library OpioidCDSREC11PatientView version '2016.4.0'

using FHIR version '4.0.1'

include FHIRHelpers version '4.0.1' called FHIRHelpers
include OpioidCDSCommon version '2016.4.0' called Common
include OpioidCDSCommonConfig version '2016.4.0' called Config
include OpioidCDSRoutines version '2016.4.0' called Routines

/*
**
**  Recommendation #11
**    Clinicians should avoid prescribing opioid pain medication and benzodiazepines
**    concurrently whenever possible (recommendation category: A, evidence type: 3)
**
**  When
**    Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting
**    Provider is prescribing a benzodiazepine medication
**    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 prescribed opioid analgesic with ambulatory misuse potential and benzodiazepine medication concurrently
**  Then
**    Recommend to avoid prescribing opioid pain medication and benzodiazepine concurrently
**      Will revise
**      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-11-patient-view

context Patient

define "Inclusion Criteria":
  (
    exists (Common."Active Ambulatory Benzodiazepine Rx")
      and exists (Common."Active Ambulatory Opioid Rx")
  )
    and not Common."Patient Age Less Than 18"
    and Routines."Is Opioid Review Useful?"

define "Exclusion Criteria":
  Common."End of Life Assessment"

define "Is Recommendation Applicable?":
  "Inclusion Criteria"
    and not "Exclusion Criteria"

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

define "Get Summary":
  if "Is Recommendation Applicable?"
    then 'Patient has active prescriptions for opioid pain medication and benzodiazepines'
  else null

define "Get Detail":
  if "Is Recommendation Applicable?"
    then 'Avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible'
  else null

// Detected Issue - Avoid prescribing opioid pain medication and benzodiazepines concurrently

define "Concurrent Benzodiazepine Prescription Issue":
  DetectedIssue {
    //identifier:,
    status: FHIR.DetectedIssueStatus { value: 'preliminary' },
    code: FHIR.CodeableConcept { text: FHIR.string { value: "Get Summary" } },
    severity: FHIR.DetectedIssueSeverity { value: 'moderate' },
    patient: FHIR.Reference { reference: FHIR.string { value: 'Patient/' + Patient.id } },
    identified: FHIR.dateTime { value: Now() },
    // TODO: Device representation...
    // author:,
    implicated:
      (Common."Active Ambulatory Benzodiazepine Rx" union Common."Active Ambulatory Opioid Rx") M
        return FHIR.Reference { reference: FHIR.string { value: 'MedicationRequest/' + M.id } },
    detail: FHIR.string { value: "Get Detail" },
    reference: FHIR.uri { value: 'http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-11-patient-view'}
  }