Id: library-OpioidCDSREC10PatientView Type: logic-library Version: 2022.1.0 Status: active Related: type: depends-on Resource: http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers type: depends-on Resource: http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommon type: depends-on Resource: http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines Data Requirements: type: Observation code filter: path: code valueset: http://fhir.org/guides/cdc/opioid-cds/ValueSet/non-opioid-drug-urine-screening type: Observation code filter: path: code valueset: http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-drug-urine-screening Content: type: text/cql library OpioidCDSREC10PatientView version '2022.1.0' using FHIR version '4.0.1' include FHIRHelpers version '4.0.1' called FHIRHelpers include OpioidCDSCommon version '2022.1.0' called Common include OpioidCDSRoutines version '2022.1.0' called Routines code "Urine Drug Screening": '310627008' from Common.SNOMED display 'Urine drug screening (procedure)' /* ** Recommendation #10 ** When prescribing opioids for subacute or chronic pain, providers should use urine drug ** testing before starting opioid therapy and consider urine drug testing at ** least annually to assess for prescribed medications as well as other controlled ** prescription drugs and illicit drugs (recommendation category: B, evidence type: 4) ** ** When ** Provider is prescribing an opioid analgesic 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 ** Urine drug screening has not been performed in last 12 months ** Then ** Recommend urine drug screening ** Will perform urine screening ** Not for chronic pain management, snooze 3 months ** N/A - see comment, snooze 3 months ** */ // META: Plan Definition: http://fhir.org/guides/cdc/opioid-cds-r4/PlanDefinition/opioid-cds-10-patient-view context Patient define "Lookback Year": Interval[Today() - 12 months - 1 days, Today() - 1 day] define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists ( Common."Active Ambulatory Opioid Rx" AmbulatoryOpioidPrescription where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription ) ) define "Is Recommendation Applicable?": "Inclusion Criteria" and not "Exclusion Criteria" define "Inclusion Criteria": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Routines."Is Opioid Review Useful?" and not "Patient had Urine Screening in Last 12 Months" define "Exclusion Criteria": Common."End of Life Assessment" define "Patient had Urine Screening in Last 12 Months": exists( "Urine Screenings during the Last 12 Months" ) define "Urine Screenings during the Last 12 Months": ( [Observation: "code" in Common."Non-opioid drug urine screening"] IllicitDrugScreen where date from IllicitDrugScreen.effective in day of "Lookback Year" and not (IllicitDrugScreen.status.value in { 'unknown', 'entered-in-error', 'cancelled' }) ) union ( [Observation: "code" in Common."Opioid drug urine screening"] OpioidDrugScreen where date from OpioidDrugScreen.effective in day of "Lookback Year" and not (OpioidDrugScreen.status.value in { 'unknown', 'entered-in-error', 'cancelled' }) ) define "No Screening In Last 12 Months Indicator": if "Is Recommendation Applicable?" then 'warning' else null define "No Screening In Last 12 Months Summary": if "Is Recommendation Applicable?" then 'Annual Urine Screening Check' else null define "No Screening In Last 12 Months Detail": if "Is Recommendation Applicable?" then 'Patients on opioid therapy should have a urine drug test performed every 12 months.' else null /* PlanDefinition: Inclusion Criteria: No Screening in Last 12 months - ServiceRequest - Urine Screening Opioids found in urine screening Illicit drugs found in urine screening */ // Service Request - Urine Screening // Detected Issue - Opioids found in urine screening // Detected Issue - Illicit drugs found in urine screening define "Urine Drug Screening Request": ServiceRequest { //identifier:, instantiatesCanonical: { FHIR.canonical { value: 'http://fhir.org/guides/cdc/activitydefinition/urine-screening-request' } }, status: FHIR.RequestStatus { value: 'draft' }, intent: FHIR.RequestIntent { value: 'proposal' }, priority: FHIR.RequestPriority { value: 'routine' }, code: FHIR.CodeableConcept { coding: { ToCoding("Urine Drug Screening") } }, subject: FHIR.Reference { reference: FHIR.string { value: 'Patient/' + Patient.id } }, occurrence: FHIR.Period { start: FHIR.dateTime { value: Today() }, end: FHIR.dateTime { value: Today() + 7 days } }, authoredOn: FHIR.dateTime { value: Now() }, reasonCode: { FHIR.CodeableConcept { text: FHIR.string { value: "No Screening In Last 12 Months Detail" } } } // doesn't really work, need a relatedArtifact here... //reasonCode: { FHIR.CodeableConcept { text: FHIR.string { value: 'https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Introduction:~:text=9%2C%20Implementation%20Considerations).-,Recommendation,-10' } } } } /* define "Opioids Issue": DetectedIssue { //identifier:, status: FHIR.ObservationStatus { value: 'preliminary' }, code: FHIR.CodeableConcept { text: FHIR.string { value: "Evidence of Opioids 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:, // TODO: Reference the lab results that were used to infer this // implicated:, detail: FHIR.string { value: "Evidence of Opioids Detail" }, reference: FHIR.uri { value: 'http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-10-patient-view'} } define "Illicit Drugs Issue": DetectedIssue { //identifier:, status: FHIR.ObservationStatus { value: 'preliminary' }, code: FHIR.CodeableConcept { text: FHIR.string { value: "Evidence of Illicit Drugs 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:, // TODO: Reference the lab results that were used to infer this // implicated:, detail: FHIR.string { value: "Evidence of Illicit Drugs Detail" }, reference: FHIR.uri { value: 'http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-10-patient-view'} } */ define function ToCoding(code System.Code): FHIR.Coding { code: FHIR.code { value: code.code }, system: FHIR.uri { value: code.system }, version: FHIR.string { value: code.version }, display: FHIR.string { value: code.display } }
Library - Recommendation #10 Patient View - Urine Drug Testing
Centers for Disease Control and Prevention (CDC)
Value set Encounter Diagnosis Condition Category
Value set Problem List Condition Category
Value set US Core Health Concern Condition Category
Value set Conditions likely terminal for opioid prescribing
Value set Limited life expectancy conditions
Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential
Is Perform Drug Screen Recommendation Applicable?
Applicable Because of Unexpected Results