Unattributed Code Systems

• http://fhir.org/guides/cdc/opioid-cds/CodeSystem/opioidcds-overrideReasons
• http://nucc.org/provider-taxonomy
• http://www.ama-assn.org/go/cpt
• urn:com.epic.cdshooks.action.code.system.preference-list-item

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Copyright and Registered Trademark Uses

• IG © 2019+ Centers for Disease Control and Prevention (CDC). Package fhir.cdc.opioid-cds-r4#2022.1.0 based on FHIR 4.0.1. Generated 2025-07-09 Links: Table of Contents | QA Report | New Issue | Issues | Version History | License ( src )
• hl7.fhir.us.hai: Healthcare Associated Infection Implementation Guide ®© HL7 | CC0 ( src )
• 2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide, published by Centers for Disease Control and Prevention (CDC). This guide is not an authorized publication; it is the continuous build for version 2022.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/opioid-cds-r4/ and changes regularly. See the Directory of published versions ( src )
• Copyright/Legal: © CDC 2016+. ( src )
• This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc. Show Usage * LOINC: ALL_URINE_DRUG_SCREENING_TESTS, AMPHETAMINE_URINE_DRUG_SCREENING_TESTS... Show 18 more , BARBITURATE_URINE_DRUG_SCREENING_TESTS, BENZODIAZEPINE_URINE_DRUG_SCREENING_TESTS, BUPRENORPHINE_URINE_DRUG_SCREENING_TESTS, CANNABINOID_URINE_DRUG_SCREENING_TESTS, COCAINE_URINE_DRUG_SCREENING_TESTS, FENTANYL_TYPE_URINE_DRUG_SCREENING_TESTS, GENERAL_OPIATE_URINE_DRUG_SCREENING_TESTS, HEROIN_URINE_DRUG_SCREENING_TESTS, METHADONE_URINE_DRUG_SCREENING_TESTS, NON_OPIOID_URINE_DRUG_SCREENING, OPIATE_SPECIFIC_URINE_DRUG_SCREENING_TESTS, OPIOID_URINE_DRUG_SCREENING, OXYCODONE_URINE_DRUG_SCREENING_TESTS, Observation/example-opioidcds, PAIN_TREATMENT_PLAN, PHENCYCLIDINE_URINE_DRUG_SCREENING_TESTS, SYNTHETIC_OPIOID_URINE_DRUG_SCREENING_TESTS and XYLAZINE_URINE_DRUG_SCREENING_TESTS ( src )
• This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html Show Usage * ActionType: PlanDefinition_Recommendation_07_Order_Sign and PlanDefinition_Recommendation_10_Patient_View * Condition Clinical Status Codes: CONDITION_CLINICAL_STATUS_ACTIVE, Condition/cancer-diagnosis, Condition/end-of-life and Condition/terminal * DefinitionTopic: ActivityDefinition_Risk_Assessment_ServiceRequest and ActivityDefinition_Urine_Screening_ServiceRequest * DoseAndRateType: MedicationRequest/example-opioidcds * QualityOfEvidenceRating: PlanDefinition_Recommendation_01_Order_Sign, PlanDefinition_Recommendation_02_Order_Sign... Show 11 more , PlanDefinition_Recommendation_03_Order_Sign, PlanDefinition_Recommendation_04_05_Order_Sign, PlanDefinition_Recommendation_06_Order_Sign, PlanDefinition_Recommendation_07_Order_Sign, PlanDefinition_Recommendation_08_Order_Sign, PlanDefinition_Recommendation_09_Order_Sign, PlanDefinition_Recommendation_10_Order_Sign, PlanDefinition_Recommendation_10_Patient_View, PlanDefinition_Recommendation_11_Order_Select, PlanDefinition_Recommendation_11_Patient_View and PlanDefinition_Recommendation_12_Patient_View * LibraryType: CDCMMEClinicalConversionFactors, ConversionFactors... Show 39 more , FHIR, FHIRHelpers, HelloWorld, HelloWorldPatientView, MMECalculator, OMTKData, OMTKData2020, OMTKLogic, OMTKLogicMK2020, OpioidCDSCommon, OpioidCDSCommonConfig, OpioidCDSREC01, OpioidCDSREC02, OpioidCDSREC03, OpioidCDSREC04And05, OpioidCDSREC06, OpioidCDSREC07, OpioidCDSREC08, OpioidCDSREC09, OpioidCDSREC10Common, OpioidCDSREC10OrderSign, OpioidCDSREC10PatientView, OpioidCDSREC11OrderSelect, OpioidCDSREC11PatientView, OpioidCDSREC12PatientView, OpioidCDSRoutines, PlanDefinition_Recommendation_01_Order_Sign, PlanDefinition_Recommendation_02_Order_Sign, PlanDefinition_Recommendation_03_Order_Sign, PlanDefinition_Recommendation_04_05_Order_Sign, PlanDefinition_Recommendation_06_Order_Sign, PlanDefinition_Recommendation_07_Order_Sign, PlanDefinition_Recommendation_08_Order_Sign, PlanDefinition_Recommendation_09_Order_Sign, PlanDefinition_Recommendation_10_Order_Sign, PlanDefinition_Recommendation_10_Patient_View, PlanDefinition_Recommendation_11_Order_Select, PlanDefinition_Recommendation_11_Patient_View and PlanDefinition_Recommendation_12_Patient_View * MedicationRequest Category Codes: MedicationDispense/ambulatory-opioid, MedicationRequest/ambulatory-opioid and Valueset_medicationrequest_category_community * Observation Category Codes: OBSERVATION_CATEGORY_LABORATORY and OBSERVATION_CATEGORY_PROCEDURE * PlanDefinitionType: PlanDefinition_Recommendation_01_Order_Sign, PlanDefinition_Recommendation_02_Order_Sign... Show 11 more , PlanDefinition_Recommendation_03_Order_Sign, PlanDefinition_Recommendation_04_05_Order_Sign, PlanDefinition_Recommendation_06_Order_Sign, PlanDefinition_Recommendation_07_Order_Sign, PlanDefinition_Recommendation_08_Order_Sign, PlanDefinition_Recommendation_09_Order_Sign, PlanDefinition_Recommendation_10_Order_Sign, PlanDefinition_Recommendation_10_Patient_View, PlanDefinition_Recommendation_11_Order_Select, PlanDefinition_Recommendation_11_Patient_View and PlanDefinition_Recommendation_12_Patient_View * StrengthOfRecommendationRating: PlanDefinition_Recommendation_01_Order_Sign, PlanDefinition_Recommendation_02_Order_Sign... Show 11 more , PlanDefinition_Recommendation_03_Order_Sign, PlanDefinition_Recommendation_04_05_Order_Sign, PlanDefinition_Recommendation_06_Order_Sign, PlanDefinition_Recommendation_07_Order_Sign, PlanDefinition_Recommendation_08_Order_Sign, PlanDefinition_Recommendation_09_Order_Sign, PlanDefinition_Recommendation_10_Order_Sign, PlanDefinition_Recommendation_10_Patient_View, PlanDefinition_Recommendation_11_Order_Select, PlanDefinition_Recommendation_11_Patient_View and PlanDefinition_Recommendation_12_Patient_View * Software System Type Codes: Device/cqf-tooling * UsageContextType: ActivityDefinition_Risk_Assessment_ServiceRequest, ActivityDefinition_Urine_Screening_ServiceRequest... Show 17 more , ConversionFactors, MMECalculator, OMTKData, OMTKLogic, PlanDefinition_Recommendation_01_Order_Sign, PlanDefinition_Recommendation_02_Order_Sign, PlanDefinition_Recommendation_03_Order_Sign, PlanDefinition_Recommendation_04_05_Order_Sign, PlanDefinition_Recommendation_06_Order_Sign, PlanDefinition_Recommendation_07_Order_Sign, PlanDefinition_Recommendation_08_Order_Sign, PlanDefinition_Recommendation_09_Order_Sign, PlanDefinition_Recommendation_10_Order_Sign, PlanDefinition_Recommendation_10_Patient_View, PlanDefinition_Recommendation_11_Order_Select, PlanDefinition_Recommendation_11_Patient_View and PlanDefinition_Recommendation_12_Patient_View * ActCode: Encounter/cancer-diagnosis and Encounter/oncologist-participant * ObservationInterpretation: Observation/example-opioidcds ( src )
• 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 } ( src )
• library FHIRHelpers version '4.0.1' using FHIR version '4.0.1' 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] define function ToCalendarUnit(unit System.String): case unit when 'ms' then 'millisecond' when 's' then 'second' when 'min' then 'minute' when 'h' then 'hour' when 'd' then 'day' when 'wk' then 'week' when 'mo' then 'month' when 'a' then 'year' else unit end define function ToQuantity(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.comparator is not null then Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.') when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end define function ToQuantityIgnoringComparator(quantity FHIR.Quantity): case when quantity is null then null when quantity.value is null then null when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org' or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) } else Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')') end define function ToInterval(quantity FHIR.Quantity): if quantity is null then null else case quantity.comparator.value when '<' then Interval[ null, ToQuantityIgnoringComparator(quantity) ) when '<=' then Interval[ null, ToQuantityIgnoringComparator(quantity) ] when '>=' then Interval[ ToQuantityIgnoringComparator(quantity), null ] when '>' then Interval( ToQuantityIgnoringComparator(quantity), null ] else Interval[ToQuantity(quantity), ToQuantity(quantity)] end define function ToRatio(ratio FHIR.Ratio): if ratio is null then null else System.Ratio { numerator: ToQuantity(ratio.numerator), denominator: ToQuantity(ratio.denominator) } define function ToInterval(range FHIR.Range): if range is null then null else Interval[ToQuantity(range.low), ToQuantity(range.high)] 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 } 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 } define function ToString(value AccountStatus): value.value define function ToString(value ActionCardinalityBehavior): value.value define function ToString(value ActionConditionKind): value.value define function ToString(value ActionGroupingBehavior): value.value define function ToString(value ActionParticipantType): value.value define function ToString(value ActionPrecheckBehavior): value.value define function ToString(value ActionRelationshipType): value.value define function ToString(value ActionRequiredBehavior): value.value define function ToString(value ActionSelectionBehavior): value.value define function ToString(value ActivityDefinitionKind): value.value define function ToString(value ActivityParticipantType): value.value define function ToString(value AddressType): value.value define function ToString(value AddressUse): value.value define function ToString(value AdministrativeGender): value.value define function ToString(value AdverseEventActuality): value.value define function ToString(value AggregationMode): value.value define function ToString(value AllergyIntoleranceCategory): value.value define function ToString(value AllergyIntoleranceCriticality): value.value define function ToString(value AllergyIntoleranceSeverity): value.value define function ToString(value AllergyIntoleranceType): value.value define function ToString(value AppointmentStatus): value.value define function ToString(value AssertionDirectionType): value.value define function ToString(value AssertionOperatorType): value.value define function ToString(value AssertionResponseTypes): value.value define function ToString(value AuditEventAction): value.value define function ToString(value AuditEventAgentNetworkType): value.value define function ToString(value AuditEventOutcome): value.value define function ToString(value BindingStrength): value.value define function ToString(value BiologicallyDerivedProductCategory): value.value define function ToString(value BiologicallyDerivedProductStatus): value.value define function ToString(value BiologicallyDerivedProductStorageScale): value.value define function ToString(value BundleType): value.value define function ToString(value CapabilityStatementKind): value.value define function ToString(value CarePlanActivityKind): value.value define function ToString(value CarePlanActivityStatus): value.value define function ToString(value CarePlanIntent): value.value define function ToString(value CarePlanStatus): value.value define function ToString(value CareTeamStatus): value.value define function ToString(value CatalogEntryRelationType): value.value define function ToString(value ChargeItemDefinitionPriceComponentType): value.value define function ToString(value ChargeItemStatus): value.value define function ToString(value ClaimResponseStatus): value.value define function ToString(value ClaimStatus): value.value define function ToString(value ClinicalImpressionStatus): value.value define function ToString(value CodeSearchSupport): value.value define function ToString(value CodeSystemContentMode): value.value define function ToString(value CodeSystemHierarchyMeaning): value.value define function ToString(value CommunicationPriority): value.value define function ToString(value CommunicationRequestStatus): value.value define function ToString(value CommunicationStatus): value.value define function ToString(value CompartmentCode): value.value define function ToString(value CompartmentType): value.value define function ToString(value CompositionAttestationMode): value.value define function ToString(value CompositionStatus): value.value define function ToString(value ConceptMapEquivalence): value.value define function ToString(value ConceptMapGroupUnmappedMode): value.value define function ToString(value ConditionalDeleteStatus): value.value define function ToString(value ConditionalReadStatus): value.value define function ToString(value ConsentDataMeaning): value.value define function ToString(value ConsentProvisionType): value.value define function ToString(value ConsentState): value.value define function ToString(value ConstraintSeverity): value.value define function ToString(value ContactPointSystem): value.value define function ToString(value ContactPointUse): value.value define function ToString(value ContractPublicationStatus): value.value define function ToString(value ContractStatus): value.value define function ToString(value ContributorType): value.value define function ToString(value CoverageStatus): value.value define function ToString(value CurrencyCode): value.value define function ToString(value DayOfWeek): value.value define function ToString(value DaysOfWeek): value.value define function ToString(value DetectedIssueSeverity): value.value define function ToString(value DetectedIssueStatus): value.value define function ToString(value DeviceMetricCalibrationState): value.value define function ToString(value DeviceMetricCalibrationType): value.value define function ToString(value DeviceMetricCategory): value.value define function ToString(value DeviceMetricColor): value.value define function ToString(value DeviceMetricOperationalStatus): value.value define function ToString(value DeviceNameType): value.value define function ToString(value DeviceRequestStatus): value.value define function ToString(value DeviceUseStatementStatus): value.value define function ToString(value DiagnosticReportStatus): value.value define function ToString(value DiscriminatorType): value.value define function ToString(value DocumentConfidentiality): value.value define function ToString(value DocumentMode): value.value define function ToString(value DocumentReferenceStatus): value.value define function ToString(value DocumentRelationshipType): value.value define function ToString(value EligibilityRequestPurpose): value.value define function ToString(value EligibilityRequestStatus): value.value define function ToString(value EligibilityResponsePurpose): value.value define function ToString(value EligibilityResponseStatus): value.value define function ToString(value EnableWhenBehavior): value.value define function ToString(value EncounterLocationStatus): value.value define function ToString(value EncounterStatus): value.value define function ToString(value EndpointStatus): value.value define function ToString(value EnrollmentRequestStatus): value.value define function ToString(value EnrollmentResponseStatus): value.value define function ToString(value EpisodeOfCareStatus): value.value define function ToString(value EventCapabilityMode): value.value define function ToString(value EventTiming): value.value define function ToString(value EvidenceVariableType): value.value define function ToString(value ExampleScenarioActorType): value.value define function ToString(value ExplanationOfBenefitStatus): value.value define function ToString(value ExposureState): value.value define function ToString(value ExtensionContextType): value.value define function ToString(value FHIRAllTypes): value.value define function ToString(value FHIRDefinedType): value.value define function ToString(value FHIRDeviceStatus): value.value define function ToString(value FHIRResourceType): value.value define function ToString(value FHIRSubstanceStatus): value.value define function ToString(value FHIRVersion): value.value define function ToString(value FamilyHistoryStatus): value.value define function ToString(value FilterOperator): value.value define function ToString(value FlagStatus): value.value define function ToString(value GoalLifecycleStatus): value.value define function ToString(value GraphCompartmentRule): value.value define function ToString(value GraphCompartmentUse): value.value define function ToString(value GroupMeasure): value.value define function ToString(value GroupType): value.value define function ToString(value GuidanceResponseStatus): value.value define function ToString(value GuidePageGeneration): value.value define function ToString(value GuideParameterCode): value.value define function ToString(value HTTPVerb): value.value define function ToString(value IdentifierUse): value.value define function ToString(value IdentityAssuranceLevel): value.value define function ToString(value ImagingStudyStatus): value.value define function ToString(value ImmunizationEvaluationStatus): value.value define function ToString(value ImmunizationStatus): value.value define function ToString(value InvoicePriceComponentType): value.value define function ToString(value InvoiceStatus): value.value define function ToString(value IssueSeverity): value.value define function ToString(value IssueType): value.value define function ToString(value LinkType): value.value define function ToString(value LinkageType): value.value define function ToString(value ListMode): value.value define function ToString(value ListStatus): value.value define function ToString(value LocationMode): value.value define function ToString(value LocationStatus): value.value define function ToString(value MeasureReportStatus): value.value define function ToString(value MeasureReportType): value.value define function ToString(value MediaStatus): value.value define function ToString(value MedicationAdministrationStatus): value.value define function ToString(value MedicationDispenseStatus): value.value define function ToString(value MedicationKnowledgeStatus): value.value define function ToString(value MedicationRequestIntent): value.value define function ToString(value MedicationRequestPriority): value.value define function ToString(value MedicationRequestStatus): value.value define function ToString(value MedicationStatementStatus): value.value define function ToString(value MedicationStatus): value.value define function ToString(value MessageSignificanceCategory): value.value define function ToString(value Messageheader_Response_Request): value.value define function ToString(value MimeType): value.value define function ToString(value NameUse): value.value define function ToString(value NamingSystemIdentifierType): value.value define function ToString(value NamingSystemType): value.value define function ToString(value NarrativeStatus): value.value define function ToString(value NoteType): value.value define function ToString(value NutritiionOrderIntent): value.value define function ToString(value NutritionOrderStatus): value.value define function ToString(value ObservationDataType): value.value define function ToString(value ObservationRangeCategory): value.value define function ToString(value ObservationStatus): value.value define function ToString(value OperationKind): value.value define function ToString(value OperationParameterUse): value.value define function ToString(value OrientationType): value.value define function ToString(value ParameterUse): value.value define function ToString(value ParticipantRequired): value.value define function ToString(value ParticipantStatus): value.value define function ToString(value ParticipationStatus): value.value define function ToString(value PaymentNoticeStatus): value.value define function ToString(value PaymentReconciliationStatus): value.value define function ToString(value ProcedureStatus): value.value define function ToString(value PropertyRepresentation): value.value define function ToString(value PropertyType): value.value define function ToString(value ProvenanceEntityRole): value.value define function ToString(value PublicationStatus): value.value define function ToString(value QualityType): value.value define function ToString(value QuantityComparator): value.value define function ToString(value QuestionnaireItemOperator): value.value define function ToString(value QuestionnaireItemType): value.value define function ToString(value QuestionnaireResponseStatus): value.value define function ToString(value ReferenceHandlingPolicy): value.value define function ToString(value ReferenceVersionRules): value.value define function ToString(value ReferredDocumentStatus): value.value define function ToString(value RelatedArtifactType): value.value define function ToString(value RemittanceOutcome): value.value define function ToString(value RepositoryType): value.value define function ToString(value RequestIntent): value.value define function ToString(value RequestPriority): value.value define function ToString(value RequestStatus): value.value define function ToString(value ResearchElementType): value.value define function ToString(value ResearchStudyStatus): value.value define function ToString(value ResearchSubjectStatus): value.value define function ToString(value ResourceType): value.value define function ToString(value ResourceVersionPolicy): value.value define function ToString(value ResponseType): value.value define function ToString(value RestfulCapabilityMode): value.value define function ToString(value RiskAssessmentStatus): value.value define function ToString(value SPDXLicense): value.value define function ToString(value SearchComparator): value.value define function ToString(value SearchEntryMode): value.value define function ToString(value SearchModifierCode): value.value define function ToString(value SearchParamType): value.value define function ToString(value SectionMode): value.value define function ToString(value SequenceType): value.value define function ToString(value ServiceRequestIntent): value.value define function ToString(value ServiceRequestPriority): value.value define function ToString(value ServiceRequestStatus): value.value define function ToString(value SlicingRules): value.value define function ToString(value SlotStatus): value.value define function ToString(value SortDirection): value.value define function ToString(value SpecimenContainedPreference): value.value define function ToString(value SpecimenStatus): value.value define function ToString(value Status): value.value define function ToString(value StrandType): value.value define function ToString(value StructureDefinitionKind): value.value define function ToString(value StructureMapContextType): value.value define function ToString(value StructureMapGroupTypeMode): value.value define function ToString(value StructureMapInputMode): value.value define function ToString(value StructureMapModelMode): value.value define function ToString(value StructureMapSourceListMode): value.value define function ToString(value StructureMapTargetListMode): value.value define function ToString(value StructureMapTransform): value.value define function ToString(value SubscriptionChannelType): value.value define function ToString(value SubscriptionStatus): value.value define function ToString(value SupplyDeliveryStatus): value.value define function ToString(value SupplyRequestStatus): value.value define function ToString(value SystemRestfulInteraction): value.value define function ToString(value TaskIntent): value.value define function ToString(value TaskPriority): value.value define function ToString(value TaskStatus): value.value define function ToString(value TestReportActionResult): value.value define function ToString(value TestReportParticipantType): value.value define function ToString(value TestReportResult): value.value define function ToString(value TestReportStatus): value.value define function ToString(value TestScriptRequestMethodCode): value.value define function ToString(value TriggerType): value.value define function ToString(value TypeDerivationRule): value.value define function ToString(value TypeRestfulInteraction): value.value define function ToString(value UDIEntryType): value.value define function ToString(value UnitsOfTime): value.value define function ToString(value Use): value.value define function ToString(value VariableType): value.value define function ToString(value VisionBase): value.value define function ToString(value VisionEyes): value.value define function ToString(value VisionStatus): value.value define function ToString(value XPathUsageType): value.value define function ToString(value base64Binary): value.value define function ToBoolean(value boolean): value.value define function ToDate(value date): value.value define function ToDateTime(value dateTime): value.value define function ToDecimal(value decimal): value.value define function ToDateTime(value instant): value.value define function ToInteger(value integer): value.value define function ToString(value string): value.value define function ToTime(value time): value.value define function ToString(value uri): value.value define function ToString(value xhtml): value.value ( src )
• library OMTKLogic version '3.0.0' /* This library provides functionality for calculating Morphine Milligram Equivalents (MME) for opioid medications, as described in the 2022 CDC Clinical Practice Guideline. The functionality in this library was developed based on the Java-based implementation described [here](http://build.fhir.org/ig/cqframework/opioid-cds-r4/service-documentation.html#solution-component-3-core-logic-processing-java-class), as well as the MME conversion calculation published as part of the 2022 CDC Clinical Practice Guideline. Note that the logic in this library (and specifically the conversion factors captured here) are based on the 2016 version of the publication available from the CDC here: https://www.cdc.gov/drugoverdose/modules/data-files.html National Center for Injury Prevention and Control. CDC compilation of benzodiazepines, muscle relaxants, stimulants, zolpidem, and opioid analgesics with oral morphine milligram equivalent conversion factors, 2018 version. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Available at https://www.cdc.gov/drugoverdose/resources/data.html This version of the OMTKLogic library uses the OMTKData library as the source for drug ingredient and strength information, rather than the OMTK data source. This library has no external dependencies and so can run in an environment that supports pure CQL. NOTE: For performance, all terminology comparisons in this library use direct integer comparison of the RxNorm codes. This product uses publicly available data courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services; NLM is not responsible for the product and does not endorse or recommend this or any other product. Nelson SJ, Zeng K, Kilbourne J, Powell T, Moore R. Normalized names for clinical drugs: RxNorm at 6 years. J Am Med Inform Assoc. 2011 Jul-Aug;18(4)441-8. doi: 10.1136/amiajnl-2011-000116. Epub 2011 Apr 21. PubMed PMID: 21515544; PubMed Central PMCID: PMC3128404. [Full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128404/) */ include OMTKData version '3.0.0' called OMTKData include ConversionFactors version '3.0.0' called ConversionFactors codesystem "RXNORM": 'http://www.nlm.nih.gov/research/umls/rxnorm' parameter ErrorLevel String default 'Warning' define function Msg(code String, errorLevel String, message String): { code: code, errorLevel: errorLevel, message: message } /* Normalizes the input units to UCUM units 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 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 Message(null, true, 'OMTKLogic.ToUCUM.UnknownUnit', ErrorLevel, 'Unknown unit ' & unit) end define function ToUCUM_Msg(unit String): unit U let result: ToUCUM(U) return { result: result, message: if result is null then Msg('OMTKLogic.ToUCUM.UnknownUnit', ErrorLevel, 'Unknown unit' & unit) else null } /* Calculates daily frequency given frequency within a period */ define function ToDaily(frequency Integer, period 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 */ when 'hour' then frequency * (24.0 / period.value) when 'minute' then frequency * (24.0 / period.value) * 60 when 'second' then frequency * (24.0 / period.value) * 60 * 60 when 'day' then frequency * (24.0 / period.value) / 24 when 'week' then frequency * (24.0 / period.value) / (24 * 7) when 'month' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'year' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ when 'hours' then frequency * (24.0 / period.value) when 'minutes' then frequency * (24.0 / period.value) * 60 when 'seconds' then frequency * (24.0 / period.value) * 60 * 60 when 'days' then frequency * (24.0 / period.value) / 24 when 'weeks' then frequency * (24.0 / period.value) / (24 * 7) when 'months' then frequency * (24.0 / period.value) / (24 * 30) /* assuming 30 days in month */ when 'years' then frequency * (24.0 / period.value) / (24 * 365) /* assuming 365 days in year */ else Message(null, true, 'OMTKLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit) end define function ToDaily_Msg(frequency Integer, period Quantity): frequency F let result: ToDaily(frequency, period) return { result: result, message: if result is null then Msg('OMTKLogic.ToDaily.UnknownUnit', ErrorLevel, 'Unknown unit ' & period.unit) else null } /* Returns the 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 }> */ /* GetIngredients: List<{ rxNormCode Code, doseFormCode Code, ingredientCode code, strength Quantity }> */ define function GetIngredients(rxNormCode Code): OMTKData.DrugIngredients DI where DI.drugCode = ToInteger(rxNormCode.code) return { rxNormCode: Code { code: ToString(DI.drugCode), system: 'http://www.nlm.nih.gov/research/umls/rxnorm', display: DI.drugName }, doseFormCode: Code { code: ToString(DI.doseFormCode), system: 'http://www.nlm.nih.gov/research/umls/rxnorm', display: DI.doseFormName }, ingredientCode: Code { code: ToString(DI.ingredientCode), system: 'http://www.nlm.nih.gov/research/umls/rxnorm', display: DI.ingredientName }, strength: Quantity { value: DI.strengthValue, unit: ToUCUM(DI.strengthUnit) } } /* Returns the first RxNorm code in the given concept that matches a drug code specified in OMTKData. */ define function GetMedicationCode(concept Concept): First( ((concept.codes) C where C.system = 'http://www.nlm.nih.gov/research/umls/rxnorm' return singleton from ( OMTKData.DrugIngredients DI where DI.drugCode = ToInteger(C.code) return Code { code: ToString(DI.drugCode), system: 'http://www.nlm.nih.gov/research/umls/rxnorm', display: DI.drugName } ) ) X where X is not null ) /* Returns the display of the given concept, if present, otherwise, looks up medication names for any RxNormCodes within the concept using the GetMedicationName function */ 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 /* Returns the display of the given code, if present, otherwise looks it up from the OMTK data */ define function GetMedicationName(rxNormCode Code): if rxNormCode.display is null then singleton from ( OMTKData.DrugIngredients DI where DI.drugCode = ToInteger(rxNormCode.code) return DI.drugName ) else rxNormCode.display /* Returns the display of the given ingredient, if present, otherwise looks it up from the OMTK data */ define function GetIngredientName(ingredientCode Code): if ingredientCode.display is null then singleton from ( OMTKData.DrugIngredients DI where DI.ingredientCode = ToInteger(ingredientCode.code) return DI.ingredientName ) else ingredientCode.display /* Returns the display of the given dose form, if present, otherwise looks it up from the OMTK data */ define function GetDoseFormName(doseFormCode Code): if doseFormCode.display is null then singleton from ( OMTKData.DrugIngredients DI where DI.doseFormCode = ToInteger(doseFormCode.code) return DI.doseFormName ) else doseFormCode.display /* Removes the last per argument from a unit NOTE: Rewrote to not use LastPositionOf, since that function is not implemented in the JS engine https://github.com/cqframework/cql-execution/issues/147 */ define function StripPer(unit String): unit X let split: Split(unit, '/'), splitCount: Count(split) return if splitCount > 1 then Substring(unit, 0, Length(unit) - Length(split[splitCount - 1]) - 1) else unit /* define function StripPer(unit String): if LastPositionOf('/', unit) >= 0 then Substring(unit, 0, LastPositionOf('/', unit)) else unit */ /* Calculates daily dose for a specific ingredient based on the ingredient strength, dose form, dose quantity, and daily frequency. In addition, returns a textual description of the daily dose. Tuple { result: Quantity, description: String } */ define function GetDailyDose(ingredientCode Code, strength Quantity, doseFormCode Code, doseQuantity Quantity, dosesPerDay Decimal): case when dosesPerDay is null or doseQuantity is null or strength is null or strength.value is null or strength.unit is null then { result: null as Quantity, description: 'Missing doses per day, dose quantity, and/or strength' } /* if patch --> daily dose = dose value (e.g, number patches with doseQuantity unit = "patch") * per-hour strength */ when ToInteger(doseFormCode.code) = 316987 then /* buprenorphine or fentanyl patch */ if ToInteger(ingredientCode.code) in { 1819, 4337 } then (Quantity { value: dosesPerDay * doseQuantity.value * strength.value, unit: strength.unit }) dailyDose return { result: dailyDose, description: GetIngredientName(ingredientCode) & ' patch: ' & ToString(doseQuantity.value) & ' * ' & ToString(dosesPerDay) & '/d * ' & ToString(strength) & ' = ' + ToString(dailyDose) } else { result: null as Quantity, description: 'Unknown patch ingredient: ' & ingredientCode.code & ':' & ingredientCode.display } /* if dose unit in actual mass units (mg or ug -- when it's a single med) --> daily dose = numTimesPerDay * dose */ when doseQuantity.unit in { 'mg', 'ug' } then (Quantity { value: dosesPerDay * doseQuantity.value, unit: doseQuantity.unit }) dailyDose return { result: dailyDose, description: GetIngredientName(ingredientCode) + ' ' + GetDoseFormName(doseFormCode) + ': ' + ToString(dosesPerDay) + '/d * ' + ToString(doseQuantity) + ' = ' + ToString(dailyDose) } /* 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 (Quantity { value: dosesPerDay * doseQuantity.value * strength.value, unit: StripPer(strength.unit) }) dailyDose return { result: dailyDose, description: GetIngredientName(ingredientCode) + ' ' + GetDoseFormName(doseFormCode) + ': ' + ToString(dosesPerDay) + '/d * ' + ToString(doseQuantity) + ' * ' & ToString(strength) & ' = ' + ToString(dailyDose) } /* 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 (Quantity { value: dosesPerDay * doseQuantity.value * strength.value, unit: StripPer(strength.unit) }) dailyDose return { result: dailyDose, description: GetIngredientName(ingredientCode) + ' ' + GetDoseFormName(doseFormCode) + ': ' + ToString(dosesPerDay) + '/d * ' + ToString(doseQuantity) + ' * ' + ToString(strength) + ' = ' + ToString(dailyDose) } 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, strength Quantity, dailyDose Quantity, dailyDoseDescription String, conversionFactor Decimal, mme Quantity }> */ define function CalculateMMEs(medications List<Tuple { rxNormCode Code, doseQuantity Quantity, dosesPerDay Decimal }>): Flatten( medications M let Ingredients: GetIngredients(M.rxNormCode) return Ingredients I let adjustedDoseQuantity: M.doseQuantity, dailyDose: GetDailyDose(I.ingredientCode, I.strength, I.doseFormCode, adjustedDoseQuantity, M.dosesPerDay), factor: ConversionFactors.GetConversionFactor(I.ingredientCode, dailyDose.result, I.doseFormCode, M.dosesPerDay) return { rxNormCode: M.rxNormCode, doseFormCode: I.doseFormCode, doseQuantity: adjustedDoseQuantity, dosesPerDay: M.dosesPerDay, ingredientCode: I.ingredientCode, strength: I.strength, dailyDose: dailyDose.result, dailyDoseDescription: dailyDose.description & (' * factor: ' + Coalesce(ToString(factor), 'No conversion factor available')), conversionFactor: factor, mme: Quantity( Round(dailyDose.result.value * factor, 1), '{MME}/d' ) } ) define function Quantity(value Decimal, unit String): if value is not null then Quantity { value: value, unit: unit } else null ( src )
• 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 } }) */ ( src )
• library OpioidCDSCommon version '2022.1.0' using FHIR version '4.0.1' include FHIRHelpers version '4.0.1' called FHIRHelpers include OMTKLogicMK2020 version '2022.1.0' called OMTKLogic codesystem "LOINC": 'http://loinc.org' codesystem "SNOMED": 'http://snomed.info/sct' codesystem "Medication Request Category Codes": 'http://terminology.hl7.org/CodeSystem/medicationrequest-category' codesystem "Medication Request Status Codes": 'http://hl7.org/fhir/medication-request-status' codesystem "Condition Clinical Status Codes": 'http://terminology.hl7.org/CodeSystem/condition-clinical' valueset "US Core Condition Category Codes": 'http://hl7.org/fhir/us/core/ValueSet/us-core-condition-category' // Expression-based valueset "Opioid analgesics with ambulatory misuse potential": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential' valueset "Extended release opioid with ambulatory misuse potential": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/extended-release-opioid-with-ambulatory-misuse-potential' valueset "Buprenorphine and methadone medications": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/buprenorphine-and-methadone-medications' // Enumerated-compose valueset "Limited life expectancy conditions": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/limited-life-expectancy-conditions' valueset "Therapies indicating end of life care": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/therapies-indicating-end-of-life-care' valueset "Conditions likely terminal for opioid prescribing": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/conditions-likely-terminal-for-opioid-prescribing' valueset "CDC malignant cancer conditions": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/cdc-malignant-cancer-conditions' valueset "Oncology specialty designations (NUCC)": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/oncology-specialty-designations' valueset "Opioid misuse disorders": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-misuse-disorders' valueset "Substance misuse behavioral counseling": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/substance-misuse-behavioral-counseling' valueset "Conditions documenting substance misuse": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/conditions-documenting-substance-misuse' // Harvested from VSAC - OID: 2.16.842022.1.013883.3.464.1003.101.12.1001 // Reviewed with Terminology, 2020-02-05 - Value set name in VSAC is "Office Visit", need to verify suitability valueset "Office Visit": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/office-visit' valueset "Opioid counseling procedure": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-counseling-procedure' /* Existing sets for first six recs */ valueset "Benzodiazepine medications": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/benzodiazepine-medications' valueset "Non-opioid drug urine screening": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/non-opioid-drug-urine-screening' valueset "Naloxone medications": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/naloxone-medications' valueset "Opioid misuse assessment procedure": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-misuse-assessment-procedure' valueset "Opioid drug urine screening": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-drug-urine-screening' valueset "Hospice Disposition": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-disposition' // Harvested from VSAC - OID: 2.16.842022.1.013762.1.4.1108.15 valueset "Hospice Finding Codes": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-finding' valueset "Hospice Procedure Codes": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-procedure' valueset "Pain treatment plan": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-treatment-plan' valueset "Pain management procedure": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-management-procedure' valueset "PDMP review procedure": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-review-procedure' valueset "PDMP data reviewed finding": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-data-reviewed-finding' code "Community": 'community' from "Medication Request Category Codes" code "Active Condition": 'active' from "Condition Clinical Status Codes" code "Active MedicationRequest": 'active' from "Medication Request Status Codes" // TODO: code "Nonpharmacologic therapy and nonopioid pharmocologic": 'TODO' from "TODO" context Patient // TODO: Capture process decisions for long-term opioid use define IsForChronicPain: true define "Active Ambulatory Opioid Rx": /* ("Get Active Ambulatory Medication Requests"([MedicationRequest: status in "Active MedicationRequest"])) Rx */ ( ("Get Active Ambulatory Medication Requests"([MedicationRequest])) MR where date from MR.authoredOn 2 years or less on or before Today() and MR.medication is Reference or MR.medication in "Opioid analgesics with ambulatory misuse potential" ) Rx let Med: [Medication: id in (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))] where not(Rx.medication is Reference) or Med.code in "Opioid analgesics with ambulatory misuse potential" return MedicationRequest { id: Rx.id, status: Rx.status, intent: Rx.intent, category: Rx.category, medication: if Rx.medication is Reference then First(Med.code) else Rx.medication as CodeableConcept, subject: Rx.subject, recorder: Rx.recorder, dosageInstruction: Rx.dosageInstruction, dispenseRequest: Rx.dispenseRequest } define "Active Ambulatory Benzodiazepine Rx": /* ("Get Active Ambulatory Medication Requests"([MedicationRequest: status in "Active MedicationRequest"])) Rx */ ( ("Get Active Ambulatory Medication Requests"([MedicationRequest])) MR where date from MR.authoredOn 2 years or less on or before Today() and MR.medication is Reference or MR.medication in "Benzodiazepine medications" ) Rx let Med: [Medication: id in (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))] where not(Rx.medication is Reference) or Med.code in "Benzodiazepine medications" return MedicationRequest { id: Rx.id, status: Rx.status, intent: Rx.intent, category: Rx.category, medication: if Rx.medication is Reference then First(Med.code) else Rx.medication as CodeableConcept, subject: Rx.subject, recorder: Rx.recorder, dosageInstruction: Rx.dosageInstruction, dispenseRequest: Rx.dispenseRequest } define "Active Ambulatory Naloxone Rx": /* ("Get Active Ambulatory Medication Requests"([MedicationRequest: status in "Active MedicationRequest"])) Rx */ ( ("Get Active Ambulatory Medication Requests"([MedicationRequest])) MR where date from MR.authoredOn 2 years or less on or before Today() and MR.medication is Reference or MR.medication in "Naloxone medications" ) Rx let Med: [Medication: id in (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))] where not(Rx.medication is Reference) or Med.code in "Naloxone medications" return MedicationRequest { id: Rx.id, status: Rx.status, intent: Rx.intent, category: Rx.category, medication: if Rx.medication is Reference then First(Med.code) else Rx.medication as CodeableConcept, subject: Rx.subject, recorder: Rx.recorder, dosageInstruction: Rx.dosageInstruction, dispenseRequest: Rx.dispenseRequest } define function "Get Active Ambulatory Medication Requests" (value List<MedicationRequest>) returns List<MedicationRequest>: value Rx where Rx.status.value = 'active' and exists ( Rx.category RxCategory where FHIRHelpers.ToConcept(RxCategory) ~ "Community" ) define function "Is Ambulatory Medication Request?" (value List<MedicationRequest>) returns List<MedicationRequest>: value Rx where exists ( Rx.category RxCategory where FHIRHelpers.ToConcept(RxCategory) ~ "Community" ) define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>): value Rx let MedRef: if (Rx.medication is FHIR.Reference) then (Rx.medication as FHIR.Reference).reference else null, Med: if MedRef is null then (Rx.medication as FHIR.CodeableConcept) else SingletonFrom([Medication: id in (Last(Split(MedRef, '/')))] Med return Med.code) where Med in "Opioid analgesics with ambulatory misuse potential" and exists ( Rx.category RxCategory where FHIRHelpers.ToConcept(RxCategory) ~ "Community" ) return MedicationRequest { id: Rx.id, status: Rx.status, intent: Rx.intent, category: Rx.category, medication: FHIR.CodeableConcept{ coding: Med.coding }, subject: Rx.subject, authoredOn: Rx.authoredOn, recorder: Rx.recorder, dosageInstruction: Rx.dosageInstruction, dispenseRequest: Rx.dispenseRequest } define function "Is Benzodiazepine?"(value List<MedicationRequest>): value Rx let MedRef: if (Rx.medication is FHIR.Reference) then (Rx.medication as FHIR.Reference).reference else null, Med: if MedRef is null then (Rx.medication as FHIR.CodeableConcept) else SingletonFrom([Medication: id in (Last(Split(MedRef, '/')))] Med return Med.code) where Med in "Benzodiazepine medications" and exists ( Rx.category RxCategory where FHIRHelpers.ToConcept(RxCategory) ~ "Community" ) return MedicationRequest { id: Rx.id, status: Rx.status, intent: Rx.intent, category: Rx.category, medication: FHIR.CodeableConcept{ coding: Med.coding }, subject: Rx.subject, authoredOn: Rx.authoredOn, recorder: Rx.recorder, dosageInstruction: Rx.dosageInstruction, dispenseRequest: Rx.dispenseRequest } define "End of Life Assessment": // 1. Conditions indicating end of life or with limited life expectancy exists ( "Conditions Indicating End of Life or With Limited Life Expectancy" ) // 2. Admitted/referred/discharged to hospice care or exists ( "Admitted/Referred/Discharged to Hospice Care" ) // 3. Medications indicating end of life /* or exists ( "Medications Indicating End of Life" ) */ define "Conditions Indicating End of Life or With Limited Life Expectancy": ( [Condition: category in "US Core Condition Category Codes"] C where C.code in "Conditions likely terminal for opioid prescribing" and exists ( C.clinicalStatus.coding Coding where FHIRHelpers.ToCode(Coding) ~ "Active Condition" ) ) union ( [Condition: category in "US Core Condition Category Codes"] C where C.code in "Limited life expectancy conditions" and exists ( C.clinicalStatus.coding Coding where FHIRHelpers.ToCode(Coding) ~ "Active Condition" ) ) define "Admitted/Referred/Discharged to Hospice Care": ( [Procedure: code in "Hospice Procedure Codes"] P where P.status.value in { 'in-progress', 'completed' } ) union ( [ServiceRequest: code in "Hospice Procedure Codes"] E where E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' } ) union ( [Observation: code in "Hospice Finding Codes"] O where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' }) ) union ( [Encounter] E where ( if E.hospitalization.dischargeDisposition.coding is null or not exists (E.hospitalization.dischargeDisposition.coding) then false else E.hospitalization.dischargeDisposition in "Hospice Disposition" ) and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' } ) /* define "Medications Indicating End of Life": ( [MedicationAdministration: "End Of Life Opioids"] MA where MA.status.value in { 'in-progress', 'on-hold', 'completed' } ) union ( [MedicationDispense: "End Of Life Opioids"] MD where MD.status.value in { 'preparation', 'in-progress', 'on-hold', 'completed' } ) union ( [MedicationRequest: "End Of Life Opioids"] MR where MR.status.value in { 'active', 'completed' } ) union ( [MedicationStatement: "End Of Life Opioids"] MS where MS.status.value in { 'active', 'completed', 'intended' } ) */ define "Previous 10 Days Interval": Interval[Today() - 10 days, Today()] define "First Month": Interval[Today() - 3 months, Today() - 2 months] define "Second Month": Interval[Today() - 2 months, Today() - 1 months] define "Third Month": Interval[Today() - 1 months, Today()] define "Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months": "Days on Opioids during Period"("First Month") >= 21 and "Days on Opioids during Period"("Second Month") >= 21 and "Days on Opioids during Period"("Third Month") >= 21 define function "Prescription Relevant Period"(prescription FHIR.MedicationRequest): if ( prescription.authoredOn is not null and prescription.dispenseRequest is not null and prescription.dispenseRequest.expectedSupplyDuration is not null ) then Interval[ date from prescription.authoredOn, date from prescription.authoredOn + System.Quantity{ value: GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration), unit: 'days' } ] else null define function "Days on Opioids during Period"(period Interval<Date>): Sum( ( collapse ( [MedicationRequest: "Opioid analgesics with ambulatory misuse potential"] OpioidPrescription return "Prescription Relevant Period"( OpioidPrescription ) intersect period ) ) OpioidUseInterval return days between start of OpioidUseInterval and end of OpioidUseInterval ) define function Prescriptions(Orders List<MedicationRequest>): Orders O let // NOTE: Assuming medication is specified as a CodeableConcept with a single RxNorm code rxNormCode: FHIRHelpers.ToCode((O.medication as FHIR.CodeableConcept).coding[0]), medicationName: OMTKLogic.GetMedicationName(rxNormCode), // NOTE: Assuming a single dosage instruction element dosageInstruction: O.dosageInstruction[0], // NOTE: Assuming a single dose and rate element doseAndRate: dosageInstruction.doseAndRate[0], repeat: dosageInstruction.timing.repeat, frequency: Coalesce(repeat.frequencyMax.value, repeat.frequency.value), period: System.Quantity { value: repeat.period.value, unit: repeat.periodUnit.value }, doseDescription: Coalesce( // There should be a conversion from FHIR.SimpleQuantity to System.Quantity if doseAndRate.dose is FHIR.Range then ToString((doseAndRate.dose as FHIR.Range).low) + '-' + ToString((doseAndRate.dose as FHIR.Range).high) + (doseAndRate.dose as FHIR.Range).high.unit.value else ToString(FHIRHelpers.ToQuantity(doseAndRate.dose)), '' ), frequencyDescription: ToString(dosageInstruction.timing.repeat.frequency.value) + Coalesce( '-' + ToString(dosageInstruction.timing.repeat.frequencyMax.value), '' ) return { rxNormCode: rxNormCode, isDraft: O.status.value = 'draft', // NOTE: Assuming asNeeded is expressed as a boolean isPRN: dosageInstruction.asNeeded, prescription: if dosageInstruction.text is not null then medicationName + ' ' + dosageInstruction.text.value else // TODO: Shouldn't need the .value here on asNeededBoolean medicationName + ' ' + doseDescription + ' q' + frequencyDescription + (if dosageInstruction.asNeeded then ' PRN' else ''), dose: if doseAndRate.dose is FHIR.Range then (doseAndRate.dose as FHIR.Range).high else FHIRHelpers.ToQuantity(doseAndRate.dose), dosesPerDay: Coalesce(OMTKLogic.ToDaily(frequency, period), 1.0) } define function MME(prescriptions List<MedicationRequest>): (Prescriptions(prescriptions)) P let mme: SingletonFrom(OMTKLogic.CalculateMMEs({ { rxNormCode: P.rxNormCode, doseQuantity: P.dose, dosesPerDay: P.dosesPerDay } })) return { rxNormCode: P.rxNormCode, isDraft: P.isDraft, isPRN: P.isPRN, prescription: P.prescription, dailyDose: mme.dailyDoseDescription, conversionFactor: mme.conversionFactor, mme: mme.mme } define function TotalMME(prescriptions List<MedicationRequest>): System.Quantity { value: Sum((MME(prescriptions)) M return M.mme.value), unit: 'mg/d' } define function GetDurationInDays(value FHIR.Duration): if value is null then null else case when value.code.value ~ 'a' then value.value.value * 365.0 when value.code.value ~ 'mo' then value.value.value * 30.0 when value.code.value ~ 'wk' then value.value.value * 7.0 when value.code.value ~ 'd' then value.value.value when value.code.value ~ 'h' then value.value.value / 24.0 when value.code.value ~ 'min' then value.value.value / 60.0 / 24.0 when value.code.value ~ 's' then value.value.value / 60.0 / 60.0 / 24.0 when value.code.value ~ 'ms' then value.value.value / 60.0 / 60.0 / 24.0 / 1000.0 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 define function GetIngredient(rxNormCode Code): OMTKLogic.GetIngredients(rxNormCode).ingredientName define function GetIngredients(rxNormCodes List<Code>): rxNormCodes rnc return GetIngredient(rnc) define function GetMedicationNames(medications List<MedicationRequest>): medications M return OMTKLogic.GetIngredients(ToRxNormCode((M.medication as FHIR.CodeableConcept).coding)).rxNormCode.display /* * Conversion Functions */ define function CodeableConceptsToString(concepts List<FHIR.CodeableConcept>): concepts c return CodeableConceptToString(c) define function CodingToString(coding FHIR.Coding): if (coding is null) then null else 'Code {' & 'code: ' & coding.code & 'system: ' & coding.system & 'version: ' & coding.version & 'display: ' & coding.display & '}' define function CodeableConceptToString(concept FHIR.CodeableConcept): if (concept is null or concept.coding is null) then null else 'CodeableConcept {' & 'Coding: [' & Combine(concept.coding Coding return CodingToString(Coding), ',') & ']' & '}' define function ToCodes(coding List<FHIR.Coding>): coding c return FHIRHelpers.ToCode(c) define function ToRxNormCode(coding List<FHIR.Coding>): singleton from ( coding C where C.system = 'http://www.nlm.nih.gov/research/umls/rxnorm' ) ( src )
• © CDC 2016+. ( src )

External References