Id: opioidcds-10-patient-view Url: Recommendation #10 - Urine Drug Testing (patient-view) Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Identifier: value: urn:oid:2.16.840.1.114222.34.11 Name: PlanDefinition_Recommendation_10_Patient_View Title: Recommendation #10 - Urine Drug Testing (patient-view) Status: active Experimental: false Type: system: http://terminology.hl7.org/CodeSystem/plan-definition-type code: eca-rule display: ECA Rule Date: 2025-08-06 Publisher: CDC / Security Risk Solutions, Inc. (SRS) Description: When prescribing opioids for subacute or chronic pain, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed medications as well as other prescribed and nonprescribed controlled substances. Logic Definitions: Library Name Name sequence OpioidCDSCommonConfig Can the implementing EHR support queries for past medications by date range? 0 // Subroutine 2 - Past Medications define "Can the implementing EHR support queries for past medications by date range?": true Library Name Name sequence OpioidCDSCommon Active Ambulatory Opioid Rx 1 define "Active Ambulatory Opioid Rx": if Config."Can the implementing EHR support queries for past medications by date range?" then ( "Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest])) ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in "Opioid analgesics with ambulatory misuse potential" else List<FHIR.MedicationRequest>{} Library Name Name sequence OpioidCDSREC10PatientView Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 2 define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": Common."Active Ambulatory Opioid Rx" AmbulatoryOpioidPrescription where Routines."Is Subacute or Chronic Pain Prescription?"(AmbulatoryOpioidPrescription) Library Name Name sequence OpioidCDSREC10PatientView Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential 3 define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists ("Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions") Library Name Name sequence OpioidCDSCommonConfig Age Less than 18 Years Is Enabled 4 // CDC 2022 General Inclusion Criteria define "Age Less than 18 Years Is Enabled": true Library Name Name sequence OpioidCDSRoutines Patient Age Less Than 18 5 define "Patient Age Less Than 18": if (Config."Age Less than 18 Years Is Enabled") then AgeInYearsAt(Today()) < 18 else false Library Name Name sequence OpioidCDSCommonConfig Sickle Cell Check Enabled 6 // Sickle Cell define "Sickle Cell Check Enabled": true Library Name Name sequence OpioidCDSCommonConfig Sickle Cell Assumed Active 7 define "Sickle Cell Assumed Active": true Library Name Name sequence OpioidCDSCommon US Core-Categorized Conditions 8 // 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"] Library Name Name sequence OpioidCDSCommon Positive Sickle Cell Condition 9 define "Positive Sickle Cell Condition": if Config."Sickle Cell Check Enabled" and not Config."Sickle Cell Assumed Active" then ( "US Core-Categorized Conditions" C where C.code in "Sickle Cell Diseases" and C.clinicalStatus in "Active Condition" ) else if Config."Sickle Cell Check Enabled" and Config."Sickle Cell Assumed Active" then ( "US Core-Categorized Conditions" C where C.code in "Sickle Cell Diseases" ) else null Library Name Name sequence OpioidCDSRoutines Condition Positive for Sickle Cell 10 define "Condition Positive for Sickle Cell": if (Config."Sickle Cell Check Enabled") then exists( Common."Positive Sickle Cell Condition" ) else false Library Name Name sequence OpioidCDSCommonConfig Active Cancer Treatment Encounters Condition Is Enabled 11 // Active Cancer Treatment define "Active Cancer Treatment Encounters Condition Is Enabled": true Library Name Name sequence OpioidCDSRoutines Encounter Period 12 // End of Opioid Naive Routine /* ** Routine #3 ** Active Cancer Treatment Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** --------------------------------------------------------------------------------------------------------------------------------- ** Two office visits within the | No | Look for a minimum of two distinct | Office Visit ** past 12 months | | encounters within 12 months of the date | ** | | of the current visit for which each of the | ** | | following is true: | ** | | - the encounter diagnosis (primary or | ** | | secondary or co-morbidity diagnosis) | ** | | is listed in the CDC Malignant Cancer | ** | | Conditions value set | ** --------------------------------------------------------------------------------------------------------------------------------- ** Office visits with an | No | The encounter is performed by an | Oncology specialty ** oncology specialist | | oncologist as defined in the oncology | designations (NUCC) ** present | | specialty designations using the | ** | | National Uniform Claim Committee | ** | | (NUCC) classifications | ** --------------------------------------------------------------------------------------------------------------------------------- ** Office visits including CDC | No | The encounter diagnosis (primary or | CDC malignant cancer ** malignant cancer | | secondary or co-morbidity diagnosis) | conditions ** condition | | is listed in the CDC Malignant Cancer | ** | | Conditions value set | ** ---------------------------------------------------------------------------------------------------------------------------------- ** */ define "Encounter Period": Interval[Today() - 12 months, Today()) Library Name Name sequence OpioidCDSCommon USCore Encounter Cancer Diagnoses 13 define "USCore Encounter Cancer Diagnoses": [Condition: category in "Encounter Diagnosis Condition Category"] CancerDiagnoses where CancerDiagnoses.code in "CDC malignant cancer conditions" Library Name Name sequence OpioidCDSRoutines Encounters with Cancer Diagnosis During Encounter Period 14 // encounter-diagnosis, problem-list and health-concern Conditions // define "US Core-Categorized Cancer Diagnoses": // Common."US Core-Categorized Conditions" C // where C.code in Common."CDC malignant cancer conditions" // define "Encounters with Cancer Diagnosis During Encounter Period": // [Encounter] Encounter // with "US Core-Categorized Cancer Diagnoses" CancerDiagnosis // such that date from Encounter.period."start".value in day of "Encounter Period" // and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id) define "Encounters with Cancer Diagnosis During Encounter Period": [Encounter] Encounters where date from Encounters.period."start" in day of "Encounter Period" and exists ( Common."USCore Encounter Cancer Diagnoses" CancerDiagnoses where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id) ) Library Name Name sequence OpioidCDSRoutines Number of Encounters with Cancer Diagnosis During Encounter Period 15 define "Number of Encounters with Cancer Diagnosis During Encounter Period": Count ("Encounters with Cancer Diagnosis During Encounter Period") Library Name Name sequence OpioidCDSRoutines Has Two or More Encounters with Cancer Diagnosis During Encounter Period 16 define "Has Two or More Encounters with Cancer Diagnosis During Encounter Period": "Number of Encounters with Cancer Diagnosis During Encounter Period" >= 2 Library Name Name sequence OpioidCDSCommon USCore Problem List Cancer Diagnoses 17 define "USCore Problem List Cancer Diagnoses": [Condition: category in "Problem List Condition Category"] CancerDiagnoses where CancerDiagnoses.code in "CDC malignant cancer conditions" Library Name Name sequence OpioidCDSRoutines Has Active Cancer Diagnosis on Problem List 18 define "Has Active Cancer Diagnosis on Problem List": exists ( Common."USCore Problem List Cancer Diagnoses" CancerDiagnoses where CancerDiagnoses.category in Common."Problem List Condition Category" and exists( CancerDiagnoses.clinicalStatus.coding ClinicalStatus where ClinicalStatus.code ~ 'active' ) ) Library Name Name sequence OpioidCDSRoutines Is Active Cancer Treatment? 19 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" or "Has Active Cancer Diagnosis on Problem List" else false Library Name Name sequence OpioidCDSCommonConfig End-Stage Disease Criteria Enabled 20 // CDC 2022 General Inclusion Criteria define "End-Stage Disease Criteria Enabled": true Library Name Name sequence OpioidCDSRoutines Conditions Likely Terminal for Opioid Prescribing 21 define "Conditions Likely Terminal for Opioid Prescribing": 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 Library Name Name sequence OpioidCDSRoutines CDC 2022 Guideline General Inclusion Criteria 22 define "CDC 2022 Guideline General Inclusion Criteria": not "Patient Age Less Than 18" and not "Condition Positive for Sickle Cell" and not "Is Active Cancer Treatment?" and not "Conditions Likely Terminal for Opioid Prescribing" Library Name Name sequence OpioidCDSCommonConfig Use Alternative UDS Lookback Period 23 define "Use Alternative UDS Lookback Period": false Library Name Name sequence OpioidCDSCommonConfig Alternative UDS Lookback Period 24 define "Alternative UDS Lookback Period": Interval[Today() - 6 months - 1 days, Today()] Library Name Name sequence OpioidCDSREC10Common All Opioid or Non-opioid UDS in Alternative Lookback Period 25 define "All Opioid or Non-opioid UDS in Alternative Lookback Period": ( [Observation: Common."All Drug Urine Screening"] Lab where date from Lab.effective in day of Config."Alternative UDS Lookback Period" and not ( Lab.status in { 'unknown', 'entered-in-error', 'cancelled' } ) ) X sort by date from effective desc Library Name Name sequence OpioidCDSREC10Common UDS Lookback Period 26 // Constants define "UDS Lookback Period": Interval[Today() - 12 months - 1 days, Today()] Library Name Name sequence OpioidCDSREC10Common All Opioid or Non-opioid UDS in Lookback Period 27 define "All Opioid or Non-opioid UDS in Lookback Period": ( [Observation: Common."All Drug Urine Screening"] Lab where date from Lab.effective in day of "UDS Lookback Period" and not ( Lab.status in { 'unknown', 'entered-in-error', 'cancelled' } ) ) X sort by date from effective desc Library Name Name sequence OpioidCDSREC10Common Inclusion Criteria For UDS Recommendation 28 /* @description: Determines whether the general inclusion criteria is met for the patient and whether they had a UDS performed in the past year */ define "Inclusion Criteria For UDS Recommendation": Routines."CDC 2022 Guideline General Inclusion Criteria" and not exists ( if Config."Use Alternative UDS Lookback Period" then "All Opioid or Non-opioid UDS in Alternative Lookback Period" else "All Opioid or Non-opioid UDS in Lookback Period" ) Library Name Name sequence OpioidCDSCommon Conditions Indicating End of Life or With Limited Life Expectancy 29 define "Conditions Indicating End of Life or With Limited Life Expectancy": ( "US Core-Categorized Conditions" C where C.code in "Conditions likely terminal for opioid prescribing" and C.clinicalStatus in "Active Condition" ) union ( "US Core-Categorized Conditions" C where C.code in "Limited life expectancy conditions" and C.clinicalStatus in "Active Condition" ) Library Name Name sequence OpioidCDSCommonConfig Hospice Findings Exclusion Enabled 30 // OpioidCDSCommon define "Hospice Findings Exclusion Enabled": false Library Name Name sequence OpioidCDSCommon Admitted/Referred/Discharged to Hospice Care 31 define "Admitted/Referred/Discharged to Hospice Care": ( if (Config."Hospice Findings Exclusion Enabled") then [Observation: code in "Hospice Finding Codes"] O where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' }) else {} ) union ( [Encounter] E where date from E.period.start 1 year or less on or before Today() and ( 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' } ) Library Name Name sequence OpioidCDSCommon End of Life Assessment 32 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" ) Library Name Name sequence OpioidCDSREC10Common Exclusion Criteria 33 define "Exclusion Criteria": Common."End of Life Assessment" Library Name Name sequence OpioidCDSREC10PatientView Is Perform Drug Screen Recommendation Applicable? 34 define "Is Perform Drug Screen Recommendation Applicable?": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Rec10Common."Inclusion Criteria For UDS Recommendation" and not Rec10Common."Exclusion Criteria" Library Name Name sequence OpioidCDSREC10Common Amphetamine Simple Identifier 35 define "Amphetamine Simple Identifier": 'Amphetamine' Library Name Name sequence OpioidCDSREC10Common Amphetamine Screenings In Lookback Period 36 // Amphetamines define "Amphetamine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Amphetamine Urine Tests" Library Name Name sequence OpioidCDSREC10Common Positive Amphetamine Screenings In Lookback Period 37 define "Positive Amphetamine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Amphetamine Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Negative Amphetamine Screenings In Lookback Period 38 define "Negative Amphetamine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Amphetamine Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Rx Lookback Period 39 define "Rx Lookback Period": Interval[Today() - 12 months - 31 days, Today()] Library Name Name sequence OpioidCDSREC10Common Normalize Rx In Lookback Period 40 define "Normalize Rx In Lookback Period": Common."Get MedicationRequest Medication as Code"( [MedicationRequest: category in Common."Community"] Rx where Rx.status in { 'active', 'completed', 'stopped' } and Rx.intent = 'order' and Common."GetDateFromMedicationRequest"(Rx) in day of "Rx Lookback Period" ) Library Name Name sequence OpioidCDSREC10Common Amphetamine Rx In Lookback Period 41 define "Amphetamine Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Amphetamine Medications" Library Name Name sequence OpioidCDSREC10Common Barbiturate Simple Identifier 42 define "Barbiturate Simple Identifier": 'Barbiturate' Library Name Name sequence OpioidCDSREC10Common Barbiturate Screenings In Lookback Period 43 // Barbiturates define "Barbiturate Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Barbiturate Urine Tests" Library Name Name sequence OpioidCDSREC10Common Positive Barbiturate Screenings In Lookback Period 44 define "Positive Barbiturate Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Barbiturate Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Negative Barbiturate Screenings In Lookback Period 45 define "Negative Barbiturate Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Barbiturate Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Barbiturate Rx In Lookback Period 46 define "Barbiturate Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Barbiturate Medications" Library Name Name sequence OpioidCDSREC10Common Benzodiazepine Simple Identifier 47 define "Benzodiazepine Simple Identifier": 'Benzodiazepine' Library Name Name sequence OpioidCDSREC10Common Benzodiazepine Screenings In Lookback Period 48 // Benzodiazepines define "Benzodiazepine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Benzodiazepine Urine Tests" Library Name Name sequence OpioidCDSREC10Common Positive Benzodiazepine Screenings In Lookback Period 49 define "Positive Benzodiazepine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Benzodiazepine Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Negative Benzodiazepine Screenings In Lookback Period 50 define "Negative Benzodiazepine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Benzodiazepine Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Benzodiazepine Rx In Lookback Period 51 define "Benzodiazepine Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Benzodiazepine medications" Library Name Name sequence OpioidCDSREC10Common Buprenorphine Simple Identifier 52 define "Buprenorphine Simple Identifier": 'Buprenorphine' Library Name Name sequence OpioidCDSREC10Common Buprenorphine Screenings In Lookback Period 53 // Buprenorphine define "Buprenorphine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Buprenorphine Urine Tests" Library Name Name sequence OpioidCDSREC10Common Positive Buprenorphine Screenings In Lookback Period 54 define "Positive Buprenorphine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Buprenorphine Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Negative Buprenorphine Screenings In Lookback Period 55 define "Negative Buprenorphine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Buprenorphine Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Buprenorphine Rx In Lookback Period 56 define "Buprenorphine Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Buprenorphine Medications" Library Name Name sequence OpioidCDSREC10Common Cannabinoid Simple Identifier 57 define "Cannabinoid Simple Identifier": 'Cannabinoid' Library Name Name sequence OpioidCDSCommonConfig Cannabinoid Urine Screening Check Enabled 58 define "Cannabinoid Urine Screening Check Enabled": false Library Name Name sequence OpioidCDSREC10Common Cannabinoid Screenings In Lookback Period 59 // Cannabinoids define "Cannabinoid Screenings In Lookback Period": if Config."Cannabinoid Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Cannabinoid Urine Tests" ) else null Library Name Name sequence OpioidCDSREC10Common Positive Cannabinoid Screenings In Lookback Period 60 define "Positive Cannabinoid Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Cannabinoid Screenings In Lookback Period", Config."Cannabinoid Urine Screening Check Enabled") Library Name Name sequence OpioidCDSREC10Common Negative Cannabinoid Screenings In Lookback Period 61 define "Negative Cannabinoid Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Cannabinoid Screenings In Lookback Period", Config."Cannabinoid Urine Screening Check Enabled") Library Name Name sequence OpioidCDSREC10Common Cocaine Simple Identifier 62 define "Cocaine Simple Identifier": 'Cocaine' Library Name Name sequence OpioidCDSREC10Common Cocaine Screenings In Lookback Period 63 // Cocaine define "Cocaine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Cocaine Urine Tests" Library Name Name sequence OpioidCDSREC10Common Positive Cocaine Screenings In Lookback Period 64 define "Positive Cocaine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Cocaine Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Negative Cocaine Screenings In Lookback Period 65 define "Negative Cocaine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Cocaine Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Fentanyl Simple Identifier 66 define "Fentanyl Simple Identifier": 'Fentanyl' Library Name Name sequence OpioidCDSCommonConfig Opiate Urine Screening Check Enabled 67 // Recommendation 10 define "Opiate Urine Screening Check Enabled": true Library Name Name sequence OpioidCDSREC10Common Fentanyl Screenings In Lookback Period 68 // Fentanyl define "Fentanyl Screenings In Lookback Period": if Config."Opiate Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" AllLabs where AllLabs.code in Common."Fentanyl Urine Tests" ) else null Library Name Name sequence OpioidCDSREC10Common Positive Fentanyl Screenings In Lookback Period 69 define "Positive Fentanyl Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Fentanyl Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled") Library Name Name sequence OpioidCDSREC10Common Negative Fentanyl Screenings In Lookback Period 70 define "Negative Fentanyl Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Fentanyl Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled") Library Name Name sequence OpioidCDSREC10Common Fentanyl Rx In Lookback Period 71 define "Fentanyl Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Fentanyl Medications" Library Name Name sequence OpioidCDSREC10Common Heroin Simple Identifier 72 define "Heroin Simple Identifier": 'Heroin (6-AM)' Library Name Name sequence OpioidCDSREC10Common Heroin Screenings In Lookback Period 73 // Heroin define "Heroin Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Heroin Urine Tests" Library Name Name sequence OpioidCDSREC10Common Positive Heroin Screenings In Lookback Period 74 define "Positive Heroin Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Heroin Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Negative Heroin Screenings In Lookback Period 75 define "Negative Heroin Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Heroin Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Methadone Simple Identifier 76 define "Methadone Simple Identifier": 'Methadone' Library Name Name sequence OpioidCDSREC10Common Methadone Screenings In Lookback Period 77 // Methadone define "Methadone Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Methadone Urine Tests" Library Name Name sequence OpioidCDSREC10Common Positive Methadone Screenings In Lookback Period 78 define "Positive Methadone Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Methadone Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Negative Methadone Screenings In Lookback Period 79 define "Negative Methadone Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Methadone Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Methadone Rx In Lookback Period 80 define "Methadone Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Methadone Medications" Library Name Name sequence OpioidCDSREC10Common Opiate Simple Identifier 81 define "Opiate Simple Identifier": 'Opiate' Library Name Name sequence OpioidCDSREC10Common Opiate Screenings In Lookback Period 82 // Opiates define "Opiate Screenings In Lookback Period": if Config."Opiate Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."General Opiate Urine Tests" ) else null Library Name Name sequence OpioidCDSREC10Common Positive Opiate Screenings In Lookback Period 83 define "Positive Opiate Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Opiate Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled") Library Name Name sequence OpioidCDSREC10Common Negative Opiate Screenings In Lookback Period 84 define "Negative Opiate Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Opiate Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled") Library Name Name sequence OpioidCDSREC10Common Opiate Rx In Lookback Period 85 define "Opiate Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Opiate Medications" Library Name Name sequence OpioidCDSREC10Common Oxycodone Simple Identifier 86 define "Oxycodone Simple Identifier": 'Oxycodone' Library Name Name sequence OpioidCDSREC10Common Oxycodone Screenings In Lookback Period 87 // Oxycodone define "Oxycodone Screenings In Lookback Period": if Config."Opiate Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Oxycodone Urine Tests" ) else null Library Name Name sequence OpioidCDSREC10Common Positive Oxycodone Screenings In Lookback Period 88 define "Positive Oxycodone Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Oxycodone Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled") Library Name Name sequence OpioidCDSREC10Common Negative Oxycodone Screenings In Lookback Period 89 define "Negative Oxycodone Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Oxycodone Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled") Library Name Name sequence OpioidCDSREC10Common Oxycodone Rx In Lookback Period 90 define "Oxycodone Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Oxycodone Medications" Library Name Name sequence OpioidCDSREC10Common PCP Simple Identifier 91 define "PCP Simple Identifier": 'Phencyclidine (PCP)' Library Name Name sequence OpioidCDSREC10Common PCP Screenings In Lookback Period 92 // PCP define "PCP Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" AllLabs where AllLabs.code in Common."PCP Urine Tests" Library Name Name sequence OpioidCDSREC10Common Positive PCP Screenings In Lookback Period 93 define "Positive PCP Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("PCP Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Negative PCP Screenings In Lookback Period 94 define "Negative PCP Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("PCP Screenings In Lookback Period", true) Library Name Name sequence OpioidCDSREC10Common Unexpected Details 95 // Details Logic define "Unexpected Details": { CreateDetailWithPossibleUnexpectedNegative( "Amphetamine Simple Identifier", "Positive Amphetamine Screenings In Lookback Period", "Negative Amphetamine Screenings In Lookback Period", "Amphetamine Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Barbiturate Simple Identifier", "Positive Barbiturate Screenings In Lookback Period", "Negative Barbiturate Screenings In Lookback Period", "Barbiturate Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Benzodiazepine Simple Identifier", "Positive Benzodiazepine Screenings In Lookback Period", "Negative Benzodiazepine Screenings In Lookback Period", "Benzodiazepine Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Buprenorphine Simple Identifier", "Positive Buprenorphine Screenings In Lookback Period", "Negative Buprenorphine Screenings In Lookback Period", "Buprenorphine Rx In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "Cannabinoid Simple Identifier", "Positive Cannabinoid Screenings In Lookback Period", "Negative Cannabinoid Screenings In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "Cocaine Simple Identifier", "Positive Cocaine Screenings In Lookback Period", "Negative Cocaine Screenings In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Fentanyl Simple Identifier", "Positive Fentanyl Screenings In Lookback Period", "Negative Fentanyl Screenings In Lookback Period", "Fentanyl Rx In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "Heroin Simple Identifier", "Positive Heroin Screenings In Lookback Period", "Negative Heroin Screenings In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Methadone Simple Identifier", "Positive Methadone Screenings In Lookback Period", "Negative Methadone Screenings In Lookback Period", "Methadone Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Opiate Simple Identifier", "Positive Opiate Screenings In Lookback Period", "Negative Opiate Screenings In Lookback Period", "Opiate Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Oxycodone Simple Identifier", "Positive Oxycodone Screenings In Lookback Period", "Negative Oxycodone Screenings In Lookback Period", "Oxycodone Rx In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "PCP Simple Identifier", "Positive PCP Screenings In Lookback Period", "Negative PCP Screenings In Lookback Period" ) } Library Name Name sequence OpioidCDSREC10Common Remove Substances Without Positive or Negative Results 96 define "Remove Substances Without Positive or Negative Results": "Unexpected Details" Details where (Details.posDates is not null and Length(Details.posDates) != 0) or (Details.negDates is not null and Length(Details.negDates) != 0) Library Name Name sequence OpioidCDSREC10Common Inclusion Criteria For Unexpected Results 97 define "Inclusion Criteria For Unexpected Results": Routines."CDC 2022 Guideline General Inclusion Criteria" and AnyTrue( "Remove Substances Without Positive or Negative Results" Details return (exists Details.unexpectedPosDetails) or (exists Details.unexpectedNegDetails) ) Library Name Name sequence OpioidCDSREC10PatientView Applicable Because of Unexpected Results 98 define "Applicable Because of Unexpected Results": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Rec10Common."Inclusion Criteria For Unexpected Results" and not Rec10Common."Exclusion Criteria" Library Name Name sequence OpioidCDSCommon Style Header 99 define "Style Header": ' \r\n .alert-body {\r\n width: 670px;\r\n font-family: segoe-ui, sans-serif;\r\n background-color: #FEFFF1;\r\n }\r\n\r\n .details-table {\r\n border-collapse:collapse;\r\n border-style: ridge;\r\n background-color: #FEFFF1;\r\n padding: 2px;\r\n }\r\n\r\n .details-caption {\r\n border-style: ridge;\r\n border-bottom: none;\r\n background-color: #FEFFF1;\r\n padding: 2px;\r\n }\r\n\r\n .details-table-header {\r\n border-style: ridge;\r\n padding: 5px;\r\n }\r\n\r\n .details-table-cell {\r\n border-style: ridge;\r\n padding: 5px;\r\n }\r\n\r\n .details-table-footer-cell {\r\n border-style: ridge;\r\n padding: 5px;\r\n font-size: small;\r\n }\r\n\r\n .details-table-cell-unexpected {\r\n border-style: ridge;\r\n padding: 5px;\r\n color: red;\r\n font-weight: bold;\r\n }\r\n\r\n .more-text {\r\n position: relative;\r\n margin-bottom: 2em;\r\n }\r\n \r\n .more {\r\n display:none;\r\n }\r\n\r\n .show-more:checked + .more {\r\n display:block;\r\n }\r\n<\/style>' Library Name Name sequence OpioidCDSREC10Common Unexpected Div Start 100 define "Unexpected Div Start": ' Patient may have unexpected urine toxicology test results<\/strong> in the past year.<\/p><\/div>' Library Name Name sequence OpioidCDSREC10Common Table Start 101 define "Table Start": ' Urine Toxicology Results<\/caption> Substance<\/th>' Library Name Name sequence OpioidCDSREC10Common All Lab Dates in Lookback Period 102 // Helpers define "All Lab Dates in Lookback Period": ( "All Opioid or Non-opioid UDS in Lookback Period" Lab return date from Lab.effective ) X sort desc Library Name Name sequence OpioidCDSREC10Common Table Headers 103 define "Table Headers": "All Lab Dates in Lookback Period" LabDate return ' ' & ToString(LabDate) & '<\/th>' Library Name Name sequence OpioidCDSREC10Common Generate Table Rows 104 define "Generate Table Rows": "Remove Substances Without Positive or Negative Results" BOT let row: ToString(IndexOf("Remove Substances Without Positive or Negative Results", BOT) + 1) return ' ' + GetExpectedColumn(BOT.ingredient) + Combine( "All Lab Dates in Lookback Period" LabDate let col: ToString(IndexOf("All Lab Dates in Lookback Period", LabDate) + 2) return all ( if BOT.unexpectedPosDetails.date contains LabDate then GetUnexpectedColumn('pos', row & ':' & col) else if BOT.unexpectedNegDetails.udsDate contains LabDate then GetUnexpectedColumn('neg', row & ':' & col) else if BOT.posDates contains LabDate then GetExpectedColumn('pos*') else if BOT.negDates contains LabDate then GetExpectedColumn('neg*') else GetExpectedColumn('n/a') ) ) + '<\/tr>' Library Name Name sequence OpioidCDSREC10Common Generate Footer Rows 105 define "Generate Footer Rows": "Remove Substances Without Positive or Negative Results" BOT let row: ToString(IndexOf("Remove Substances Without Positive or Negative Results", BOT) + 1), colspan: Length("All Lab Dates in Lookback Period") + 1 return Combine( "All Lab Dates in Lookback Period" LabDate let col: ToString(IndexOf("All Lab Dates in Lookback Period", LabDate) + 2) return all ( if BOT.unexpectedPosDetails.date contains LabDate then Coalesce( BOT.unexpectedPosDetails PosDetail where PosDetail.date same day as LabDate return ' ' & GetFooterColumn(colspan, row & ':' & col & ' - Possible unexpected substance found: ' & PosDetail.udsDetail) & '<\/tr>' ) else if BOT.unexpectedNegDetails.udsDate contains LabDate then Coalesce( BOT.unexpectedNegDetails NegDetail where NegDetail.udsDate same day as LabDate return ' ' & GetFooterColumn(colspan, row + ':' & col & ' - Possible unexpected negative result found: prescribed ' & NegDetail.rxDetail & ' on ' & ToString(NegDetail.rxDate)) & '<\/tr>' ) else '' ) ) Library Name Name sequence OpioidCDSREC10Common Table End 106 define "Table End": '<\/table><\/div>' Library Name Name sequence OpioidCDSREC10Common Details Table 107 define "Details Table": "Table Start" & Combine("Table Headers") & ' ' & Combine("Generate Table Rows") & ' ' & ' ' & Combine("Generate Footer Rows") & '<\/tfoot>' & "Table End" Library Name Name sequence OpioidCDSREC10Common Expected Result Footnote 108 define "Expected Result Footnote": ' * - These are expected results based on an analysis of the patient\'s medication list 30 days prior to the corresponding lab results.<\/div>' Library Name Name sequence OpioidCDSREC10Common Details More Info 109 define "Details More Info": ' \r\n Note on false positives and unexpected negative results...<\/p>\r\n Show more\r\n \r\n An unexpectedly negative test may be due to time since last dose, diversion, intermittent use, aberrant drug use behavior, or other factors, including a false negative result. Clinicians should interpret this result in the context of the overall treatment plan.<\/p>\r\n\r\n Positive results may be a false positives or could represent occasional use or possible substance use disorder.<br\/><br\/>For a review regarding interpreting possible false positive urine toxicology results, see http:\/\/pubmed.ncbi.nlm.nih.gov\/24986836<\/a>. It is unknown if the findings reported in this article can be extrapolated to other laboratory analyzers that were not used in the referenced studies.<br\/><br\/>For guidance regarding evaluating and addressing unexpected toxicology tests results, see Recommendation 10 of the 22 CDC Clinical Practice Guideiline<\/a>.<\/p><\/div>\r\n<\/div>' Library Name Name sequence OpioidCDSREC10Common Div End 110 define "Div End": '<\/div>' Library Name Name sequence OpioidCDSREC10Common Get HTML Details 111 // HTML Generation define "Get HTML Details": Common."Style Header" & "Unexpected Div Start" & "Details Table" & "Expected Result Footnote" & "Details More Info" & "Div End" Library Name Name sequence OpioidCDSREC10PatientView Detail 112 define "Detail": Rec10Common."Get HTML Details" Library Name Name sequence OpioidCDSCommon Get MedicationRequest Medication as Code 113 define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>): value Rx let Med: if Rx.medication is Reference then singleton from ( [Medication] M where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/'))) ) else null return MedicationRequest { id: Rx.id, status: Rx.status, intent: Rx.intent, category: Rx.category, medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept, subject: Rx.subject, authoredOn: Rx.authoredOn, recorder: Rx.recorder, dosageInstruction: Rx.dosageInstruction, dispenseRequest: Rx.dispenseRequest } Library Name Name sequence FHIRHelpers ToString 114 define function ToString(value string): value.value Library Name Name sequence OpioidCDSCommon Get Active Ambulatory Medication Requests 115 define function "Get Active Ambulatory Medication Requests" (value List<MedicationRequest>) returns List<MedicationRequest>: value Rx where Rx.status.value = 'active' and Rx.category in "Community" Library Name Name sequence FHIRHelpers ToConcept 116 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 } Library Name Name sequence FHIRHelpers ToCode 117 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 } Library Name Name sequence FHIRHelpers ToDateTime 118 define function ToDateTime(value dateTime): value.value Library Name Name sequence OpioidCDSRoutines Is Subacute or Chronic Pain Prescription? 119 // End of Active Cancer Treatment Routine /* ** Routine #4 ** For Subacute or Chronic Pain Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** ----------------------------------------------------------------------------------------------------------------------------------- ** Order for opioid analgesic | Yes | Order for opioid analgesics with ambulatory | Opioid analgesics with ** with expected supply | | misuse potential with a supply duration of >= | ambulatory misuse potential ** duration >= 28 days | | 28 days | ** | | | ** | | - Subacute definition = order for opioid | ** | | analgesics with ambulatory misuse | ** | | potential with a supply duration of one to | ** | | two months. | ** | | - Chronic pain definition = order for opioid | ** | | analgesics with ambulatory misuse | ** | | potential with a supply duration of >= two | ** | | months. | ** ----------------------------------------------------------------------------------------------------------------------------------- ** */ define function "Is Subacute or Chronic Pain Prescription?"(prescription FHIR.MedicationRequest): "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription) or "Is Subacute or Chronic Pain Using Validity Period"(prescription) Library Name Name sequence OpioidCDSRoutines Is Subacute or Chronic Pain Using Expected Supply Duration 120 define function "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription FHIR.MedicationRequest): ( prescription.dispenseRequest is not null and prescription.dispenseRequest.expectedSupplyDuration is not null and ( Common.GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration) >= 28 days ) ) Library Name Name sequence OpioidCDSCommon GetDurationInDays 121 define function GetDurationInDays(value FHIR.Duration): if value is null then null else case when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' } when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' } when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' } when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' } when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' } when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' } when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' } when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' } 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 Library Name Name sequence OpioidCDSRoutines Is Subacute or Chronic Pain Using Validity Period 122 define function "Is Subacute or Chronic Pain Using Validity Period"(prescription FHIR.MedicationRequest): ( prescription.dispenseRequest is not null and prescription.dispenseRequest.validityPeriod is not null and ( days between prescription.dispenseRequest.validityPeriod.start and prescription.dispenseRequest.validityPeriod.end >= 28 ) ) Library Name Name sequence FHIRHelpers ToDateTime 123 define function ToDateTime(value instant): value.value Library Name Name sequence FHIRHelpers ToString 124 define function ToString(value ObservationStatus): value.value Library Name Name sequence OpioidCDSREC10Common CreateDetailWithPossibleUnexpectedNegative 125 define function CreateDetailWithPossibleUnexpectedNegative(TheSubstance String, ThePosLabs List<Observation>, TheNegLabs List<Observation>, TheMeds List<MedicationRequest>): { ingredient: TheSubstance, posDates: ( ThePosLabs PosLab return date from PosLab.effective ), negDates: ( TheNegLabs NegLab return date from NegLab.effective ), unexpectedPosDetails: ( ThePosLabs PosLab where not exists ( TheMeds Rx where Common.GetDateFromMedicationRequest(Rx) in day of Interval[ date from PosLab.effective - 31 days, date from PosLab.effective - 1 days ] ) return { date: date from PosLab.effective, udsDetail: if exists(PosLab.code.coding) then PosLab.code.coding[0].display else 'Unable to determine a detailed identifier' } ), unexpectedNegDetails: ( from TheNegLabs NegLab, ( if exists(TheMeds) then TheMeds else { null as MedicationRequest } ) Rx let medDate: Common.GetDateFromMedicationRequest(Rx) where medDate in day of Interval[date from NegLab.effective - 31 days, date from NegLab.effective - 1 days] return { udsDate: date from NegLab.effective, udsDetail: if exists (NegLab.code.coding) then NegLab.code.coding[0].display else 'Unable to determine a detailed identifier', rxDate: medDate, rxDetail: if Rx.medication.text is not null then Rx.medication.text else if exists (Rx.medication.coding) and Rx.medication.coding[0].display is not null then Rx.medication.coding[0].display else 'Unable to determine a detailed identifier' } ) } Library Name Name sequence OpioidCDSCommon GetDateFromMedicationRequest 126 define function "GetDateFromMedicationRequest"(med FHIR.MedicationRequest): if med is null then null else if med.authoredOn is not null then date from med.authoredOn else Max( med.dosageInstruction DI return Coalesce( // If there are timing events, take the latest. Max(DI.timing.event E return date from E), // Otherwise, if there's a Period, use its start. if DI.timing.repeat is not null and DI.timing.repeat.bounds is FHIR.Period then date from start of FHIRHelpers.ToInterval(DI.timing.repeat.bounds as FHIR.Period) else null ) ) Library Name Name sequence FHIRHelpers ToInterval 127 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] Library Name Name sequence OpioidCDSREC10Common GetPositiveLabsInLookbackPeriod 128 define function GetPositiveLabsInLookbackPeriod(Labs List<FHIR.Observation>, Enabled Boolean): if Enabled then Labs Lab where StartsWith(Lower(Lab.value as FHIR.string), 'pos') else {} Library Name Name sequence OpioidCDSREC10Common GetNegativeLabsInLookbackPeriod 129 define function GetNegativeLabsInLookbackPeriod(Labs List<FHIR.Observation>, Enabled Boolean): if Enabled then Labs Lab where StartsWith(Lower(Lab.value as FHIR.string), 'neg') else {} Library Name Name sequence FHIRHelpers ToString 130 define function ToString(value MedicationRequestStatus): value.value Library Name Name sequence FHIRHelpers ToString 131 define function ToString(value MedicationRequestIntent): value.value Library Name Name sequence OpioidCDSREC10Common CreateDetailWithoutPossibleUnexpectedNegative 132 define function CreateDetailWithoutPossibleUnexpectedNegative(TheSubstance String, ThePosLabs List<Observation>, TheNegLabs List<Observation>): { ingredient: TheSubstance, posDates: ( ThePosLabs PosLab return date from PosLab.effective ), negDates: ( TheNegLabs NegLab return date from NegLab.effective ), unexpectedPosDetails: ( ThePosLabs PosLab return { date: date from PosLab.effective, udsDetail: if exists (PosLab.code.coding) then PosLab.code.coding[0].display else 'Unable to determine a detailed identifier' } ), unexpectedNegDetails: { null as Tuple{ udsDate System.Date, udsDetail System.String, rxDate System.Date, rxDetail System.String } } } Library Name Name sequence OpioidCDSREC10Common GetExpectedColumn 133 define function GetExpectedColumn(Content String): ' ' & Content & '<\/td>' Library Name Name sequence OpioidCDSREC10Common GetUnexpectedColumn 134 // Functions define function GetUnexpectedColumn(Result String, Superscript String): ' ' & Result & '' & Superscript & '<\/sup><\/td>' Library Name Name sequence OpioidCDSREC10Common GetFooterColumn 135 define function GetFooterColumn(colspan Integer, message String): ' ' & message & '<\/td>' Knowledge Capability: shareable computable executable publishable Use Context: code value display focus 82423001 Chronic pain (finding) focus Purpose: The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. Usage: Before starting opioids and periodically (at least annually) during opioid therapy, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed opioids and other prescription and nonprescription controlled substances that increase risk for overdose when combined with opioids, including nonprescribed and illicit opioids and benzodiazepines. Copyright: © CDC 2016+. Related Artifacts: Documentation 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain Libraries: Library - Recommendation #10 Patient View - Urine Drug Testing Actions: 1. Consider the Benefits and Risks of Conducting a Urine Toxicology Screen: Consider the benefits and risks of toxicology testing to assess for prescribed medications as well as other prescribed and nonprescribed controlled substances.#xD; #xD; For guidance regarding utilizing toxicology tests when prescribing opioids, see [Recommendation 10 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%204).-,Implementation%20Considerations,-Toxicology%20testing%20should). When: Named Event: patient-view If: Applicability: Patient has not had a urine screening in the past 12 months (Is Perform Drug Screen Recommendation Applicable?) Then: : Document - Ordered toxicology screen Then: : Document - Risks outweigh benefits Then: : Snooze* - N/A see comment, snooze 3 months Then: 2. Patient May Have Unexpected Toxicology Test Results: Patient may have unexpected urine toxicology test results in the past year When: Named Event: patient-view If: Applicability: Urine screening tested positive for cocaine, opiates or PCP (Applicable Because of Unexpected Results) Then: : Document - Will repeat urine drug screen more frequently Then: : Will consult with patient regarding possible unexpected test results Then: : Document - Will assess patient for substance use disorder Then: : Snooze* - Patient's test results were expected, snooze for 3 months Then: : Snooze* - N/A snooze for 3 months Then:
Value set Opioid analgesics with ambulatory misuse potential
Value set Encounter Diagnosis Condition Category
Value set Problem List Condition Category
Value set US Core Health Concern Condition Category
Value set CDC malignant cancer conditions
Value set Conditions likely terminal for opioid prescribing
Value set Limited life expectancy conditions
Is Perform Drug Screen Recommendation Applicable?
Applicable Because of Unexpected Results
Can the implementing EHR support queries for past medications by date range?
// Subroutine 2 - Past Medications define "Can the implementing EHR support queries for past medications by date range?": true
define "Active Ambulatory Opioid Rx": if Config."Can the implementing EHR support queries for past medications by date range?" then ( "Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest])) ) Rx where date from Rx.authoredOn 2 years or less on or before Today() and Rx.medication in "Opioid analgesics with ambulatory misuse potential" else List<FHIR.MedicationRequest>{}
Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": Common."Active Ambulatory Opioid Rx" AmbulatoryOpioidPrescription where Routines."Is Subacute or Chronic Pain Prescription?"(AmbulatoryOpioidPrescription)
Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists ("Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions")
// CDC 2022 General Inclusion Criteria define "Age Less than 18 Years Is Enabled": true
define "Patient Age Less Than 18": if (Config."Age Less than 18 Years Is Enabled") then AgeInYearsAt(Today()) < 18 else false
// Sickle Cell define "Sickle Cell Check Enabled": true
define "Sickle Cell Assumed Active": true
// 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 "Positive Sickle Cell Condition": if Config."Sickle Cell Check Enabled" and not Config."Sickle Cell Assumed Active" then ( "US Core-Categorized Conditions" C where C.code in "Sickle Cell Diseases" and C.clinicalStatus in "Active Condition" ) else if Config."Sickle Cell Check Enabled" and Config."Sickle Cell Assumed Active" then ( "US Core-Categorized Conditions" C where C.code in "Sickle Cell Diseases" ) else null
define "Condition Positive for Sickle Cell": if (Config."Sickle Cell Check Enabled") then exists( Common."Positive Sickle Cell Condition" ) else false
Active Cancer Treatment Encounters Condition Is Enabled
// Active Cancer Treatment define "Active Cancer Treatment Encounters Condition Is Enabled": true
// End of Opioid Naive Routine /* ** Routine #3 ** Active Cancer Treatment Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** --------------------------------------------------------------------------------------------------------------------------------- ** Two office visits within the | No | Look for a minimum of two distinct | Office Visit ** past 12 months | | encounters within 12 months of the date | ** | | of the current visit for which each of the | ** | | following is true: | ** | | - the encounter diagnosis (primary or | ** | | secondary or co-morbidity diagnosis) | ** | | is listed in the CDC Malignant Cancer | ** | | Conditions value set | ** --------------------------------------------------------------------------------------------------------------------------------- ** Office visits with an | No | The encounter is performed by an | Oncology specialty ** oncology specialist | | oncologist as defined in the oncology | designations (NUCC) ** present | | specialty designations using the | ** | | National Uniform Claim Committee | ** | | (NUCC) classifications | ** --------------------------------------------------------------------------------------------------------------------------------- ** Office visits including CDC | No | The encounter diagnosis (primary or | CDC malignant cancer ** malignant cancer | | secondary or co-morbidity diagnosis) | conditions ** condition | | is listed in the CDC Malignant Cancer | ** | | Conditions value set | ** ---------------------------------------------------------------------------------------------------------------------------------- ** */ define "Encounter Period": Interval[Today() - 12 months, Today())
define "USCore Encounter Cancer Diagnoses": [Condition: category in "Encounter Diagnosis Condition Category"] CancerDiagnoses where CancerDiagnoses.code in "CDC malignant cancer conditions"
Encounters with Cancer Diagnosis During Encounter Period
// encounter-diagnosis, problem-list and health-concern Conditions // define "US Core-Categorized Cancer Diagnoses": // Common."US Core-Categorized Conditions" C // where C.code in Common."CDC malignant cancer conditions" // define "Encounters with Cancer Diagnosis During Encounter Period": // [Encounter] Encounter // with "US Core-Categorized Cancer Diagnoses" CancerDiagnosis // such that date from Encounter.period."start".value in day of "Encounter Period" // and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id) define "Encounters with Cancer Diagnosis During Encounter Period": [Encounter] Encounters where date from Encounters.period."start" in day of "Encounter Period" and exists ( Common."USCore Encounter Cancer Diagnoses" CancerDiagnoses where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id) )
Number of Encounters with Cancer Diagnosis During Encounter Period
define "Number of Encounters with Cancer Diagnosis During Encounter Period": Count ("Encounters with Cancer Diagnosis During Encounter Period")
Has Two or More Encounters with Cancer Diagnosis During Encounter Period
define "Has Two or More Encounters with Cancer Diagnosis During Encounter Period": "Number of Encounters with Cancer Diagnosis During Encounter Period" >= 2
define "USCore Problem List Cancer Diagnoses": [Condition: category in "Problem List Condition Category"] CancerDiagnoses where CancerDiagnoses.code in "CDC malignant cancer conditions"
Has Active Cancer Diagnosis on Problem List
define "Has Active Cancer Diagnosis on Problem List": exists ( Common."USCore Problem List Cancer Diagnoses" CancerDiagnoses where CancerDiagnoses.category in Common."Problem List Condition Category" and exists( CancerDiagnoses.clinicalStatus.coding ClinicalStatus where ClinicalStatus.code ~ 'active' ) )
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" or "Has Active Cancer Diagnosis on Problem List" else false
// CDC 2022 General Inclusion Criteria define "End-Stage Disease Criteria Enabled": true
Conditions Likely Terminal for Opioid Prescribing
define "Conditions Likely Terminal for Opioid Prescribing": 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
CDC 2022 Guideline General Inclusion Criteria
define "CDC 2022 Guideline General Inclusion Criteria": not "Patient Age Less Than 18" and not "Condition Positive for Sickle Cell" and not "Is Active Cancer Treatment?" and not "Conditions Likely Terminal for Opioid Prescribing"
define "Use Alternative UDS Lookback Period": false
define "Alternative UDS Lookback Period": Interval[Today() - 6 months - 1 days, Today()]
All Opioid or Non-opioid UDS in Alternative Lookback Period
define "All Opioid or Non-opioid UDS in Alternative Lookback Period": ( [Observation: Common."All Drug Urine Screening"] Lab where date from Lab.effective in day of Config."Alternative UDS Lookback Period" and not ( Lab.status in { 'unknown', 'entered-in-error', 'cancelled' } ) ) X sort by date from effective desc
// Constants define "UDS Lookback Period": Interval[Today() - 12 months - 1 days, Today()]
All Opioid or Non-opioid UDS in Lookback Period
define "All Opioid or Non-opioid UDS in Lookback Period": ( [Observation: Common."All Drug Urine Screening"] Lab where date from Lab.effective in day of "UDS Lookback Period" and not ( Lab.status in { 'unknown', 'entered-in-error', 'cancelled' } ) ) X sort by date from effective desc
Inclusion Criteria For UDS Recommendation
/* @description: Determines whether the general inclusion criteria is met for the patient and whether they had a UDS performed in the past year */ define "Inclusion Criteria For UDS Recommendation": Routines."CDC 2022 Guideline General Inclusion Criteria" and not exists ( if Config."Use Alternative UDS Lookback Period" then "All Opioid or Non-opioid UDS in Alternative Lookback Period" else "All Opioid or Non-opioid UDS in Lookback Period" )
Conditions Indicating End of Life or With Limited Life Expectancy
define "Conditions Indicating End of Life or With Limited Life Expectancy": ( "US Core-Categorized Conditions" C where C.code in "Conditions likely terminal for opioid prescribing" and C.clinicalStatus in "Active Condition" ) union ( "US Core-Categorized Conditions" C where C.code in "Limited life expectancy conditions" and C.clinicalStatus in "Active Condition" )
// OpioidCDSCommon define "Hospice Findings Exclusion Enabled": false
Admitted/Referred/Discharged to Hospice Care
define "Admitted/Referred/Discharged to Hospice Care": ( if (Config."Hospice Findings Exclusion Enabled") then [Observation: code in "Hospice Finding Codes"] O where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' }) else {} ) union ( [Encounter] E where date from E.period.start 1 year or less on or before Today() and ( 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 "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" )
define "Exclusion Criteria": Common."End of Life Assessment"
define "Is Perform Drug Screen Recommendation Applicable?": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Rec10Common."Inclusion Criteria For UDS Recommendation" and not Rec10Common."Exclusion Criteria"
define "Amphetamine Simple Identifier": 'Amphetamine'
Amphetamine Screenings In Lookback Period
// Amphetamines define "Amphetamine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Amphetamine Urine Tests"
Positive Amphetamine Screenings In Lookback Period
define "Positive Amphetamine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Amphetamine Screenings In Lookback Period", true)
Negative Amphetamine Screenings In Lookback Period
define "Negative Amphetamine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Amphetamine Screenings In Lookback Period", true)
define "Rx Lookback Period": Interval[Today() - 12 months - 31 days, Today()]
define "Normalize Rx In Lookback Period": Common."Get MedicationRequest Medication as Code"( [MedicationRequest: category in Common."Community"] Rx where Rx.status in { 'active', 'completed', 'stopped' } and Rx.intent = 'order' and Common."GetDateFromMedicationRequest"(Rx) in day of "Rx Lookback Period" )
define "Amphetamine Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Amphetamine Medications"
define "Barbiturate Simple Identifier": 'Barbiturate'
Barbiturate Screenings In Lookback Period
// Barbiturates define "Barbiturate Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Barbiturate Urine Tests"
Positive Barbiturate Screenings In Lookback Period
define "Positive Barbiturate Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Barbiturate Screenings In Lookback Period", true)
Negative Barbiturate Screenings In Lookback Period
define "Negative Barbiturate Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Barbiturate Screenings In Lookback Period", true)
define "Barbiturate Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Barbiturate Medications"
define "Benzodiazepine Simple Identifier": 'Benzodiazepine'
Benzodiazepine Screenings In Lookback Period
// Benzodiazepines define "Benzodiazepine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Benzodiazepine Urine Tests"
Positive Benzodiazepine Screenings In Lookback Period
define "Positive Benzodiazepine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Benzodiazepine Screenings In Lookback Period", true)
Negative Benzodiazepine Screenings In Lookback Period
define "Negative Benzodiazepine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Benzodiazepine Screenings In Lookback Period", true)
define "Benzodiazepine Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Benzodiazepine medications"
define "Buprenorphine Simple Identifier": 'Buprenorphine'
Buprenorphine Screenings In Lookback Period
// Buprenorphine define "Buprenorphine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Buprenorphine Urine Tests"
Positive Buprenorphine Screenings In Lookback Period
define "Positive Buprenorphine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Buprenorphine Screenings In Lookback Period", true)
Negative Buprenorphine Screenings In Lookback Period
define "Negative Buprenorphine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Buprenorphine Screenings In Lookback Period", true)
define "Buprenorphine Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Buprenorphine Medications"
define "Cannabinoid Simple Identifier": 'Cannabinoid'
Cannabinoid Urine Screening Check Enabled
define "Cannabinoid Urine Screening Check Enabled": false
Cannabinoid Screenings In Lookback Period
// Cannabinoids define "Cannabinoid Screenings In Lookback Period": if Config."Cannabinoid Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Cannabinoid Urine Tests" ) else null
Positive Cannabinoid Screenings In Lookback Period
define "Positive Cannabinoid Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Cannabinoid Screenings In Lookback Period", Config."Cannabinoid Urine Screening Check Enabled")
Negative Cannabinoid Screenings In Lookback Period
define "Negative Cannabinoid Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Cannabinoid Screenings In Lookback Period", Config."Cannabinoid Urine Screening Check Enabled")
define "Cocaine Simple Identifier": 'Cocaine'
// Cocaine define "Cocaine Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Cocaine Urine Tests"
Positive Cocaine Screenings In Lookback Period
define "Positive Cocaine Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Cocaine Screenings In Lookback Period", true)
Negative Cocaine Screenings In Lookback Period
define "Negative Cocaine Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Cocaine Screenings In Lookback Period", true)
define "Fentanyl Simple Identifier": 'Fentanyl'
// Recommendation 10 define "Opiate Urine Screening Check Enabled": true
// Fentanyl define "Fentanyl Screenings In Lookback Period": if Config."Opiate Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" AllLabs where AllLabs.code in Common."Fentanyl Urine Tests" ) else null
Positive Fentanyl Screenings In Lookback Period
define "Positive Fentanyl Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Fentanyl Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
Negative Fentanyl Screenings In Lookback Period
define "Negative Fentanyl Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Fentanyl Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
define "Fentanyl Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Fentanyl Medications"
define "Heroin Simple Identifier": 'Heroin (6-AM)'
// Heroin define "Heroin Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Heroin Urine Tests"
Positive Heroin Screenings In Lookback Period
define "Positive Heroin Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Heroin Screenings In Lookback Period", true)
Negative Heroin Screenings In Lookback Period
define "Negative Heroin Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Heroin Screenings In Lookback Period", true)
define "Methadone Simple Identifier": 'Methadone'
// Methadone define "Methadone Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Methadone Urine Tests"
Positive Methadone Screenings In Lookback Period
define "Positive Methadone Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Methadone Screenings In Lookback Period", true)
Negative Methadone Screenings In Lookback Period
define "Negative Methadone Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Methadone Screenings In Lookback Period", true)
define "Methadone Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Methadone Medications"
define "Opiate Simple Identifier": 'Opiate'
// Opiates define "Opiate Screenings In Lookback Period": if Config."Opiate Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."General Opiate Urine Tests" ) else null
Positive Opiate Screenings In Lookback Period
define "Positive Opiate Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Opiate Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
Negative Opiate Screenings In Lookback Period
define "Negative Opiate Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Opiate Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
define "Opiate Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Opiate Medications"
define "Oxycodone Simple Identifier": 'Oxycodone'
// Oxycodone define "Oxycodone Screenings In Lookback Period": if Config."Opiate Urine Screening Check Enabled" then ( "All Opioid or Non-opioid UDS in Lookback Period" Lab where Lab.code in Common."Oxycodone Urine Tests" ) else null
Positive Oxycodone Screenings In Lookback Period
define "Positive Oxycodone Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("Oxycodone Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
Negative Oxycodone Screenings In Lookback Period
define "Negative Oxycodone Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("Oxycodone Screenings In Lookback Period", Config."Opiate Urine Screening Check Enabled")
define "Oxycodone Rx In Lookback Period": "Normalize Rx In Lookback Period" Rx where Rx.medication in Common."Oxycodone Medications"
define "PCP Simple Identifier": 'Phencyclidine (PCP)'
// PCP define "PCP Screenings In Lookback Period": "All Opioid or Non-opioid UDS in Lookback Period" AllLabs where AllLabs.code in Common."PCP Urine Tests"
Positive PCP Screenings In Lookback Period
define "Positive PCP Screenings In Lookback Period": GetPositiveLabsInLookbackPeriod("PCP Screenings In Lookback Period", true)
Negative PCP Screenings In Lookback Period
define "Negative PCP Screenings In Lookback Period": GetNegativeLabsInLookbackPeriod("PCP Screenings In Lookback Period", true)
// Details Logic define "Unexpected Details": { CreateDetailWithPossibleUnexpectedNegative( "Amphetamine Simple Identifier", "Positive Amphetamine Screenings In Lookback Period", "Negative Amphetamine Screenings In Lookback Period", "Amphetamine Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Barbiturate Simple Identifier", "Positive Barbiturate Screenings In Lookback Period", "Negative Barbiturate Screenings In Lookback Period", "Barbiturate Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Benzodiazepine Simple Identifier", "Positive Benzodiazepine Screenings In Lookback Period", "Negative Benzodiazepine Screenings In Lookback Period", "Benzodiazepine Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Buprenorphine Simple Identifier", "Positive Buprenorphine Screenings In Lookback Period", "Negative Buprenorphine Screenings In Lookback Period", "Buprenorphine Rx In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "Cannabinoid Simple Identifier", "Positive Cannabinoid Screenings In Lookback Period", "Negative Cannabinoid Screenings In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "Cocaine Simple Identifier", "Positive Cocaine Screenings In Lookback Period", "Negative Cocaine Screenings In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Fentanyl Simple Identifier", "Positive Fentanyl Screenings In Lookback Period", "Negative Fentanyl Screenings In Lookback Period", "Fentanyl Rx In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "Heroin Simple Identifier", "Positive Heroin Screenings In Lookback Period", "Negative Heroin Screenings In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Methadone Simple Identifier", "Positive Methadone Screenings In Lookback Period", "Negative Methadone Screenings In Lookback Period", "Methadone Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Opiate Simple Identifier", "Positive Opiate Screenings In Lookback Period", "Negative Opiate Screenings In Lookback Period", "Opiate Rx In Lookback Period" ), CreateDetailWithPossibleUnexpectedNegative( "Oxycodone Simple Identifier", "Positive Oxycodone Screenings In Lookback Period", "Negative Oxycodone Screenings In Lookback Period", "Oxycodone Rx In Lookback Period" ), CreateDetailWithoutPossibleUnexpectedNegative( "PCP Simple Identifier", "Positive PCP Screenings In Lookback Period", "Negative PCP Screenings In Lookback Period" ) }
Remove Substances Without Positive or Negative Results
define "Remove Substances Without Positive or Negative Results": "Unexpected Details" Details where (Details.posDates is not null and Length(Details.posDates) != 0) or (Details.negDates is not null and Length(Details.negDates) != 0)
Inclusion Criteria For Unexpected Results
define "Inclusion Criteria For Unexpected Results": Routines."CDC 2022 Guideline General Inclusion Criteria" and AnyTrue( "Remove Substances Without Positive or Negative Results" Details return (exists Details.unexpectedPosDetails) or (exists Details.unexpectedNegDetails) )
define "Applicable Because of Unexpected Results": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Rec10Common."Inclusion Criteria For Unexpected Results" and not Rec10Common."Exclusion Criteria"
define "Style Header": ' \r\n .alert-body {\r\n width: 670px;\r\n font-family: segoe-ui, sans-serif;\r\n background-color: #FEFFF1;\r\n }\r\n\r\n .details-table {\r\n border-collapse:collapse;\r\n border-style: ridge;\r\n background-color: #FEFFF1;\r\n padding: 2px;\r\n }\r\n\r\n .details-caption {\r\n border-style: ridge;\r\n border-bottom: none;\r\n background-color: #FEFFF1;\r\n padding: 2px;\r\n }\r\n\r\n .details-table-header {\r\n border-style: ridge;\r\n padding: 5px;\r\n }\r\n\r\n .details-table-cell {\r\n border-style: ridge;\r\n padding: 5px;\r\n }\r\n\r\n .details-table-footer-cell {\r\n border-style: ridge;\r\n padding: 5px;\r\n font-size: small;\r\n }\r\n\r\n .details-table-cell-unexpected {\r\n border-style: ridge;\r\n padding: 5px;\r\n color: red;\r\n font-weight: bold;\r\n }\r\n\r\n .more-text {\r\n position: relative;\r\n margin-bottom: 2em;\r\n }\r\n \r\n .more {\r\n display:none;\r\n }\r\n\r\n .show-more:checked + .more {\r\n display:block;\r\n }\r\n<\/style>'
define "Unexpected Div Start": ' Patient may have unexpected urine toxicology test results<\/strong> in the past year.<\/p><\/div>'
define "Table Start": ' Urine Toxicology Results<\/caption> Substance<\/th>'
// Helpers define "All Lab Dates in Lookback Period": ( "All Opioid or Non-opioid UDS in Lookback Period" Lab return date from Lab.effective ) X sort desc
define "Table Headers": "All Lab Dates in Lookback Period" LabDate return ' ' & ToString(LabDate) & '<\/th>'
define "Generate Table Rows": "Remove Substances Without Positive or Negative Results" BOT let row: ToString(IndexOf("Remove Substances Without Positive or Negative Results", BOT) + 1) return ' ' + GetExpectedColumn(BOT.ingredient) + Combine( "All Lab Dates in Lookback Period" LabDate let col: ToString(IndexOf("All Lab Dates in Lookback Period", LabDate) + 2) return all ( if BOT.unexpectedPosDetails.date contains LabDate then GetUnexpectedColumn('pos', row & ':' & col) else if BOT.unexpectedNegDetails.udsDate contains LabDate then GetUnexpectedColumn('neg', row & ':' & col) else if BOT.posDates contains LabDate then GetExpectedColumn('pos*') else if BOT.negDates contains LabDate then GetExpectedColumn('neg*') else GetExpectedColumn('n/a') ) ) + '<\/tr>'
define "Generate Footer Rows": "Remove Substances Without Positive or Negative Results" BOT let row: ToString(IndexOf("Remove Substances Without Positive or Negative Results", BOT) + 1), colspan: Length("All Lab Dates in Lookback Period") + 1 return Combine( "All Lab Dates in Lookback Period" LabDate let col: ToString(IndexOf("All Lab Dates in Lookback Period", LabDate) + 2) return all ( if BOT.unexpectedPosDetails.date contains LabDate then Coalesce( BOT.unexpectedPosDetails PosDetail where PosDetail.date same day as LabDate return ' ' & GetFooterColumn(colspan, row & ':' & col & ' - Possible unexpected substance found: ' & PosDetail.udsDetail) & '<\/tr>' ) else if BOT.unexpectedNegDetails.udsDate contains LabDate then Coalesce( BOT.unexpectedNegDetails NegDetail where NegDetail.udsDate same day as LabDate return ' ' & GetFooterColumn(colspan, row + ':' & col & ' - Possible unexpected negative result found: prescribed ' & NegDetail.rxDetail & ' on ' & ToString(NegDetail.rxDate)) & '<\/tr>' ) else '' ) )
define "Table End": '<\/table><\/div>'
define "Details Table": "Table Start" & Combine("Table Headers") & ' ' & Combine("Generate Table Rows") & ' ' & ' ' & Combine("Generate Footer Rows") & '<\/tfoot>' & "Table End"
define "Expected Result Footnote": ' * - These are expected results based on an analysis of the patient\'s medication list 30 days prior to the corresponding lab results.<\/div>'
define "Details More Info": ' \r\n Note on false positives and unexpected negative results...<\/p>\r\n Show more\r\n \r\n An unexpectedly negative test may be due to time since last dose, diversion, intermittent use, aberrant drug use behavior, or other factors, including a false negative result. Clinicians should interpret this result in the context of the overall treatment plan.<\/p>\r\n\r\n Positive results may be a false positives or could represent occasional use or possible substance use disorder.<br\/><br\/>For a review regarding interpreting possible false positive urine toxicology results, see http:\/\/pubmed.ncbi.nlm.nih.gov\/24986836<\/a>. It is unknown if the findings reported in this article can be extrapolated to other laboratory analyzers that were not used in the referenced studies.<br\/><br\/>For guidance regarding evaluating and addressing unexpected toxicology tests results, see Recommendation 10 of the 22 CDC Clinical Practice Guideiline<\/a>.<\/p><\/div>\r\n<\/div>'
// HTML Generation define "Get HTML Details": Common."Style Header" & "Unexpected Div Start" & "Details Table" & "Expected Result Footnote" & "Details More Info" & "Div End"
define "Detail": Rec10Common."Get HTML Details"
Get MedicationRequest Medication as Code
define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>): value Rx let Med: if Rx.medication is Reference then singleton from ( [Medication] M where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/'))) ) else null return MedicationRequest { id: Rx.id, status: Rx.status, intent: Rx.intent, category: Rx.category, medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept, subject: Rx.subject, authoredOn: Rx.authoredOn, recorder: Rx.recorder, dosageInstruction: Rx.dosageInstruction, dispenseRequest: Rx.dispenseRequest }
define function ToString(value string): value.value
Get Active Ambulatory Medication Requests
define function "Get Active Ambulatory Medication Requests" (value List<MedicationRequest>) returns List<MedicationRequest>: value Rx where Rx.status.value = 'active' and Rx.category in "Community"
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 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 ToDateTime(value dateTime): value.value
Is Subacute or Chronic Pain Prescription?
// End of Active Cancer Treatment Routine /* ** Routine #4 ** For Subacute or Chronic Pain Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** ----------------------------------------------------------------------------------------------------------------------------------- ** Order for opioid analgesic | Yes | Order for opioid analgesics with ambulatory | Opioid analgesics with ** with expected supply | | misuse potential with a supply duration of >= | ambulatory misuse potential ** duration >= 28 days | | 28 days | ** | | | ** | | - Subacute definition = order for opioid | ** | | analgesics with ambulatory misuse | ** | | potential with a supply duration of one to | ** | | two months. | ** | | - Chronic pain definition = order for opioid | ** | | analgesics with ambulatory misuse | ** | | potential with a supply duration of >= two | ** | | months. | ** ----------------------------------------------------------------------------------------------------------------------------------- ** */ define function "Is Subacute or Chronic Pain Prescription?"(prescription FHIR.MedicationRequest): "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription) or "Is Subacute or Chronic Pain Using Validity Period"(prescription)
Is Subacute or Chronic Pain Using Expected Supply Duration
define function "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription FHIR.MedicationRequest): ( prescription.dispenseRequest is not null and prescription.dispenseRequest.expectedSupplyDuration is not null and ( Common.GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration) >= 28 days ) )
define function GetDurationInDays(value FHIR.Duration): if value is null then null else case when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' } when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' } when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' } when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' } when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' } when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' } when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' } when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' } 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
Is Subacute or Chronic Pain Using Validity Period
define function "Is Subacute or Chronic Pain Using Validity Period"(prescription FHIR.MedicationRequest): ( prescription.dispenseRequest is not null and prescription.dispenseRequest.validityPeriod is not null and ( days between prescription.dispenseRequest.validityPeriod.start and prescription.dispenseRequest.validityPeriod.end >= 28 ) )
define function ToDateTime(value instant): value.value
define function ToString(value ObservationStatus): value.value
define function CreateDetailWithPossibleUnexpectedNegative(TheSubstance String, ThePosLabs List<Observation>, TheNegLabs List<Observation>, TheMeds List<MedicationRequest>): { ingredient: TheSubstance, posDates: ( ThePosLabs PosLab return date from PosLab.effective ), negDates: ( TheNegLabs NegLab return date from NegLab.effective ), unexpectedPosDetails: ( ThePosLabs PosLab where not exists ( TheMeds Rx where Common.GetDateFromMedicationRequest(Rx) in day of Interval[ date from PosLab.effective - 31 days, date from PosLab.effective - 1 days ] ) return { date: date from PosLab.effective, udsDetail: if exists(PosLab.code.coding) then PosLab.code.coding[0].display else 'Unable to determine a detailed identifier' } ), unexpectedNegDetails: ( from TheNegLabs NegLab, ( if exists(TheMeds) then TheMeds else { null as MedicationRequest } ) Rx let medDate: Common.GetDateFromMedicationRequest(Rx) where medDate in day of Interval[date from NegLab.effective - 31 days, date from NegLab.effective - 1 days] return { udsDate: date from NegLab.effective, udsDetail: if exists (NegLab.code.coding) then NegLab.code.coding[0].display else 'Unable to determine a detailed identifier', rxDate: medDate, rxDetail: if Rx.medication.text is not null then Rx.medication.text else if exists (Rx.medication.coding) and Rx.medication.coding[0].display is not null then Rx.medication.coding[0].display else 'Unable to determine a detailed identifier' } ) }
define function "GetDateFromMedicationRequest"(med FHIR.MedicationRequest): if med is null then null else if med.authoredOn is not null then date from med.authoredOn else Max( med.dosageInstruction DI return Coalesce( // If there are timing events, take the latest. Max(DI.timing.event E return date from E), // Otherwise, if there's a Period, use its start. if DI.timing.repeat is not null and DI.timing.repeat.bounds is FHIR.Period then date from start of FHIRHelpers.ToInterval(DI.timing.repeat.bounds as FHIR.Period) else null ) )
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 GetPositiveLabsInLookbackPeriod(Labs List<FHIR.Observation>, Enabled Boolean): if Enabled then Labs Lab where StartsWith(Lower(Lab.value as FHIR.string), 'pos') else {}
define function GetNegativeLabsInLookbackPeriod(Labs List<FHIR.Observation>, Enabled Boolean): if Enabled then Labs Lab where StartsWith(Lower(Lab.value as FHIR.string), 'neg') else {}
define function ToString(value MedicationRequestStatus): value.value
define function ToString(value MedicationRequestIntent): value.value
define function CreateDetailWithoutPossibleUnexpectedNegative(TheSubstance String, ThePosLabs List<Observation>, TheNegLabs List<Observation>): { ingredient: TheSubstance, posDates: ( ThePosLabs PosLab return date from PosLab.effective ), negDates: ( TheNegLabs NegLab return date from NegLab.effective ), unexpectedPosDetails: ( ThePosLabs PosLab return { date: date from PosLab.effective, udsDetail: if exists (PosLab.code.coding) then PosLab.code.coding[0].display else 'Unable to determine a detailed identifier' } ), unexpectedNegDetails: { null as Tuple{ udsDate System.Date, udsDetail System.String, rxDate System.Date, rxDetail System.String } } }
define function GetExpectedColumn(Content String): ' ' & Content & '<\/td>'
// Functions define function GetUnexpectedColumn(Result String, Superscript String): ' ' & Result & '' & Superscript & '<\/sup><\/td>'
define function GetFooterColumn(colspan Integer, message String): ' ' & message & '<\/td>'
Recommendation #10 - Urine Drug Testing (patient-view)
CDC / Security Risk Solutions, Inc. (SRS)
When prescribing opioids for subacute or chronic pain, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed medications as well as other prescribed and nonprescribed controlled substances.
The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.
Before starting opioids and periodically (at least annually) during opioid therapy, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed opioids and other prescription and nonprescription controlled substances that increase risk for overdose when combined with opioids, including nonprescribed and illicit opioids and benzodiazepines.
2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Consider the Benefits and Risks of Conducting a Urine Toxicology Screen
Consider the benefits and risks of toxicology testing to assess for prescribed medications as well as other prescribed and nonprescribed controlled substances. For guidance regarding utilizing toxicology tests when prescribing opioids, see [Recommendation 10 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%204).-,Implementation%20Considerations,-Toxicology%20testing%20should).
Patient has not had a urine screening in the past 12 months
Snooze* - N/A see comment, snooze 3 months
Patient May Have Unexpected Toxicology Test Results
Patient may have unexpected urine toxicology test results in the past year
Urine screening tested positive for cocaine, opiates or PCP
Document - Will repeat urine drug screen more frequently
Will consult with patient regarding possible unexpected test results
Document - Will assess patient for substance use disorder
Snooze* - Patient's test results were expected, snooze for 3 months