCode) then /* buprenorphine or fentanyl patch */ if ToInteger(ingredientCode.code) in { 1819, 4337 } then ingredientName + ' patch: ' + ToString(doseQuantity.value) + ' * ' + ToString(strength.value) + ' = ' + ToString(dailyDose.value) else null /* if dose unit in actual mass units (mg or mcg -- when it's a single med) */ when doseQuantity.unit in { 'mg', 'mcg' } then ingredientName + ' ' + doseFormName + ': ' + ToString(dosesPerDay) + '/d * ' + ToString(doseQuantity.value) + ' = ' + ToString(dailyDose.value) /* if doseQuantity in actual volume units (mL) or not in actual units (e.g. 1 tab, 1 spray) */ else ingredientName + ' ' + doseFormName + ': ' + ToString(dosesPerDay) + '/d * ' + ToString(doseQuantity.value) + ' * ' + ToString(strength.value) + ' = ' + ToString(dailyDose.value) end /* Calculates MMEs for the given input prescription information and returns it as a list of tuples: List<Tuple { rxNormCode Code, doseFormCode Code, doseQuantity Quantity, dosesPerDay Decimal, ingredientCode Code, ingredientName String, strength Quantity, dailyDose Quantity, dailyDoseDescription String, conversionFactor Decimal, mme Quantity }> */ define function CalculateMMEs(medications List<Tuple { rxNormCode System.Code, doseQuantity System.Quantity, dosesPerDay System.Decimal }>): Flatten( medications M let Ingredients: GetIngredients(M.rxNormCode) return Ingredients I let adjustedDoseQuantity: EnsureMicrogramQuantity(M.doseQuantity), dailyDose: GetDailyDose(I.ingredientCode, I.strength, I.doseFormCode, adjustedDoseQuantity, M.dosesPerDay), factor: GetConversionFactor(I.ingredientCode, dailyDose, I.doseFormCode) return { rxNormCode: M.rxNormCode, doseFormCode: I.doseFormCode, doseQuantity: adjustedDoseQuantity, dosesPerDay: M.dosesPerDay, ingredientCode: I.ingredientCode, ingredientName: I.ingredientName, strength: I.strength, dailyDose: dailyDose, dailyDoseDescription: GetDailyDoseDescription(I.ingredientCode, I.ingredientName, I.strength, I.doseFormCode, I.doseFormName, adjustedDoseQuantity, M.dosesPerDay, dailyDose), conversionFactor: factor, mme: System.Quantity { value: dailyDose.value * factor, unit: dailyDose.unit + '/d' } } ) /* define TestCalculateMMEs: CalculateMMEs({ { rxNormCode: Code '388508' from RxNorm, doseQuantity: Quantity { value: 1, unit: 'patch' }, dosesPerDay: 0.33 } }) */ Content: application/elm+xml Encoded data (305300 characters) Content: application/elm+json Encoded data (598168 characters)
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