library OpioidCDSREC04 version '0.1.1'
using FHIR version '4.0.1'
include FHIRHelpers version '4.0.1' called FHIRHelpers
include OpioidCDSCommon version '0.1.1' called Common
include OpioidCDSRoutines version '0.1.1' called Routines
/*
** Recommendation #4
** Prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids
**
** When
** Provider is prescribing an extended release opioid with ambulatory misuse potential in the outpatient setting
** Prescription is for treating chronic pain.
** Opioid review is useful for this patient:
** Patient is 18 or over
** Patient does not have findings indicating limited life expectancy
** Patient does not have orders for therapies indicating end of life care
** Patient is not undergoing active cancer treatment:
** Patient has had at least 2 encounters within the past year with any diagnosis of cancer
** Patient is opioid naive:
** No indication of opioid use in the past 90 days from a prescription, self report, or a dispensing event
** Then
** Recommend use of immediate release opioids:
** Will prescribe immediate release opioid analgesic with ambulatory misuse potential
** Benefits outweigh risks, snooze 3 months
** N/A - see comment, snooze 3 months
**
*/
// META: Plan Definition: http://fhir.org/guides/cdc/opioid-cds-r4/PlanDefinition/opioid-cds-04
parameter ContextPrescriptions List<MedicationRequest>
context Patient
define "Inclusion Period":
Interval[Today() - 91 days, Today() - 1 days]
define "Encounter Period":
Interval[Today() - 12 months - 1 days, Today() - 1 days]
define "Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
where Routines."Is Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )
and AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential"
define "Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential":
exists( "Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )
define "Is Recommendation Applicable?":
"Inclusion Criteria"
and not "Exclusion Criteria"
define "Inclusion Criteria":
"Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential"
and Routines."Is Opioid Review Useful?"
and Routines."Is Opioid Naive?"
define "Exclusion Criteria":
Common."End of Life Assessment"
define "Get Indicator":
if "Is Recommendation Applicable?"
then 'warning'
else null
define "Get Summary":
if "Is Recommendation Applicable?"
then 'Recommend use of immediate-release opioids instead of extended release/long acting opioids when starting patient on opioids.'
else null
define "Get Detail":
if "Is Recommendation Applicable?"
then 'The following medication requests(s) release rates should be re-evaluated: ' + Combine( flatten( Common.GetMedicationNames( "Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ) ), ', ' )
else null
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