value: cdc-opioid-guidance

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

code: eca-rule

display: ECA Rule

define "Get Summary":
  if "Is Recommendation Applicable?"
    then 'Recommend counseling regarding potential opioid harms and risks'
  else null

define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
  ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
    where Routines."Is Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )

define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
  exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )

define "Patient Age Less Than 18":
  if (Config."Age Less than 18 Years Is Enabled") then
    AgeInYearsAt(Today()) < 18
  else
    false

// 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"]

/* define "Patient Age Less Than 18":
  if (Config."Age Less than 18 Years Is Enabled") then
    AgeInYearsAt(Today()) < 18
  else
    false */
define "Conditions Indicating End Of Life Present":
  exists (
    Common."US Core-Categorized Conditions" LLEC
      where LLEC.code in Common."Limited life expectancy conditions"
        and LLEC.clinicalStatus in Common."Active Condition"
  )

define "Service Requests":
   [ServiceRequest] SR
    return SR

/*
**  Routine #1
**  Opioid Review Useful Routine
**
**  Definition              | Answer to Proceed   | Details                                      | Data (Terminology) Requirement
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Age < 18 years?         | No                  | Calculate age from date of birth; exclude    | Date of birth
**                          |                     | patients with age less than 18 years at the  |
**                          |                     | time of the prescription                     |
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Limited life            | No                  | Look for documented findings consistent      | Limited life expectancy conditions
**  expectancy conditions   |                     | with those listed in the limited life        |
**  present?                |                     | expectancy value set (terminal illness, bad  |
**                          |                     | prognosis, pre-terminal)                     |
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Order for therapies     | No                  | Look for patients with an existing order for | Therapies indicating end of life care
**  indicating end of life  |                     | therapies indicating end of life care        |
**  care in past 90 days?   |                     | written within past 90 days                  |
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Active cancer           | No                  | See sub-routine 3                            | See sub-routine 3
**  treatment?              |                     |                                              |
**  ------------------------------------------------------------------------------------------------------------------------------------
**  Conditions Likely       | No                  | Look for patients with active conditions in  | Conditions likely terminal for opioid
**  Terminal for opioid     |                     | the value set end-of-life-conditions         | prescribing
**  prescribing present?    |                     |                                              |
**  ------------------------------------------------------------------------------------------------------------------------------------
**
*/
define "Palliative Care Lookback Period":
  Interval[Today() - 90 days, Today()]

define "Order For Palliative Care In Past 90 Days":
  exists (
    Common."Service Requests" SR
    where SR.status in { 'active', 'completed'}
      and SR.intent in {'proposal', 'plan,', 'directive', 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}
      and FHIRHelpers.ToDateTime(SR.authoredOn) during day of "Palliative Care Lookback Period"
      and SR.code in Common."Therapies indicating end of life care"
  )

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"
    else
      false

define "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present":
  if (Config."End-Stage Disease Criteria Enabled") then
    exists (
      Common."US Core-Categorized Conditions" EOLC
        where EOLC.code in Common."Conditions likely terminal for opioid prescribing"
          and EOLC.clinicalStatus in Common."Active Condition"
    )
  else
    false

define "Is Opioid Review Useful?":
  /* not "Patient Age Less Than 18" */
    not "Conditions Indicating End Of Life Present"
    and not "Order For Palliative Care In Past 90 Days"
    and not "Is Active Cancer Treatment?"
    and not "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present"

// Recommendation 3
define "Opioid Harms & Risks Discussion in Past 90 Days Criteria Enabled":
  true

define "Opioid Harms & Risks Counseling Lookback Period":
  Interval[Today() - 90 days, Today() - 1 days]

define "Documented Discussions of Opioid Harms and Risks in Past 90 Days Excluding Today":
  [Procedure: Common."Opioid counseling procedure"] P
    where P.performed during day of "Opioid Harms & Risks Counseling Lookback Period"
      and P.status ~ 'completed'

define "Ordered Discussions of Opioid Harms and Risks in Past 90 Days Excluding Today":
  [ServiceRequest: Common."Opioid counseling procedure"] SR
    where SR.occurrence during day of "Opioid Harms & Risks Counseling Lookback Period"

define "No Documented Discussions of Opioid Harms and Risks":
  Config."Opioid Harms & Risks Discussion in Past 90 Days Criteria Enabled"
    and not (
      exists ( "Documented Discussions of Opioid Harms and Risks in Past 90 Days Excluding Today" )
        or exists ( "Ordered Discussions of Opioid Harms and Risks in Past 90 Days Excluding Today" )
    )

define "Inclusion Criteria":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
    and not Common."Patient Age Less Than 18"
    and Routines."Is Opioid Review Useful?"
    and "No Documented Discussions of Opioid Harms and Risks"

define "Is Recommendation Applicable?":
  "Inclusion Criteria"

define "Get Detail":
  if "Is Recommendation Applicable?"
    then 'Medication requests(s): '
      + Combine(("Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" M
           return Coalesce(M.medication.text, '<Unable to determine medication name>')), ', ')
  else null

define "Get Indicator":
  if "Is Recommendation Applicable?"
    then 'warning'
  else null

Documentation

• CDC 2016 Guideline for prescribing opioids for chronic pain