From 85ceaa599249a630fe81f54e52b635266f6e37c8 Mon Sep 17 00:00:00 2001 From: Chris Moesel Date: Thu, 20 Feb 2020 16:21:45 -0500 Subject: [PATCH 1/3] Update CQL w/ ValueSet updates and Code Updates Update to new versions of the CQL w/ the following changes: - Updates to existing value sets and addition of new value sets - Addition of standardized LOINC codes for PEG and STarTBack - Updated CDS Connect Commons libraries w/ minor fixes and enhancements - Updated FHIRHelpers for DSTU2 - Updated valueset-db.json w/ latest valueset expansions Also added the CQL source files that were used to build the JSON files. See the CQL files for detailed changes logs. --- .../CDS_Connect_Commons_for_FHIRv102.cql | 538 + .../CDS_Connect_Commons_for_FHIRv102.json | 103 +- src/cql/dstu2/FHIRHelpers.cql | 197 + src/cql/dstu2/FHIRHelpers.json | 400 +- ...s_to_Consider_in_Managing_Chronic_Pain.cql | 1087 + ..._to_Consider_in_Managing_Chronic_Pain.json | 1347 +- .../r4/CDS_Connect_Commons_for_FHIRv400.cql | 535 + .../r4/CDS_Connect_Commons_for_FHIRv400.json | 360 +- src/cql/r4/FHIRHelpers.cql | 269 + ...ider_in_Managing_Chronic_Pain_FHIRv400.cql | 1094 + ...der_in_Managing_Chronic_Pain_FHIRv400.json | 1237 +- src/cql/valueset-db.json | 20869 ++++++++-------- 12 files changed, 16594 insertions(+), 11442 deletions(-) create mode 100644 src/cql/dstu2/CDS_Connect_Commons_for_FHIRv102.cql create mode 100644 src/cql/dstu2/FHIRHelpers.cql create mode 100644 src/cql/dstu2/Factors_to_Consider_in_Managing_Chronic_Pain.cql create mode 100644 src/cql/r4/CDS_Connect_Commons_for_FHIRv400.cql create mode 100644 src/cql/r4/FHIRHelpers.cql create mode 100644 src/cql/r4/Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400.cql diff --git a/src/cql/dstu2/CDS_Connect_Commons_for_FHIRv102.cql b/src/cql/dstu2/CDS_Connect_Commons_for_FHIRv102.cql new file mode 100644 index 000000000..24e5832f1 --- /dev/null +++ b/src/cql/dstu2/CDS_Connect_Commons_for_FHIRv102.cql @@ -0,0 +1,538 @@ +// CDS Connect Commons for FHIRv102 +// Change log: +// - 1.3.1: +// - Changed C.dateRecorded to C.dateRecorded.value in ConditionLookBack +// - Changed G.statusDate to G.statusDate.value in GoalLookBack +library CDS_Connect_Commons_for_FHIRv102 version '1.3.1' + +using FHIR version '1.0.2' + +// Include the FHIRHelpers library for simplifying interacton w/ the FHIR data model +include FHIRHelpers version '1.0.2' called FHIRHelpers + +// -------------------------------------------------- GENERAL --------------------------------------------------------- + +/** + * A null-safe version of ToConcept. Whereas FHIRHelpers.ToConcept will take a null argument and produce a + * System.Concept that is empty, this implementation returns null instead. + * @param C - a FHIR CodeableConcept + * @returns {System.Concept} a CQL Concept or null if null was passed in + */ +define function NullSafeToConcept(Cpt FHIR.CodeableConcept): + if Cpt is not null then FHIRHelpers.ToConcept(Cpt) else null + +/** + * A null-safe version of ToInterval for Period. Whereas FHIRHelpers.ToInterval will take a null argument and produce a + * System.Interval that is empty, this implementation returns null instead. + * @param P - a FHIR Period + * @returns {System.Interval} a CQL Interval or null if null was passed in + */ +define function NullSafePeriodToInterval(Pd FHIR.Period): + if Pd is not null then Interval[Pd."start".value, Pd."end".value] else null + +/** + * A null-safe version of ToInterval for Range. Whereas FHIRHelpers.ToInterval will take a null argument and produce a + * System.Interval that is empty, this implementation returns null instead. + * @param P - a FHIR Range + * @returns {System.Interval} a CQL Interval or null if null was passed in + */ +define function NullSafeRangeToInterval(Rg FHIR.Range): + if Rg is not null + then Interval[NullSafeToQuantity(Rg.low), NullSafeToQuantity(Rg.high)] + else null + +/** + * Same as NullSafePeriodToInterval; kept for backward compatibility. [Deprecated] + * @param P - a FHIR Period + * @returns {System.Interval} a CQL Interval or null if null was passed in + */ +define function NullSafeToInterval(Pd FHIR.Period): + NullSafePeriodToInterval(Pd) + +/** + * A null-safe version of ToQuantity. Whereas FHIRHelpers.ToQuantity will take a null argument and produce a + * System.Quantity that is empty, this implementation returns null instead. + * @param C - a FHIR Quantity + * @returns {System.Quantity} a CQL Quantity or null if null was passed in + */ +define function NullSafeToQuantity(Qty FHIR.Quantity): + if Qty is not null then + System.Quantity { + value: Qty.value.value, + unit: Coalesce(Qty.unit.value, Qty.code.value) + } + else null + +// -------------------------------------------------- OBSERVATIONS ----------------------------------------------------- + +/** + * Filters Observations by a concept rather than by a ValueSet. In CQL 1.3, this will be built into the retrieve, + * but for now, we must use a query where clause. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of Observations matching the concept, or null if null was passed in + */ +define function ObservationsByConcept(Koncept System.Concept): + [Observation] O where NullSafeToConcept(O.code) ~ Koncept + +/** + * Observations that are complete and verified. In FHIR DSTU2, there are two statuses that indicate this state: 'final' + * and 'amended'. + * @see http://hl7.org/fhir/DSTU2/valueset-observation-status.html + * @param ObsList - a list of Observations + * @returns {List} a list of verified Observations, or null if null was passed in + */ +define function Verified(ObsList List): + ObsList O where O.status.value in {'final', 'amended'} + +/** + * Observations that have quantity values recorded in the requested unit. + * @param ObsList - a list of Observations + * @param Unit - the unit to require in the Observations quantity value + * @returns {List} a list of Observations with the required unit, or null if null was passed in + */ +define function WithUnit(ObsList List, Unit String): + ObsList O where O.valueQuantity.unit.value = Unit or O.valueQuantity.code.value = Unit + +/** + * Observations with an effective or issued date in the specified "look back" period. For example, LDL-C Tests in the + * last 6 years. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param ObsList - a list of Observations + * @returns {List} a list of Observations with effective or issued date specified lookback period, or null + * if null was passed in + */ +define function ObservationLookBack(ObsList List, LookBack System.Quantity): + ObsList O + let LookBackInterval: Interval[Now() - LookBack, Now()] + where O.effectiveDateTime.value in LookBackInterval + or NullSafeToInterval(O.effectivePeriod) overlaps LookBackInterval + or O.issued in LookBackInterval + +/** + * The most recent observation. For each Observation, this algorithm will use the FindDate function, which uses the + * first non-null date value from these fields: effectiveDateTime, effectivePeriod.end, effectivePeriod.start, issued. + * The found date will be used to compare Observations and determine the most recent one. + * @see FindDate(Observation) + * @param ObsList - a list of Observations + * @returns {Observation} the most recent Observation from the list, or null if null was passed in + */ +define function MostRecent(ObsList List): + Last(ObsList O sort by Coalesce(effectiveDateTime.value, effectivePeriod."end".value, effectivePeriod."start".value, issued.value)) + +/** + * Extracts the quantity value from an Observation, returning it as a CQL Quantity + * @param Obs - an observation + * @returns {System.Quantity} the Observation's value as a quantity, or null if there is no quantity value + */ +define function QuantityValue(Obs Observation): + NullSafeToQuantity(Obs.valueQuantity) + +/** + * Extracts the CodeableConcept value from an Observation, returning it as a CQL Concept + * @param Obs - an observation + * @returns {System.Concept} the Observation's value as a concept, or null if there is no CodeabeConcept value + */ +define function ConceptValue(Obs Observation): + NullSafeToConcept(Obs.valueCodeableConcept) + +/** + * Finds the first non-null meaningful date that can be associated with this Observation. This will look through the + * following fields in the following order: effectiveDateTime, effectivePeriod.end, effectivePeriod.start, issued. + * @param Obs - an Observation + * @returns {System.DateTime} the first non-null meaningful date, or null if non is found + */ +define function FindDate(Obs Observation): + Coalesce(Obs.effectiveDateTime.value, Obs.effectivePeriod."end".value, Obs.effectivePeriod."start".value, Obs.issued.value) + +// TODO: Confirm that this works as expected +/** + * The highest observation. + * The value will be used to compare Observations and determine the highest one. + * @param ObsList - a list of Observations + * @returns {System.Quantity} the quantity with the highest value from the list, or null if null was passed in + */ +define function HighestObservation(ObsList List): + Max(ObsList O return NullSafeToQuantity(O.valueQuantity)) + + +// -------------------------------------------------- CONDITIONS ------------------------------------------------------- + +/** + * Filters Conditions by a concept rather than by a ValueSet. In CQL 1.3, this will be built into the retrieve, + * but for now, we must use a query where clause. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of Conditions matching the concept, or null if null was passed in + */ +define function ConditionsByConcept(Koncept System.Concept): + [Condition] C where NullSafeToConcept(C.code) ~ Koncept + +/** + * Conditions that are confirmed. In FHIR DSTU2, this is reflected by verificationStatus: 'confirmed'. + * @see http://hl7.org/fhir/DSTU2/valueset-condition-ver-status.html + * @param CondList - a list of Conditions + * @returns {List} a list of confirmed Conditions, or null if null was passed in + */ +define function Confirmed(CondList List): + CondList C where C.verificationStatus.value = 'confirmed' + +/** + * Conditions that are active. In FHIR DSTU2, this is reflected by clinicalStatus: 'active' and the absence of any + * abatement information (i.e., if it abated, it is no longer active). + * TODO: Rename to Active once the execution engine supports overloaded functions. + * @see http://hl7.org/fhir/DSTU2/valueset-condition-clinical.html + * @param CondList - a list of Conditions + * @returns {List} a list of active Conditions, or null if null was passed in + */ +define function ActiveCondition(CondList List): + CondList C + where C.clinicalStatus.value = 'active' + and C.abatementDateTime is null + and C.abatementQuantity is null + and C.abatementBoolean.value is not true + and C.abatementPeriod is null + and C.abatementRange is null + and C.abatementString is null + +/** + * Conditions that are active or recurring. In FHIR DSTU2, this is reflected by clinicalStatus: 'active' or 'relapse'. + * We do not check for null abatement information because it may have dates from when the now recurring condition + * initially went into remission. + * @see http://hl7.org/fhir/DSTU2/valueset-condition-clinical.html + * @param CondList - a list of Conditions + * @returns {List} a list of active or recurring Conditions, or null if null was passed in + */ +define function ActiveOrRecurring(CondList List): + CondList C where C.clinicalStatus.value in {'active', 'relapse'} + +/** + * Conditions with an onset or recorded date in the specified "look back" period. For example, pregnancy in + * the last 42 weeks. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param CondList - a list of Conditions + * @returns {List} a list of Conditions with onset or recorded date specified lookback period, or null + * if null was passed in + */ +define function ConditionLookBack(CondList List, LookBack System.Quantity): + CondList C + let LookBackInterval: Interval[Now() - LookBack, Now()] + where C.onsetDateTime.value in LookBackInterval + or NullSafeToInterval(C.onsetPeriod) overlaps LookBackInterval + or C.dateRecorded.value in LookBackInterval + // TODO Confirm these are the correct fields to use + +// -------------------------------------------------- PROCEDURES ------------------------------------------------------- + + /** + * Filters Procedures by a concept rather than by a ValueSet. In CQL 1.3, this will be built into the retrieve, + * but for now, we must use a query where clause. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of Procedures matching the concept, or null if null was passed in + */ + define function ProceduresByConcept(Koncept System.Concept): + [Procedure] P where NullSafeToConcept(P.code) ~ Koncept + +/** + * Procedures that are completed. In FHIR DSTU2, this is reflected by status: 'completed'. In addition, the + * notPerformed flag must be checked to ensure it is not 'true'. + * @see http://hl7.org/fhir/DSTU2/valueset-procedure-status.html + * @param ProcList - a list of Procedures + * @returns {List} a list of completed Procedures, or null if null was passed in + */ +define function Completed(ProcList List): + ProcList P + where P.status.value = 'completed' + and P.notPerformed.value is not true + +/** + * Procedures that are in progress. In FHIR DSTU2, this is reflected by status: 'in-progress'. In addition, the + * notPerformed flag must be checked to ensure it is not 'true'. + * @see http://hl7.org/fhir/DSTU2/valueset-procedure-status.html + * @param ProcList - a list of Procedures + * @returns {List} a list of completed Procedures, or null if null was passed in + */ +define function ProcedureInProgress(ProcList List): + ProcList P + where P.status.value = 'in-progress' + and P.notPerformed.value is not true + +/** + * Procedures that actually happened or are happening. In FHIR DSTU2, there are a few properties that negate the + * procedure, most notably when status is 'entered-in-error' or notPerformed is true. + * @see http://hl7.org/fhir/DSTU2/valueset-procedure-status.html + * @param ProcList - a list of Procedures + * @returns {List} a list of Procedures that actually happened or are happening, or null if null was passed in + */ +define function ProcedurePerformance(ProcList List): + ProcList P + where P.status.value != 'entered-in-error' + and P.notPerformed.value is not true + +/** + * Procedures performed in the specified "look back" period. For example, PCIs performed in the + * past 2 weeks. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param ProcList - a list of Procedures + * @param LookBack - the lookback period for when the procedure was performed + * @returns {List} a list of Procedures performed in the look back period, or null if null + * was passed in + */ +define function ProcedureLookBack(ProcList List, LookBack System.Quantity): + ProcList P + let LookBackInterval: Interval[Now() - LookBack, Now()] + where P.performedDateTime.value in LookBackInterval + or NullSafeToInterval(P.performedPeriod) overlaps LookBackInterval + +// ---------------------------------------------- PROCEDUREREQUESTS ---------------------------------------------------- + + /** + * Filters ProcedureRequests by a concept rather than by a ValueSet. In CQL 1.3, this will be built into the retrieve, + * but for now, we must use a query where clause. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of ProcedureRequests matching the concept, or null if null was passed in + */ + define function ProcedureRequestsByConcept(Koncept System.Concept): + [ProcedureRequest] P where NullSafeToConcept(P.code) ~ Koncept + +/** + * ProcedureRequests that are accepted, in progress, or completed. In FHIR DSTU2, this is reflected by the corresponding + * status status values. + * @see http://hl7.org/fhir/DSTU2/valueset-procedure-request-status.html + * @param ProcReqList - a list of ProcedureRequests + * @returns {List} a list of accepted, in-progress, or completed ProcedureRequests, + * or null if null was passed in + */ +define function ProcedureRequestAcceptedOrInProgressOrCompleted(ProcReqList List): + ProcReqList P + where P.status.value in List{'accepted', 'in-progress', 'completed'} + +/** + * ProcedureRequests ordered in the specified "look back" period. For example, PCIs ordered in the + * past 2 weeks. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param ProcReqList - a list of ProcedureRequests + * @param LookBack - the lookback period for when the procedure was ordered + * @returns {List} a list of ProcedureRequests ordered in the look back period, or null if null + * was passed in + */ +define function ProcedureRequestLookBack(ProcReqList List, LookBack System.Quantity): + ProcReqList P + where P.orderedOn.value in Interval[Now() - LookBack, Now()] + +// ----------------------------------------------- REFERRALREQUESTS ---------------------------------------------------- + + /** + * Filters ReferralRequests by a concept rather than by a ValueSet. In CQL 1.3, this will be built into the retrieve, + * but for now, we must use a query where clause. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of ReferralRequests matching the concept, or null if null was passed in + */ + define function ReferralRequestsByServiceRequestedConcept(Koncept System.Concept): + [ReferralRequest] R + where exists((R.serviceRequested) SRC where NullSafeToConcept(SRC) ~ Koncept) + +/** + * ReferralRequests that are accepted, active, or completed. In FHIR DSTU2, this is reflected by the corresponding + * status status values. + * @see http://hl7.org/fhir/DSTU2/valueset-referralstatus.html + * @param ReferralList - a list of ReferralRequests + * @returns {List} a list of accepted, active, or completed ReferralRequests, + * or null if null was passed in + */ +define function ReferralRequestAcceptedOrActiveOrCompleted(ReferralList List): + ReferralList R + where R.status.value in List{'accepted', 'active', 'completed'} + +/** + * ReferralRequests requested in the specified "look back" period. For example, pace make insertions referrals sent + * in the past 2 weeks. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param ReferralList - a list of ReferralRequests + * @param LookBack - the lookback period for when the referral was sent + * @returns {List} a list of ReferralRequests sent in the look back period, or null if null + * was passed in + */ +define function ReferralRequestLookBack(ReferralList List, LookBack System.Quantity): + ReferralList R + where R.dateSent.value in Interval[Now() - LookBack, Now()] + +// -------------------------------------------------- MEDICATIONS ------------------------------------------------------ + +/** + * Filters MedicationStatements by a concept rather than by a ValueSet. In CQL 1.3, this will be built into the retrieve, + * but for now, we must use a query where clause. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of MedicationStatement matching the concept, or null if null was passed in + */ +define function MedicationStatementsByConcept(Koncept System.Concept): + [MedicationStatement] M where NullSafeToConcept(M.medicationCodeableConcept) ~ Koncept + +/** + * Filters MedicationOrders by a concept rather than by a ValueSet. In CQL 1.3, this will be built into the retrieve, + * but for now, we must use a query where clause. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of MedicationOrders matching the concept, or null if null was passed in + */ +define function MedicationOrdersByConcept(Koncept System.Concept): + [MedicationOrder] M where NullSafeToConcept(M.medicationCodeableConcept) ~ Koncept + +/** + * Medications that are active, according to a statement, but not necessarily verified via a prescription. For example, + * medications that a patient has self-reported to be taking. In FHIR DSTU2, this is reflected by MedicationStatement + * with status 'active', no flag indicating it wasn't taken, and no end date or an end date in the future. + * TODO: Rename to Active once the execution engine supports overloaded functions. + * @see http://hl7.org/fhir/DSTU2/valueset-medication-statement-status.html + * @param MedList - a list of MedicationStatements + * @returns {List} a list of active medication statements, or null if null was passed in + */ +define function ActiveMedicationStatement(MedList List): + MedList M + let EffectivePeriod: NullSafeToInterval(M.effectivePeriod) + where M.status.value = 'active' + and M.wasNotTaken.value is not true + and (end of EffectivePeriod is null or end of EffectivePeriod after Now()) + +/** + * Medications that are active or completed, according to a statement, but not necessarily verified via a prescription. + * For example, medications that a patient has self-reported to be taking. In FHIR DSTU2, this is reflected by + * MedicationStatement with status 'active' or 'completed', and no flag indicating it wasn't taken. + * TODO: Rename to ActiveOrCompleted once the execution engine supports overloaded functions. + * @see http://hl7.org/fhir/DSTU2/valueset-medication-statement-status.html + * @param MedList - a list of MedicationStatements + * @returns {List} a list of active or completed medication statements, or null if null was passed + * in + */ +define function ActiveOrCompletedMedicationStatement(MedList List): + MedList M + where M.status.value = 'active' + or M.status.value = 'completed' + and M.wasNotTaken.value is not true + +/** +* Medications that are active, according to a prescription. In FHIR DSTU2, this is reflected by MedicationOrder +* with status 'active' and no dateEnded. There is currently an open question in the FHIR chat to determine if this +* is the right approach. +* TODO: Revisit based on outcome of FHIR chat. +* TODO: Rename to Active once the execution engine supports overloaded functions. +* @see https://chat.fhir.org/#narrow/stream/implementers/topic/Meaning.20of.20.22active.22.20and.20.22completed.22.20in.20MedicationRequest +* @see http://hl7.org/fhir/DSTU2/valueset-medication-order-status.html +* @param MedList - a list of MedicationOrders +* @returns {List} a list of active medication orders, or null if null was passed in +*/ +define function ActiveMedicationOrder(MedList List): + MedList M + where M.status.value = 'active' + and M.dateEnded.value is null + +/** +* Medications that are active or completed, according to a prescription. In FHIR DSTU2, this is reflected by MedicationOrder +* with status 'active' or 'completed' +* @see http://hl7.org/fhir/DSTU2/valueset-medication-order-status.html +* @param MedList - a list of MedicationOrders +* @returns {List} a list of active medication orders, or null if null was passed in +*/ +define function ActiveOrCompletedMedicationOrder(MedList List): + MedList M + where M.status.value = 'active' + or M.status.value = 'completed' + +/** +* Medications that are active, completed, or stopped, according to a prescription. In FHIR DSTU2, this is reflected by +* MedicationOrder with status 'active', 'completed', or 'stopped' +* @see http://hl7.org/fhir/DSTU2/valueset-medication-order-status.html +* @param MedList - a list of MedicationOrders +* @returns {List} a list of active medication orders, or null if null was passed in +*/ +define function ActiveCompletedOrStoppedMedicationOrder(MedList List): + MedList M + where M.status.value = 'active' + or M.status.value = 'completed' + or M.status.value = 'stopped' + +/** + * MedicationStatement with an effective date in the specified "look back" period. For example, statements about opioid + * use in the last 180 days. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param MedList - a list of MedicationStatements + * @param LookBack - a duration Quantity indicating how far back to look for MedicationStatements + * @returns {List} a list of MedicationStatements with effective date in the specified lookback + * period, or null if null was passed in + */ +define function MedicationStatementLookBack(MedList List, LookBack System.Quantity): + MedList M + let LookBackInterval: Interval[Now() - LookBack, Now()] + where M.effectiveDateTime.value in LookBackInterval + or NullSafeToInterval(M.effectivePeriod) overlaps LookBackInterval + +/** + * MedicationOrders with a written date in the specified "look back" period. For example, opioid orders in the last + * 180 days. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param OrderList - a list of MedicationOrders + * @param LookBack - a duration Quantity indicating how far back to look for MedicationOrders + * @returns {List} a list of MedicationOrders with written date in the specified lookback period, + * or null if null was passed in + */ +define function MedicationOrderLookBack(MedList List, LookBack System.Quantity): + MedList M where M.dateWritten.value in Interval[Now() - LookBack, Now()] + +// -------------------------------------------------- ENCOUNTERS ------------------------------------------------------ + +/** + * Filters Encounters by a concept rather than by a ValueSet. In CQL 1.3, this will be built into the retrieve, + * but for now, we must use a query where clause. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of Encounters matching the concept, or null if null was passed in + */ +define function EncountersByConcept(Koncept System.Concept): + [Encounter] E where exists( (E.type) ET where NullSafeToConcept(ET) ~ Koncept ) + +/** + * Encounters that are in progress. In FHIR DSTU2, this is reflected by status: 'in-progress'. + * @see http://hl7.org/fhir/DSTU2/valueset-encounter-state.html + * @param EncList - a list of Encounters + * @returns {List} a list of in progress encounters, or null if null was passed in + */ +define function InProgress(EncList List): + EncList E + where E.status.value = 'in-progress' + +// -------------------------------------------------- ALLERGY INTOLERANCES --------------------------------------------- + +/** + * Filters AllergyIntolerances by a concept rather than by a ValueSet. In CQL 1.3, this will be built into the retrieve, + * but for now, we must use a query where clause. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of Allergy Intolerances matching the concept, or null if null was passed in + */ +define function AllergyIntolerancesByConcept(Koncept System.Concept): + [AllergyIntolerance] A where NullSafeToConcept(A.substance) ~ Koncept + +/** +* AllergyIntolerances that are active or confirmed. In FHIR DSTU2, this is reflected by AllergyIntolerance +* with status 'active' or 'confirmed' +* @see http://hl7.org/fhir/DSTU2/valueset-allergy-intolerance-status.html +* @param AllergyIntolList - a list of AllergyIntolerances +* @returns {List} a list of active or confirmed allergy intolerances, or null if null was passed in +*/ +define function ActiveOrConfirmedAllergyIntolerance(AllergyIntolList List): + AllergyIntolList A + where A.status.value = 'active' + or A.status.value = 'confirmed' + +// -------------------------------------------------------- GOALS ------------------------------------------------------ + +/** + * Goals with a start, target, or status date in the specified "look back" period. For example, Pain Management Goals + * in the last 2 years. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param GoalList - a list of Goals + * @returns {List} a list of Goals with a start, target, or status date in the specified lookback period, or null + * if null was passed in + */ +define function GoalLookBack(GoalList List, LookBack System.Quantity): + GoalList G + let LookBackInterval: Interval[Now() - LookBack, Now()] + where G.startDate.value in LookBackInterval + or G.targetDate.value in LookBackInterval + or (G.startDate.value + NullSafeToQuantity(G.targetQuantity)) in LookBackInterval + or G.statusDate.value in LookBackInterval diff --git a/src/cql/dstu2/CDS_Connect_Commons_for_FHIRv102.json b/src/cql/dstu2/CDS_Connect_Commons_for_FHIRv102.json index a7a37f957..3fa0be8f9 100644 --- a/src/cql/dstu2/CDS_Connect_Commons_for_FHIRv102.json +++ b/src/cql/dstu2/CDS_Connect_Commons_for_FHIRv102.json @@ -2,7 +2,7 @@ "library" : { "identifier" : { "id" : "CDS_Connect_Commons_for_FHIRv102", - "version" : "1.3.0" + "version" : "1.3.1" }, "schemaIdentifier" : { "id" : "urn:hl7-org:elm", @@ -1117,14 +1117,16 @@ }, { "type" : "In", "operand" : [ { - "name" : "ToDateTime", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", - "operand" : [ { - "path" : "dateRecorded", - "scope" : "C", - "type" : "Property" - } ] + "type" : "ToDateTime", + "operand" : { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "dateRecorded", + "scope" : "C", + "type" : "Property" + } + } }, { "name" : "LookBackInterval", "type" : "QueryLetRef" @@ -2590,12 +2592,15 @@ "operand" : [ { "type" : "In", "operand" : [ { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "startDate", - "scope" : "G", - "type" : "Property" + "type" : "ToDateTime", + "operand" : { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "startDate", + "scope" : "G", + "type" : "Property" + } } }, { "name" : "LookBackInterval", @@ -2604,12 +2609,15 @@ }, { "type" : "In", "operand" : [ { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "targetDate", - "scope" : "G", - "type" : "Property" + "type" : "ToDateTime", + "operand" : { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "targetDate", + "scope" : "G", + "type" : "Property" + } } }, { "name" : "LookBackInterval", @@ -2619,24 +2627,27 @@ }, { "type" : "In", "operand" : [ { - "type" : "Add", - "operand" : [ { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "startDate", - "scope" : "G", - "type" : "Property" - } - }, { - "name" : "NullSafeToQuantity", - "type" : "FunctionRef", + "type" : "ToDateTime", + "operand" : { + "type" : "Add", "operand" : [ { - "path" : "targetQuantity", - "scope" : "G", - "type" : "Property" + "path" : "value", + "type" : "Property", + "source" : { + "path" : "startDate", + "scope" : "G", + "type" : "Property" + } + }, { + "name" : "NullSafeToQuantity", + "type" : "FunctionRef", + "operand" : [ { + "path" : "targetQuantity", + "scope" : "G", + "type" : "Property" + } ] } ] - } ] + } }, { "name" : "LookBackInterval", "type" : "QueryLetRef" @@ -2645,14 +2656,16 @@ }, { "type" : "In", "operand" : [ { - "name" : "ToDateTime", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", - "operand" : [ { - "path" : "statusDate", - "scope" : "G", - "type" : "Property" - } ] + "type" : "ToDateTime", + "operand" : { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "statusDate", + "scope" : "G", + "type" : "Property" + } + } }, { "name" : "LookBackInterval", "type" : "QueryLetRef" diff --git a/src/cql/dstu2/FHIRHelpers.cql b/src/cql/dstu2/FHIRHelpers.cql new file mode 100644 index 000000000..8f789b5ef --- /dev/null +++ b/src/cql/dstu2/FHIRHelpers.cql @@ -0,0 +1,197 @@ +library FHIRHelpers version '1.0.2' + +using FHIR version '1.0.2' + +define function ToInterval(period FHIR.Period): + if period is null then + null + else + Interval[period."start".value, period."end".value] + +define function ToQuantity(quantity FHIR.Quantity): + if quantity is null then + null + else + System.Quantity { value: quantity.value.value, unit: quantity.unit.value } + +define function ToInterval(range FHIR.Range): + if range is null then + null + else + Interval[ToQuantity(range.low), ToQuantity(range.high)] + +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 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 ToString(value FHIR.uuid): value.value +define function ToString(value FHIR.ProvenanceEntityRole): value.value +define function ToString(value FHIR.UnitsOfTime): value.value +define function ToString(value FHIR.AddressType): value.value +define function ToString(value FHIR.AllergyIntoleranceCategory): value.value +define function ToString(value FHIR.SpecimenStatus): value.value +define function ToString(value FHIR.DetectedIssueSeverity): value.value +define function ToString(value FHIR.IssueSeverity): value.value +define function ToString(value FHIR.DataElementStringency): value.value +define function ToString(value FHIR.VisionEyes): value.value +define function ToString(value FHIR.StructureDefinitionKind): value.value +define function ToString(value FHIR.QuestionnaireResponseStatus): value.value +define function ToString(value FHIR.AllergyIntoleranceType): value.value +define function ToString(value FHIR.DocumentRelationshipType): value.value +define function ToString(value FHIR.ConformanceResourceStatus): value.value +define function ToString(value FHIR.CarePlanActivityStatus): value.value +define function ToString(value FHIR.ActionList): value.value +define function ToString(value FHIR.ParticipationStatus): value.value +define function ToDateTime(value FHIR.instant): value.value +define function ToDateTime(value FHIR.dateTime): value.value +define function ToDate(value FHIR.date): value.value +define function ToString(value FHIR.DocumentMode): value.value +define function ToString(value FHIR.AssertionOperatorType): value.value +define function ToString(value FHIR.DaysOfWeek): value.value +define function ToString(value FHIR.ConformanceEventMode): value.value +define function ToString(value FHIR.IssueType): value.value +define function ToString(value FHIR.TransactionMode): value.value +define function ToString(value FHIR.ContentType): value.value +define function ToString(value FHIR.FamilyHistoryStatus): value.value +define function ToInteger(value FHIR.positiveInt): value.value +define function ToString(value FHIR.AuditEventParticipantNetworkType): value.value +define function ToString(value FHIR.CommunicationStatus): value.value +define function ToString(value FHIR.ClinicalImpressionStatus): value.value +define function ToString(value FHIR.AssertionResponseTypes): value.value +define function ToString(value FHIR.DeviceUseRequestPriority): value.value +define function ToString(value FHIR.OrderStatus): value.value +define function ToString(value FHIR.NarrativeStatus): value.value +define function ToString(value FHIR.string): value.value +define function ToString(value FHIR.GuidePageKind): value.value +define function ToString(value FHIR.GuideDependencyType): value.value +define function ToString(value FHIR.ResourceVersionPolicy): value.value +define function ToString(value FHIR.MedicationAdministrationStatus): value.value +define function ToString(value FHIR.RestfulConformanceMode): value.value +define function ToString(value FHIR.NamingSystemIdentifierType): value.value +define function ToString(value FHIR.AccountStatus): value.value +define function ToString(value FHIR.ProcedureRequestPriority): value.value +define function ToString(value FHIR.MedicationDispenseStatus): value.value +define function ToString(value FHIR.IdentifierUse): value.value +define function ToString(value FHIR.DigitalMediaType): value.value +define function ToString(value FHIR.BindingStrength): value.value +define function ToString(value FHIR.ParticipantRequired): value.value +define function ToString(value FHIR.XPathUsageType): value.value +define function ToString(value FHIR.InstanceAvailability): value.value +define function ToString(value FHIR.id): value.value +define function ToString(value FHIR.FilterOperator): value.value +define function ToString(value FHIR.NamingSystemType): value.value +define function ToString(value FHIR.ExtensionContext): value.value +define function ToString(value FHIR.ClaimType): value.value +define function ToString(value FHIR.AuditEventOutcome): value.value +define function ToString(value FHIR.ConstraintSeverity): value.value +define function ToString(value FHIR.GuideResourcePurpose): value.value +define function ToString(value FHIR.ProcedureStatus): value.value +define function ToString(value FHIR.DeviceMetricCategory): value.value +define function ToString(value FHIR.QuestionnaireStatus): value.value +define function ToString(value FHIR.ResponseType): value.value +define function ToDecimal(value FHIR.decimal): value.value +define function ToString(value FHIR.AggregationMode): value.value +define function ToString(value FHIR.EventTiming): value.value +define function ToString(value FHIR.GoalStatus): value.value +define function ToString(value FHIR.SearchParamType): value.value +define function ToString(value FHIR.SystemRestfulInteraction): value.value +define function ToString(value FHIR.SubscriptionChannelType): value.value +define function ToString(value FHIR.ProcedureRequestStatus): value.value +define function ToString(value FHIR.ReferralStatus): value.value +define function ToString(value FHIR.AssertionDirectionType): value.value +define function ToString(value FHIR.SlicingRules): value.value +define function ToString(value FHIR.LinkType): value.value +define function ToString(value FHIR.AllergyIntoleranceCriticality): value.value +define function ToString(value FHIR.ConceptMapEquivalence): value.value +define function ToString(value FHIR.PropertyRepresentation): value.value +define function ToString(value FHIR.AuditEventAction): value.value +define function ToString(value FHIR.SearchModifierCode): value.value +define function ToString(value FHIR.DeviceUseRequestStatus): value.value +define function ToString(value FHIR.CompositionStatus): value.value +define function ToString(value FHIR.AppointmentStatus): value.value +define function ToString(value FHIR.MessageSignificanceCategory): value.value +define function ToString(value FHIR.OperationParameterUse): value.value +define function ToString(value FHIR.ListMode): value.value +define function ToString(value FHIR.ObservationStatus): value.value +define function ToString(value FHIR.ParticipantStatus): value.value +define function ToString(value FHIR.AdministrativeGender): value.value +define function ToString(value FHIR.ConformanceStatementKind): value.value +define function ToString(value FHIR.DiagnosticOrderStatus): value.value +define function ToBoolean(value FHIR.boolean): value.value +define function ToString(value FHIR.DeviceMetricCalibrationType): value.value +define function ToString(value FHIR.code): value.value +define function ToString(value FHIR.SupplyRequestStatus): value.value +define function ToString(value FHIR.EncounterLocationStatus): value.value +define function ToString(value FHIR.SupplyDeliveryStatus): value.value +define function ToString(value FHIR.DiagnosticReportStatus): value.value +define function ToString(value FHIR.FlagStatus): value.value +define function ToString(value FHIR.AllergyIntoleranceCertainty): value.value +define function ToString(value FHIR.CarePlanStatus): value.value +define function ToString(value FHIR.ListStatus): value.value +define function ToString(value FHIR.base64Binary): value.value +define function ToString(value FHIR.AddressUse): value.value +define function ToString(value FHIR.ConditionalDeleteStatus): value.value +define function ToString(value FHIR.ContactPointUse): value.value +define function ToString(value FHIR.DeviceMetricOperationalStatus): value.value +define function ToString(value FHIR.NutritionOrderStatus): value.value +define function ToString(value FHIR.DiagnosticOrderPriority): value.value +define function ToString(value FHIR.uri): value.value +define function ToString(value FHIR.Use): value.value +define function ToString(value FHIR.IdentityAssuranceLevel): value.value +define function ToString(value FHIR.DeviceMetricColor): value.value +define function ToString(value FHIR.SearchEntryMode): value.value +define function ToTime(value FHIR.time): value.value +define function ToString(value FHIR.ConditionVerificationStatus): value.value +define function ToString(value FHIR.AllergyIntoleranceSeverity): value.value +define function ToString(value FHIR.OperationKind): value.value +define function ToString(value FHIR.ObservationRelationshipType): value.value +define function ToInteger(value FHIR.unsignedInt): value.value +define function ToString(value FHIR.NameUse): value.value +define function ToString(value FHIR.SubscriptionStatus): value.value +define function ToString(value FHIR.CommunicationRequestStatus): value.value +define function ToString(value FHIR.DocumentReferenceStatus): value.value +define function ToString(value FHIR.LocationMode): value.value +define function ToInteger(value FHIR.integer): value.value +define function ToString(value FHIR.CarePlanRelationship): value.value +define function ToString(value FHIR.LocationStatus): value.value +define function ToString(value FHIR.UnknownContentCode): value.value +define function ToString(value FHIR.NoteType): value.value +define function ToString(value FHIR.EncounterState): value.value +define function ToString(value FHIR.EncounterClass): value.value +define function ToString(value FHIR.HTTPVerb): value.value +define function ToString(value FHIR.EpisodeOfCareStatus): value.value +define function ToString(value FHIR.RemittanceOutcome): value.value +define function ToString(value FHIR.ContactPointSystem): value.value +define function ToString(value FHIR.MedicationOrderStatus): value.value +define function ToString(value FHIR.SlotStatus): value.value +define function ToString(value FHIR.markdown): value.value +define function ToString(value FHIR.MedicationStatementStatus): value.value +define function ToString(value FHIR.QuantityComparator): value.value +define function ToString(value FHIR.oid): value.value +define function ToString(value FHIR.DeviceStatus): value.value +define function ToString(value FHIR.Measmnt_Principle): value.value +define function ToString(value FHIR.SampledDataDataType): value.value +define function ToString(value FHIR.AllergyIntoleranceStatus): value.value +define function ToString(value FHIR.CompositionAttestationMode): value.value +define function ToString(value FHIR.DeviceMetricCalibrationState): value.value +define function ToString(value FHIR.GroupType): value.value +define function ToString(value FHIR.TypeRestfulInteraction): value.value +define function ToString(value FHIR.AnswerFormat): value.value +define function ToString(value FHIR.VisionBase): value.value +define function ToString(value FHIR.BundleType): value.value diff --git a/src/cql/dstu2/FHIRHelpers.json b/src/cql/dstu2/FHIRHelpers.json index 9aba15315..fc196b580 100644 --- a/src/cql/dstu2/FHIRHelpers.json +++ b/src/cql/dstu2/FHIRHelpers.json @@ -25,30 +25,57 @@ "accessLevel" : "Public", "type" : "FunctionDef", "expression" : { - "lowClosed" : true, - "highClosed" : true, - "type" : "Interval", - "low" : { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "start", - "type" : "Property", - "source" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "IsNull", + "operand" : { "name" : "period", "type" : "OperandRef" } } }, - "high" : { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "end", + "then" : { + "type" : "As", + "operand" : { + "type" : "Null" + }, + "asTypeSpecifier" : { + "type" : "IntervalTypeSpecifier", + "pointType" : { + "name" : "{urn:hl7-org:elm-types:r1}DateTime", + "type" : "NamedTypeSpecifier" + } + } + }, + "else" : { + "lowClosed" : true, + "highClosed" : true, + "type" : "Interval", + "low" : { + "path" : "value", "type" : "Property", "source" : { - "name" : "period", - "type" : "OperandRef" + "path" : "start", + "type" : "Property", + "source" : { + "name" : "period", + "type" : "OperandRef" + } + } + }, + "high" : { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "end", + "type" : "Property", + "source" : { + "name" : "period", + "type" : "OperandRef" + } } } } @@ -66,37 +93,58 @@ "accessLevel" : "Public", "type" : "FunctionDef", "expression" : { - "classType" : "{urn:hl7-org:elm-types:r1}Quantity", - "type" : "Instance", - "element" : [ { - "name" : "value", - "value" : { - "path" : "value", - "type" : "Property", - "source" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "quantity", + "type" : "OperandRef" + } + } + }, + "then" : { + "asType" : "{urn:hl7-org:elm-types:r1}Quantity", + "type" : "As", + "operand" : { + "type" : "Null" + } + }, + "else" : { + "classType" : "{urn:hl7-org:elm-types:r1}Quantity", + "type" : "Instance", + "element" : [ { + "name" : "value", + "value" : { "path" : "value", "type" : "Property", "source" : { - "name" : "quantity", - "type" : "OperandRef" + "path" : "value", + "type" : "Property", + "source" : { + "name" : "quantity", + "type" : "OperandRef" + } } } - } - }, { - "name" : "unit", - "value" : { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "unit", + }, { + "name" : "unit", + "value" : { + "path" : "value", "type" : "Property", "source" : { - "name" : "quantity", - "type" : "OperandRef" + "path" : "unit", + "type" : "Property", + "source" : { + "name" : "quantity", + "type" : "OperandRef" + } } } - } - } ] + } ] + } }, "operand" : [ { "name" : "quantity", @@ -111,32 +159,59 @@ "accessLevel" : "Public", "type" : "FunctionDef", "expression" : { - "lowClosed" : true, - "highClosed" : true, - "type" : "Interval", - "low" : { - "name" : "ToQuantity", - "type" : "FunctionRef", - "operand" : [ { - "path" : "low", - "type" : "Property", - "source" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "IsNull", + "operand" : { "name" : "range", "type" : "OperandRef" } - } ] + } }, - "high" : { - "name" : "ToQuantity", - "type" : "FunctionRef", - "operand" : [ { - "path" : "high", - "type" : "Property", - "source" : { - "name" : "range", - "type" : "OperandRef" + "then" : { + "type" : "As", + "operand" : { + "type" : "Null" + }, + "asTypeSpecifier" : { + "type" : "IntervalTypeSpecifier", + "pointType" : { + "name" : "{urn:hl7-org:elm-types:r1}Quantity", + "type" : "NamedTypeSpecifier" } - } ] + } + }, + "else" : { + "lowClosed" : true, + "highClosed" : true, + "type" : "Interval", + "low" : { + "name" : "ToQuantity", + "type" : "FunctionRef", + "operand" : [ { + "path" : "low", + "type" : "Property", + "source" : { + "name" : "range", + "type" : "OperandRef" + } + } ] + }, + "high" : { + "name" : "ToQuantity", + "type" : "FunctionRef", + "operand" : [ { + "path" : "high", + "type" : "Property", + "source" : { + "name" : "range", + "type" : "OperandRef" + } + } ] + } } }, "operand" : [ { @@ -152,65 +227,86 @@ "accessLevel" : "Public", "type" : "FunctionDef", "expression" : { - "classType" : "{urn:hl7-org:elm-types:r1}Code", - "type" : "Instance", - "element" : [ { - "name" : "code", - "value" : { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "code", + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "coding", + "type" : "OperandRef" + } + } + }, + "then" : { + "asType" : "{urn:hl7-org:elm-types:r1}Code", + "type" : "As", + "operand" : { + "type" : "Null" + } + }, + "else" : { + "classType" : "{urn:hl7-org:elm-types:r1}Code", + "type" : "Instance", + "element" : [ { + "name" : "code", + "value" : { + "path" : "value", "type" : "Property", "source" : { - "name" : "coding", - "type" : "OperandRef" + "path" : "code", + "type" : "Property", + "source" : { + "name" : "coding", + "type" : "OperandRef" + } } } - } - }, { - "name" : "system", - "value" : { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "system", + }, { + "name" : "system", + "value" : { + "path" : "value", "type" : "Property", "source" : { - "name" : "coding", - "type" : "OperandRef" + "path" : "system", + "type" : "Property", + "source" : { + "name" : "coding", + "type" : "OperandRef" + } } } - } - }, { - "name" : "version", - "value" : { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "version", + }, { + "name" : "version", + "value" : { + "path" : "value", "type" : "Property", "source" : { - "name" : "coding", - "type" : "OperandRef" + "path" : "version", + "type" : "Property", + "source" : { + "name" : "coding", + "type" : "OperandRef" + } } } - } - }, { - "name" : "display", - "value" : { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "display", + }, { + "name" : "display", + "value" : { + "path" : "value", "type" : "Property", "source" : { - "name" : "coding", - "type" : "OperandRef" + "path" : "display", + "type" : "Property", + "source" : { + "name" : "coding", + "type" : "OperandRef" + } } } - } - } ] + } ] + } }, "operand" : [ { "name" : "coding", @@ -225,50 +321,71 @@ "accessLevel" : "Public", "type" : "FunctionDef", "expression" : { - "classType" : "{urn:hl7-org:elm-types:r1}Concept", - "type" : "Instance", - "element" : [ { - "name" : "codes", - "value" : { - "type" : "Query", - "source" : [ { - "alias" : "C", - "expression" : { - "path" : "coding", - "type" : "Property", - "source" : { - "name" : "concept", - "type" : "OperandRef" + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "concept", + "type" : "OperandRef" + } + } + }, + "then" : { + "asType" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "As", + "operand" : { + "type" : "Null" + } + }, + "else" : { + "classType" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "Instance", + "element" : [ { + "name" : "codes", + "value" : { + "type" : "Query", + "source" : [ { + "alias" : "C", + "expression" : { + "path" : "coding", + "type" : "Property", + "source" : { + "name" : "concept", + "type" : "OperandRef" + } + } + } ], + "relationship" : [ ], + "return" : { + "expression" : { + "name" : "ToCode", + "type" : "FunctionRef", + "operand" : [ { + "name" : "C", + "type" : "AliasRef" + } ] } - } - } ], - "relationship" : [ ], - "return" : { - "expression" : { - "name" : "ToCode", - "type" : "FunctionRef", - "operand" : [ { - "name" : "C", - "type" : "AliasRef" - } ] } } - } - }, { - "name" : "display", - "value" : { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "text", + }, { + "name" : "display", + "value" : { + "path" : "value", "type" : "Property", "source" : { - "name" : "concept", - "type" : "OperandRef" + "path" : "text", + "type" : "Property", + "source" : { + "name" : "concept", + "type" : "OperandRef" + } } } - } - } ] + } ] + } }, "operand" : [ { "name" : "concept", @@ -678,7 +795,7 @@ } } ] }, { - "name" : "ToDateTime", + "name" : "ToDate", "context" : "Patient", "accessLevel" : "Public", "type" : "FunctionDef", @@ -3381,3 +3498,4 @@ } } } + diff --git a/src/cql/dstu2/Factors_to_Consider_in_Managing_Chronic_Pain.cql b/src/cql/dstu2/Factors_to_Consider_in_Managing_Chronic_Pain.cql new file mode 100644 index 000000000..51602b8b5 --- /dev/null +++ b/src/cql/dstu2/Factors_to_Consider_in_Managing_Chronic_Pain.cql @@ -0,0 +1,1087 @@ +// # Introduction + +// The Pain Management Summary artifact provides relevant information to consider when managing a patient’s pain. +// This CDS logic was informed by the Centers for Disease Control and Prevention (CDC) Guideline for Opioid Prescribing +// for Chronic Pain. The CDS is not a direct representation of any one recommendation statement within the guideline. +// Instead, the CDS compiles clinical concepts mentioned throughout the guideline in one consolidated summary for +// clinician review. +// +// In the process of authoring the logic, certain assumptions were made and details developed when the guideline did +// not provide enough specificity. These decisions were made in the context of the CDS Connect Workgroup and CDC +// stakeholders, and are documented in the logic and/or in the CDS Connect artifact metadata. +// +// Version 1.0.1 updates the CDS Connect Commons library to 1.3.1 to resolve an implicit conversion from FHIR.Date +// to System.DateTime that is no longer allowed by the CQL-to-ELM translator. +// +// Version 1.1.0 contains the following changes from the artifact that was piloted: +// - Added the following value sets for identifying Risk Factors for Opiod-Related Harms (in addition to existing ones) +// - Depression Diagnosis ICD9 (2.16.840.1.113883.3.600.143) +// - Anxiety Disorders ICD9 (2.16.840.1.113883.3.1240.2017.3.2.1015) +// - Substance Abuse (2.16.840.1.113883.3.464.1003.106.11.1010) +// - Pregnancy (New ICD10 codes published in 2018 and 2019)": '2.16.840.1.113762.1.4.1032.80' +// - Changed the Suicide Attempt value set to 2.16.840.1.113762.1.4.1032.102 +// - Removed specific inclusion of SNOMED-CT 86849004 since it is now in the Suicide Attempt value set +// - Added LOINC codes for the Pain intensity, Enjoyment of life, General activity scale [PEG] +// - Previous local codes are still supported (but discouraged) +// - Added logic to normalize long LOINC display text for PEG codes to shorter names +// - Added LOINC code for the STarT Back Screening Tool +// - Previous local code is still supported (but discouraged) +// - Added logic to display range for Opioid Risk Tool (ORT) +// - Updated QuantityText logic to not include '{score}' units (since scalar number is enough in those cases) + +// +// ##Source guideline: [CDC Guideline for Opioid Prescribing for Chronic Pain](https://www.cdc.gov/drugoverdose/prescribing/guideline.html) + +library Factors_to_Consider_in_Managing_Chronic_Pain version '1.1.0' + +// # Data model # + +// The FHIR DSTU2 model is preferred by CDS Connect artifacts due to its current adoption in Health IT products. +using FHIR version '1.0.2' + +// # Referenced libraries # + +// The CDS Connect Commons for FHIRv102 library provides functions representing commonly used CDS logic and patterns. +include CDS_Connect_Commons_for_FHIRv102 version '1.3.1' called C3F +// The FHIRHelpers library provides common functions for simplifying interaction w/ the FHIR v102 data model. +include FHIRHelpers version '1.0.2' called FHIRHelpers + +// # Value sets and codes # + +// ## Code Systems ## + +codesystem "LOINC": 'http://loinc.org' +codesystem "SNOMED-CT": 'http://snomed.info/sct' + +// Several concepts needed by the Pain Management Summary CDS do not yet have standardized codes associated with them. +// The CDS logic authors have registered new Logical Object Identifier Names and Codes (LOINC) codes, but they are +// not yet available. Once available, the CDS will be updated. Until then, CDS implementors will need to map to +// local codes (signified by the LOCAL code system below) or replace them with their own codes. +codesystem "LOCAL": 'http://cds.ahrq.gov/cdsconnect/pms' + +// ## Value sets ## + +// List value sets used by the artifact. The links to the Value Set Authority Center (VSAC) point to the latest +// expansion of each value set available. + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.37/expansion) +valueset "Conditions associated with chronic pain": '2.16.840.1.113762.1.4.1032.37' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.34/expansion) +valueset "Opioid Pain Medications": '2.16.840.1.113762.1.4.1032.34' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.54/expansion) +valueset "Adjuvant Analgesic Medications": '2.16.840.1.113762.1.4.1032.54' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1007/expansion) +valueset "Major Depression": '2.16.840.1.113883.3.464.1003.105.12.1007' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.600.143/expansion) +valueset "Depression Diagnosis ICD9": '2.16.840.1.113883.3.600.143' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.52/expansion) +valueset "Anxiety": '2.16.840.1.113762.1.4.1032.52' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.1240.2017.3.2.1015/expansion) +valueset "Anxiety Disorders ICD9": '2.16.840.1.113883.3.1240.2017.3.2.1015' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.106.12.1004/expansion) +valueset "Substance use disorder": '2.16.840.1.113883.3.464.1003.106.12.1004' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.106.11.1010/expansion) +valueset "Substance Abuse": '2.16.840.1.113883.3.464.1003.106.11.1010' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.102/expansion) +valueset "Suicide Attempt": '2.16.840.1.113762.1.4.1032.102' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.53/expansion) +valueset "Sleep-disordered breathing": '2.16.840.1.113762.1.4.1032.53' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1028/expansion) +valueset "Kidney Failure": '2.16.840.1.113883.3.464.1003.109.12.1028' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.199.12.1035/expansion) +valueset "Chronic Liver Disease": '2.16.840.1.113883.3.464.1003.199.12.1035' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1047.42/expansion) +valueset "Liver Disease": '2.16.840.1.113762.1.4.1047.42' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.378/expansion) +valueset "Pregnancy": '2.16.840.1.113883.3.526.3.378' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.80/expansion) +valueset "Pregnancy (New ICD10 codes published in 2018 and 2019)": '2.16.840.1.113762.1.4.1032.80' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.26/expansion) +valueset "Non opiod pain medications": '2.16.840.1.113762.1.4.1032.26' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.36/expansion) +valueset "Non pharmacologic treatments for chronic pain": '2.16.840.1.113762.1.4.1032.36' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.55/expansion) +valueset "Risk assessments relevant to pain management": '2.16.840.1.113762.1.4.1032.55' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.43/expansion) +valueset "Benzodiazepine medications": '2.16.840.1.113762.1.4.1032.43' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.42/expansion) +valueset "Naloxone medications": '2.16.840.1.113762.1.4.1032.42' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.28/expansion) +valueset "Urine drug screen for pain management": '2.16.840.1.113762.1.4.1032.28' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.44/expansion) +valueset "Stool softeners and laxatives": '2.16.840.1.113762.1.4.1032.44' + +// ## Individual codes ## + +// list individual codes from code systems used directly in the CQL logic. Individual codes are used when there is +// a single code from a particular vocabulary standard used to represent a clinical concept. It is considered +// best-practice not to create value sets containing a single code. + +code "Pregnancy status code": '82810-3' from "LOINC" display 'Pregnancy status' +code "Pregnant code": '77386006' from "SNOMED-CT" display 'Patient currently pregnant (finding)' +code "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] code": + '55758-7' from "LOINC" display 'Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]' +code "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported] code": + '44261-6' from "LOINC" display 'Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]' +code "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ] code": + '70274-6' from "LOINC" display 'Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]' +code "Total score [AUDIT] code": '75624-7' from "LOINC" display 'Total score [AUDIT]' +code "Total score [AUDIT-C] code": '75626-2' from "LOINC" display 'Total score [AUDIT-C]' +code "Total score [DAST-10] code": '82667-7' from "LOINC" display 'Total score [DAST-10]' +code "Total score ORT code": '91392-1' from "LOINC" display 'Total score ORT' +code "Pain severity Wong-Baker FACES Scale code": '38221-8' from "LOINC" display 'Pain severity Wong-Baker FACES Scale' + +// The Pain intensity, Enjoyment of life, General activity scale [PEG] now has standardized LOINC codes available. +// These LOINC codes were not available when the initial version of the Pain Management Summary was developed. +// New systems implementing the Pain Management Summary should use the standardized codes, but the legacy local codes +// are also retained in order to allow existing systems to continue to function. Existing systems, however, are +// strongly encouraged to adopt the standardized LOINC codes. + +code "Mean score [PEG] code": '91147-9' from "LOINC" display 'Mean score [PEG]' +code "Pain severity in the past week - 0-10 numeric rating [Reported] code": + '75893-8' from "LOINC" display 'Pain severity in the past week - 0-10 numeric rating [Reported]' +code "What number best describes how pain has interfered with your enjoyment of life during the past week code": + '91145-3' from "LOINC" display 'What number best describes how pain has interfered with your enjoyment of life during the past week' +code "What number best describes how pain has interfered with your general activity during the past week code": + '91146-1' from "LOINC" display 'What number best describes how pain has interfered with your general activity during the past week' + +// Legacy local codes for the Pain intensity, Enjoyment of life, General activity scale [PEG]. +// New systems should use the LOINC codes above instead. + +code "Pain Enjoyment General Activity (PEG) Assessment LEGACY code": + 'PEGASSESSMENT' from "LOCAL" display 'Pain Enjoyment General Activity (PEG) Assessment' +code "Pain LEGACY code": 'PEGPAIN' from "LOCAL" display 'Pain' +code "Enjoyment of life LEGACY code": 'PEGENJOYMENT' from "LOCAL" display 'Enjoyment of life' +code "General activity LEGACY code": 'PEGGENERALACTIVITY' from "LOCAL" display 'General activity' + +// The STarT Back Screening Tool now has a standardized LOINC code available. This LOINC code was not available +// when the initial version of the Pain Management Summary was developed. New systems implementing the Pain Management +// Summary should use the standardized code, but the legacy local code is also retained in order to allow existing +// systems to continue to function. Existing systems, however, are strongly encouraged to adopt the standardized LOINC +// code. + +code "Total score [STarT Back] code": '91351-7' from "LOINC" display 'Total score [STarT Back]' + +// Legacy local code for the STarT Back Screening Tool. New systems should use the LOINC codes above instead. + +code "STarT Back Screening Tool LEGACY code": 'STARTBACK' from "LOCAL" display 'STarT Back Screening Tool' + +// The following codes do not yet have standardized codes associated with them so are expressed as LOCAL codes. +// As standardized codes become available, this CDS will be updated to use standard codes rather than LOCAL codes. + +code "Single question r/t ETOH use code": 'SQETOHUSE' from "LOCAL" display 'Single question r/t ETOH use' +code "Single question r/t drug use code": 'SQDRUGUSE' from "LOCAL" display 'Single question r/t drug use' +code "Morphine Milligram Equivalent (MME) code": 'MME' from "LOCAL" display 'Morphine Milligram Equivalent (MME)' + +// CQL currently requires concept declarations to contain references to code declarations. + +concept "Pregnancy status": { "Pregnancy status code" } display 'Pregnancy status' +concept "Pregnant": { "Pregnant code" } display 'Patient currently pregnant (finding)' +concept "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]": + { "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] code" } + display 'Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]' +concept "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]": + { "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported] code" } + display 'Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]' +concept "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]": + { "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ] code" } + display 'Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]' +concept "Total score [AUDIT]": { "Total score [AUDIT] code" } display 'Total score [AUDIT]' +concept "Total score [AUDIT-C]": { "Total score [AUDIT-C] code" } display 'Total score [AUDIT-C]' +concept "Total score [DAST-10]": { "Total score [DAST-10] code" } display 'Total score [DAST-10]' +concept "Total score ORT": { "Total score ORT code" } display 'Total score ORT' +concept "Pain severity Wong-Baker FACES Scale": + { "Pain severity Wong-Baker FACES Scale code" } display 'Pain severity Wong-Baker FACES Scale' +concept "Pain severity in the past week - 0-10 numeric rating [Reported]": + { "Pain severity in the past week - 0-10 numeric rating [Reported] code" } + display 'Pain severity in the past week - 0-10 numeric rating [Reported]' +concept "What number best describes how pain has interfered with your enjoyment of life during the past week": + { "What number best describes how pain has interfered with your enjoyment of life during the past week code" } + display 'What number best describes how pain has interfered with your enjoyment of life during the past week' +concept "What number best describes how pain has interfered with your general activity during the past week": + { "What number best describes how pain has interfered with your general activity during the past week code" } + display 'What number best describes how pain has interfered with your general activity during the past week' +concept "Mean score [PEG]": { "Mean score [PEG] code" } display 'Mean score [PEG]' +concept "Pain Enjoyment General Activity (PEG) Assessment LEGACY": + { "Pain Enjoyment General Activity (PEG) Assessment LEGACY code" } display 'Pain Enjoyment General Activity (PEG) Assessment' +concept "Pain LEGACY": { "Pain LEGACY code" } display 'Pain' +concept "Enjoyment of life LEGACY": { "Enjoyment of life LEGACY code" } display 'Enjoyment of life' +concept "General activity LEGACY": { "General activity LEGACY code" } display 'General activity' +concept "Total score [STarT Back]": { "Total score [STarT Back] code" } display 'Total score [STarT Back]' +concept "STarT Back Screening Tool LEGACY": { "STarT Back Screening Tool LEGACY code" } display 'STarT Back Screening Tool' +concept "Single question r/t ETOH use": { "Single question r/t ETOH use code" } display 'Single question r/t ETOH use' +concept "Single question r/t drug use": { "Single question r/t drug use code" } display 'Single question r/t drug use' +concept "Morphine Milligram Equivalent (MME)": + { "Morphine Milligram Equivalent (MME) code" } display 'Morphine Milligram Equivalent (MME)' + +// # Parameters # + +// The InclusionMedicationsLookbackPeriod allows CDS implementors to specify how far the inclusion logic should look +// back for qualifying active medications. By default, the inclusion logic will look back 180 days. +parameter InclusionMedicationsLookbackPeriod default 180 days + +// # CDS logic # + +context Patient + +// ## Re-usable functions ## + +// The summary logic contains many constructs that are needed throughout the logic. Where possible, these constructs +// have been developed as re-usable functions that can be invoked wherever they are needed. + +// Returns the first-found display text for a CodeableConcept, looking first at the `text` attribute, then the +// `display` on each `coding` until it finds a non-null value. Some PEG codes are normalized due to length. +// @param c - a FHIR CodeableConcept to get text from +// @returns {System.String} the display text or null if none is found +define function ConceptText(c FHIR.CodeableConcept): + if c ~ "Mean score [PEG]" or c ~ "Pain Enjoyment General Activity (PEG) Assessment LEGACY" + then 'Mean score [PEG]' + else if c ~ "Pain severity in the past week - 0-10 numeric rating [Reported]" or c ~ "Pain LEGACY" + then 'Pain' + else if c ~ "What number best describes how pain has interfered with your enjoyment of life during the past week" + or c ~ "Enjoyment of life LEGACY" + then 'Enjoyment of life' + else if c ~ "What number best describes how pain has interfered with your general activity during the past week" + or c ~ "General activity LEGACY" + then 'General activity' + else + Coalesce(c.text.value, Coalesce((c.coding) c2 return c2.display.value)) + +// We do not reliably get ranges back from EHR data, but ranges are important to understanding assessment scores in +// the summary. This function adds ranges to the name for known assessments. +// @param c - a FHIR CodeableConcept to get the updated text for +// @returns {System.String} the display text with range information appended +define function ConceptTextWithRange(c FHIR.CodeableConcept): + if c ~ "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" + then ConceptText(c) + ' [Range: 0-6]' + else if c ~ "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]" + then ConceptText(c) + ' [Range: 0-27]' + else if c ~ "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" + then ConceptText(c) + ' [Range: 0-21]' + else if c ~ "Total score [AUDIT]" + then ConceptText(c) + ' [Range: 0-40]' + else if c ~ "Total score [AUDIT-C]" + then ConceptText(c) + ' [Range: 0-12]' + else if c ~ "Total score [DAST-10]" + then ConceptText(c) + ' [Range: 0-10]' + else if c ~ "Total score ORT" + then ConceptText(c) + ' [Range: 0-26]' + else if c ~ "Pain severity Wong-Baker FACES Scale" + then ConceptText(c) + ' [Range: 0-10]' + else if c ~ "Mean score [PEG]" + or c ~ "Pain Enjoyment General Activity (PEG) Assessment LEGACY" + then ConceptText(c) + ' [Range: 0-10]' + else if c ~ "Total score [STarT Back]" + or c ~ "STarT Back Screening Tool LEGACY" + then ConceptText(c) + ' [Range: 0-9]' + else + ConceptText(c) + +// Returns a text representation of a date using the CQL `ToString` function. +// @param d - a FHIR date to get text for +// @returns {System.String} the text representation of the date +define function DateText(d FHIR.date): + ToString(d.value) + +// Returns a text representation of a dateTime using the CQL `ToString` function. +// @param d - a FHIR dateTime to get text for +// @returns {System.String} the text representation of the dateTime +define function DateTimeText(d FHIR.dateTime): + ToString(d.value) + +// Returns a text representation of an instant using the CQL `ToString` function. +// @param i - a FHIR instant to get text for +// @returns {System.String} the text representation of the instant +define function InstantText(i FHIR.instant): + ToString(i.value) + +// Returns a text representation of a Quantity with the Quantity's value and unit. +// If the unit is {score}, then omit it (as it is not useful to display) +// @param q - a FHIR Quantity to get text for +// @returns {System.String} the text representation of the Quantity +define function QuantityText(q FHIR.Quantity): + if (q is null) then null + else if (q.unit is not null and q.unit.value != '{score}') then ToString(q.value.value) + ' ' + q.unit.value + else if (q.code is not null and q.code.value != '{score}') then ToString(q.value.value) + ' ' + q.code.value + else ToString(q.value.value) + +// Returns a tuple containing a Period's start and end as text representations. +// @param p - a FHIR Period to get a tuple for +// @returns {Tuple} the tuple representation of the Period +define function PeriodObject(p FHIR.Period): + if p is null then null + else + { + Start: DateTimeText(p."start"), + End: DateTimeText(p."end") + } + +// Returns a tuple containing a Range's low and high as text representations. +// @param r - a FHIR Range to get a tuple for +// @returns {Tuple} the tuple representation of the Range +define function RangeObject(r FHIR.Range): + if r is null then null + else + { + Low: QuantityText(r.low), + High: QuantityText(r.high) + } + +// Returns a text representation of a date associated with an Observation, preferring `effectiveDateTime`, then +// `effectivePeriod.start`, then `issued`. +// @param o - a FHIR Observation to get the text date from +// @returns {System.String} the text representation of a relevant date from the Observation +define function ObservationDate(o FHIR.Observation): + Coalesce(DateTimeText(o.effectiveDateTime), DateTimeText(o.effectivePeriod.start), InstantText(o.issued)) + +// Returns a text representation of a date associated with a MedicationStatement, preferring `effectiveDateTime`, then +// `effectivePeriod.start`. +// @param m - a FHIR MedicationStatement to get the text date from +// @returns {System.String} the text representation of a relevant date from the MedicationStatement +define function MedicationStatementDate(s FHIR.MedicationStatement): + Coalesce(DateTimeText(s.effectiveDateTime), DateTimeText(s.effectivePeriod."start")) + +// Returns a text representation of a Condition's onset, whether represented as a dateTime, Period, Quantity (Age), +// Range (Age), or string. +// @param c - a FHIR Condition to get the text representation of the onset from +// @returns {System.String} the text representation of the Condition's onset +define function Onset(c FHIR.Condition): + Coalesce( List{ + DateTimeText(c.onsetDateTime), + QuantityText(c.onsetQuantity), + PeriodObject(c.onsetPeriod), + RangeObject(c.onsetRange), + c.onsetString.value + }) + +// Returns a text representation of a Condition's abatement, whether represented as a dateTime, Period, Quantity (Age), +// Range (Age), string, or boolean. +// @param c - a FHIR Condition to get the text representation of the abatement from +// @returns {System.String} the text representation of the Condition's abatement +define function Abatement(c FHIR.Condition): + Coalesce( List{ + DateTimeText(c.abatementDateTime), + QuantityText(c.abatementQuantity), + PeriodObject(c.abatementPeriod), + RangeObject(c.abatementRange), + c.abatementString.value, + ToString(c.abatementBoolean.value) + }) + +// ## Target population ## + +// INCLUSIONS + +// Determines if patient's age, in years, at the time CQL is run, is at least 18 years old +define Is18orOlder: + AgeInYears() >= 18 + +// Conditions associated with chronic pain +define ConditionsAssociatedWithChronicPain: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Conditions associated with chronic pain"])) + +// Determines if the patient has any of the conditions associated with chronic pain +define HasConditionAssociatedWithChronicPain: + exists(ConditionsAssociatedWithChronicPain) + +// Determines if the patient has any record of opioid pain medications in the lookback period +// - Medication Order within past 180 days (lookback can be made a parameter) +// - Medication Statement by patient within past 180 days (lookback can be made a parameter) +define HasRecentOpioidPainMedication: + exists(C3F.ActiveCompletedOrStoppedMedicationOrder(C3F.MedicationOrderLookBack( + [MedicationOrder: "Opioid Pain Medications"], + InclusionMedicationsLookbackPeriod) + )) + or exists(C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Opioid Pain Medications"], + InclusionMedicationsLookbackPeriod) + )) + +// Determines if the patient has any record of adjuvant analgesic medications in the lookback period +// - Medication Order within past 180 days (lookback can be made a parameter) +// - Medication Statement by patient within past 180 days (lookback can be made a parameter) +define HasRecentAdjuvantAnalgesicMedication: + exists(C3F.ActiveCompletedOrStoppedMedicationOrder(C3F.MedicationOrderLookBack( + [MedicationOrder: "Adjuvant Analgesic Medications"], + InclusionMedicationsLookbackPeriod) + )) + or exists(C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Adjuvant Analgesic Medications"], + InclusionMedicationsLookbackPeriod) + )) + +// Determines if the patient meets the inclusion criteria for the CDS. Inclusion criteria is: +// - Age >=18 years +// - AND +// - OR Conditions associated with chronic pain +// - OR Opioid pain medication +// - OR Adjuvant analgesic medication +define MeetsInclusionCriteria: + Is18orOlder + and ( + HasConditionAssociatedWithChronicPain + or HasRecentOpioidPainMedication + or HasRecentAdjuvantAnalgesicMedication + ) + +// EXCLUSIONS + +// TAKE NOTICE: This CDS is not intended for patients who meet any of the following criteria: +// 1. Younger than 18 years of age +// 2. Undergoing end-of-life care (hospice or palliative) +// 3. Undergoing active cancer treatment +// +// The first exclusion is explicitly accounted for under INCLUSIONS. +// The second and third exclusions cannot be realiably detected for all patients using just EHR data. For that reason +// they are not implemented in this CDS. Care providers should use their judgement when applying this CDS to their +// patients. + +// ## Intervention(s) ## + +// DISPLAY and POPULATE a Pain Management Summary of the following items: + +// PERTINENT MEDICAL HISTORY + +// Conditions associated with chronic pain and their dates of onset + +define ReportConditionsAssociatedWithChronicPain: + (ConditionsAssociatedWithChronicPain) C + return { + Name: ConceptText(C.code), + Status: C.clinicalStatus.value, + Onset: Onset(C), + DateRecorded: DateText(C.dateRecorded) + } + sort by (Onset as String) desc + +// Conditions that are risk factors for opioid-related harms and their dates of onset +// This is a union of nine value sets (w/ different filtering criteria) + +define DepressionConditions: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Major Depression"])) + union C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Depression Diagnosis ICD9"])) + +define AnxietyConditions: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Anxiety"])) + union C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Anxiety Disorders ICD9"])) + +define SubstanceUseDisorderConditions: + C3F.Confirmed([Condition: "Substance use disorder"]) + union C3F.Confirmed([Condition: "Substance Abuse"]) + +define SuicideAttemptConditions: + C3F.Confirmed([Condition: "Suicide Attempt"]) + +define SleepDisorderedBreathingConditions: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Sleep-disordered breathing"])) + +define RenalDysfunctionConditions: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Kidney Failure"])) + +define HepaticDysfunctionConditions: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Chronic Liver Disease"])) + union C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Liver Disease"])) + +define PregnancyConditions: + C3F.Confirmed(C3F.ConditionLookBack(C3F.ActiveOrRecurring( + [Condition: "Pregnancy"]) + union [Condition: "Pregnancy (New ICD10 codes published in 2018 and 2019)"], + 42 weeks + )) + +define PregnancyObservations: + C3F.Verified(C3F.ObservationLookBack([Observation: "Pregnancy status"], 42 weeks)) + +define MostRecentPregnancyObservation: + C3F.MostRecent(PregnancyObservations) + +define MostRecentPregnancyObservationIsPositive: + C3F.ConceptValue(MostRecentPregnancyObservation) ~ "Pregnant" + +define Is65orOlder: + AgeInYears() >= 65 + +define ConditionRiskFactorsForOpioidRelatedHarms: + DepressionConditions + union AnxietyConditions + union SubstanceUseDisorderConditions + union SuicideAttemptConditions + union SleepDisorderedBreathingConditions + union RenalDysfunctionConditions + union HepaticDysfunctionConditions + union PregnancyConditions + +// Encounter diagnoses that are risk factors for opioid-related harms and their dates of onset. Some risk factors may +// not exist on the problem list, and therefore may not be represented as Conditions (depending on EHR implementation). +// For this, the logic also looks at the patient's encounters, trying to find risk factors recorded as encounter +// diagnoses. + +define EncounterRiskFactorsForOpioidRelatedHarms: + [Encounter] E where exists( + E.reason R where + C3F.NullSafeToConcept(R) in "Major Depression" + or C3F.NullSafeToConcept(R) in "Depression Diagnosis ICD9" + or C3F.NullSafeToConcept(R) in "Anxiety" + or C3F.NullSafeToConcept(R) in "Anxiety Disorders ICD9" + or C3F.NullSafeToConcept(R) in "Substance use disorder" + or C3F.NullSafeToConcept(R) in "Substance Abuse" + or C3F.NullSafeToConcept(R) in "Suicide Attempt" + or C3F.NullSafeToConcept(R) in "Sleep-disordered breathing" + or C3F.NullSafeToConcept(R) in "Kidney Failure" + or C3F.NullSafeToConcept(R) in "Chronic Liver Disease" + or C3F.NullSafeToConcept(R) in "Liver Disease" + // Pregnancy not considered in Encounter diagnoses because this is an unrestricted lookback. + ) + +// NOTE: As a convention, if an expression's name starts with "Report", its purpose is to format data for the purpose +// of building the final summary object. + +// Format the risk factors in a uniform way despite the different sources of the data (conditions, encounter diagnoses, +// etc.). Note that conditions do not have a "Visit" date and encounter diagnoses do not have a status, onset date, +// recorded date, or abatement date. + +define ReportConditionRiskFactorsForOpioidRelatedHarms: + (ConditionRiskFactorsForOpioidRelatedHarms) C + return { + Name: ConceptText(C.code), + Status: C.clinicalStatus.value, + Onset: Onset(C), + DateRecorded: DateText(C.dateRecorded), + Abatement: Abatement(C), + Visit: null as Tuple{ Start String, End String } + } + sort by (Onset as String) desc, (Abatement as String) desc + +define function GetEncounterDiagnosesRiskFactorsForOpioidRelatedHarms(enc Encounter): + (enc.reason) R + where C3F.NullSafeToConcept(R) in "Major Depression" + or C3F.NullSafeToConcept(R) in "Depression Diagnosis ICD9" + or C3F.NullSafeToConcept(R) in "Anxiety" + or C3F.NullSafeToConcept(R) in "Anxiety Disorders ICD9" + or C3F.NullSafeToConcept(R) in "Substance use disorder" + or C3F.NullSafeToConcept(R) in "Substance Abuse" + or C3F.NullSafeToConcept(R) in "Suicide Attempt" + or C3F.NullSafeToConcept(R) in "Sleep-disordered breathing" + or C3F.NullSafeToConcept(R) in "Kidney Failure" + or C3F.NullSafeToConcept(R) in "Chronic Liver Disease" + or C3F.NullSafeToConcept(R) in "Liver Disease" + // Pregnancy not considered in Encounter diagnoses because this is an unrestricted lookback. + return { + Name: ConceptText(R), + Status: null as String, + Onset: null as String, + DateRecorded: null as String, + Abatement: null as String, + Visit: PeriodObject(enc.period) + } + +define ReportEncounterRiskFactorsForOpioidRelatedHarms: + (flatten((EncounterRiskFactorsForOpioidRelatedHarms) E + return GetEncounterDiagnosesRiskFactorsForOpioidRelatedHarms(E))) D + sort by Visit.Start desc, Visit.End desc + +// Shape the pregnancy Observation as a Condition, since this is the backup approach for detecting a pregnancy in case +// there are no active Conditions found. +define ReportMostRecentPositivePregnancyObservation: + if MostRecentPregnancyObservationIsPositive then + { + Name: ConceptText(MostRecentPregnancyObservation.code), + Status: ConceptText(MostRecentPregnancyObservation.valueCodeableConcept), + Onset: ToString(Coalesce( + MostRecentPregnancyObservation.effectiveDateTime.value, + MostRecentPregnancyObservation.effectivePeriod.start + )), + DateRecorded: ToString(MostRecentPregnancyObservation.issued), + Abatement: null as String, + Visit: null as Tuple{ Start String, End String } + } + else + null + +// Shape the case of being 65 or older as a Condition for the purposes of building the summary. +define ReportOlderThan65: + if Is65orOlder then + { + Name: '65 years or older', + Status: 'active', + Onset: null as String, + DateRecorded: null as String, + Abatement: null as String, + Visit: null as Tuple{ Start String, End String } + } + else + null + +define ReportRiskFactorsForOpioidRelatedHarms: + // If a pregnancy Condition is present, use that. + if Exists(PregnancyConditions) then + (ReportConditionRiskFactorsForOpioidRelatedHarms + union ReportEncounterRiskFactorsForOpioidRelatedHarms + union ReportOlderThan65) C + // Otherwise, try to find a positive pregnancy status in an Observation. + else + (ReportConditionRiskFactorsForOpioidRelatedHarms + union ReportEncounterRiskFactorsForOpioidRelatedHarms + union ReportOlderThan65 + union ReportMostRecentPositivePregnancyObservation) C + sort by (if Onset is not null then Onset as String else Visit.Start) desc, Visit.End desc, (Abatement as String) desc + +// PAIN ASSESSMENT + +// Numeric pain intensity assessment - scores and dates (lookback 2 years) + +define NumericPainIntensityAssessments: + C3F.Verified(C3F.ObservationLookBack([Observation: "Pain severity Wong-Baker FACES Scale"], 2 years)) + +define ReportNumericPainIntensityAssessments: + (NumericPainIntensityAssessments) A + return { + Name: ConceptTextWithRange(A.code), + Score: QuantityText(A.valueQuantity), + Interpretation: Coalesce( ConceptText(A.interpretation), ConceptText(A.valueCodeableConcept) ), + Date: ObservationDate(A) + } + sort by Date desc + +// Pain Enjoyment General Activity (PEG) Assessment - scores and dates (lookback 2 years) +// Note: this includes listing the response to each of the 3 questions, plus the total score. The Pain Management +// Sumnmary currently supports both the LOINC representations and the legacy local code representations. +// +// 1. Observation w/ LOINC mean score as primary code and mean score as valueQuantity +// * code: LOINC 91147-9 "Mean score [PEG]" +// * valueQuantity: (mean score) +// * component: +// - +// * code: LOINC 75893-8 "What number best describes your pain on average in the past week?" +// * valueQuantity: (pain score) +// - +// * code: LOINC 91145-3 "What number best describes how, during the past week, pain has interfered with your enjoyment of life?" +// * valueQuantity: (enjoyment of life score) +// - +// * code: LOINC 91146-1 "What number best describes how, during the past week, pain has interfered with your general activity?" +// * valueQuantity: (general activity score) +// +// 2. LEGACY: Observation w/ LOCAL code as primary code and mean score as valueQuantity +// * code: LOCAL PEGASSESSMENT "Pain Enjoyment General Activity (PEG) Assessment" +// * valueQuantity: (mean score) +// * component: +// - +// * code: LOCAL PEGPAIN "Pain" +// * valueQuantity: (pain score) +// - +// * code: LOCAL PEGENJOYMENT "Enjoyment of life" +// * valueQuantity: (enjoyment of life score) +// - +// * code: LOCAL PEGGENERALACTIVITY "General activity" +// * valueQuantity: (general activity score) + +define PainEnjoymentGeneralActivityAssessments: + C3F.Verified(C3F.ObservationLookBack( + [Observation: "Mean score [PEG]"] + union [Observation: "Pain Enjoyment General Activity (PEG) Assessment LEGACY"], + 2 years + )) + +define ReportPainEnjoymentGeneralActivityAssessments: + (PainEnjoymentGeneralActivityAssessments) A + let + Pain: (A.component) C + where C.code ~ "Pain severity in the past week - 0-10 numeric rating [Reported]" + or C.code ~ "Pain LEGACY", + Enjoyment: (A.component) C + where C.code ~ "What number best describes how pain has interfered with your enjoyment of life during the past week" + or C.code ~ "Enjoyment of life LEGACY", + GeneralActivity: (A.component) C + where C.code ~ "What number best describes how pain has interfered with your general activity during the past week" + or C.code ~ "General activity LEGACY" + where true // grammar needs a where statement to separate the "let" from the "return" + return { + // NOTE: Hard-code in names because the real LOINC code displays are quite long + Name: ConceptTextWithRange(A.code), + Score: QuantityText(A.valueQuantity), + Interpretation: Coalesce( ConceptText(A.interpretation), ConceptText(A.valueCodeableConcept) ), + Questions: ({ First(Pain), First(Enjoyment), First(GeneralActivity) }) C + where C is not null + return { "Name": ConceptText(C.code), "Score": QuantityText(C.valueQuantity) }, + Date: ObservationDate(A) + } + sort by Date desc + +// STarT Back Screening Tool - Overall score and dates (lookback 2 years) + +define STarTBackAssessments: + C3F.Verified(C3F.ObservationLookBack( + [Observation: "Total score [STarT Back]"] + union [Observation: "STarT Back Screening Tool LEGACY"], + 2 years + )) + + +define ReportSTarTBackAssessments: + (STarTBackAssessments) A + return { + Name: ConceptTextWithRange(A.code), + Score: QuantityText(A.valueQuantity), + Interpretation: Coalesce( ConceptText(A.interpretation), ConceptText(A.valueCodeableConcept) ), + Date: ObservationDate(A) + } + sort by Date desc + +// HISTORICAL TREATMENTS + +// Opioid medication orders and statements with dates (lookback 2 years) + +define OpioidMedicationOrders: + C3F.ActiveCompletedOrStoppedMedicationOrder(C3F.MedicationOrderLookBack( + [MedicationOrder: "Opioid Pain Medications"], + 2 years + )) + +define OpioidMedicationStatements: + C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Opioid Pain Medications"], + 2 years + )) + +define ReportOpioidMedicationOrders: + (OpioidMedicationOrders) O + return { + Type: 'Order', + Name: ConceptText(O.medicationCodeableConcept), + Start: DateTimeText(O.dateWritten), + End: DateTimeText(O.dateEnded), + Status: O.status.value + } + sort by Start desc, End desc + +define ReportOpioidMedicationStatements: + (OpioidMedicationStatements) S + return { + Type: 'Statement', + Name: ConceptText(S.medicationCodeableConcept), + Start: MedicationStatementDate(S), + End: DateTimeText(S.effectivePeriod."end"), + Status: S.status.value + } + sort by Start desc, End desc + +define ReportOpioidMedications: + (ReportOpioidMedicationOrders union ReportOpioidMedicationStatements) M + sort by Start desc, End desc + +// Non-opioid medication orders and statements with dates (lookback 2 years) + +define NonOpioidMedicationOrders: + C3F.ActiveCompletedOrStoppedMedicationOrder(C3F.MedicationOrderLookBack( + [MedicationOrder: "Non opiod pain medications"], + 2 years + )) + +define NonOpioidMedicationStatements: + C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Non opiod pain medications"], + 2 years + )) + +define ReportNonOpioidMedicationOrders: + (NonOpioidMedicationOrders) O + return { + Type: 'Order', + Name: ConceptText(O.medicationCodeableConcept), + Start: DateTimeText(O.dateWritten), + End: DateTimeText(O.dateEnded), + Status: O.status.value + } + sort by Start desc, End desc + +define ReportNonOpioidMedicationStatements: + (NonOpioidMedicationStatements) S + return { + Type: 'Statement', + Name: ConceptText(S.medicationCodeableConcept), + Start: MedicationStatementDate(S), + End: DateTimeText(S.effectivePeriod."end"), + Status: S.status.value + } + sort by Start desc, End desc + +define ReportNonOpioidMedications: + (ReportNonOpioidMedicationOrders union ReportNonOpioidMedicationStatements) M + sort by Start desc, End desc + +// Non-pharmacologic treatment orders and referrals with dates (lookback 2 years) + +define NonPharmacologicTreatmentProcedures: + C3F.ProcedurePerformance(C3F.ProcedureLookBack([Procedure: "Non pharmacologic treatments for chronic pain"], 2 years)) + +define ReportNonPharmacologicTreatmentProcedures: + (NonPharmacologicTreatmentProcedures) P + return { + Type: 'Procedure', + Name: ConceptText(P.code), + Date: Coalesce(DateTimeText(P.performedDateTime), DateTimeText(P.performedPeriod."start")) + } + sort by Date desc + +define NonPharmacologicTreatmentProcedureRequests: + C3F.ProcedureRequestAcceptedOrInProgressOrCompleted( + C3F.ProcedureRequestLookBack([ProcedureRequest: "Non pharmacologic treatments for chronic pain"], 2 years) + ) + +define ReportNonPharmacologicTreatmentProcedureRequests: + (NonPharmacologicTreatmentProcedureRequests) P + return { + Type: 'ProcedureRequest', + Name: ConceptText(P.code), + Date: DateTimeText(P.orderedOn) + } + sort by Date desc + +define NonPharmacologicTreatmentReferralRequests: + C3F.ReferralRequestAcceptedOrActiveOrCompleted(C3F.ReferralRequestLookBack( + [ReferralRequest] R where exists( + (R.serviceRequested) SR where SR in "Non pharmacologic treatments for chronic pain" + ), + 2 years + )) + +define ReportNonPharmacologicTreatmentReferralRequests: + (NonPharmacologicTreatmentReferralRequests) P + return { + Type: 'Referral', + Name: Coalesce((P.serviceRequested) SR return ConceptText(SR)), + Date: DateTimeText(P.dateSent) + } + sort by Date desc + +define ReportNonPharmacologicTreatments: + (ReportNonPharmacologicTreatmentProcedures + union ReportNonPharmacologicTreatmentProcedureRequests + union ReportNonPharmacologicTreatmentReferralRequests) M + sort by Date desc + +// Stool softeners and laxatives - orders and statements with dates (lookback 6 months) + +define StoolSoftenersAndLaxativesOrders: + C3F.ActiveCompletedOrStoppedMedicationOrder(C3F.MedicationOrderLookBack( + [MedicationOrder: "Stool softeners and laxatives"], + 6 months + )) + +define StoolSoftenersAndLaxativesStatements: + C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Stool softeners and laxatives"], + 6 months + )) + +define ReportStoolSoftenersAndLaxativesOrders: + (StoolSoftenersAndLaxativesOrders) O + return { + Type: 'Order', + Name: ConceptText(O.medicationCodeableConcept), + Start: DateTimeText(O.dateWritten), + End: DateTimeText(O.dateEnded), + Status: O.status.value + } + sort by Start desc, End desc + +define ReportStoolSoftenersAndLaxativesStatements: + (StoolSoftenersAndLaxativesStatements) S + return { + Type: 'Statement', + Name: ConceptText(S.medicationCodeableConcept), + Start: MedicationStatementDate(S), + End: DateTimeText(S.effectivePeriod."end"), + Status: S.status.value + } + sort by Start desc, End desc + +define ReportStoolSoftenersAndLaxatives: + (ReportStoolSoftenersAndLaxativesOrders union ReportStoolSoftenersAndLaxativesStatements) M + sort by Start desc, End desc + +// RISK CONSIDERATIONS + +// MME (MOST RECENT w/ lookback 6 months) - amount and date + +define MostRecentMME: + C3F.MostRecent(C3F.Verified(C3F.ObservationLookBack([Observation: "Morphine Milligram Equivalent (MME)"], 6 months))) + +define ReportMostRecentMME: + if MostRecentMME is null + then null + else + (MostRecentMME) M + return { + Name: ConceptText(M.code), + Result: QuantityText(M.valueQuantity), + Date: ObservationDate(M) + } + +// Urine drug screen - dates and results (all screens w/ lookback of 1 year) + +define UrineDrugScreens: + C3F.Verified(C3F.ObservationLookBack([Observation: "Urine drug screen for pain management"], 1 year)) + +define ReportUrineDrugScreens: + (UrineDrugScreens) S + return { + Name: ConceptText(S.code), + Result: Coalesce( QuantityText(S.valueQuantity), S.valueString.value, ConceptText(S.valueCodeableConcept) ), + Interpretation: Coalesce( ConceptText(S.interpretation) ), + Date: ObservationDate(S) + } + sort by Date desc + +// Benzodiazepine Medications (lookback of 2 years)- orders and statements with dates + +define BenzodiazepineMedicationOrders: + C3F.ActiveCompletedOrStoppedMedicationOrder(C3F.MedicationOrderLookBack( + [MedicationOrder: "Benzodiazepine medications"], + 2 years + )) + +define BenzodiazepineMedicationStatements: + C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Benzodiazepine medications"], + 2 years + )) + +define ReportBenzodiazepineMedicationOrders: + (BenzodiazepineMedicationOrders) O + return { + Type: 'Order', + Name: ConceptText(O.medicationCodeableConcept), + Start: DateTimeText(O.dateWritten), + End: DateTimeText(O.dateEnded), + Status: O.status.value + } + sort by Start desc, End desc + +define ReportBenzodiazepineMedicationStatements: + (BenzodiazepineMedicationStatements) S + return { + Type: 'Statement', + Name: ConceptText(S.medicationCodeableConcept), + Start: MedicationStatementDate(S), + End: DateTimeText(S.effectivePeriod."end"), + Status: S.status.value + } + sort by Start desc, End desc + +define ReportBenzodiazepineMedications: + (ReportBenzodiazepineMedicationOrders union ReportBenzodiazepineMedicationStatements) M + sort by Start desc, End desc + +// Naloxone Medications (unrestricted lookback) - orders and statements with dates + +define NaloxoneMedicationOrders: + C3F.ActiveCompletedOrStoppedMedicationOrder([MedicationOrder: "Naloxone medications"]) + +define NaloxoneMedicationStatements: + C3F.ActiveOrCompletedMedicationStatement([MedicationStatement: "Naloxone medications"]) + +define ReportNaloxoneMedicationOrders: + (NaloxoneMedicationOrders) O + return { + Type: 'Order', + Name: ConceptText(O.medicationCodeableConcept), + Start: DateTimeText(O.dateWritten), + End: DateTimeText(O.dateEnded), + Status: O.status.value + } + sort by Start desc, End desc + +define ReportNaloxoneMedicationStatements: + (NaloxoneMedicationStatements) S + return { + Type: 'Statement', + Name: ConceptText(S.medicationCodeableConcept), + Start: MedicationStatementDate(S), + End: DateTimeText(S.effectivePeriod."end"), + Status: S.status.value + } + sort by Start desc, End desc + +define ReportNaloxoneMedications: + (ReportNaloxoneMedicationOrders union ReportNaloxoneMedicationStatements) M + sort by Start desc, End desc + +// Risk screenings relevant to pain management - overall scores and dates (MOST RECENT w/ lookback 1 year) + +define RiskScreeningsRelevantToPainManagement: + C3F.Verified(C3F.ObservationLookBack( + [Observation: "Risk assessments relevant to pain management"] + union [Observation: "Single question r/t ETOH use"] + union [Observation: "Single question r/t drug use"] + , 1 year)) + +define ReportRiskScreeningsRelevantToPainManagement: + (RiskScreeningsRelevantToPainManagement) S + return { + Name: ConceptTextWithRange(S.code), + Score: Coalesce( QuantityText(S.valueQuantity), S.valueString.value ), + Interpretation: Coalesce( ConceptText(S.interpretation), ConceptText(S.valueCodeableConcept) ), + Date: ObservationDate(S) + } + sort by Date desc + +// SUMMARY + +// The Summary object represents the full Pain Management Summary to be displayed to the clinician. All values are +// returned as user-friendly text representations, but a robust user interface (UI) should be implemented to +// display the data to the user in a friendly manner. See the Pain Management Summary SMART on FHIR application as +// an example of how to integrate this summary into an EHR using modern web UI technologies. + +define Summary: { + Patient: { + Name: Combine(Patient.name.given G return G.value, ' ') + ' ' + Combine(Patient.name.family F return F.value, ' '), + Gender: Patient.gender.value, + Age: AgeInYears(), + MeetsInclusionCriteria: MeetsInclusionCriteria + }, + PertinentMedicalHistory: { + ConditionsAssociatedWithChronicPain: ReportConditionsAssociatedWithChronicPain, + RiskFactorsForOpioidRelatedHarms: ReportRiskFactorsForOpioidRelatedHarms + }, + PainAssessments: { + NumericPainIntensityAssessments: ReportNumericPainIntensityAssessments, + PainEnjoymentGeneralActivityAssessments: ReportPainEnjoymentGeneralActivityAssessments, + STarTBackAssessments: ReportSTarTBackAssessments + }, + HistoricalTreatments: { + OpioidMedications: ReportOpioidMedications, + NonOpioidMedications: ReportNonOpioidMedications, + NonPharmacologicTreatments: ReportNonPharmacologicTreatments, + StoolSoftenersAndLaxatives: ReportStoolSoftenersAndLaxatives + }, + RiskConsiderations: { + MostRecentMME: ReportMostRecentMME, + UrineDrugScreens: ReportUrineDrugScreens, + BenzodiazepineMedications: ReportBenzodiazepineMedications, + NaloxoneMedications: ReportNaloxoneMedications, + RiskScreeningsRelevantToPainManagement: ReportRiskScreeningsRelevantToPainManagement + } +} diff --git a/src/cql/dstu2/Factors_to_Consider_in_Managing_Chronic_Pain.json b/src/cql/dstu2/Factors_to_Consider_in_Managing_Chronic_Pain.json index e1a1ccb99..2992138bf 100644 --- a/src/cql/dstu2/Factors_to_Consider_in_Managing_Chronic_Pain.json +++ b/src/cql/dstu2/Factors_to_Consider_in_Managing_Chronic_Pain.json @@ -2,7 +2,7 @@ "library" : { "identifier" : { "id" : "Factors_to_Consider_in_Managing_Chronic_Pain", - "version" : "1.0.0" + "version" : "1.1.0" }, "schemaIdentifier" : { "id" : "urn:hl7-org:elm", @@ -22,7 +22,7 @@ "def" : [ { "localIdentifier" : "C3F", "path" : "CDS_Connect_Commons_for_FHIRv102", - "version" : "1.3.0" + "version" : "1.3.1" }, { "localIdentifier" : "FHIRHelpers", "path" : "FHIRHelpers", @@ -72,17 +72,29 @@ "name" : "Major Depression", "id" : "2.16.840.1.113883.3.464.1003.105.12.1007", "accessLevel" : "Public" + }, { + "name" : "Depression Diagnosis ICD9", + "id" : "2.16.840.1.113883.3.600.143", + "accessLevel" : "Public" }, { "name" : "Anxiety", "id" : "2.16.840.1.113762.1.4.1032.52", "accessLevel" : "Public" + }, { + "name" : "Anxiety Disorders ICD9", + "id" : "2.16.840.1.113883.3.1240.2017.3.2.1015", + "accessLevel" : "Public" }, { "name" : "Substance use disorder", "id" : "2.16.840.1.113883.3.464.1003.106.12.1004", "accessLevel" : "Public" }, { - "name" : "Suicide attempt", - "id" : "2.16.840.1.113762.1.4.1032.40", + "name" : "Substance Abuse", + "id" : "2.16.840.1.113883.3.464.1003.106.11.1010", + "accessLevel" : "Public" + }, { + "name" : "Suicide Attempt", + "id" : "2.16.840.1.113762.1.4.1032.102", "accessLevel" : "Public" }, { "name" : "Sleep-disordered breathing", @@ -104,6 +116,10 @@ "name" : "Pregnancy", "id" : "2.16.840.1.113883.3.526.3.378", "accessLevel" : "Public" + }, { + "name" : "Pregnancy (New ICD10 codes published in 2018 and 2019)", + "id" : "2.16.840.1.113762.1.4.1032.80", + "accessLevel" : "Public" }, { "name" : "Non opiod pain medications", "id" : "2.16.840.1.113762.1.4.1032.26", @@ -151,14 +167,6 @@ "codeSystem" : { "name" : "SNOMED-CT" } - }, { - "name" : "Suicidal deliberate poisoning code", - "id" : "86849004", - "display" : "Suicidal deliberate poisoning", - "accessLevel" : "Public", - "codeSystem" : { - "name" : "SNOMED-CT" - } }, { "name" : "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] code", "id" : "55758-7", @@ -207,6 +215,14 @@ "codeSystem" : { "name" : "LOINC" } + }, { + "name" : "Total score ORT code", + "id" : "91392-1", + "display" : "Total score ORT", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } }, { "name" : "Pain severity Wong-Baker FACES Scale code", "id" : "38221-8", @@ -216,7 +232,39 @@ "name" : "LOINC" } }, { - "name" : "Pain Enjoyment General Activity (PEG) Assessment code", + "name" : "Mean score [PEG] code", + "id" : "91147-9", + "display" : "Mean score [PEG]", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } + }, { + "name" : "Pain severity in the past week - 0-10 numeric rating [Reported] code", + "id" : "75893-8", + "display" : "Pain severity in the past week - 0-10 numeric rating [Reported]", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } + }, { + "name" : "What number best describes how pain has interfered with your enjoyment of life during the past week code", + "id" : "91145-3", + "display" : "What number best describes how pain has interfered with your enjoyment of life during the past week", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } + }, { + "name" : "What number best describes how pain has interfered with your general activity during the past week code", + "id" : "91146-1", + "display" : "What number best describes how pain has interfered with your general activity during the past week", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } + }, { + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY code", "id" : "PEGASSESSMENT", "display" : "Pain Enjoyment General Activity (PEG) Assessment", "accessLevel" : "Public", @@ -224,7 +272,7 @@ "name" : "LOCAL" } }, { - "name" : "Pain code", + "name" : "Pain LEGACY code", "id" : "PEGPAIN", "display" : "Pain", "accessLevel" : "Public", @@ -232,7 +280,7 @@ "name" : "LOCAL" } }, { - "name" : "Enjoyment of life code", + "name" : "Enjoyment of life LEGACY code", "id" : "PEGENJOYMENT", "display" : "Enjoyment of life", "accessLevel" : "Public", @@ -240,7 +288,7 @@ "name" : "LOCAL" } }, { - "name" : "General activity code", + "name" : "General activity LEGACY code", "id" : "PEGGENERALACTIVITY", "display" : "General activity", "accessLevel" : "Public", @@ -248,7 +296,15 @@ "name" : "LOCAL" } }, { - "name" : "STarT Back Screening Tool code", + "name" : "Total score [STarT Back] code", + "id" : "91351-7", + "display" : "Total score [STarT Back]", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } + }, { + "name" : "STarT Back Screening Tool LEGACY code", "id" : "STARTBACK", "display" : "STarT Back Screening Tool", "accessLevel" : "Public", @@ -296,13 +352,6 @@ "code" : [ { "name" : "Pregnant code" } ] - }, { - "name" : "Suicidal deliberate poisoning", - "display" : "Suicidal deliberate poisoning", - "accessLevel" : "Public", - "code" : [ { - "name" : "Suicidal deliberate poisoning code" - } ] }, { "name" : "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]", "display" : "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]", @@ -345,6 +394,13 @@ "code" : [ { "name" : "Total score [DAST-10] code" } ] + }, { + "name" : "Total score ORT", + "display" : "Total score ORT", + "accessLevel" : "Public", + "code" : [ { + "name" : "Total score ORT code" + } ] }, { "name" : "Pain severity Wong-Baker FACES Scale", "display" : "Pain severity Wong-Baker FACES Scale", @@ -353,39 +409,74 @@ "name" : "Pain severity Wong-Baker FACES Scale code" } ] }, { - "name" : "Pain Enjoyment General Activity (PEG) Assessment", + "name" : "Pain severity in the past week - 0-10 numeric rating [Reported]", + "display" : "Pain severity in the past week - 0-10 numeric rating [Reported]", + "accessLevel" : "Public", + "code" : [ { + "name" : "Pain severity in the past week - 0-10 numeric rating [Reported] code" + } ] + }, { + "name" : "What number best describes how pain has interfered with your enjoyment of life during the past week", + "display" : "What number best describes how pain has interfered with your enjoyment of life during the past week", + "accessLevel" : "Public", + "code" : [ { + "name" : "What number best describes how pain has interfered with your enjoyment of life during the past week code" + } ] + }, { + "name" : "What number best describes how pain has interfered with your general activity during the past week", + "display" : "What number best describes how pain has interfered with your general activity during the past week", + "accessLevel" : "Public", + "code" : [ { + "name" : "What number best describes how pain has interfered with your general activity during the past week code" + } ] + }, { + "name" : "Mean score [PEG]", + "display" : "Mean score [PEG]", + "accessLevel" : "Public", + "code" : [ { + "name" : "Mean score [PEG] code" + } ] + }, { + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY", "display" : "Pain Enjoyment General Activity (PEG) Assessment", "accessLevel" : "Public", "code" : [ { - "name" : "Pain Enjoyment General Activity (PEG) Assessment code" + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY code" } ] }, { - "name" : "Pain", + "name" : "Pain LEGACY", "display" : "Pain", "accessLevel" : "Public", "code" : [ { - "name" : "Pain code" + "name" : "Pain LEGACY code" } ] }, { - "name" : "Enjoyment of life", + "name" : "Enjoyment of life LEGACY", "display" : "Enjoyment of life", "accessLevel" : "Public", "code" : [ { - "name" : "Enjoyment of life code" + "name" : "Enjoyment of life LEGACY code" } ] }, { - "name" : "General activity", + "name" : "General activity LEGACY", "display" : "General activity", "accessLevel" : "Public", "code" : [ { - "name" : "General activity code" + "name" : "General activity LEGACY code" } ] }, { - "name" : "STarT Back Screening Tool", + "name" : "Total score [STarT Back]", + "display" : "Total score [STarT Back]", + "accessLevel" : "Public", + "code" : [ { + "name" : "Total score [STarT Back] code" + } ] + }, { + "name" : "STarT Back Screening Tool LEGACY", "display" : "STarT Back Screening Tool", "accessLevel" : "Public", "code" : [ { - "name" : "STarT Back Screening Tool code" + "name" : "STarT Back Screening Tool LEGACY code" } ] }, { "name" : "Single question r/t ETOH use", @@ -427,47 +518,223 @@ "accessLevel" : "Public", "type" : "FunctionDef", "expression" : { - "type" : "Coalesce", - "operand" : [ { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "text", - "type" : "Property", - "source" : { - "name" : "c", - "type" : "OperandRef" - } - } - }, { - "type" : "Coalesce", - "operand" : [ { - "type" : "Query", - "source" : [ { - "alias" : "c2", - "expression" : { - "path" : "coding", - "type" : "Property", - "source" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { "name" : "c", "type" : "OperandRef" - } + } ] + }, { + "name" : "Mean score [PEG]", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Mean score [PEG]", + "type" : "Literal" + }, + "else" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Pain severity in the past week - 0-10 numeric rating [Reported]", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Pain LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Pain", + "type" : "Literal" + }, + "else" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "What number best describes how pain has interfered with your enjoyment of life during the past week", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Enjoyment of life LEGACY", + "type" : "ConceptRef" + } ] + } ] } - } ], - "relationship" : [ ], - "return" : { - "expression" : { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "display", - "scope" : "c2", - "type" : "Property" + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Enjoyment of life", + "type" : "Literal" + }, + "else" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "What number best describes how pain has interfered with your general activity during the past week", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "General activity LEGACY", + "type" : "ConceptRef" + } ] + } ] } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "General activity", + "type" : "Literal" + }, + "else" : { + "type" : "Coalesce", + "operand" : [ { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "text", + "type" : "Property", + "source" : { + "name" : "c", + "type" : "OperandRef" + } + } + }, { + "type" : "Coalesce", + "operand" : [ { + "type" : "Query", + "source" : [ { + "alias" : "c2", + "expression" : { + "path" : "coding", + "type" : "Property", + "source" : { + "name" : "c", + "type" : "OperandRef" + } + } + } ], + "relationship" : [ ], + "return" : { + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "display", + "scope" : "c2", + "type" : "Property" + } + } + } + } ] + } ] } } - } ] - } ] + } + } }, "operand" : [ { "name" : "c", @@ -713,7 +980,7 @@ "type" : "OperandRef" } ] }, { - "name" : "Pain severity Wong-Baker FACES Scale", + "name" : "Total score ORT", "type" : "ConceptRef" } ] } @@ -729,7 +996,7 @@ } ] }, { "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : " [Range: 0-10]", + "value" : " [Range: 0-26]", "type" : "Literal" } ] }, @@ -749,7 +1016,7 @@ "type" : "OperandRef" } ] }, { - "name" : "Pain Enjoyment General Activity (PEG) Assessment", + "name" : "Pain severity Wong-Baker FACES Scale", "type" : "ConceptRef" } ] } @@ -775,18 +1042,35 @@ "asType" : "{urn:hl7-org:elm-types:r1}Boolean", "type" : "As", "operand" : { - "type" : "Equivalent", + "type" : "Or", "operand" : [ { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", + "type" : "Equivalent", "operand" : [ { - "name" : "c", - "type" : "OperandRef" + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Mean score [PEG]", + "type" : "ConceptRef" } ] }, { - "name" : "STarT Back Screening Tool", - "type" : "ConceptRef" + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY", + "type" : "ConceptRef" + } ] } ] } }, @@ -801,17 +1085,71 @@ } ] }, { "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : " [Range: 0-9]", + "value" : " [Range: 0-10]", "type" : "Literal" } ] }, "else" : { - "name" : "ConceptText", - "type" : "FunctionRef", - "operand" : [ { - "name" : "c", - "type" : "OperandRef" - } ] + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Total score [STarT Back]", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "STarT Back Screening Tool LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + }, + "then" : { + "type" : "Concatenate", + "operand" : [ { + "name" : "ConceptText", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : " [Range: 0-9]", + "type" : "Literal" + } ] + }, + "else" : { + "name" : "ConceptText", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + } } } } @@ -929,18 +1267,42 @@ "asType" : "{urn:hl7-org:elm-types:r1}Boolean", "type" : "As", "operand" : { - "type" : "Not", - "operand" : { - "type" : "IsNull", + "type" : "And", + "operand" : [ { + "type" : "Not", "operand" : { - "path" : "unit", - "type" : "Property", - "source" : { - "name" : "q", - "type" : "OperandRef" + "type" : "IsNull", + "operand" : { + "path" : "unit", + "type" : "Property", + "source" : { + "name" : "q", + "type" : "OperandRef" + } } } - } + }, { + "type" : "Not", + "operand" : { + "type" : "Equal", + "operand" : [ { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "unit", + "type" : "Property", + "source" : { + "name" : "q", + "type" : "OperandRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "{score}", + "type" : "Literal" + } ] + } + } ] } }, "then" : { @@ -985,18 +1347,42 @@ "asType" : "{urn:hl7-org:elm-types:r1}Boolean", "type" : "As", "operand" : { - "type" : "Not", - "operand" : { - "type" : "IsNull", + "type" : "And", + "operand" : [ { + "type" : "Not", "operand" : { - "path" : "code", - "type" : "Property", - "source" : { - "name" : "q", - "type" : "OperandRef" + "type" : "IsNull", + "operand" : { + "path" : "code", + "type" : "Property", + "source" : { + "name" : "q", + "type" : "OperandRef" + } } } - } + }, { + "type" : "Not", + "operand" : { + "type" : "Equal", + "operand" : [ { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "code", + "type" : "Property", + "source" : { + "name" : "q", + "type" : "OperandRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "{score}", + "type" : "Literal" + } ] + } + } ] } }, "then" : { @@ -1459,122 +1845,22 @@ "path" : "value", "type" : "Property", "source" : { - "path" : "abatementBoolean", - "type" : "Property", - "source" : { - "name" : "c", - "type" : "OperandRef" - } - } - } - } ] - } ] - }, - "operand" : [ { - "name" : "c", - "operandTypeSpecifier" : { - "name" : "{http://hl7.org/fhir}Condition", - "type" : "NamedTypeSpecifier" - } - } ] - }, { - "name" : "SortPegComponents", - "context" : "Patient", - "accessLevel" : "Public", - "type" : "FunctionDef", - "expression" : { - "type" : "Flatten", - "operand" : { - "type" : "List", - "element" : [ { - "type" : "Query", - "source" : [ { - "alias" : "OC", - "expression" : { - "name" : "c", - "type" : "OperandRef" - } - } ], - "relationship" : [ ], - "where" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", - "operand" : [ { - "path" : "code", - "scope" : "OC", - "type" : "Property" - } ] - }, { - "name" : "Pain", - "type" : "ConceptRef" - } ] - } - }, { - "type" : "Query", - "source" : [ { - "alias" : "OC", - "expression" : { - "name" : "c", - "type" : "OperandRef" - } - } ], - "relationship" : [ ], - "where" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", - "operand" : [ { - "path" : "code", - "scope" : "OC", - "type" : "Property" - } ] - }, { - "name" : "Enjoyment of life", - "type" : "ConceptRef" - } ] - } - }, { - "type" : "Query", - "source" : [ { - "alias" : "OC", - "expression" : { - "name" : "c", - "type" : "OperandRef" + "path" : "abatementBoolean", + "type" : "Property", + "source" : { + "name" : "c", + "type" : "OperandRef" + } } - } ], - "relationship" : [ ], - "where" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", - "operand" : [ { - "path" : "code", - "scope" : "OC", - "type" : "Property" - } ] - }, { - "name" : "General activity", - "type" : "ConceptRef" - } ] } } ] - } + } ] }, "operand" : [ { "name" : "c", "operandTypeSpecifier" : { - "type" : "ListTypeSpecifier", - "elementType" : { - "name" : "{http://hl7.org/fhir}Observation.Component", - "type" : "NamedTypeSpecifier" - } + "name" : "{http://hl7.org/fhir}Condition", + "type" : "NamedTypeSpecifier" } } ] }, { @@ -1859,21 +2145,42 @@ "context" : "Patient", "accessLevel" : "Public", "expression" : { - "name" : "Confirmed", - "libraryName" : "C3F", - "type" : "FunctionRef", + "type" : "Union", "operand" : [ { - "name" : "ActiveOrRecurring", + "name" : "Confirmed", "libraryName" : "C3F", "type" : "FunctionRef", "operand" : [ { - "dataType" : "{http://hl7.org/fhir}Condition", - "codeProperty" : "code", - "type" : "Retrieve", - "codes" : { - "name" : "Major Depression", - "type" : "ValueSetRef" - } + "name" : "ActiveOrRecurring", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Major Depression", + "type" : "ValueSetRef" + } + } ] + } ] + }, { + "name" : "Confirmed", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "name" : "ActiveOrRecurring", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Depression Diagnosis ICD9", + "type" : "ValueSetRef" + } + } ] } ] } ] } @@ -1882,21 +2189,42 @@ "context" : "Patient", "accessLevel" : "Public", "expression" : { - "name" : "Confirmed", - "libraryName" : "C3F", - "type" : "FunctionRef", + "type" : "Union", "operand" : [ { - "name" : "ActiveOrRecurring", + "name" : "Confirmed", "libraryName" : "C3F", "type" : "FunctionRef", "operand" : [ { - "dataType" : "{http://hl7.org/fhir}Condition", - "codeProperty" : "code", - "type" : "Retrieve", - "codes" : { - "name" : "Anxiety", - "type" : "ValueSetRef" - } + "name" : "ActiveOrRecurring", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Anxiety", + "type" : "ValueSetRef" + } + } ] + } ] + }, { + "name" : "Confirmed", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "name" : "ActiveOrRecurring", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Anxiety Disorders ICD9", + "type" : "ValueSetRef" + } + } ] } ] } ] } @@ -1904,24 +2232,6 @@ "name" : "SubstanceUseDisorderConditions", "context" : "Patient", "accessLevel" : "Public", - "expression" : { - "name" : "Confirmed", - "libraryName" : "C3F", - "type" : "FunctionRef", - "operand" : [ { - "dataType" : "{http://hl7.org/fhir}Condition", - "codeProperty" : "code", - "type" : "Retrieve", - "codes" : { - "name" : "Substance use disorder", - "type" : "ValueSetRef" - } - } ] - } - }, { - "name" : "SuicideAttemptConditions", - "context" : "Patient", - "accessLevel" : "Public", "expression" : { "type" : "Union", "operand" : [ { @@ -1933,7 +2243,7 @@ "codeProperty" : "code", "type" : "Retrieve", "codes" : { - "name" : "Suicide attempt", + "name" : "Substance use disorder", "type" : "ValueSetRef" } } ] @@ -1946,15 +2256,30 @@ "codeProperty" : "code", "type" : "Retrieve", "codes" : { - "type" : "ToList", - "operand" : { - "name" : "Suicidal deliberate poisoning", - "type" : "ConceptRef" - } + "name" : "Substance Abuse", + "type" : "ValueSetRef" } } ] } ] } + }, { + "name" : "SuicideAttemptConditions", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "name" : "Confirmed", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Suicide Attempt", + "type" : "ValueSetRef" + } + } ] + } }, { "name" : "SleepDisorderedBreathingConditions", "context" : "Patient", @@ -2058,15 +2383,26 @@ "libraryName" : "C3F", "type" : "FunctionRef", "operand" : [ { - "name" : "ActiveOrRecurring", - "libraryName" : "C3F", - "type" : "FunctionRef", + "type" : "Union", "operand" : [ { + "name" : "ActiveOrRecurring", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Pregnancy", + "type" : "ValueSetRef" + } + } ] + }, { "dataType" : "{http://hl7.org/fhir}Condition", "codeProperty" : "code", "type" : "Retrieve", "codes" : { - "name" : "Pregnancy", + "name" : "Pregnancy (New ICD10 codes published in 2018 and 2019)", "type" : "ValueSetRef" } } ] @@ -2175,41 +2511,41 @@ "operand" : [ { "type" : "Union", "operand" : [ { - "type" : "Union", - "operand" : [ { - "type" : "Union", - "operand" : [ { - "type" : "Union", - "operand" : [ { - "name" : "DepressionConditions", - "type" : "ExpressionRef" - }, { - "name" : "AnxietyConditions", - "type" : "ExpressionRef" - } ] - }, { - "name" : "SubstanceUseDisorderConditions", - "type" : "ExpressionRef" - } ] - }, { - "name" : "SuicideAttemptConditions", - "type" : "ExpressionRef" - } ] + "name" : "DepressionConditions", + "type" : "ExpressionRef" + }, { + "name" : "AnxietyConditions", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Union", + "operand" : [ { + "name" : "SubstanceUseDisorderConditions", + "type" : "ExpressionRef" }, { - "name" : "SleepDisorderedBreathingConditions", + "name" : "SuicideAttemptConditions", "type" : "ExpressionRef" } ] + } ] + }, { + "type" : "Union", + "operand" : [ { + "name" : "SleepDisorderedBreathingConditions", + "type" : "ExpressionRef" }, { "name" : "RenalDysfunctionConditions", "type" : "ExpressionRef" } ] - }, { + } ] + }, { + "type" : "Union", + "operand" : [ { "name" : "HepaticDysfunctionConditions", "type" : "ExpressionRef" + }, { + "name" : "PregnancyConditions", + "type" : "ExpressionRef" } ] - }, { - "name" : "PregnancyConditions", - "type" : "ExpressionRef" } ] } }, { @@ -2256,19 +2592,53 @@ "operand" : [ { "type" : "Or", "operand" : [ { - "type" : "InValueSet", - "code" : { - "name" : "NullSafeToConcept", - "libraryName" : "C3F", - "type" : "FunctionRef", + "type" : "Or", + "operand" : [ { + "type" : "Or", "operand" : [ { - "name" : "R", - "type" : "AliasRef" + "type" : "InValueSet", + "code" : { + "name" : "NullSafeToConcept", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Major Depression" + } + }, { + "type" : "InValueSet", + "code" : { + "name" : "NullSafeToConcept", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Depression Diagnosis ICD9" + } } ] - }, - "valueset" : { - "name" : "Major Depression" - } + }, { + "type" : "InValueSet", + "code" : { + "name" : "NullSafeToConcept", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Anxiety" + } + } ] }, { "type" : "InValueSet", "code" : { @@ -2281,7 +2651,7 @@ } ] }, "valueset" : { - "name" : "Anxiety" + "name" : "Anxiety Disorders ICD9" } } ] }, { @@ -2311,12 +2681,12 @@ } ] }, "valueset" : { - "name" : "Suicide attempt" + "name" : "Substance Abuse" } } ] }, { - "type" : "Equivalent", - "operand" : [ { + "type" : "InValueSet", + "code" : { "name" : "NullSafeToConcept", "libraryName" : "C3F", "type" : "FunctionRef", @@ -2324,10 +2694,10 @@ "name" : "R", "type" : "AliasRef" } ] - }, { - "name" : "Suicidal deliberate poisoning", - "type" : "ConceptRef" - } ] + }, + "valueset" : { + "name" : "Suicide Attempt" + } } ] }, { "type" : "InValueSet", @@ -2475,13 +2845,13 @@ "type" : "TupleTypeSpecifier", "element" : [ { "name" : "Start", - "type" : { + "elementType" : { "name" : "{urn:hl7-org:elm-types:r1}String", "type" : "NamedTypeSpecifier" } }, { "name" : "End", - "type" : { + "elementType" : { "name" : "{urn:hl7-org:elm-types:r1}String", "type" : "NamedTypeSpecifier" } @@ -2561,19 +2931,53 @@ "operand" : [ { "type" : "Or", "operand" : [ { - "type" : "InValueSet", - "code" : { - "name" : "NullSafeToConcept", - "libraryName" : "C3F", - "type" : "FunctionRef", + "type" : "Or", + "operand" : [ { + "type" : "Or", "operand" : [ { - "name" : "R", - "type" : "AliasRef" + "type" : "InValueSet", + "code" : { + "name" : "NullSafeToConcept", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Major Depression" + } + }, { + "type" : "InValueSet", + "code" : { + "name" : "NullSafeToConcept", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Depression Diagnosis ICD9" + } } ] - }, - "valueset" : { - "name" : "Major Depression" - } + }, { + "type" : "InValueSet", + "code" : { + "name" : "NullSafeToConcept", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Anxiety" + } + } ] }, { "type" : "InValueSet", "code" : { @@ -2586,7 +2990,7 @@ } ] }, "valueset" : { - "name" : "Anxiety" + "name" : "Anxiety Disorders ICD9" } } ] }, { @@ -2616,12 +3020,12 @@ } ] }, "valueset" : { - "name" : "Suicide attempt" + "name" : "Substance Abuse" } } ] }, { - "type" : "Equivalent", - "operand" : [ { + "type" : "InValueSet", + "code" : { "name" : "NullSafeToConcept", "libraryName" : "C3F", "type" : "FunctionRef", @@ -2629,10 +3033,10 @@ "name" : "R", "type" : "AliasRef" } ] - }, { - "name" : "Suicidal deliberate poisoning", - "type" : "ConceptRef" - } ] + }, + "valueset" : { + "name" : "Suicide Attempt" + } } ] }, { "type" : "InValueSet", @@ -2968,13 +3372,13 @@ "type" : "TupleTypeSpecifier", "element" : [ { "name" : "Start", - "type" : { + "elementType" : { "name" : "{urn:hl7-org:elm-types:r1}String", "type" : "NamedTypeSpecifier" } }, { "name" : "End", - "type" : { + "elementType" : { "name" : "{urn:hl7-org:elm-types:r1}String", "type" : "NamedTypeSpecifier" } @@ -3123,13 +3527,13 @@ "type" : "TupleTypeSpecifier", "element" : [ { "name" : "Start", - "type" : { + "elementType" : { "name" : "{urn:hl7-org:elm-types:r1}String", "type" : "NamedTypeSpecifier" } }, { "name" : "End", - "type" : { + "elementType" : { "name" : "{urn:hl7-org:elm-types:r1}String", "type" : "NamedTypeSpecifier" } @@ -3249,27 +3653,27 @@ "operand" : [ { "type" : "Union", "operand" : [ { - "type" : "Union", - "operand" : [ { - "name" : "ReportConditionRiskFactorsForOpioidRelatedHarms", - "type" : "ExpressionRef" - }, { - "name" : "ReportEncounterRiskFactorsForOpioidRelatedHarms", - "type" : "ExpressionRef" - } ] + "name" : "ReportConditionRiskFactorsForOpioidRelatedHarms", + "type" : "ExpressionRef" }, { + "name" : "ReportEncounterRiskFactorsForOpioidRelatedHarms", + "type" : "ExpressionRef" + } ] + }, { + "type" : "Union", + "operand" : [ { "type" : "ToList", "operand" : { "name" : "ReportOlderThan65", "type" : "ExpressionRef" } + }, { + "type" : "ToList", + "operand" : { + "name" : "ReportMostRecentPositivePregnancyObservation", + "type" : "ExpressionRef" + } } ] - }, { - "type" : "ToList", - "operand" : { - "name" : "ReportMostRecentPositivePregnancyObservation", - "type" : "ExpressionRef" - } } ] } } ], @@ -3470,16 +3874,30 @@ "libraryName" : "C3F", "type" : "FunctionRef", "operand" : [ { - "dataType" : "{http://hl7.org/fhir}Observation", - "codeProperty" : "code", - "type" : "Retrieve", - "codes" : { - "type" : "ToList", - "operand" : { - "name" : "Pain Enjoyment General Activity (PEG) Assessment", - "type" : "ConceptRef" + "type" : "Union", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Observation", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "type" : "ToList", + "operand" : { + "name" : "Mean score [PEG]", + "type" : "ConceptRef" + } } - } + }, { + "dataType" : "{http://hl7.org/fhir}Observation", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "type" : "ToList", + "operand" : { + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY", + "type" : "ConceptRef" + } + } + } ] }, { "value" : 2, "unit" : "years", @@ -3500,7 +3918,157 @@ "type" : "ExpressionRef" } } ], + "let" : [ { + "identifier" : "Pain", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "C", + "expression" : { + "path" : "component", + "scope" : "A", + "type" : "Property" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "Pain severity in the past week - 0-10 numeric rating [Reported]", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "Pain LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + } + }, { + "identifier" : "Enjoyment", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "C", + "expression" : { + "path" : "component", + "scope" : "A", + "type" : "Property" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "What number best describes how pain has interfered with your enjoyment of life during the past week", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "Enjoyment of life LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + } + }, { + "identifier" : "GeneralActivity", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "C", + "expression" : { + "path" : "component", + "scope" : "A", + "type" : "Property" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "What number best describes how pain has interfered with your general activity during the past week", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "General activity LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + } + } ], "relationship" : [ ], + "where" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Boolean", + "value" : "true", + "type" : "Literal" + }, "return" : { "expression" : { "type" : "Tuple", @@ -3555,16 +4123,39 @@ "source" : [ { "alias" : "C", "expression" : { - "name" : "SortPegComponents", - "type" : "FunctionRef", - "operand" : [ { - "path" : "component", - "scope" : "A", - "type" : "Property" + "type" : "List", + "element" : [ { + "type" : "First", + "source" : { + "name" : "Pain", + "type" : "QueryLetRef" + } + }, { + "type" : "First", + "source" : { + "name" : "Enjoyment", + "type" : "QueryLetRef" + } + }, { + "type" : "First", + "source" : { + "name" : "GeneralActivity", + "type" : "QueryLetRef" + } } ] } } ], "relationship" : [ ], + "where" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "C", + "type" : "AliasRef" + } + } + }, "return" : { "expression" : { "type" : "Tuple", @@ -3628,16 +4219,30 @@ "libraryName" : "C3F", "type" : "FunctionRef", "operand" : [ { - "dataType" : "{http://hl7.org/fhir}Observation", - "codeProperty" : "code", - "type" : "Retrieve", - "codes" : { - "type" : "ToList", - "operand" : { - "name" : "STarT Back Screening Tool", - "type" : "ConceptRef" + "type" : "Union", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Observation", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "type" : "ToList", + "operand" : { + "name" : "Total score [STarT Back]", + "type" : "ConceptRef" + } } - } + }, { + "dataType" : "{http://hl7.org/fhir}Observation", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "type" : "ToList", + "operand" : { + "name" : "STarT Back Screening Tool LEGACY", + "type" : "ConceptRef" + } + } + } ] }, { "value" : 2, "unit" : "years", diff --git a/src/cql/r4/CDS_Connect_Commons_for_FHIRv400.cql b/src/cql/r4/CDS_Connect_Commons_for_FHIRv400.cql new file mode 100644 index 000000000..c95f0b51d --- /dev/null +++ b/src/cql/r4/CDS_Connect_Commons_for_FHIRv400.cql @@ -0,0 +1,535 @@ +// CDS Connect Commons for FHIRv400 +// Change log: +// - 1.0.1 +// - Fix logic for ActiveOrRecurring to use equivalence matching (instead of "in" +// which uses equality matching) +// - Add back ...ByConcept functions for backwards compatibility w/ libraries that +// might expect them +library CDS_Connect_Commons_for_FHIRv400 version '1.0.1' + +using FHIR version '4.0.0' + +// Include the FHIRHelpers library for simplifying interacton w/ the FHIR data model +include FHIRHelpers version '4.0.0' called FHIRHelpers + +codesystem "AIVERSTATUS": 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification' +codesystem "AICLINSTATUS": 'http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical' +codesystem "CONDVERSTATUS": 'http://terminology.hl7.org/CodeSystem/condition-ver-status' +codesystem "CONDCLINSTATUS": 'http://terminology.hl7.org/CodeSystem/condition-clinical' +code "AllergyIntolerance Confirmed code": 'confirmed' from "AIVERSTATUS" display 'Confirmed' +code "AllergyIntolerance Active code": 'active' from "AICLINSTATUS" display 'Active' +code "Condition Confirmed code": 'confirmed' from "CONDVERSTATUS" display 'Confirmed' +code "Condition Active code": 'active' from "CONDCLINSTATUS" display 'Active' +code "Condition Recurrence code": 'recurrence' from "CONDCLINSTATUS" display 'Recurrence' +code "Condition Relapse code": 'relapse' from "CONDCLINSTATUS" display 'Relapse' +concept "AllergyIntolerance Confirmed": { "AllergyIntolerance Confirmed code" } display 'Confirmed' +concept "AllergyIntolerance Active": { "AllergyIntolerance Active code" } display 'Active' +concept "Condition Confirmed": { "Condition Confirmed code" } display 'Confirmed' +concept "Condition Active": { "Condition Active code" } display 'Active' +concept "Condition Recurrence": { "Condition Recurrence code" } display 'Recurrence' +concept "Condition Relapse": { "Condition Relapse code" } display 'Relapse' + +// -------------------------------------------------- GENERAL --------------------------------------------------------- + +/** + * Converts a FHIR Period to a CQL Interval. FHIRHelpers provides a function for this, but + * FHIRHelpers provides several overloads of the ToInterval function, and the JavaScript CQL + * Execution Framework apparently does not handle this correctly. Creating uniquely named + * functions here ensures safe execution. + * @param period - a FHIR Period + * @returns {System.Interval} a CQL Interval or null if null was passed in + */ +define function PeriodToInterval(period FHIR.Period): + if period is null then + null + else + Interval[period."start".value, period."end".value] + +/** + * Converts a FHIR Range to a CQL Interval. FHIRHelpers provides a function for this, but + * FHIRHelpers provides several overloads of the ToInterval function, and the JavaScript CQL + * Execution Framework apparently does not handle this correctly. Creating uniquely named + * functions here ensures safe execution. + * @param range - a FHIR Range + * @returns {System.Interval} a CQL Interval or null if null was passed in + */ +define function RangeToInterval(range FHIR.Range): + if range is null then + null + else + Interval[FHIRHelpers.ToQuantity(range.low), FHIRHelpers.ToQuantity(range.high)] + +// -------------------------------------------------- OBSERVATIONS ----------------------------------------------------- + +/** + * Filters Observations by a concept rather than by a ValueSet. In CQL 1.3, this is built into the retrieve, + * but for backwards compatibility, we keep this query where clause as an option. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of Observations matching the concept, or null if null was passed in + */ +define function ObservationsByConcept(Koncept System.Concept): + [Observation] O where FHIRHelpers.ToConcept(O.code) ~ Koncept + +/** + * Observations that are complete and verified. In FHIR R4, there are three statuses that indicate this state: 'final', + * 'corrected', and 'amended'. + * @see http://hl7.org/fhir/R4/valueset-observation-status.html + * @param ObsList - a list of Observations + * @returns {List} a list of verified Observations, or null if null was passed in + */ +define function Verified(ObsList List): + ObsList O where O.status.value in {'final', 'corrected', 'amended'} + +/** + * Observations that have quantity values recorded in the requested unit. + * @param ObsList - a list of Observations + * @param Unit - the unit to require in the Observations quantity value + * @returns {List} a list of Observations with the required unit, or null if null was passed in + */ +define function WithUnit(ObsList List, Unit String): + ObsList O + where (O.value as FHIR.Quantity).unit.value = Unit or (O.value as FHIR.Quantity).code.value = Unit + +/** + * Observations with an effective or issued date in the specified "look back" period. For example, LDL-C Tests in the + * last 6 years. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param ObsList - a list of Observations + * @returns {List} a list of Observations with effective or issued date specified lookback period, or null + * if null was passed in + */ +define function ObservationLookBack(ObsList List, LookBack System.Quantity): + ObsList O + let LookBackInterval: Interval[Now() - LookBack, Now()] + where (O.effective as FHIR.dateTime).value in LookBackInterval + or PeriodToInterval(O.effective as FHIR.Period) overlaps LookBackInterval + or O.issued.value in LookBackInterval + +/** + * The most recent observation. For each Observation, this algorithm will use the Coalesce function, which uses the + * first non-null date value from these fields: effectiveDateTime, effectiveInstant, effectivePeriod.end, + * effectivePeriod.start, issued. The found date will be used to compare Observations and determine the most recent + * one. NOTE: We can't use FindDate because it appears that the execution engine may have problems sorting by the + * result of a function. + * @param ObsList - a list of Observations + * @returns {Observation} the most recent Observation from the list, or null if null was passed in + */ +define function MostRecent(ObsList List): + Last(ObsList O sort by Coalesce( + (effective as FHIR.dateTime).value, + (effective as FHIR.instant).value, + (effective as FHIR.Period)."end".value, + (effective as FHIR.Period)."start".value, + issued.value) + ) + +/** + * Extracts the quantity value from an Observation, returning it as a CQL Quantity + * @param Obs - an observation + * @returns {System.Quantity} the Observation's value as a quantity, or null if there is no quantity value + */ +define function QuantityValue(Obs Observation): + FHIRHelpers.ToQuantity(Obs.value as FHIR.Quantity) + +/** + * Extracts the CodeableConcept value from an Observation, returning it as a CQL Concept + * @param Obs - an observation + * @returns {System.Concept} the Observation's value as a concept, or null if there is no CodeabeConcept value + */ +define function ConceptValue(Obs Observation): + FHIRHelpers.ToConcept(Obs.value as FHIR.CodeableConcept) + +/** + * Finds the first non-null meaningful date that can be associated with this Observation. This will look through the + * following fields in the following order: effectiveDateTime, effectiveInstant, effectivePeriod.end, + * effectivePeriod.start, issued. + * @param Obs - an Observation + * @returns {System.DateTime} the first non-null meaningful date, or null if non is found + */ +define function FindDate(Obs Observation): + Coalesce( + (Obs.effective as FHIR.dateTime).value, + (Obs.effective as FHIR.instant).value, + (Obs.effective as FHIR.Period)."end".value, + (Obs.effective as FHIR.Period)."start".value, + Obs.issued.value + ) + +/** + * The highest observation. + * The value will be used to compare Observations and determine the highest one. + * @param ObsList - a list of Observations + * @returns {System.Quantity} the quantity with the highest value from the list, or null if null was passed in + */ +define function HighestObservation(ObsList List): + Max(ObsList O return FHIRHelpers.ToQuantity(O.value as FHIR.Quantity)) + + +// -------------------------------------------------- CONDITIONS ------------------------------------------------------- + +/** + * Filters Conditions by a concept rather than by a ValueSet. In CQL 1.3, this is built into the retrieve, + * but for backwards compatibility, we keep this query where clause as an option. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of Conditions matching the concept, or null if null was passed in + */ +define function ConditionsByConcept(Koncept System.Concept): + [Condition] C where FHIRHelpers.ToConcept(C.code) ~ Koncept + +/** + * Conditions that are confirmed. In FHIR R4, this is reflected by verificationStatus: 'confirmed'. + * @see http://hl7.org/fhir/R4/valueset-condition-ver-status.html + * @param CondList - a list of Conditions + * @returns {List} a list of confirmed Conditions, or null if null was passed in + */ +define function Confirmed(CondList List): + CondList C where C.verificationStatus ~ "Condition Confirmed" + +/** + * Conditions that are active. In FHIR R4, this is reflected by clinicalStatus: 'active' and the absence of any + * abatement information (i.e., if it abated, it is no longer active). + * TODO: Rename to Active once the execution engine supports overloaded functions. + * @see http://hl7.org/fhir/R4/valueset-condition-clinical.html + * @param CondList - a list of Conditions + * @returns {List} a list of active Conditions, or null if null was passed in + */ +define function ActiveCondition(CondList List): + CondList C + where C.clinicalStatus ~ "Condition Active" + and C.abatement is null + +/** + * Conditions that are active or recurring. In FHIR R4, this is reflected by clinicalStatus: 'active', 'recurrence', or + * 'relapse'. We do not check for null abatement information because it may have dates from when the now recurring + * condition initially went into remission. + * @see http://hl7.org/fhir/R4/valueset-condition-clinical.html + * @param CondList - a list of Conditions + * @returns {List} a list of active or recurring Conditions, or null if null was passed in + */ +define function ActiveOrRecurring(CondList List): + CondList C + where C.clinicalStatus ~ "Condition Active" + or C.clinicalStatus ~ "Condition Recurrence" + or C.clinicalStatus ~ "Condition Relapse" + +/** + * Conditions with an onset or recorded date in the specified "look back" period. For example, pregnancy in + * the last 42 weeks. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param CondList - a list of Conditions + * @returns {List} a list of Conditions with onset or recorded date specified lookback period, or null + * if null was passed in + */ +define function ConditionLookBack(CondList List, LookBack System.Quantity): + CondList C + let LookBackInterval: Interval[Now() - LookBack, Now()] + where (C.onset as FHIR.dateTime).value in LookBackInterval + or PeriodToInterval(C.onset as FHIR.Period) overlaps LookBackInterval + or C.recordedDate.value in LookBackInterval + +/** + * The most recent condition. For each Condition, this algorithm will use the Coalesce function, which uses the + * first non-null result from these fields: onsetDateTime, onsetPeriod.end, onsetPeriod.start, assertedDate. + * The found date will be used to compare Conditions and determine the most recent one. + * @param CondList - a list of Conditions + * @returns {Condition} the most recent Condition from the list, or null if null was passed in + */ +define function MostRecentCondition(CondList List): + Last(CondList C sort by Coalesce( + (onset as FHIR.dateTime).value, + (onset as FHIR.Period)."end".value, + (onset as FHIR.Period)."start".value, + recordedDate.value) + ) + + // -------------------------------------------------- PROCEDURES ------------------------------------------------------ + + /** + * Filters Procedures by a concept rather than by a ValueSet. In CQL 1.3, this is built into the retrieve, + * but for backwards compatibility, we keep this query where clause as an option. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of Procedures matching the concept, or null if null was passed in + */ + define function ProceduresByConcept(Koncept System.Concept): + [Procedure] P where FHIRHelpers.ToConcept(P.code) ~ Koncept + +/** + * Procedures that are completed. In FHIR R4, this is reflected by status: 'completed'. + * @see http://hl7.org/fhir/R4/valueset-event-status.html + * @param ProcList - a list of Procedures + * @returns {List} a list of completed Procedures, or null if null was passed in + */ +define function Completed(ProcList List): + ProcList P + where P.status.value = 'completed' + +/** + * Procedures that are in progress. In FHIR R4, this is reflected by status: 'in-progress'. + * @see http://hl7.org/fhir/R4/valueset-event-status.html + * @param ProcList - a list of Procedures + * @returns {List} a list of completed Procedures, or null if null was passed in + */ +define function ProcedureInProgress(ProcList List): + ProcList P + where P.status.value = 'in-progress' + +/** + * Procedures that actually happened or are happening. In FHIR R4, there are a few properties that negate the + * procedure, most notably when status is 'preparation', 'not-done', 'entered-in-error', or 'unknown'. + * @see http://hl7.org/fhir/R4/valueset-event-status.html + * @param ProcList - a list of Procedures + * @returns {List} a list of Procedures that actually happened or are happening, or null if null was passed in + */ +define function ProcedurePerformance(ProcList List): + ProcList P + where not (P.status.value in {'preparation', 'not-done', 'entered-in-error', 'unknown'}) + +/** + * Procedures performed in the specified "look back" period. For example, PCIs performed in the + * past 2 weeks. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param ProcList - a list of Procedures + * @param LookBack - the lookback period for when the procedure was performed + * @returns {List} a list of Procedures performed in the look back period, or null if null + * was passed in + */ +define function ProcedureLookBack(ProcList List, LookBack System.Quantity): + ProcList P + let LookBackInterval: Interval[Now() - LookBack, Now()] + where (P.performed as FHIR.dateTime).value in LookBackInterval + or PeriodToInterval(P.performed as FHIR.Period) overlaps LookBackInterval + +/** + * The most recent procedure. For each Procedure, this algorithm will use the Coalesce function, which returns the + * first non-null result from these fields: performedDateTime, performedPeriod.end, performedPeriod.start. + * The found date will be used to compare Procedures and determine the most recent one. + * @param ProcList - a list of Procedures + * @returns {Procedure} the most recent Procedure from the list, or null if null was passed in + */ +define function MostRecentProcedure(ProcList List): + Last(ProcList P sort by Coalesce( + (performed as FHIR.dateTime).value, + (performed as FHIR.Period)."end".value, + (performed as FHIR.Period)."start".value) + ) + +// ----------------------------------------------- SERVICEREQUESTS ----------------------------------------------------- + +// NOTE: In FHIR R4, ProcedureRequest and ReferralRequest are replaced by ServiceRequest + +/** + * ServiceRequests that are active or completed. In FHIR R4, this is reflected by the corresponding + * status values. + * @see http://hl7.org/fhir/R4/valueset-request-status.html + * @param ServiceRequestList - a list of ServiceRequests + * @returns {List} a list of accepted, in-progress, or completed ProcedureRequests, + * or null if null was passed in + */ +define function ServiceRequestActiveOrCompleted(ServiceRequestList List): + ServiceRequestList S + where S.status.value in List{'active', 'completed'} + +/** + * ServiceRequests ordered in the specified "look back" period. For example, PCIs ordered in the + * past 2 weeks. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param ServiceRequestList - a list of ServiceRequests + * @param LookBack - the lookback period for when the service was ordered + * @returns {List} a list of ServiceRequests ordered in the look back period, or null if null + * was passed in + */ +define function ServiceRequestLookBack(ServiceRequestList List, LookBack System.Quantity): + ServiceRequestList S + where S.authoredOn.value in Interval[Now() - LookBack, Now()] + +// -------------------------------------------------- MEDICATIONS ------------------------------------------------------ + +/** + * Filters MedicationStatements by a concept rather than by a ValueSet. In CQL 1.3, this is built into the retrieve, + * but for backwards compatibility, we keep this query where clause as an option. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of MedicationStatement matching the concept, or null if null was passed in + */ +define function MedicationStatementsByConcept(Koncept System.Concept): + [MedicationStatement] M where FHIRHelpers.ToConcept(M.medication as FHIR.CodeableConcept) ~ Koncept + +/** + * Filters MedicationRequests by a concept rather than by a ValueSet. In CQL 1.3, this is built into the retrieve, + * but for backwards compatibility, we keep this query where clause as an option. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of MedicationRequests matching the concept, or null if null was passed in + */ +define function MedicationRequestsByConcept(Koncept System.Concept): + [MedicationRequest] M where FHIRHelpers.ToConcept(M.medication as FHIR.CodeableConcept) ~ Koncept + +/** + * Medications that are active, according to a statement, but not necessarily verified via a prescription. For example, + * medications that a patient has self-reported to be taking. This may, however, also represent medications that are + * expected to be active after providing a prescription (e.g., clinician-reported). In FHIR R4, this is reflected by + * MedicationStatement with status 'active' and no end date or an end date in the future. + * TODO: Rename to Active once the execution engine supports overloaded functions. + * @see http://hl7.org/fhir/R4/valueset-medication-statement-status.html + * @param MedList - a list of MedicationStatements + * @returns {List} a list of active medication statements, or null if null was passed in + */ +define function ActiveMedicationStatement(MedList List): + MedList M + let EffectivePeriod: PeriodToInterval(M.effective as FHIR.Period) + where M.status.value = 'active' + and (end of EffectivePeriod is null or end of EffectivePeriod after Now()) + +/** +* Medication requests that are active. In FHIR R4, this is reflected by MedicationRequest with status 'active'. +* Note that in R4, the MedicationRequest Boundaries and Relationships now says: "When reporting on the usage of +* a medication by a patient, the MedicationStatement resource should be used." It also indicates that: +* "A medication statement is not a part of the prescribe->dispense->administer sequence but is a report that +* such a sequence (or at least a part of it) did take place resulting in a belief that the patient has received +* a particular medication." In this regard, MedicationStatement is more appropriate as an indication of an actually +* active medication, although it's not clear if vendors really will automatically create MedicationStatements in +* these cases or not. Until we know, MedicationRequest may be the best proxy we have for an active medication. +* TODO: Should the "intent" field be considered (e.g., is it still active if intent is "proposal" or "plan")? +* TODO: Rename to Active once the execution engine supports overloaded functions. +* @see http://hl7.org/fhir/R4/valueset-medicationrequest-status.html +* @param MedList - a list of MedicationRequests +* @returns {List} a list of active medication requests, or null if null was passed in +*/ +define function ActiveMedicationRequest(MedList List): + MedList M where M.status.value = 'active' + +/** +* Medication requests that are active or completed, according to a prescription. In FHIR R4, this is reflected by MedicationRequest +* with status 'active' or 'completed'. See the note above (in ActiveMedicationRequest) for more nuance regarding MedicationRequest +* vs. MedicationStatement. +* @see http://hl7.org/fhir/R4/valueset-medicationrequest-status.html +* @param MedList - a list of MedicationRequests +* @returns {List} a list of active medication requests, or null if null was passed in +*/ +define function ActiveOrCompletedMedicationRequest(MedList List): + MedList M + where M.status.value = 'active' + or M.status.value = 'completed' + +/** + * Medications that are active or completed, according to a statement, but not necessarily verified via a prescription. + * For example, medications that a patient has self-reported to be taking. This may, however, also represent + * medications that are expected to be active after providing a prescription (e.g., clinician-reported). In FHIR R4, + * this is reflected by MedicationStatement with status 'active' or 'completed'. + * TODO: Rename to ActiveOrCompleted once the execution engine supports overloaded functions. + * @see http://hl7.org/fhir/R4/valueset-medication-statement-status.html + * @param MedList - a list of MedicationStatements + * @returns {List} a list of active or completed medication statements, or null if null was passed + * in + */ +define function ActiveOrCompletedMedicationStatement(MedList List): + MedList M + where M.status.value = 'active' + or M.status.value = 'completed' + +/** +* Medication requests that are active, completed, or stopped, according to a prescription. In FHIR R4, this is +* reflected by MedicationRequest with status 'active', 'completed', or 'stopped'. See the note above +* (in ActiveMedicationRequest) for more nuance regarding MedicationRequest vs. MedicationStatement. +* @see http://hl7.org/fhir/R4/valueset-medicationrequest-status.html +* @param MedList - a list of MedicationOrders +* @returns {List} a list of active medication requests, or null if null was passed in +*/ +define function ActiveCompletedOrStoppedMedicationRequest(MedList List): + MedList M + where M.status.value = 'active' + or M.status.value = 'completed' + or M.status.value = 'stopped' + +/** +* Medication requests that are issued in the specified "look back" period. +* TODO: Rename to LookBack once the execution engine supports overloaded functions. +* @param MedList - a list of Medications +* @param LookBack - the lookback period for when the medication was prescribed +* @returns {List} a list of Medications prescribed in the look back period, or null if null +* was passed in +*/ +define function MedicationRequestLookBack(MedList List, LookBack System.Quantity): + MedList M + let LookBackInterval: Interval[Now() - LookBack, Now()] + where M.authoredOn.value in LookBackInterval + // DSTU2 also checked the dateEnded property of MedicationOrder, but this doesn't exist for MedicationRequest + +/** +* Medication Statements that are issued in the specified "look back" period. +* TODO: Rename to LookBack once the execution engine supports overloaded functions. +* @param MedList - a list of Medications +* @param LookBack - the lookback period for when the medication was prescribed +* @returns {List} a list of Medications prescribed in the look back period, or null if null +* was passed in +*/ +define function MedicationStatementLookBack(MedList List, LookBack System.Quantity): + MedList M + let LookBackInterval: Interval[Now() - LookBack, Now()] + where (M.effective as FHIR.dateTime).value in LookBackInterval + or PeriodToInterval(M.effective as FHIR.Period) overlaps LookBackInterval + +// -------------------------------------------------- ENCOUNTERS ------------------------------------------------------ + +/** + * Filters Encounters by a concept rather than by a ValueSet. In CQL 1.3, this is built into the retrieve, + * but for backwards compatibility, we keep this query where clause as an option. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of Encounters matching the concept, or null if null was passed in + */ +define function EncountersByConcept(Koncept System.Concept): + [Encounter] E where exists( (E.type) ET where FHIRHelpers.ToConcept(ET) ~ Koncept ) + +/** + * Encounters that are in progress. In FHIR R4, this is reflected by status: 'in-progress'. + * @see http://hl7.org/fhir/R4/valueset-encounter-status.html + * @param EncList - a list of Encounters + * @returns {List} a list of in progress encounters, or null if null was passed in + */ +define function InProgress(EncList List): + EncList E + where E.status.value = 'in-progress' + +// -------------------------------------------------- ALLERGY INTOLERANCES ------------------------------------------------------ + +/** + * Filters AllergyIntolerances by a concept rather than by a ValueSet. In CQL 1.3, this is built into the retrieve, + * but for backwards compatibility, we keep this query where clause as an option. + * @param Koncept - the concept to filter on (intentionally mispelled to avoid naming clashes) + * @returns {List} a list of Allergy Intolerances matching the concept, or null if null was passed in + */ +define function AllergyIntolerancesByConcept(Koncept System.Concept): + [AllergyIntolerance] A where FHIRHelpers.ToConcept(A.code) ~ Koncept + +/** +* AllergyIntolerances that are active or confirmed. In FHIR STU3, this is reflected by AllergyIntolerance +* with clinicalStatus 'active' or verificationStatus 'confirmed' +* @see https://www.hl7.org/fhir/R4/valueset-allergy-clinical-status.html +* @see https://www.hl7.org/fhir/R4/valueset-allergy-verification-status.html +* @param AllergyIntolList - a list of AllergyIntolerances +* @returns {List} a list of active or confirmed allergy intolerances, or null if null was passed in +*/ +define function ActiveOrConfirmedAllergyIntolerance(AllergyIntolList List): + AllergyIntolList A + where A.clinicalStatus ~ "AllergyIntolerance Active" + or A.verificationStatus ~ "AllergyIntolerance Confirmed" + +// -------------------------------------------------------- GOALS ------------------------------------------------------ + +/** + * Goals with a start, target, or status date in the specified "look back" period. For example, Pain Management Goals + * in the last 2 years. + * TODO: Rename to LookBack once the execution engine supports overloaded functions. + * @param GoalList - a list of Goals + * @returns {List} a list of Goals with a start, target, or status date in the specified lookback period, or null + * if null was passed in + */ +define function GoalLookBack(GoalList List, LookBack System.Quantity): + GoalList G + let LookBackInterval: Interval[Now() - LookBack, Now()], + StartDate: (G.start as FHIR.date).value, + StatusDate: G.statusDate.value, + TargetDates: (G.target) T return (T.due as FHIR.date).value, + TargetQuantities: (G.target) T return FHIRHelpers.ToQuantity(T.due as FHIR.Duration) + where StartDate in LookBackInterval + or StatusDate in LookBackInterval + or exists(TargetDates TD where TD in LookBackInterval) + or exists(TargetQuantities TQ where (StartDate + TQ) in LookBackInterval) diff --git a/src/cql/r4/CDS_Connect_Commons_for_FHIRv400.json b/src/cql/r4/CDS_Connect_Commons_for_FHIRv400.json index abd815bd8..6caeebe07 100644 --- a/src/cql/r4/CDS_Connect_Commons_for_FHIRv400.json +++ b/src/cql/r4/CDS_Connect_Commons_for_FHIRv400.json @@ -2,7 +2,7 @@ "library" : { "identifier" : { "id" : "CDS_Connect_Commons_for_FHIRv400", - "version" : "1.0.0" + "version" : "1.0.1" }, "schemaIdentifier" : { "id" : "urn:hl7-org:elm", @@ -279,6 +279,45 @@ "type" : "NamedTypeSpecifier" } } ] + }, { + "name" : "ObservationsByConcept", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "O", + "expression" : { + "dataType" : "{http://hl7.org/fhir}Observation", + "type" : "Retrieve" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "O", + "type" : "Property" + } ] + }, { + "name" : "Koncept", + "type" : "OperandRef" + } ] + } + }, + "operand" : [ { + "name" : "Koncept", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "NamedTypeSpecifier" + } + } ] }, { "name" : "Verified", "context" : "Patient", @@ -877,6 +916,45 @@ } } } ] + }, { + "name" : "ConditionsByConcept", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "C", + "expression" : { + "dataType" : "{http://hl7.org/fhir}Condition", + "type" : "Retrieve" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "Koncept", + "type" : "OperandRef" + } ] + } + }, + "operand" : [ { + "name" : "Koncept", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "NamedTypeSpecifier" + } + } ] }, { "name" : "Confirmed", "context" : "Patient", @@ -987,24 +1065,51 @@ } ], "relationship" : [ ], "where" : { - "type" : "In", + "type" : "Or", "operand" : [ { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", + "type" : "Or", "operand" : [ { - "path" : "clinicalStatus", - "scope" : "C", - "type" : "Property" + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "clinicalStatus", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "Condition Active", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "clinicalStatus", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "Condition Recurrence", + "type" : "ConceptRef" + } ] } ] }, { - "type" : "List", - "element" : [ { - "name" : "Condition Active", - "type" : "ConceptRef" - }, { - "name" : "Condition Recurrence", - "type" : "ConceptRef" + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "clinicalStatus", + "scope" : "C", + "type" : "Property" + } ] }, { "name" : "Condition Relapse", "type" : "ConceptRef" @@ -1238,6 +1343,45 @@ } } } ] + }, { + "name" : "ProceduresByConcept", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "P", + "expression" : { + "dataType" : "{http://hl7.org/fhir}Procedure", + "type" : "Retrieve" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "P", + "type" : "Property" + } ] + }, { + "name" : "Koncept", + "type" : "OperandRef" + } ] + } + }, + "operand" : [ { + "name" : "Koncept", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "NamedTypeSpecifier" + } + } ] }, { "name" : "Completed", "context" : "Patient", @@ -1683,6 +1827,100 @@ "type" : "NamedTypeSpecifier" } } ] + }, { + "name" : "MedicationStatementsByConcept", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "M", + "expression" : { + "dataType" : "{http://hl7.org/fhir}MedicationStatement", + "type" : "Retrieve" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "strict" : false, + "type" : "As", + "operand" : { + "path" : "medication", + "scope" : "M", + "type" : "Property" + }, + "asTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}CodeableConcept", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "Koncept", + "type" : "OperandRef" + } ] + } + }, + "operand" : [ { + "name" : "Koncept", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "MedicationRequestsByConcept", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "M", + "expression" : { + "dataType" : "{http://hl7.org/fhir}MedicationRequest", + "type" : "Retrieve" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "strict" : false, + "type" : "As", + "operand" : { + "path" : "medication", + "scope" : "M", + "type" : "Property" + }, + "asTypeSpecifier" : { + "name" : "{http://hl7.org/fhir}CodeableConcept", + "type" : "NamedTypeSpecifier" + } + } ] + }, { + "name" : "Koncept", + "type" : "OperandRef" + } ] + } + }, + "operand" : [ { + "name" : "Koncept", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "NamedTypeSpecifier" + } + } ] }, { "name" : "ActiveMedicationStatement", "context" : "Patient", @@ -2178,6 +2416,59 @@ "type" : "NamedTypeSpecifier" } } ] + }, { + "name" : "EncountersByConcept", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "E", + "expression" : { + "dataType" : "{http://hl7.org/fhir}Encounter", + "type" : "Retrieve" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Exists", + "operand" : { + "type" : "Query", + "source" : [ { + "alias" : "ET", + "expression" : { + "path" : "type", + "scope" : "E", + "type" : "Property" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "ET", + "type" : "AliasRef" + } ] + }, { + "name" : "Koncept", + "type" : "OperandRef" + } ] + } + } + } + }, + "operand" : [ { + "name" : "Koncept", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "NamedTypeSpecifier" + } + } ] }, { "name" : "InProgress", "context" : "Patient", @@ -2220,6 +2511,45 @@ } } } ] + }, { + "name" : "AllergyIntolerancesByConcept", + "context" : "Patient", + "accessLevel" : "Public", + "type" : "FunctionDef", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "A", + "expression" : { + "dataType" : "{http://hl7.org/fhir}AllergyIntolerance", + "type" : "Retrieve" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "A", + "type" : "Property" + } ] + }, { + "name" : "Koncept", + "type" : "OperandRef" + } ] + } + }, + "operand" : [ { + "name" : "Koncept", + "operandTypeSpecifier" : { + "name" : "{urn:hl7-org:elm-types:r1}Concept", + "type" : "NamedTypeSpecifier" + } + } ] }, { "name" : "ActiveOrConfirmedAllergyIntolerance", "context" : "Patient", diff --git a/src/cql/r4/FHIRHelpers.cql b/src/cql/r4/FHIRHelpers.cql new file mode 100644 index 000000000..52efa58f0 --- /dev/null +++ b/src/cql/r4/FHIRHelpers.cql @@ -0,0 +1,269 @@ +library FHIRHelpers version '4.0.0' + +using FHIR version '4.0.0' + +define function ToInterval(period FHIR.Period): + if period is null then + null + else + Interval[period."start".value, period."end".value] + +define function ToQuantity(quantity FHIR.Quantity): + if quantity is null then + null + else + System.Quantity { value: quantity.value.value, unit: quantity.unit.value } + +define function ToInterval(range FHIR.Range): + if range is null then + null + else + Interval[ToQuantity(range.low), ToQuantity(range.high)] + +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 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 ToString(value FHIR.uuid): value.value +define function ToString(value FHIR.TestScriptRequestMethodCode): value.value +define function ToString(value FHIR.SortDirection): value.value +define function ToString(value FHIR.BiologicallyDerivedProductStatus): value.value +define function ToString(value FHIR.UnitsOfTime): value.value +define function ToString(value FHIR.AddressType): value.value +define function ToString(value FHIR.AllergyIntoleranceCategory): value.value +define function ToString(value FHIR.IssueSeverity): value.value +define function ToString(value FHIR.CareTeamStatus): value.value +define function ToString(value FHIR.EncounterStatus): value.value +define function ToString(value FHIR.StructureDefinitionKind): value.value +define function ToString(value FHIR.PublicationStatus): value.value +define function ToString(value FHIR.FHIRVersion): value.value +define function ToString(value FHIR.CarePlanActivityKind): value.value +define function ToString(value FHIR.StructureMapSourceListMode): value.value +define function ToString(value FHIR.RequestStatus): value.value +define function ToString(value FHIR.strandType): value.value +define function ToString(value FHIR.QuestionnaireResponseStatus): value.value +define function ToString(value FHIR.SearchComparator): value.value +define function ToString(value FHIR.ChargeItemStatus): value.value +define function ToString(value FHIR.ActionParticipantType): value.value +define function ToString(value FHIR.AllergyIntoleranceType): value.value +define function ToString(value FHIR.CarePlanActivityStatus): value.value +define function ToString(value FHIR.InvoiceStatus): value.value +define function ToString(value FHIR.ClaimProcessingCodes): value.value +define function ToString(value FHIR.RequestResourceType): value.value +define function ToString(value FHIR.ParticipationStatus): value.value +define function ToString(value FHIR.DeviceNameType): value.value +define function ToString(value FHIR.DocumentMode): value.value +define function ToString(value FHIR.AssertionOperatorType): value.value +define function ToString(value FHIR.DaysOfWeek): value.value +define function ToString(value FHIR.IssueType): value.value +define function ToString(value FHIR.canonical): value.value +define function ToString(value FHIR.StructureMapContextType): value.value +define function ToString(value FHIR.FamilyHistoryStatus): value.value +define function ToString(value FHIR.status): value.value +define function ToString(value FHIR.ExtensionContextType): value.value +define function ToString(value FHIR.AssertionResponseTypes): value.value +define function ToString(value FHIR.RequestIntent): value.value +define function ToString(value FHIR.string): value.value +define function ToString(value FHIR.ActionRequiredBehavior): value.value +define function ToString(value FHIR.GraphCompartmentUse): value.value +define function ToString(value FHIR.orientationType): value.value +define function ToString(value FHIR.AccountStatus): value.value +define function ToString(value FHIR.IdentifierUse): value.value +define function ToString(value FHIR.StructureMapTargetListMode): value.value +define function ToString(value FHIR.ExposureState): value.value +define function ToString(value FHIR.TestReportParticipantType): value.value +define function ToString(value FHIR.BindingStrength): value.value +define function ToString(value FHIR.RequestPriority): value.value +define function ToString(value FHIR.ParticipantRequired): value.value +define function ToString(value FHIR.XPathUsageType): value.value +define function ToString(value FHIR.id): value.value +define function ToString(value FHIR.FilterOperator): value.value +define function ToString(value FHIR.NamingSystemType): value.value +define function ToString(value FHIR.ContractResourceStatusCodes): value.value +define function ToString(value FHIR.ResearchSubjectStatus): value.value +define function ToString(value FHIR.StructureMapTransform): value.value +define function ToString(value FHIR.ResponseType): value.value +define function ToDecimal(value FHIR.decimal): value.value +define function ToString(value FHIR.AggregationMode): value.value +define function ToString(value FHIR.sequenceType): value.value +define function ToString(value FHIR.SystemRestfulInteraction): value.value +define function ToString(value FHIR.AdverseEventActuality): value.value +define function ToString(value FHIR.SubscriptionChannelType): value.value +define function ToString(value FHIR.AssertionDirectionType): value.value +define function ToString(value FHIR.CarePlanIntent): value.value +define function ToString(value FHIR.AllergyIntoleranceCriticality): value.value +define function ToString(value FHIR.PropertyRepresentation): value.value +define function ToString(value FHIR.TriggerType): value.value +define function ToString(value FHIR.CompositionStatus): value.value +define function ToString(value FHIR.AppointmentStatus): value.value +define function ToString(value FHIR.MessageSignificanceCategory): value.value +define function ToString(value FHIR.ListMode): value.value +define function ToString(value FHIR.ResearchElementType): value.value +define function ToString(value FHIR.ObservationStatus): value.value +define function ToString(value FHIR.ResourceType): value.value +define function ToBoolean(value FHIR.boolean): value.value +define function ToString(value FHIR.StructureMapGroupTypeMode): value.value +define function ToString(value FHIR.SupplyRequestStatus): value.value +define function ToString(value FHIR.EncounterLocationStatus): value.value +define function ToString(value FHIR.ConditionalDeleteStatus): value.value +define function ToString(value FHIR.url): value.value +define function ToString(value FHIR.uri): value.value +define function ToString(value FHIR.Use): value.value +define function ToString(value FHIR.MedicationRequestStatus): value.value +define function ToString(value FHIR.IdentityAssuranceLevel): value.value +define function ToString(value FHIR.DeviceMetricColor): value.value +define function ToTime(value FHIR.time): value.value +define function ToString(value FHIR.ConditionalReadStatus): value.value +define function ToString(value FHIR.AllergyIntoleranceSeverity): value.value +define function ToString(value FHIR.FinancialResourceStatusCodes): value.value +define function ToString(value FHIR.OperationKind): value.value +define function ToString(value FHIR.SubscriptionStatus): value.value +define function ToString(value FHIR.GoalLifecycleStatus): value.value +define function ToString(value FHIR.ObservationDataType): value.value +define function ToString(value FHIR.DocumentReferenceStatus): value.value +define function ToString(value FHIR.repositoryType): value.value +define function ToString(value FHIR.LocationStatus): value.value +define function ToString(value FHIR.NoteType): value.value +define function ToString(value FHIR.TestReportStatus): value.value +define function ToString(value FHIR.CodeSystemContentMode): value.value +define function ToString(value FHIR.FHIRDeviceStatus): value.value +define function ToString(value FHIR.ContactPointSystem): value.value +define function ToString(value FHIR.SlotStatus): value.value +define function ToString(value FHIR.PropertyType): value.value +define function ToString(value FHIR.TypeDerivationRule): value.value +define function ToString(value FHIR.GuidanceResponseStatus): value.value +define function ToString(value FHIR.RelatedArtifactType): value.value +define function ToString(value FHIR.oid): value.value +define function ToString(value FHIR.CompartmentType): value.value +define function ToString(value FHIR.MedicationRequestIntent): value.value +define function ToString(value FHIR.InvoicePriceComponentType): value.value +define function ToString(value FHIR.DeviceMetricCalibrationState): value.value +define function ToString(value FHIR.GroupType): value.value +define function ToString(value FHIR.EnableWhenBehavior): value.value +define function ToString(value FHIR.TaskIntent): value.value +define function ToString(value FHIR.ImmunizationEvaluationStatusCodes): value.value +define function ToString(value FHIR.ExampleScenarioActorType): value.value +define function ToString(value FHIR.ProvenanceEntityRole): value.value +define function ToString(value FHIR.SpecimenStatus): value.value +define function ToString(value FHIR.RestfulCapabilityMode): value.value +define function ToString(value FHIR.DetectedIssueSeverity): value.value +define function ToString(value FHIR.VisionEyes): value.value +define function ToString(value FHIR.ConsentDataMeaning): value.value +define function ToString(value FHIR.messageheaderResponseRequest): value.value +define function ToString(value FHIR.GuidePageGeneration): value.value +define function ToString(value FHIR.DocumentRelationshipType): value.value +define function ToString(value FHIR.VariableType): value.value +define function ToString(value FHIR.TestReportResult): value.value +define function ToString(value FHIR.ConceptMapGroupUnmappedMode): value.value +define function ToDateTime(value FHIR.instant): value.value +define function ToDateTime(value FHIR.dateTime): value.value +define function ToDate(value FHIR.date): value.value +define function ToInteger(value FHIR.positiveInt): value.value +define function ToString(value FHIR.ClinicalImpressionStatus): value.value +define function ToString(value FHIR.EligibilityResponsePurpose): value.value +define function ToString(value FHIR.NarrativeStatus): value.value +define function ToString(value FHIR.ImagingStudyStatus): value.value +define function ToString(value FHIR.EndpointStatus): value.value +define function ToString(value FHIR.BiologicallyDerivedProductCategory): value.value +define function ToString(value FHIR.ResourceVersionPolicy): value.value +define function ToString(value FHIR.ActionCardinalityBehavior): value.value +define function ToString(value FHIR.GroupMeasure): value.value +define function ToString(value FHIR.NamingSystemIdentifierType): value.value +define function ToString(value FHIR.ImmunizationStatusCodes): value.value +define function ToString(value FHIR.MedicationStatusCodes): value.value +define function ToString(value FHIR.DiscriminatorType): value.value +define function ToString(value FHIR.StructureMapInputMode): value.value +define function ToString(value FHIR.LinkageType): value.value +define function ToString(value FHIR.ReferenceHandlingPolicy): value.value +define function ToString(value FHIR.ResearchStudyStatus): value.value +define function ToString(value FHIR.AuditEventOutcome): value.value +define function ToString(value FHIR.SpecimenContainedPreference): value.value +define function ToString(value FHIR.ActionRelationshipType): value.value +define function ToString(value FHIR.ConstraintSeverity): value.value +define function ToString(value FHIR.EventCapabilityMode): value.value +define function ToString(value FHIR.CodeSearchSupport): value.value +define function ToString(value FHIR.ObservationRangeCategory): value.value +define function ToString(value FHIR.UDIEntryType): value.value +define function ToString(value FHIR.DeviceMetricCategory): value.value +define function ToString(value FHIR.TestReportActionResult): value.value +define function ToString(value FHIR.CapabilityStatementKind): value.value +define function ToString(value FHIR.EventTiming): value.value +define function ToString(value FHIR.SearchParamType): value.value +define function ToString(value FHIR.ActionGroupingBehavior): value.value +define function ToString(value FHIR.StructureMapModelMode): value.value +define function ToString(value FHIR.TaskStatus): value.value +define function ToString(value FHIR.BiologicallyDerivedProductStorageScale): value.value +define function ToString(value FHIR.GraphCompartmentRule): value.value +define function ToString(value FHIR.SlicingRules): value.value +define function ToString(value FHIR.ExplanationOfBenefitStatus): value.value +define function ToString(value FHIR.GuideParameterCode): value.value +define function ToString(value FHIR.CatalogEntryRelationType): value.value +define function ToString(value FHIR.LinkType): value.value +define function ToString(value FHIR.ConceptMapEquivalence): value.value +define function ToString(value FHIR.AuditEventAction): value.value +define function ToString(value FHIR.SearchModifierCode): value.value +define function ToString(value FHIR.EventStatus): value.value +define function ToString(value FHIR.OperationParameterUse): value.value +define function ToString(value FHIR.ConsentProvisionType): value.value +define function ToString(value FHIR.ActionConditionKind): value.value +define function ToString(value FHIR.qualityType): value.value +define function ToString(value FHIR.AdministrativeGender): value.value +define function ToString(value FHIR.QuestionnaireItemType): value.value +define function ToString(value FHIR.DeviceMetricCalibrationType): value.value +define function ToString(value FHIR.EvidenceVariableType): value.value +define function ToString(value FHIR.code): value.value +define function ToString(value FHIR.ActionSelectionBehavior): value.value +define function ToString(value FHIR.SupplyDeliveryStatus): value.value +define function ToString(value FHIR.DiagnosticReportStatus): value.value +define function ToString(value FHIR.FlagStatus): value.value +define function ToString(value FHIR.SPDXLicense): value.value +define function ToString(value FHIR.ListStatus): value.value +define function ToString(value FHIR.base64Binary): value.value +define function ToString(value FHIR.DeviceUseStatementStatus): value.value +define function ToString(value FHIR.AuditEventAgentNetworkType): value.value +define function ToString(value FHIR.ExpressionLanguage): value.value +define function ToString(value FHIR.AddressUse): value.value +define function ToString(value FHIR.ContactPointUse): value.value +define function ToString(value FHIR.DeviceMetricOperationalStatus): value.value +define function ToString(value FHIR.ContributorType): value.value +define function ToString(value FHIR.ReferenceVersionRules): value.value +define function ToString(value FHIR.MeasureReportStatus): value.value +define function ToString(value FHIR.SearchEntryMode): value.value +define function ToInteger(value FHIR.unsignedInt): value.value +define function ToString(value FHIR.NameUse): value.value +define function ToString(value FHIR.LocationMode): value.value +define function ToInteger(value FHIR.integer): value.value +define function ToString(value FHIR.FHIRSubstanceStatus): value.value +define function ToString(value FHIR.QuestionnaireItemOperator): value.value +define function ToString(value FHIR.HTTPVerb): value.value +define function ToString(value FHIR.EpisodeOfCareStatus): value.value +define function ToString(value FHIR.RemittanceOutcome): value.value +define function ToString(value FHIR.markdown): value.value +define function ToString(value FHIR.EligibilityRequestPurpose): value.value +define function ToString(value FHIR.QuantityComparator): value.value +define function ToString(value FHIR.MeasureReportType): value.value +define function ToString(value FHIR.ActionPrecheckBehavior): value.value +define function ToString(value FHIR.SampledDataDataType): value.value +define function ToString(value FHIR.CompositionAttestationMode): value.value +define function ToString(value FHIR.TypeRestfulInteraction): value.value +define function ToString(value FHIR.CodeSystemHierarchyMeaning): value.value +define function ToString(value FHIR.vConfidentialityClassification): value.value +define function ToString(value FHIR.ContractResourcePublicationStatusCodes): value.value +define function ToString(value FHIR.VisionBase): value.value +define function ToString(value FHIR.BundleType): value.value diff --git a/src/cql/r4/Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400.cql b/src/cql/r4/Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400.cql new file mode 100644 index 000000000..d25c13af7 --- /dev/null +++ b/src/cql/r4/Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400.cql @@ -0,0 +1,1094 @@ +// # Introduction + +// The Pain Management Summary artifact provides relevant information to consider when managing a patient’s pain. +// This CDS logic was informed by the Centers for Disease Control and Prevention (CDC) Guideline for Opioid Prescribing +// for Chronic Pain. The CDS is not a direct representation of any one recommendation statement within the guideline. +// Instead, the CDS compiles clinical concepts mentioned throughout the guideline in one consolidated summary for +// clinician review. +// +// In the process of authoring the logic, certain assumptions were made and details developed when the guideline did +// not provide enough specificity. These decisions were made in the context of the CDS Connect Workgroup and CDC +// stakeholders, and are documented in the logic and/or in the CDS Connect artifact metadata. +// +// NOTE: This is a FHIR R4 port of the original FHIR DSTU2 CQL piloted for CDS Connect. In addition to the changes +// to support FHIR R4, it contains the following additional changes from the artifact that was piloted: +// - Added the following value sets for identifying Risk Factors for Opiod-Related Harms (in addition to existing ones) +// - Depression Diagnosis ICD9 (2.16.840.1.113883.3.600.143) +// - Anxiety Disorders ICD9 (2.16.840.1.113883.3.1240.2017.3.2.1015) +// - Substance Abuse (2.16.840.1.113883.3.464.1003.106.11.1010) +// - Pregnancy (New ICD10 codes published in 2018 and 2019)": '2.16.840.1.113762.1.4.1032.80' +// - Changed the Suicide Attempt value set to 2.16.840.1.113762.1.4.1032.102 +// - Removed specific inclusion of SNOMED-CT 86849004 since it is now in the Suicide Attempt value set +// - Added LOINC codes for the Pain intensity, Enjoyment of life, General activity scale [PEG] +// - Previous local codes are still supported (but discouraged) +// - Added logic to normalize long LOINC display text for PEG codes to shorter names +// - Added LOINC code for the STarT Back Screening Tool +// - Previous local code is still supported (but discouraged) +// - Added logic to display range for Opioid Risk Tool (ORT) +// - Updated QuantityText logic to not include '{score}' units (since scalar number is enough in those cases) +// +// ##Source guideline: [CDC Guideline for Opioid Prescribing for Chronic Pain](https://www.cdc.gov/drugoverdose/prescribing/guideline.html) + +library Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400 version '1.0.0' + +// # Data model # + +// The FHIR R4 model is used for testing purposes only. It has not been piloted. +using FHIR version '4.0.0' + +// # Referenced libraries # + +// The CDS Connect Commons for FHIRv400 library provides functions representing commonly used CDS logic and patterns. +include CDS_Connect_Commons_for_FHIRv400 version '1.0.1' called C3F +// The FHIRHelpers library provides common functions for simplifying interaction w/ the FHIR R4 data model. +include FHIRHelpers version '4.0.0' called FHIRHelpers + +// # Value sets and codes # + +// ## Code Systems ## + +codesystem "LOINC": 'http://loinc.org' +codesystem "SNOMED-CT": 'http://snomed.info/sct' + +// Several concepts needed by the Pain Management Summary CDS do not yet have standardized codes associated with them. +// The CDS logic authors have registered new Logical Object Identifier Names and Codes (LOINC) codes, but they are +// not yet available. Once available, the CDS will be updated. Until then, CDS implementors will need to map to +// local codes (signified by the LOCAL code system below) or replace them with their own codes. +codesystem "LOCAL": 'http://cds.ahrq.gov/cdsconnect/pms' + +// ## Value sets ## + +// List value sets used by the artifact. The links to the Value Set Authority Center (VSAC) point to the latest +// expansion of each value set available. + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.37/expansion) +valueset "Conditions associated with chronic pain": '2.16.840.1.113762.1.4.1032.37' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.34/expansion) +valueset "Opioid Pain Medications": '2.16.840.1.113762.1.4.1032.34' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.54/expansion) +valueset "Adjuvant Analgesic Medications": '2.16.840.1.113762.1.4.1032.54' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.105.12.1007/expansion) +valueset "Major Depression": '2.16.840.1.113883.3.464.1003.105.12.1007' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.600.143/expansion) +valueset "Depression Diagnosis ICD9": '2.16.840.1.113883.3.600.143' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.52/expansion) +valueset "Anxiety": '2.16.840.1.113762.1.4.1032.52' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.1240.2017.3.2.1015/expansion) +valueset "Anxiety Disorders ICD9": '2.16.840.1.113883.3.1240.2017.3.2.1015' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.106.12.1004/expansion) +valueset "Substance use disorder": '2.16.840.1.113883.3.464.1003.106.12.1004' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.106.11.1010/expansion) +valueset "Substance Abuse": '2.16.840.1.113883.3.464.1003.106.11.1010' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.102/expansion) +valueset "Suicide Attempt": '2.16.840.1.113762.1.4.1032.102' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.53/expansion) +valueset "Sleep-disordered breathing": '2.16.840.1.113762.1.4.1032.53' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.109.12.1028/expansion) +valueset "Kidney Failure": '2.16.840.1.113883.3.464.1003.109.12.1028' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.199.12.1035/expansion) +valueset "Chronic Liver Disease": '2.16.840.1.113883.3.464.1003.199.12.1035' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1047.42/expansion) +valueset "Liver Disease": '2.16.840.1.113762.1.4.1047.42' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.378/expansion) +valueset "Pregnancy": '2.16.840.1.113883.3.526.3.378' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.80/expansion) +valueset "Pregnancy (New ICD10 codes published in 2018 and 2019)": '2.16.840.1.113762.1.4.1032.80' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.26/expansion) +valueset "Non opiod pain medications": '2.16.840.1.113762.1.4.1032.26' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.36/expansion) +valueset "Non pharmacologic treatments for chronic pain": '2.16.840.1.113762.1.4.1032.36' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.55/expansion) +valueset "Risk assessments relevant to pain management": '2.16.840.1.113762.1.4.1032.55' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.43/expansion) +valueset "Benzodiazepine medications": '2.16.840.1.113762.1.4.1032.43' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.42/expansion) +valueset "Naloxone medications": '2.16.840.1.113762.1.4.1032.42' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.28/expansion) +valueset "Urine drug screen for pain management": '2.16.840.1.113762.1.4.1032.28' + +// [See value set in VSAC](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1032.44/expansion) +valueset "Stool softeners and laxatives": '2.16.840.1.113762.1.4.1032.44' + +// ## Individual codes ## + +// list individual codes from code systems used directly in the CQL logic. Individual codes are used when there is +// a single code from a particular vocabulary standard used to represent a clinical concept. It is considered +// best-practice not to create value sets containing a single code. + +code "Pregnancy status code": '82810-3' from "LOINC" display 'Pregnancy status' +code "Pregnant code": '77386006' from "SNOMED-CT" display 'Patient currently pregnant (finding)' +code "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] code": + '55758-7' from "LOINC" display 'Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]' +code "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported] code": + '44261-6' from "LOINC" display 'Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]' +code "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ] code": + '70274-6' from "LOINC" display 'Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]' +code "Total score [AUDIT] code": '75624-7' from "LOINC" display 'Total score [AUDIT]' +code "Total score [AUDIT-C] code": '75626-2' from "LOINC" display 'Total score [AUDIT-C]' +code "Total score [DAST-10] code": '82667-7' from "LOINC" display 'Total score [DAST-10]' +code "Total score ORT code": '91392-1' from "LOINC" display 'Total score ORT' +code "Pain severity Wong-Baker FACES Scale code": '38221-8' from "LOINC" display 'Pain severity Wong-Baker FACES Scale' + +// The Pain intensity, Enjoyment of life, General activity scale [PEG] now has standardized LOINC codes available. +// These LOINC codes were not available when the initial version of the Pain Management Summary was developed. +// New systems implementing the Pain Management Summary should use the standardized codes, but the legacy local codes +// are also retained in order to allow existing systems to continue to function. Existing systems, however, are +// strongly encouraged to adopt the standardized LOINC codes. + +code "Mean score [PEG] code": '91147-9' from "LOINC" display 'Mean score [PEG]' +code "Pain severity in the past week - 0-10 numeric rating [Reported] code": + '75893-8' from "LOINC" display 'Pain severity in the past week - 0-10 numeric rating [Reported]' +code "What number best describes how pain has interfered with your enjoyment of life during the past week code": + '91145-3' from "LOINC" display 'What number best describes how pain has interfered with your enjoyment of life during the past week' +code "What number best describes how pain has interfered with your general activity during the past week code": + '91146-1' from "LOINC" display 'What number best describes how pain has interfered with your general activity during the past week' + +// Legacy local codes for the Pain intensity, Enjoyment of life, General activity scale [PEG]. +// New systems should use the LOINC codes above instead. + +code "Pain Enjoyment General Activity (PEG) Assessment LEGACY code": + 'PEGASSESSMENT' from "LOCAL" display 'Pain Enjoyment General Activity (PEG) Assessment' +code "Pain LEGACY code": 'PEGPAIN' from "LOCAL" display 'Pain' +code "Enjoyment of life LEGACY code": 'PEGENJOYMENT' from "LOCAL" display 'Enjoyment of life' +code "General activity LEGACY code": 'PEGGENERALACTIVITY' from "LOCAL" display 'General activity' + +// The STarT Back Screening Tool now has a standardized LOINC code available. This LOINC code was not available +// when the initial version of the Pain Management Summary was developed. New systems implementing the Pain Management +// Summary should use the standardized code, but the legacy local code is also retained in order to allow existing +// systems to continue to function. Existing systems, however, are strongly encouraged to adopt the standardized LOINC +// code. + +code "Total score [STarT Back] code": '91351-7' from "LOINC" display 'Total score [STarT Back]' + +// Legacy local code for the STarT Back Screening Tool. New systems should use the LOINC codes above instead. + +code "STarT Back Screening Tool LEGACY code": 'STARTBACK' from "LOCAL" display 'STarT Back Screening Tool' + +// The following codes do not yet have standardized codes associated with them so are expressed as LOCAL codes. +// As standardized codes become available, this CDS will be updated to use standard codes rather than LOCAL codes. + +code "Single question r/t ETOH use code": 'SQETOHUSE' from "LOCAL" display 'Single question r/t ETOH use' +code "Single question r/t drug use code": 'SQDRUGUSE' from "LOCAL" display 'Single question r/t drug use' +code "Morphine Milligram Equivalent (MME) code": 'MME' from "LOCAL" display 'Morphine Milligram Equivalent (MME)' + +// CQL currently requires concept declarations to contain references to code declarations. + +concept "Pregnancy status": { "Pregnancy status code" } display 'Pregnancy status' +concept "Pregnant": { "Pregnant code" } display 'Patient currently pregnant (finding)' +concept "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]": + { "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] code" } + display 'Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]' +concept "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]": + { "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported] code" } + display 'Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]' +concept "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]": + { "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ] code" } + display 'Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]' +concept "Total score [AUDIT]": { "Total score [AUDIT] code" } display 'Total score [AUDIT]' +concept "Total score [AUDIT-C]": { "Total score [AUDIT-C] code" } display 'Total score [AUDIT-C]' +concept "Total score [DAST-10]": { "Total score [DAST-10] code" } display 'Total score [DAST-10]' +concept "Total score ORT": { "Total score ORT code" } display 'Total score ORT' +concept "Pain severity Wong-Baker FACES Scale": + { "Pain severity Wong-Baker FACES Scale code" } display 'Pain severity Wong-Baker FACES Scale' +concept "Pain severity in the past week - 0-10 numeric rating [Reported]": + { "Pain severity in the past week - 0-10 numeric rating [Reported] code" } + display 'Pain severity in the past week - 0-10 numeric rating [Reported]' +concept "What number best describes how pain has interfered with your enjoyment of life during the past week": + { "What number best describes how pain has interfered with your enjoyment of life during the past week code" } + display 'What number best describes how pain has interfered with your enjoyment of life during the past week' +concept "What number best describes how pain has interfered with your general activity during the past week": + { "What number best describes how pain has interfered with your general activity during the past week code" } + display 'What number best describes how pain has interfered with your general activity during the past week' +concept "Mean score [PEG]": { "Mean score [PEG] code" } display 'Mean score [PEG]' +concept "Pain Enjoyment General Activity (PEG) Assessment LEGACY": + { "Pain Enjoyment General Activity (PEG) Assessment LEGACY code" } display 'Pain Enjoyment General Activity (PEG) Assessment' +concept "Pain LEGACY": { "Pain LEGACY code" } display 'Pain' +concept "Enjoyment of life LEGACY": { "Enjoyment of life LEGACY code" } display 'Enjoyment of life' +concept "General activity LEGACY": { "General activity LEGACY code" } display 'General activity' +concept "Total score [STarT Back]": { "Total score [STarT Back] code" } display 'Total score [STarT Back]' +concept "STarT Back Screening Tool LEGACY": { "STarT Back Screening Tool LEGACY code" } display 'STarT Back Screening Tool' +concept "Single question r/t ETOH use": { "Single question r/t ETOH use code" } display 'Single question r/t ETOH use' +concept "Single question r/t drug use": { "Single question r/t drug use code" } display 'Single question r/t drug use' +concept "Morphine Milligram Equivalent (MME)": + { "Morphine Milligram Equivalent (MME) code" } display 'Morphine Milligram Equivalent (MME)' + +// # Parameters # + +// The InclusionMedicationsLookbackPeriod allows CDS implementors to specify how far the inclusion logic should look +// back for qualifying active medications. By default, the inclusion logic will look back 180 days. +parameter InclusionMedicationsLookbackPeriod default 180 days + +// # CDS logic # + +context Patient + +// ## Re-usable functions ## + +// The summary logic contains many constructs that are needed throughout the logic. Where possible, these constructs +// have been developed as re-usable functions that can be invoked wherever they are needed. + +// Returns the first-found display text for a CodeableConcept, looking first at the `text` attribute, then the +// `display` on each `coding` until it finds a non-null value. Some PEG codes are normalized due to length. +// @param c - a FHIR CodeableConcept to get text from +// @returns {System.String} the display text or null if none is found + +define function ConceptText(c FHIR.CodeableConcept): + if c ~ "Mean score [PEG]" or c ~ "Pain Enjoyment General Activity (PEG) Assessment LEGACY" + then 'Mean score [PEG]' + else if c ~ "Pain severity in the past week - 0-10 numeric rating [Reported]" or c ~ "Pain LEGACY" + then 'Pain' + else if c ~ "What number best describes how pain has interfered with your enjoyment of life during the past week" + or c ~ "Enjoyment of life LEGACY" + then 'Enjoyment of life' + else if c ~ "What number best describes how pain has interfered with your general activity during the past week" + or c ~ "General activity LEGACY" + then 'General activity' + else + Coalesce(c.text.value, Coalesce((c.coding) c2 return c2.display.value)) + +// We do not reliably get ranges back from EHR data, but ranges are important to understanding assessment scores in +// the summary. This function adds ranges to the name for known assessments. +// @param c - a FHIR CodeableConcept to get the updated text for +// @returns {System.String} the display text with range information appended +define function ConceptTextWithRange(c FHIR.CodeableConcept): + if c ~ "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]" + then ConceptText(c) + ' [Range: 0-6]' + else if c ~ "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]" + then ConceptText(c) + ' [Range: 0-27]' + else if c ~ "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]" + then ConceptText(c) + ' [Range: 0-21]' + else if c ~ "Total score [AUDIT]" + then ConceptText(c) + ' [Range: 0-40]' + else if c ~ "Total score [AUDIT-C]" + then ConceptText(c) + ' [Range: 0-12]' + else if c ~ "Total score [DAST-10]" + then ConceptText(c) + ' [Range: 0-10]' + else if c ~ "Total score ORT" + then ConceptText(c) + ' [Range: 0-26]' + else if c ~ "Pain severity Wong-Baker FACES Scale" + then ConceptText(c) + ' [Range: 0-10]' + else if c ~ "Mean score [PEG]" + or c ~ "Pain Enjoyment General Activity (PEG) Assessment LEGACY" + then ConceptText(c) + ' [Range: 0-10]' + else if c ~ "Total score [STarT Back]" + or c ~ "STarT Back Screening Tool LEGACY" + then ConceptText(c) + ' [Range: 0-9]' + else + ConceptText(c) + +// Returns a text representation of a date using the CQL `ToString` function. +// @param d - a FHIR date to get text for +// @returns {System.String} the text representation of the date +define function DateText(d FHIR.date): + ToString(d.value) + +// Returns a text representation of a dateTime using the CQL `ToString` function. +// @param d - a FHIR dateTime to get text for +// @returns {System.String} the text representation of the dateTime +define function DateTimeText(d FHIR.dateTime): + ToString(d.value) + +// Returns a text representation of an instant using the CQL `ToString` function. +// @param i - a FHIR instant to get text for +// @returns {System.String} the text representation of the instant +define function InstantText(i FHIR.instant): + ToString(i.value) + +// Returns a text representation of a Quantity with the Quantity's value and unit. +// If the unit is {score}, then omit it (as it is not useful to display) +// @param q - a FHIR Quantity to get text for +// @returns {System.String} the text representation of the Quantity +define function QuantityText(q FHIR.Quantity): + if (q is null) then null + else if (q.unit is not null and q.unit.value != '{score}') then ToString(q.value.value) + ' ' + q.unit.value + else if (q.code is not null and q.code.value != '{score}') then ToString(q.value.value) + ' ' + q.code.value + else ToString(q.value.value) + +// Returns a tuple containing a Period's start and end as text representations. +// @param p - a FHIR Period to get a tuple for +// @returns {Tuple} the tuple representation of the Period +define function PeriodObject(p FHIR.Period): + if p is null then null + else + { + Start: DateTimeText(p."start"), + End: DateTimeText(p."end") + } + +// Returns a tuple containing a Range's low and high as text representations. +// @param r - a FHIR Range to get a tuple for +// @returns {Tuple} the tuple representation of the Range +define function RangeObject(r FHIR.Range): + if r is null then null + else + { + Low: QuantityText(r.low), + High: QuantityText(r.high) + } + +// Returns a text representation of a date associated with an Observation, preferring `effectiveDateTime`, then +// `effectivePeriod.start`, then `issued`. +// @param o - a FHIR Observation to get the text date from +// @returns {System.String} the text representation of a relevant date from the Observation +define function ObservationDate(o FHIR.Observation): + Coalesce( + DateTimeText(o.effective as FHIR.dateTime), + InstantText(o.effective as FHIR.instant), + DateTimeText((o.effective as FHIR.Period)."start"), + InstantText(o.issued) + ) + +// Returns a text representation of a date associated with a MedicationStatement, preferring `effectiveDateTime`, then +// `.start`. +// @param s - a FHIR MedicationStatement to get the text date from +// @returns {System.String} the text representation of a relevant date from the MedicationStatement +define function MedicationStatementDate(s FHIR.MedicationStatement): + Coalesce( + DateTimeText(s.effective as FHIR.dateTime), + DateTimeText((s.effective as FHIR.Period)."start") + ) + +// Returns a text representation of a Condition's onset, whether represented as a dateTime, Period, Quantity (Age), +// Range (Age), or string. +// @param c - a FHIR Condition to get the text representation of the onset from +// @returns {System.String} the text representation of the Condition's onset +define function Onset(c FHIR.Condition): + Coalesce( List{ + DateTimeText(c.onset as FHIR.dateTime), + QuantityText(c.onset as FHIR.Age), + PeriodObject(c.onset as FHIR.Period), + RangeObject(c.onset as FHIR.Range), + (c.onset as FHIR.string).value + }) + +// Returns a text representation of a Condition's abatement, whether represented as a dateTime, Period, Quantity (Age), +// Range (Age), string, or boolean. +// @param c - a FHIR Condition to get the text representation of the abatement from +// @returns {System.String} the text representation of the Condition's abatement +define function Abatement(c FHIR.Condition): + Coalesce( List{ + DateTimeText(c.abatement as FHIR.dateTime), + QuantityText(c.abatement as FHIR.Age), + PeriodObject(c.abatement as FHIR.Period), + RangeObject(c.abatement as FHIR.Range), + (c.abatement as FHIR.string).value + }) + +// ## Target population ## + +// INCLUSIONS + +// Determines if patient's age, in years, at the time CQL is run, is at least 18 years old +define Is18orOlder: + AgeInYears() >= 18 + +// Conditions associated with chronic pain +define ConditionsAssociatedWithChronicPain: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Conditions associated with chronic pain"])) + +// Determines if the patient has any of the conditions associated with chronic pain +define HasConditionAssociatedWithChronicPain: + exists(ConditionsAssociatedWithChronicPain) + +// Determines if the patient has any record of opioid pain medications in the lookback period +// - Medication Request within past 180 days (lookback can be made a parameter) +// - Medication Statement by patient within past 180 days (lookback can be made a parameter) +define HasRecentOpioidPainMedication: + exists(C3F.ActiveCompletedOrStoppedMedicationRequest(C3F.MedicationRequestLookBack( + [MedicationRequest: "Opioid Pain Medications"], + InclusionMedicationsLookbackPeriod) + )) + or exists(C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Opioid Pain Medications"], + InclusionMedicationsLookbackPeriod) + )) + +// Determines if the patient has any record of adjuvant analgesic medications in the lookback period +// - Medication Request within past 180 days (lookback can be made a parameter) +// - Medication Statement by patient within past 180 days (lookback can be made a parameter) +define HasRecentAdjuvantAnalgesicMedication: + exists(C3F.ActiveCompletedOrStoppedMedicationRequest(C3F.MedicationRequestLookBack( + [MedicationRequest: "Adjuvant Analgesic Medications"], + InclusionMedicationsLookbackPeriod) + )) + or exists(C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Adjuvant Analgesic Medications"], + InclusionMedicationsLookbackPeriod) + )) + +// Determines if the patient meets the inclusion criteria for the CDS. Inclusion criteria is: +// - Age >=18 years +// - AND +// - OR Conditions associated with chronic pain +// - OR Opioid pain medication +// - OR Adjuvant analgesic medication +define MeetsInclusionCriteria: + Is18orOlder + and ( + HasConditionAssociatedWithChronicPain + or HasRecentOpioidPainMedication + or HasRecentAdjuvantAnalgesicMedication + ) + +// EXCLUSIONS + +// TAKE NOTICE: This CDS is not intended for patients who meet any of the following criteria: +// 1. Younger than 18 years of age +// 2. Undergoing end-of-life care (hospice or palliative) +// 3. Undergoing active cancer treatment +// +// The first exclusion is explicitly accounted for under INCLUSIONS. +// The second and third exclusions cannot be realiably detected for all patients using just EHR data. For that reason +// they are not implemented in this CDS. Care providers should use their judgement when applying this CDS to their +// patients. + +// ## Intervention(s) ## + +// DISPLAY and POPULATE a Pain Management Summary of the following items: + +// PERTINENT MEDICAL HISTORY + +// Conditions associated with chronic pain and their dates of onset + +define ReportConditionsAssociatedWithChronicPain: + (ConditionsAssociatedWithChronicPain) C + return { + Name: ConceptText(C.code), + Status: C.clinicalStatus.coding[0].code.value, + Onset: Onset(C), + DateRecorded: DateTimeText(C.recordedDate) + } + sort by (Onset as String) desc + +// Conditions that are risk factors for opioid-related harms and their dates of onset +// This is a union of nine value sets (w/ different filtering criteria) + +define DepressionConditions: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Major Depression"])) + union C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Depression Diagnosis ICD9"])) + +define AnxietyConditions: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Anxiety"])) + union C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Anxiety Disorders ICD9"])) + +define SubstanceUseDisorderConditions: + C3F.Confirmed([Condition: "Substance use disorder"]) + union C3F.Confirmed([Condition: "Substance Abuse"]) + +define SuicideAttemptConditions: + C3F.Confirmed([Condition: "Suicide Attempt"]) + +define SleepDisorderedBreathingConditions: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Sleep-disordered breathing"])) + +define RenalDysfunctionConditions: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Kidney Failure"])) + +define HepaticDysfunctionConditions: + C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Chronic Liver Disease"])) + union C3F.Confirmed(C3F.ActiveOrRecurring([Condition: "Liver Disease"])) + +define PregnancyConditions: + C3F.Confirmed(C3F.ConditionLookBack(C3F.ActiveOrRecurring( + [Condition: "Pregnancy"]) + union [Condition: "Pregnancy (New ICD10 codes published in 2018 and 2019)"], + 42 weeks + )) + +define PregnancyObservations: + C3F.Verified(C3F.ObservationLookBack([Observation: "Pregnancy status"], 42 weeks)) + +define MostRecentPregnancyObservation: + C3F.MostRecent(PregnancyObservations) + +define MostRecentPregnancyObservationIsPositive: + C3F.ConceptValue(MostRecentPregnancyObservation) ~ "Pregnant" + +define Is65orOlder: + AgeInYears() >= 65 + +define ConditionRiskFactorsForOpioidRelatedHarms: + DepressionConditions + union AnxietyConditions + union SubstanceUseDisorderConditions + union SuicideAttemptConditions + union SleepDisorderedBreathingConditions + union RenalDysfunctionConditions + union HepaticDysfunctionConditions + union PregnancyConditions + +// Encounter diagnoses that are risk factors for opioid-related harms and their dates of onset. Some risk factors may +// not exist on the problem list, and therefore may not be represented as Conditions (depending on EHR implementation). +// For this, the logic also looks at the patient's encounters, trying to find risk factors recorded as encounter +// diagnosis codes. We do not look at the reasonReference field because the Conditions referred to would already be +// reflected in the expression that queries over Conditions. + +define EncounterRiskFactorsForOpioidRelatedHarms: + [Encounter] E where exists( + E.reasonCode R where + FHIRHelpers.ToConcept(R) in "Major Depression" + or FHIRHelpers.ToConcept(R) in "Depression Diagnosis ICD9" + or FHIRHelpers.ToConcept(R) in "Anxiety" + or FHIRHelpers.ToConcept(R) in "Anxiety Disorders ICD9" + or FHIRHelpers.ToConcept(R) in "Substance use disorder" + or FHIRHelpers.ToConcept(R) in "Substance Abuse" + or FHIRHelpers.ToConcept(R) in "Suicide Attempt" + or FHIRHelpers.ToConcept(R) in "Sleep-disordered breathing" + or FHIRHelpers.ToConcept(R) in "Kidney Failure" + or FHIRHelpers.ToConcept(R) in "Chronic Liver Disease" + or FHIRHelpers.ToConcept(R) in "Liver Disease" + // Pregnancy not considered in Encounter diagnoses because this is an unrestricted lookback. + ) + +// NOTE: As a convention, if an expression's name starts with "Report", its purpose is to format data for the purpose +// of building the final summary object. + +// Format the risk factors in a uniform way despite the different sources of the data (conditions, encounter diagnoses, +// etc.). Note that conditions do not have a "Visit" date and encounter diagnoses do not have a status, onset date, +// recorded date, or abatement date. + +define ReportConditionRiskFactorsForOpioidRelatedHarms: + (ConditionRiskFactorsForOpioidRelatedHarms) C + return { + Name: ConceptText(C.code), + Status: C.clinicalStatus.coding[0].code.value, + Onset: Onset(C), + DateRecorded: DateTimeText(C.recordedDate), + Abatement: Abatement(C), + Visit: null as Tuple{ Start String, End String } + } + sort by (Onset as String) desc, (Abatement as String) desc + +define function GetEncounterDiagnosesRiskFactorsForOpioidRelatedHarms(enc Encounter): + (enc.reasonCode) R + where FHIRHelpers.ToConcept(R) in "Major Depression" + or FHIRHelpers.ToConcept(R) in "Depression Diagnosis ICD9" + or FHIRHelpers.ToConcept(R) in "Anxiety" + or FHIRHelpers.ToConcept(R) in "Anxiety Disorders ICD9" + or FHIRHelpers.ToConcept(R) in "Substance use disorder" + or FHIRHelpers.ToConcept(R) in "Substance Abuse" + or FHIRHelpers.ToConcept(R) in "Suicide Attempt" + or FHIRHelpers.ToConcept(R) in "Sleep-disordered breathing" + or FHIRHelpers.ToConcept(R) in "Kidney Failure" + or FHIRHelpers.ToConcept(R) in "Chronic Liver Disease" + or FHIRHelpers.ToConcept(R) in "Liver Disease" + // Pregnancy not considered in Encounter diagnoses because this is an unrestricted lookback. + return { + Name: ConceptText(R), + Status: null as String, + Onset: null as String, + DateRecorded: null as String, + Abatement: null as String, + Visit: PeriodObject(enc.period) + } + +define ReportEncounterRiskFactorsForOpioidRelatedHarms: + (flatten((EncounterRiskFactorsForOpioidRelatedHarms) E + return GetEncounterDiagnosesRiskFactorsForOpioidRelatedHarms(E))) D + sort by Visit.Start desc, Visit.End desc + +// Shape the pregnancy Observation as a Condition, since this is the backup approach for detecting a pregnancy in case +// there are no active Conditions found. +define ReportMostRecentPositivePregnancyObservation: + if MostRecentPregnancyObservationIsPositive then + { + Name: ConceptText(MostRecentPregnancyObservation.code), + Status: ConceptText(MostRecentPregnancyObservation.value as FHIR.CodeableConcept), + Onset: ToString(Coalesce( + (MostRecentPregnancyObservation.effective as FHIR.dateTime).value, + (MostRecentPregnancyObservation.effective as FHIR.instant).value, + (MostRecentPregnancyObservation.effective as FHIR.Period)."start".value + )), + DateRecorded: ToString(MostRecentPregnancyObservation.issued.value), + Abatement: null as String, + Visit: null as Tuple{ Start String, End String } + } + else + null + +// Shape the case of being 65 or older as a Condition for the purposes of building the summary. +define ReportOlderThan65: + if Is65orOlder then + { + Name: '65 years or older', + Status: 'active', + Onset: null as String, + DateRecorded: null as String, + Abatement: null as String, + Visit: null as Tuple{ Start String, End String } + } + else + null + +define ReportRiskFactorsForOpioidRelatedHarms: + // If a pregnancy Condition is present, use that. + if Exists(PregnancyConditions) then + (ReportConditionRiskFactorsForOpioidRelatedHarms + union ReportEncounterRiskFactorsForOpioidRelatedHarms + union ReportOlderThan65) C + // Otherwise, try to find a positive pregnancy status in an Observation. + else + (ReportConditionRiskFactorsForOpioidRelatedHarms + union ReportEncounterRiskFactorsForOpioidRelatedHarms + union ReportOlderThan65 + union ReportMostRecentPositivePregnancyObservation) C + sort by (if Onset is not null then Onset as String else Visit.Start) desc, Visit.End desc, (Abatement as String) desc + +// PAIN ASSESSMENT + +// Numeric pain intensity assessment - scores and dates (lookback 2 years) + +define NumericPainIntensityAssessments: + C3F.Verified(C3F.ObservationLookBack([Observation: "Pain severity Wong-Baker FACES Scale"], 2 years)) + +define ReportNumericPainIntensityAssessments: + (NumericPainIntensityAssessments) A + return { + Name: ConceptTextWithRange(A.code), + Score: QuantityText(A.value as FHIR.Quantity), + Interpretation: Coalesce( ConceptText(First(A.interpretation)), ConceptText(A.value as FHIR.CodeableConcept) ), + Date: ObservationDate(A) + } + sort by Date desc + +// Pain Enjoyment General Activity (PEG) Assessment - scores and dates (lookback 2 years) +// Note: this includes listing the response to each of the 3 questions, plus the total score. The Pain Management +// Sumnmary currently supports both the LOINC representations and the legacy local code representations. +// +// 1. Observation w/ LOINC mean score as primary code and mean score as valueQuantity +// * code: LOINC 91147-9 "Mean score [PEG]" +// * valueQuantity: (mean score) +// * component: +// - +// * code: LOINC 75893-8 "What number best describes your pain on average in the past week?" +// * valueQuantity: (pain score) +// - +// * code: LOINC 91145-3 "What number best describes how, during the past week, pain has interfered with your enjoyment of life?" +// * valueQuantity: (enjoyment of life score) +// - +// * code: LOINC 91146-1 "What number best describes how, during the past week, pain has interfered with your general activity?" +// * valueQuantity: (general activity score) +// +// 2. LEGACY: Observation w/ LOCAL code as primary code and mean score as valueQuantity +// * code: LOCAL PEGASSESSMENT "Pain Enjoyment General Activity (PEG) Assessment" +// * valueQuantity: (mean score) +// * component: +// - +// * code: LOCAL PEGPAIN "Pain" +// * valueQuantity: (pain score) +// - +// * code: LOCAL PEGENJOYMENT "Enjoyment of life" +// * valueQuantity: (enjoyment of life score) +// - +// * code: LOCAL PEGGENERALACTIVITY "General activity" +// * valueQuantity: (general activity score) + +define PainEnjoymentGeneralActivityAssessments: + C3F.Verified(C3F.ObservationLookBack( + [Observation: "Mean score [PEG]"] + union [Observation: "Pain Enjoyment General Activity (PEG) Assessment LEGACY"], + 2 years + )) + +define ReportPainEnjoymentGeneralActivityAssessments: + (PainEnjoymentGeneralActivityAssessments) A + let + Pain: (A.component) C + where C.code ~ "Pain severity in the past week - 0-10 numeric rating [Reported]" + or C.code ~ "Pain LEGACY", + Enjoyment: (A.component) C + where C.code ~ "What number best describes how pain has interfered with your enjoyment of life during the past week" + or C.code ~ "Enjoyment of life LEGACY", + GeneralActivity: (A.component) C + where C.code ~ "What number best describes how pain has interfered with your general activity during the past week" + or C.code ~ "General activity LEGACY" + where true // grammar needs a where statement to separate the "let" from the "return" + return { + // NOTE: Hard-code in names because the real LOINC code displays are quite long + Name: ConceptTextWithRange(A.code), + Score: QuantityText(A.value as FHIR.Quantity), + Interpretation: Coalesce( ConceptText(First(A.interpretation)), ConceptText(A.value as FHIR.CodeableConcept) ), + Questions: ({ First(Pain), First(Enjoyment), First(GeneralActivity) }) C + where C is not null + return { "Name": ConceptText(C.code), "Score": QuantityText(C.value as FHIR.Quantity) }, + Date: ObservationDate(A) + } + sort by Date desc + +// STarT Back Screening Tool - Overall score and dates (lookback 2 years) + +define STarTBackAssessments: + C3F.Verified(C3F.ObservationLookBack( + [Observation: "Total score [STarT Back]"] + union [Observation: "STarT Back Screening Tool LEGACY"], + 2 years + )) + +define ReportSTarTBackAssessments: + (STarTBackAssessments) A + return { + Name: ConceptTextWithRange(A.code), + Score: QuantityText(A.value as FHIR.Quantity), + Interpretation: Coalesce( ConceptText(First(A.interpretation)), ConceptText(A.value as FHIR.CodeableConcept) ), + Date: ObservationDate(A) + } + sort by Date desc + +// HISTORICAL TREATMENTS + +// Opioid medication orders and statements with dates (lookback 2 years) + +define OpioidMedicationRequests: + C3F.ActiveCompletedOrStoppedMedicationRequest(C3F.MedicationRequestLookBack( + [MedicationRequest: "Opioid Pain Medications"], + 2 years + )) + +define OpioidMedicationStatements: + C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Opioid Pain Medications"], + 2 years + )) + +define ReportOpioidMedicationRequests: + (OpioidMedicationRequests) O + return { + Type: 'Request', + Name: ConceptText(O.medication as FHIR.CodeableConcept), + Start: DateTimeText(O.authoredOn), + End: null as String, // MedicationRequest end date not supported in R4, + Status: O.status.value + } + sort by Start desc, End desc + +define ReportOpioidMedicationStatements: + (OpioidMedicationStatements) S + return { + Type: 'Statement', + Name: ConceptText(S.medication as FHIR.CodeableConcept), + Start: MedicationStatementDate(S), + End: DateTimeText((S.effective as FHIR.Period)."end"), + Status: S.status.value + } + sort by Start desc, End desc + +define ReportOpioidMedications: + (ReportOpioidMedicationRequests union ReportOpioidMedicationStatements) M + sort by Start desc, End desc + +// Non-opioid medication orders and statements with dates (lookback 2 years) + +define NonOpioidMedicationRequests: + C3F.ActiveCompletedOrStoppedMedicationRequest(C3F.MedicationRequestLookBack( + [MedicationRequest: "Non opiod pain medications"], + 2 years + )) + +define NonOpioidMedicationStatements: + C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Non opiod pain medications"], + 2 years + )) + +define ReportNonOpioidMedicationRequests: + (NonOpioidMedicationRequests) O + return { + Type: 'Request', + Name: ConceptText(O.medication as FHIR.CodeableConcept), + Start: DateTimeText(O.authoredOn), + End: null as String, // MedicationRequest end date not supported in R4, + Status: O.status.value + } + sort by Start desc, End desc + +define ReportNonOpioidMedicationStatements: + (NonOpioidMedicationStatements) S + return { + Type: 'Statement', + Name: ConceptText(S.medication as FHIR.CodeableConcept), + Start: MedicationStatementDate(S), + End: DateTimeText((S.effective as FHIR.Period)."end"), + Status: S.status.value + } + sort by Start desc, End desc + +define ReportNonOpioidMedications: + (ReportNonOpioidMedicationRequests union ReportNonOpioidMedicationStatements) M + sort by Start desc, End desc + +// Non-pharmacologic treatments, orders, and referrals with dates (lookback 2 years) + +define NonPharmacologicTreatmentProcedures: + C3F.ProcedurePerformance(C3F.ProcedureLookBack([Procedure: "Non pharmacologic treatments for chronic pain"], 2 years)) + +define ReportNonPharmacologicTreatmentProcedures: + (NonPharmacologicTreatmentProcedures) P + return { + Type: 'Procedure', + Name: ConceptText(P.code), + Date: Coalesce( + DateTimeText(P.performed as FHIR.dateTime), + DateTimeText((P.performed as FHIR.Period)."start") + ) + } + sort by Date desc + +define NonPharmacologicTreatmentServiceRequests: + C3F.ServiceRequestActiveOrCompleted( + C3F.ServiceRequestLookBack([ServiceRequest: "Non pharmacologic treatments for chronic pain"], 2 years) + ) + +define ReportNonPharmacologicTreatmentServiceRequests: + (NonPharmacologicTreatmentServiceRequests) P + return { + Type: 'ServiceRequest', + Name: ConceptText(P.code), + Date: DateTimeText(P.authoredOn) + } + sort by Date desc + +define ReportNonPharmacologicTreatments: + (ReportNonPharmacologicTreatmentProcedures + union ReportNonPharmacologicTreatmentServiceRequests) M + sort by Date desc + +// Stool softeners and laxatives - orders and statements with dates (lookback 6 months) + +define StoolSoftenersAndLaxativesRequests: + C3F.ActiveCompletedOrStoppedMedicationRequest(C3F.MedicationRequestLookBack( + [MedicationRequest: "Stool softeners and laxatives"], + 6 months + )) + +define StoolSoftenersAndLaxativesStatements: + C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Stool softeners and laxatives"], + 6 months + )) + +define ReportStoolSoftenersAndLaxativesRequests: + (StoolSoftenersAndLaxativesRequests) O + return { + Type: 'Request', + Name: ConceptText(O.medication as FHIR.CodeableConcept), + Start: DateTimeText(O.authoredOn), + End: null as String, // MedicationRequest end date not supported in R4, + Status: O.status.value + } + sort by Start desc, End desc + +define ReportStoolSoftenersAndLaxativesStatements: + (StoolSoftenersAndLaxativesStatements) S + return { + Type: 'Statement', + Name: ConceptText(S.medication as FHIR.CodeableConcept), + Start: MedicationStatementDate(S), + End: DateTimeText((S.effective as FHIR.Period)."end"), + Status: S.status.value + } + sort by Start desc, End desc + +define ReportStoolSoftenersAndLaxatives: + (ReportStoolSoftenersAndLaxativesRequests union ReportStoolSoftenersAndLaxativesStatements) M + sort by Start desc, End desc + +// RISK CONSIDERATIONS + +// MME (MOST RECENT w/ lookback 6 months) - amount and date + +define MostRecentMME: + C3F.MostRecent(C3F.Verified(C3F.ObservationLookBack([Observation: "Morphine Milligram Equivalent (MME)"], 6 months))) + +define ReportMostRecentMME: + if MostRecentMME is null + then null + else + (MostRecentMME) M + return { + Name: ConceptText(M.code), + Result: QuantityText(M.value as FHIR.Quantity), + Date: ObservationDate(M) + } + +// Urine drug screen - dates and results (all screens w/ lookback of 1 year) + +define UrineDrugScreens: + C3F.Verified(C3F.ObservationLookBack([Observation: "Urine drug screen for pain management"], 1 year)) + +define ReportUrineDrugScreens: + (UrineDrugScreens) S + return { + Name: ConceptText(S.code), + Result: Coalesce( + QuantityText(S.value as FHIR.Quantity), + (S.value as FHIR.string).value, + ConceptText(S.value as FHIR.CodeableConcept) + ), + Interpretation: ConceptText(First(S.interpretation)), + Date: ObservationDate(S) + } + sort by Date desc + +// Benzodiazepine Medications (lookback of 2 years)- orders and statements with dates + +define BenzodiazepineMedicationRequests: + C3F.ActiveCompletedOrStoppedMedicationRequest(C3F.MedicationRequestLookBack( + [MedicationRequest: "Benzodiazepine medications"], + 2 years + )) + +define function MedicationStatementLookBack(MedList List, LookBack System.Quantity): +MedList M + let LookBackInterval: Interval[Now() - LookBack, Now()] + where (M.effective as FHIR.dateTime).value in LookBackInterval + or C3F.PeriodToInterval(M.effective as FHIR.Period) overlaps LookBackInterval + +define BenzodiazepineMedicationStatements: + C3F.ActiveOrCompletedMedicationStatement(C3F.MedicationStatementLookBack( + [MedicationStatement: "Benzodiazepine medications"], + 2 years + )) + +define ReportBenzodiazepineMedicationRequests: + (BenzodiazepineMedicationRequests) O + return { + Type: 'Request', + Name: ConceptText(O.medication as FHIR.CodeableConcept), + Start: DateTimeText(O.authoredOn), + End: null as String, // MedicationRequest end date not supported in R4, + Status: O.status.value + } + sort by Start desc, End desc + +define ReportBenzodiazepineMedicationStatements: + (BenzodiazepineMedicationStatements) S + return { + Type: 'Statement', + Name: ConceptText(S.medication as FHIR.CodeableConcept), + Start: MedicationStatementDate(S), + End: DateTimeText((S.effective as FHIR.Period)."end"), + Status: S.status.value + } + sort by Start desc, End desc + +define ReportBenzodiazepineMedications: + (ReportBenzodiazepineMedicationRequests union ReportBenzodiazepineMedicationStatements) M + sort by Start desc, End desc + +// Naloxone Medications (unrestricted lookback) - orders and statements with dates + +define NaloxoneMedicationRequests: + C3F.ActiveCompletedOrStoppedMedicationRequest([MedicationRequest: "Naloxone medications"]) + +define NaloxoneMedicationStatements: + C3F.ActiveOrCompletedMedicationStatement([MedicationStatement: "Naloxone medications"]) + +define ReportNaloxoneMedicationRequests: + (NaloxoneMedicationRequests) O + return { + Type: 'Request', + Name: ConceptText(O.medication as FHIR.CodeableConcept), + Start: DateTimeText(O.authoredOn), + End: null as String, // MedicationRequest end date not supported in R4, + Status: O.status.value + } + sort by Start desc, End desc + +define ReportNaloxoneMedicationStatements: + (NaloxoneMedicationStatements) S + return { + Type: 'Statement', + Name: ConceptText(S.medication as FHIR.CodeableConcept), + Start: MedicationStatementDate(S), + End: DateTimeText((S.effective as FHIR.Period)."end"), + Status: S.status.value + } + sort by Start desc, End desc + +define ReportNaloxoneMedications: + (ReportNaloxoneMedicationRequests union ReportNaloxoneMedicationStatements) M + sort by Start desc, End desc + +// Risk screenings relevant to pain management - overall scores and dates (MOST RECENT w/ lookback 1 year) + +define RiskScreeningsRelevantToPainManagement: + C3F.Verified(C3F.ObservationLookBack( + [Observation: "Risk assessments relevant to pain management"] + union [Observation: "Single question r/t ETOH use"] + union [Observation: "Single question r/t drug use"] + , 1 year)) + +define ReportRiskScreeningsRelevantToPainManagement: + (RiskScreeningsRelevantToPainManagement) S + return { + Name: ConceptTextWithRange(S.code), + Score: Coalesce( + QuantityText(S.value as FHIR.Quantity), + (S.value as FHIR.string).value + ), + Interpretation: Coalesce( + ConceptText(First(S.interpretation)), + ConceptText(S.value as FHIR.CodeableConcept) + ), + Date: ObservationDate(S) + } + sort by Date desc + +// SUMMARY + +// The Summary object represents the full Pain Management Summary to be displayed to the clinician. All values are +// returned as user-friendly text representations, but a robust user interface (UI) should be implemented to +// display the data to the user in a friendly manner. See the Pain Management Summary SMART on FHIR application as +// an example of how to integrate this summary into an EHR using modern web UI technologies. + +define Summary: { + Patient: { + Name: Combine(Patient.name.given G return G.value, ' ') + ' ' + Combine(Patient.name.family F return F.value, ' '), + Gender: Patient.gender.value, + Age: AgeInYears(), + MeetsInclusionCriteria: MeetsInclusionCriteria + }, + PertinentMedicalHistory: { + ConditionsAssociatedWithChronicPain: ReportConditionsAssociatedWithChronicPain, + RiskFactorsForOpioidRelatedHarms: ReportRiskFactorsForOpioidRelatedHarms + }, + PainAssessments: { + NumericPainIntensityAssessments: ReportNumericPainIntensityAssessments, + PainEnjoymentGeneralActivityAssessments: ReportPainEnjoymentGeneralActivityAssessments, + STarTBackAssessments: ReportSTarTBackAssessments + }, + HistoricalTreatments: { + OpioidMedications: ReportOpioidMedications, + NonOpioidMedications: ReportNonOpioidMedications, + NonPharmacologicTreatments: ReportNonPharmacologicTreatments, + StoolSoftenersAndLaxatives: ReportStoolSoftenersAndLaxatives + }, + RiskConsiderations: { + MostRecentMME: ReportMostRecentMME, + UrineDrugScreens: ReportUrineDrugScreens, + BenzodiazepineMedications: ReportBenzodiazepineMedications, + NaloxoneMedications: ReportNaloxoneMedications, + RiskScreeningsRelevantToPainManagement: ReportRiskScreeningsRelevantToPainManagement + } +} diff --git a/src/cql/r4/Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400.json b/src/cql/r4/Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400.json index 21a133f23..6f23fcd80 100644 --- a/src/cql/r4/Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400.json +++ b/src/cql/r4/Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400.json @@ -22,7 +22,7 @@ "def" : [ { "localIdentifier" : "C3F", "path" : "CDS_Connect_Commons_for_FHIRv400", - "version" : "1.0.0" + "version" : "1.0.1" }, { "localIdentifier" : "FHIRHelpers", "path" : "FHIRHelpers", @@ -72,17 +72,29 @@ "name" : "Major Depression", "id" : "2.16.840.1.113883.3.464.1003.105.12.1007", "accessLevel" : "Public" + }, { + "name" : "Depression Diagnosis ICD9", + "id" : "2.16.840.1.113883.3.600.143", + "accessLevel" : "Public" }, { "name" : "Anxiety", "id" : "2.16.840.1.113762.1.4.1032.52", "accessLevel" : "Public" + }, { + "name" : "Anxiety Disorders ICD9", + "id" : "2.16.840.1.113883.3.1240.2017.3.2.1015", + "accessLevel" : "Public" }, { "name" : "Substance use disorder", "id" : "2.16.840.1.113883.3.464.1003.106.12.1004", "accessLevel" : "Public" }, { - "name" : "Suicide attempt", - "id" : "2.16.840.1.113762.1.4.1032.40", + "name" : "Substance Abuse", + "id" : "2.16.840.1.113883.3.464.1003.106.11.1010", + "accessLevel" : "Public" + }, { + "name" : "Suicide Attempt", + "id" : "2.16.840.1.113762.1.4.1032.102", "accessLevel" : "Public" }, { "name" : "Sleep-disordered breathing", @@ -104,6 +116,10 @@ "name" : "Pregnancy", "id" : "2.16.840.1.113883.3.526.3.378", "accessLevel" : "Public" + }, { + "name" : "Pregnancy (New ICD10 codes published in 2018 and 2019)", + "id" : "2.16.840.1.113762.1.4.1032.80", + "accessLevel" : "Public" }, { "name" : "Non opiod pain medications", "id" : "2.16.840.1.113762.1.4.1032.26", @@ -151,14 +167,6 @@ "codeSystem" : { "name" : "SNOMED-CT" } - }, { - "name" : "Suicidal deliberate poisoning code", - "id" : "86849004", - "display" : "Suicidal deliberate poisoning", - "accessLevel" : "Public", - "codeSystem" : { - "name" : "SNOMED-CT" - } }, { "name" : "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] code", "id" : "55758-7", @@ -207,6 +215,14 @@ "codeSystem" : { "name" : "LOINC" } + }, { + "name" : "Total score ORT code", + "id" : "91392-1", + "display" : "Total score ORT", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } }, { "name" : "Pain severity Wong-Baker FACES Scale code", "id" : "38221-8", @@ -216,7 +232,39 @@ "name" : "LOINC" } }, { - "name" : "Pain Enjoyment General Activity (PEG) Assessment code", + "name" : "Mean score [PEG] code", + "id" : "91147-9", + "display" : "Mean score [PEG]", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } + }, { + "name" : "Pain severity in the past week - 0-10 numeric rating [Reported] code", + "id" : "75893-8", + "display" : "Pain severity in the past week - 0-10 numeric rating [Reported]", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } + }, { + "name" : "What number best describes how pain has interfered with your enjoyment of life during the past week code", + "id" : "91145-3", + "display" : "What number best describes how pain has interfered with your enjoyment of life during the past week", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } + }, { + "name" : "What number best describes how pain has interfered with your general activity during the past week code", + "id" : "91146-1", + "display" : "What number best describes how pain has interfered with your general activity during the past week", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } + }, { + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY code", "id" : "PEGASSESSMENT", "display" : "Pain Enjoyment General Activity (PEG) Assessment", "accessLevel" : "Public", @@ -224,7 +272,7 @@ "name" : "LOCAL" } }, { - "name" : "Pain code", + "name" : "Pain LEGACY code", "id" : "PEGPAIN", "display" : "Pain", "accessLevel" : "Public", @@ -232,7 +280,7 @@ "name" : "LOCAL" } }, { - "name" : "Enjoyment of life code", + "name" : "Enjoyment of life LEGACY code", "id" : "PEGENJOYMENT", "display" : "Enjoyment of life", "accessLevel" : "Public", @@ -240,7 +288,7 @@ "name" : "LOCAL" } }, { - "name" : "General activity code", + "name" : "General activity LEGACY code", "id" : "PEGGENERALACTIVITY", "display" : "General activity", "accessLevel" : "Public", @@ -248,7 +296,15 @@ "name" : "LOCAL" } }, { - "name" : "STarT Back Screening Tool code", + "name" : "Total score [STarT Back] code", + "id" : "91351-7", + "display" : "Total score [STarT Back]", + "accessLevel" : "Public", + "codeSystem" : { + "name" : "LOINC" + } + }, { + "name" : "STarT Back Screening Tool LEGACY code", "id" : "STARTBACK", "display" : "STarT Back Screening Tool", "accessLevel" : "Public", @@ -296,13 +352,6 @@ "code" : [ { "name" : "Pregnant code" } ] - }, { - "name" : "Suicidal deliberate poisoning", - "display" : "Suicidal deliberate poisoning", - "accessLevel" : "Public", - "code" : [ { - "name" : "Suicidal deliberate poisoning code" - } ] }, { "name" : "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]", "display" : "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]", @@ -345,6 +394,13 @@ "code" : [ { "name" : "Total score [DAST-10] code" } ] + }, { + "name" : "Total score ORT", + "display" : "Total score ORT", + "accessLevel" : "Public", + "code" : [ { + "name" : "Total score ORT code" + } ] }, { "name" : "Pain severity Wong-Baker FACES Scale", "display" : "Pain severity Wong-Baker FACES Scale", @@ -353,39 +409,74 @@ "name" : "Pain severity Wong-Baker FACES Scale code" } ] }, { - "name" : "Pain Enjoyment General Activity (PEG) Assessment", + "name" : "Pain severity in the past week - 0-10 numeric rating [Reported]", + "display" : "Pain severity in the past week - 0-10 numeric rating [Reported]", + "accessLevel" : "Public", + "code" : [ { + "name" : "Pain severity in the past week - 0-10 numeric rating [Reported] code" + } ] + }, { + "name" : "What number best describes how pain has interfered with your enjoyment of life during the past week", + "display" : "What number best describes how pain has interfered with your enjoyment of life during the past week", + "accessLevel" : "Public", + "code" : [ { + "name" : "What number best describes how pain has interfered with your enjoyment of life during the past week code" + } ] + }, { + "name" : "What number best describes how pain has interfered with your general activity during the past week", + "display" : "What number best describes how pain has interfered with your general activity during the past week", + "accessLevel" : "Public", + "code" : [ { + "name" : "What number best describes how pain has interfered with your general activity during the past week code" + } ] + }, { + "name" : "Mean score [PEG]", + "display" : "Mean score [PEG]", + "accessLevel" : "Public", + "code" : [ { + "name" : "Mean score [PEG] code" + } ] + }, { + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY", "display" : "Pain Enjoyment General Activity (PEG) Assessment", "accessLevel" : "Public", "code" : [ { - "name" : "Pain Enjoyment General Activity (PEG) Assessment code" + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY code" } ] }, { - "name" : "Pain", + "name" : "Pain LEGACY", "display" : "Pain", "accessLevel" : "Public", "code" : [ { - "name" : "Pain code" + "name" : "Pain LEGACY code" } ] }, { - "name" : "Enjoyment of life", + "name" : "Enjoyment of life LEGACY", "display" : "Enjoyment of life", "accessLevel" : "Public", "code" : [ { - "name" : "Enjoyment of life code" + "name" : "Enjoyment of life LEGACY code" } ] }, { - "name" : "General activity", + "name" : "General activity LEGACY", "display" : "General activity", "accessLevel" : "Public", "code" : [ { - "name" : "General activity code" + "name" : "General activity LEGACY code" + } ] + }, { + "name" : "Total score [STarT Back]", + "display" : "Total score [STarT Back]", + "accessLevel" : "Public", + "code" : [ { + "name" : "Total score [STarT Back] code" } ] }, { - "name" : "STarT Back Screening Tool", + "name" : "STarT Back Screening Tool LEGACY", "display" : "STarT Back Screening Tool", "accessLevel" : "Public", "code" : [ { - "name" : "STarT Back Screening Tool code" + "name" : "STarT Back Screening Tool LEGACY code" } ] }, { "name" : "Single question r/t ETOH use", @@ -427,47 +518,223 @@ "accessLevel" : "Public", "type" : "FunctionDef", "expression" : { - "type" : "Coalesce", - "operand" : [ { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "text", - "type" : "Property", - "source" : { - "name" : "c", - "type" : "OperandRef" - } - } - }, { - "type" : "Coalesce", - "operand" : [ { - "type" : "Query", - "source" : [ { - "alias" : "c2", - "expression" : { - "path" : "coding", - "type" : "Property", - "source" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { "name" : "c", "type" : "OperandRef" - } + } ] + }, { + "name" : "Mean score [PEG]", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Mean score [PEG]", + "type" : "Literal" + }, + "else" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Pain severity in the past week - 0-10 numeric rating [Reported]", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Pain LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Pain", + "type" : "Literal" + }, + "else" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "What number best describes how pain has interfered with your enjoyment of life during the past week", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Enjoyment of life LEGACY", + "type" : "ConceptRef" + } ] + } ] } - } ], - "relationship" : [ ], - "return" : { - "expression" : { - "path" : "value", - "type" : "Property", - "source" : { - "path" : "display", - "scope" : "c2", - "type" : "Property" + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "Enjoyment of life", + "type" : "Literal" + }, + "else" : { + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "What number best describes how pain has interfered with your general activity during the past week", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "General activity LEGACY", + "type" : "ConceptRef" + } ] + } ] } + }, + "then" : { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "General activity", + "type" : "Literal" + }, + "else" : { + "type" : "Coalesce", + "operand" : [ { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "text", + "type" : "Property", + "source" : { + "name" : "c", + "type" : "OperandRef" + } + } + }, { + "type" : "Coalesce", + "operand" : [ { + "type" : "Query", + "source" : [ { + "alias" : "c2", + "expression" : { + "path" : "coding", + "type" : "Property", + "source" : { + "name" : "c", + "type" : "OperandRef" + } + } + } ], + "relationship" : [ ], + "return" : { + "expression" : { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "display", + "scope" : "c2", + "type" : "Property" + } + } + } + } ] + } ] } } - } ] - } ] + } + } }, "operand" : [ { "name" : "c", @@ -713,7 +980,7 @@ "type" : "OperandRef" } ] }, { - "name" : "Pain severity Wong-Baker FACES Scale", + "name" : "Total score ORT", "type" : "ConceptRef" } ] } @@ -729,7 +996,7 @@ } ] }, { "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : " [Range: 0-10]", + "value" : " [Range: 0-26]", "type" : "Literal" } ] }, @@ -749,7 +1016,7 @@ "type" : "OperandRef" } ] }, { - "name" : "Pain Enjoyment General Activity (PEG) Assessment", + "name" : "Pain severity Wong-Baker FACES Scale", "type" : "ConceptRef" } ] } @@ -775,18 +1042,35 @@ "asType" : "{urn:hl7-org:elm-types:r1}Boolean", "type" : "As", "operand" : { - "type" : "Equivalent", + "type" : "Or", "operand" : [ { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", + "type" : "Equivalent", "operand" : [ { - "name" : "c", - "type" : "OperandRef" + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Mean score [PEG]", + "type" : "ConceptRef" } ] }, { - "name" : "STarT Back Screening Tool", - "type" : "ConceptRef" + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY", + "type" : "ConceptRef" + } ] } ] } }, @@ -801,17 +1085,71 @@ } ] }, { "valueType" : "{urn:hl7-org:elm-types:r1}String", - "value" : " [Range: 0-9]", + "value" : " [Range: 0-10]", "type" : "Literal" } ] }, "else" : { - "name" : "ConceptText", - "type" : "FunctionRef", - "operand" : [ { - "name" : "c", - "type" : "OperandRef" - } ] + "type" : "If", + "condition" : { + "asType" : "{urn:hl7-org:elm-types:r1}Boolean", + "type" : "As", + "operand" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "Total score [STarT Back]", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "name" : "STarT Back Screening Tool LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + }, + "then" : { + "type" : "Concatenate", + "operand" : [ { + "name" : "ConceptText", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : " [Range: 0-9]", + "type" : "Literal" + } ] + }, + "else" : { + "name" : "ConceptText", + "type" : "FunctionRef", + "operand" : [ { + "name" : "c", + "type" : "OperandRef" + } ] + } } } } @@ -929,18 +1267,42 @@ "asType" : "{urn:hl7-org:elm-types:r1}Boolean", "type" : "As", "operand" : { - "type" : "Not", - "operand" : { - "type" : "IsNull", + "type" : "And", + "operand" : [ { + "type" : "Not", "operand" : { - "path" : "unit", - "type" : "Property", - "source" : { - "name" : "q", - "type" : "OperandRef" + "type" : "IsNull", + "operand" : { + "path" : "unit", + "type" : "Property", + "source" : { + "name" : "q", + "type" : "OperandRef" + } } } - } + }, { + "type" : "Not", + "operand" : { + "type" : "Equal", + "operand" : [ { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "unit", + "type" : "Property", + "source" : { + "name" : "q", + "type" : "OperandRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "{score}", + "type" : "Literal" + } ] + } + } ] } }, "then" : { @@ -985,18 +1347,42 @@ "asType" : "{urn:hl7-org:elm-types:r1}Boolean", "type" : "As", "operand" : { - "type" : "Not", - "operand" : { - "type" : "IsNull", + "type" : "And", + "operand" : [ { + "type" : "Not", "operand" : { - "path" : "code", - "type" : "Property", - "source" : { - "name" : "q", - "type" : "OperandRef" + "type" : "IsNull", + "operand" : { + "path" : "code", + "type" : "Property", + "source" : { + "name" : "q", + "type" : "OperandRef" + } } } - } + }, { + "type" : "Not", + "operand" : { + "type" : "Equal", + "operand" : [ { + "path" : "value", + "type" : "Property", + "source" : { + "path" : "code", + "type" : "Property", + "source" : { + "name" : "q", + "type" : "OperandRef" + } + } + }, { + "valueType" : "{urn:hl7-org:elm-types:r1}String", + "value" : "{score}", + "type" : "Literal" + } ] + } + } ] } }, "then" : { @@ -1594,106 +1980,6 @@ "type" : "NamedTypeSpecifier" } } ] - }, { - "name" : "SortPegComponents", - "context" : "Patient", - "accessLevel" : "Public", - "type" : "FunctionDef", - "expression" : { - "type" : "Flatten", - "operand" : { - "type" : "List", - "element" : [ { - "type" : "Query", - "source" : [ { - "alias" : "OC", - "expression" : { - "name" : "c", - "type" : "OperandRef" - } - } ], - "relationship" : [ ], - "where" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", - "operand" : [ { - "path" : "code", - "scope" : "OC", - "type" : "Property" - } ] - }, { - "name" : "Pain", - "type" : "ConceptRef" - } ] - } - }, { - "type" : "Query", - "source" : [ { - "alias" : "OC", - "expression" : { - "name" : "c", - "type" : "OperandRef" - } - } ], - "relationship" : [ ], - "where" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", - "operand" : [ { - "path" : "code", - "scope" : "OC", - "type" : "Property" - } ] - }, { - "name" : "Enjoyment of life", - "type" : "ConceptRef" - } ] - } - }, { - "type" : "Query", - "source" : [ { - "alias" : "OC", - "expression" : { - "name" : "c", - "type" : "OperandRef" - } - } ], - "relationship" : [ ], - "where" : { - "type" : "Equivalent", - "operand" : [ { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", - "operand" : [ { - "path" : "code", - "scope" : "OC", - "type" : "Property" - } ] - }, { - "name" : "General activity", - "type" : "ConceptRef" - } ] - } - } ] - } - }, - "operand" : [ { - "name" : "c", - "operandTypeSpecifier" : { - "type" : "ListTypeSpecifier", - "elementType" : { - "name" : "{http://hl7.org/fhir}Observation.Component", - "type" : "NamedTypeSpecifier" - } - } - } ] }, { "name" : "Is18orOlder", "context" : "Patient", @@ -1991,21 +2277,42 @@ "context" : "Patient", "accessLevel" : "Public", "expression" : { - "name" : "Confirmed", - "libraryName" : "C3F", - "type" : "FunctionRef", + "type" : "Union", "operand" : [ { - "name" : "ActiveOrRecurring", + "name" : "Confirmed", "libraryName" : "C3F", "type" : "FunctionRef", "operand" : [ { - "dataType" : "{http://hl7.org/fhir}Condition", - "codeProperty" : "code", - "type" : "Retrieve", - "codes" : { - "name" : "Major Depression", - "type" : "ValueSetRef" - } + "name" : "ActiveOrRecurring", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Major Depression", + "type" : "ValueSetRef" + } + } ] + } ] + }, { + "name" : "Confirmed", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "name" : "ActiveOrRecurring", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Depression Diagnosis ICD9", + "type" : "ValueSetRef" + } + } ] } ] } ] } @@ -2014,21 +2321,42 @@ "context" : "Patient", "accessLevel" : "Public", "expression" : { - "name" : "Confirmed", - "libraryName" : "C3F", - "type" : "FunctionRef", + "type" : "Union", "operand" : [ { - "name" : "ActiveOrRecurring", + "name" : "Confirmed", "libraryName" : "C3F", "type" : "FunctionRef", "operand" : [ { - "dataType" : "{http://hl7.org/fhir}Condition", - "codeProperty" : "code", - "type" : "Retrieve", - "codes" : { - "name" : "Anxiety", - "type" : "ValueSetRef" - } + "name" : "ActiveOrRecurring", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Anxiety", + "type" : "ValueSetRef" + } + } ] + } ] + }, { + "name" : "Confirmed", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "name" : "ActiveOrRecurring", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Anxiety Disorders ICD9", + "type" : "ValueSetRef" + } + } ] } ] } ] } @@ -2036,24 +2364,6 @@ "name" : "SubstanceUseDisorderConditions", "context" : "Patient", "accessLevel" : "Public", - "expression" : { - "name" : "Confirmed", - "libraryName" : "C3F", - "type" : "FunctionRef", - "operand" : [ { - "dataType" : "{http://hl7.org/fhir}Condition", - "codeProperty" : "code", - "type" : "Retrieve", - "codes" : { - "name" : "Substance use disorder", - "type" : "ValueSetRef" - } - } ] - } - }, { - "name" : "SuicideAttemptConditions", - "context" : "Patient", - "accessLevel" : "Public", "expression" : { "type" : "Union", "operand" : [ { @@ -2065,7 +2375,7 @@ "codeProperty" : "code", "type" : "Retrieve", "codes" : { - "name" : "Suicide attempt", + "name" : "Substance use disorder", "type" : "ValueSetRef" } } ] @@ -2078,15 +2388,30 @@ "codeProperty" : "code", "type" : "Retrieve", "codes" : { - "type" : "ToList", - "operand" : { - "name" : "Suicidal deliberate poisoning", - "type" : "ConceptRef" - } + "name" : "Substance Abuse", + "type" : "ValueSetRef" } } ] } ] } + }, { + "name" : "SuicideAttemptConditions", + "context" : "Patient", + "accessLevel" : "Public", + "expression" : { + "name" : "Confirmed", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Suicide Attempt", + "type" : "ValueSetRef" + } + } ] + } }, { "name" : "SleepDisorderedBreathingConditions", "context" : "Patient", @@ -2190,15 +2515,26 @@ "libraryName" : "C3F", "type" : "FunctionRef", "operand" : [ { - "name" : "ActiveOrRecurring", - "libraryName" : "C3F", - "type" : "FunctionRef", + "type" : "Union", "operand" : [ { + "name" : "ActiveOrRecurring", + "libraryName" : "C3F", + "type" : "FunctionRef", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Condition", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "name" : "Pregnancy", + "type" : "ValueSetRef" + } + } ] + }, { "dataType" : "{http://hl7.org/fhir}Condition", "codeProperty" : "code", "type" : "Retrieve", "codes" : { - "name" : "Pregnancy", + "name" : "Pregnancy (New ICD10 codes published in 2018 and 2019)", "type" : "ValueSetRef" } } ] @@ -2388,19 +2724,53 @@ "operand" : [ { "type" : "Or", "operand" : [ { - "type" : "InValueSet", - "code" : { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", + "type" : "Or", + "operand" : [ { + "type" : "Or", "operand" : [ { - "name" : "R", - "type" : "AliasRef" + "type" : "InValueSet", + "code" : { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Major Depression" + } + }, { + "type" : "InValueSet", + "code" : { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Depression Diagnosis ICD9" + } } ] - }, - "valueset" : { - "name" : "Major Depression" - } + }, { + "type" : "InValueSet", + "code" : { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Anxiety" + } + } ] }, { "type" : "InValueSet", "code" : { @@ -2413,7 +2783,7 @@ } ] }, "valueset" : { - "name" : "Anxiety" + "name" : "Anxiety Disorders ICD9" } } ] }, { @@ -2443,12 +2813,12 @@ } ] }, "valueset" : { - "name" : "Suicide attempt" + "name" : "Substance Abuse" } } ] }, { - "type" : "Equivalent", - "operand" : [ { + "type" : "InValueSet", + "code" : { "name" : "ToConcept", "libraryName" : "FHIRHelpers", "type" : "FunctionRef", @@ -2456,10 +2826,10 @@ "name" : "R", "type" : "AliasRef" } ] - }, { - "name" : "Suicidal deliberate poisoning", - "type" : "ConceptRef" - } ] + }, + "valueset" : { + "name" : "Suicide Attempt" + } } ] }, { "type" : "InValueSet", @@ -2708,19 +3078,53 @@ "operand" : [ { "type" : "Or", "operand" : [ { - "type" : "InValueSet", - "code" : { - "name" : "ToConcept", - "libraryName" : "FHIRHelpers", - "type" : "FunctionRef", + "type" : "Or", + "operand" : [ { + "type" : "Or", "operand" : [ { - "name" : "R", - "type" : "AliasRef" + "type" : "InValueSet", + "code" : { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Major Depression" + } + }, { + "type" : "InValueSet", + "code" : { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Depression Diagnosis ICD9" + } } ] - }, - "valueset" : { - "name" : "Major Depression" - } + }, { + "type" : "InValueSet", + "code" : { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "name" : "R", + "type" : "AliasRef" + } ] + }, + "valueset" : { + "name" : "Anxiety" + } + } ] }, { "type" : "InValueSet", "code" : { @@ -2733,7 +3137,7 @@ } ] }, "valueset" : { - "name" : "Anxiety" + "name" : "Anxiety Disorders ICD9" } } ] }, { @@ -2763,12 +3167,12 @@ } ] }, "valueset" : { - "name" : "Suicide attempt" + "name" : "Substance Abuse" } } ] }, { - "type" : "Equivalent", - "operand" : [ { + "type" : "InValueSet", + "code" : { "name" : "ToConcept", "libraryName" : "FHIRHelpers", "type" : "FunctionRef", @@ -2776,10 +3180,10 @@ "name" : "R", "type" : "AliasRef" } ] - }, { - "name" : "Suicidal deliberate poisoning", - "type" : "ConceptRef" - } ] + }, + "valueset" : { + "name" : "Suicide Attempt" + } } ] }, { "type" : "InValueSet", @@ -3677,16 +4081,30 @@ "libraryName" : "C3F", "type" : "FunctionRef", "operand" : [ { - "dataType" : "{http://hl7.org/fhir}Observation", - "codeProperty" : "code", - "type" : "Retrieve", - "codes" : { - "type" : "ToList", - "operand" : { - "name" : "Pain Enjoyment General Activity (PEG) Assessment", - "type" : "ConceptRef" + "type" : "Union", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Observation", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "type" : "ToList", + "operand" : { + "name" : "Mean score [PEG]", + "type" : "ConceptRef" + } } - } + }, { + "dataType" : "{http://hl7.org/fhir}Observation", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "type" : "ToList", + "operand" : { + "name" : "Pain Enjoyment General Activity (PEG) Assessment LEGACY", + "type" : "ConceptRef" + } + } + } ] }, { "value" : 2, "unit" : "years", @@ -3707,7 +4125,157 @@ "type" : "ExpressionRef" } } ], + "let" : [ { + "identifier" : "Pain", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "C", + "expression" : { + "path" : "component", + "scope" : "A", + "type" : "Property" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "Pain severity in the past week - 0-10 numeric rating [Reported]", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "Pain LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + } + }, { + "identifier" : "Enjoyment", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "C", + "expression" : { + "path" : "component", + "scope" : "A", + "type" : "Property" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "What number best describes how pain has interfered with your enjoyment of life during the past week", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "Enjoyment of life LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + } + }, { + "identifier" : "GeneralActivity", + "expression" : { + "type" : "Query", + "source" : [ { + "alias" : "C", + "expression" : { + "path" : "component", + "scope" : "A", + "type" : "Property" + } + } ], + "relationship" : [ ], + "where" : { + "type" : "Or", + "operand" : [ { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "What number best describes how pain has interfered with your general activity during the past week", + "type" : "ConceptRef" + } ] + }, { + "type" : "Equivalent", + "operand" : [ { + "name" : "ToConcept", + "libraryName" : "FHIRHelpers", + "type" : "FunctionRef", + "operand" : [ { + "path" : "code", + "scope" : "C", + "type" : "Property" + } ] + }, { + "name" : "General activity LEGACY", + "type" : "ConceptRef" + } ] + } ] + } + } + } ], "relationship" : [ ], + "where" : { + "valueType" : "{urn:hl7-org:elm-types:r1}Boolean", + "value" : "true", + "type" : "Literal" + }, "return" : { "expression" : { "type" : "Tuple", @@ -3781,16 +4349,39 @@ "source" : [ { "alias" : "C", "expression" : { - "name" : "SortPegComponents", - "type" : "FunctionRef", - "operand" : [ { - "path" : "component", - "scope" : "A", - "type" : "Property" + "type" : "List", + "element" : [ { + "type" : "First", + "source" : { + "name" : "Pain", + "type" : "QueryLetRef" + } + }, { + "type" : "First", + "source" : { + "name" : "Enjoyment", + "type" : "QueryLetRef" + } + }, { + "type" : "First", + "source" : { + "name" : "GeneralActivity", + "type" : "QueryLetRef" + } } ] } } ], "relationship" : [ ], + "where" : { + "type" : "Not", + "operand" : { + "type" : "IsNull", + "operand" : { + "name" : "C", + "type" : "AliasRef" + } + } + }, "return" : { "expression" : { "type" : "Tuple", @@ -3862,16 +4453,30 @@ "libraryName" : "C3F", "type" : "FunctionRef", "operand" : [ { - "dataType" : "{http://hl7.org/fhir}Observation", - "codeProperty" : "code", - "type" : "Retrieve", - "codes" : { - "type" : "ToList", - "operand" : { - "name" : "STarT Back Screening Tool", - "type" : "ConceptRef" + "type" : "Union", + "operand" : [ { + "dataType" : "{http://hl7.org/fhir}Observation", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "type" : "ToList", + "operand" : { + "name" : "Total score [STarT Back]", + "type" : "ConceptRef" + } } - } + }, { + "dataType" : "{http://hl7.org/fhir}Observation", + "codeProperty" : "code", + "type" : "Retrieve", + "codes" : { + "type" : "ToList", + "operand" : { + "name" : "STarT Back Screening Tool LEGACY", + "type" : "ConceptRef" + } + } + } ] }, { "value" : 2, "unit" : "years", diff --git a/src/cql/valueset-db.json b/src/cql/valueset-db.json index ceedee22c..e950270da 100644 --- a/src/cql/valueset-db.json +++ b/src/cql/valueset-db.json @@ -1,46067 +1,45828 @@ { + 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"http://hl7.org/fhir/sid/icd-9-cm", + "version": "2013" } ] } From 0204321641e3433719ec860ea05d66c9614eb5e4 Mon Sep 17 00:00:00 2001 From: Chris Moesel Date: Thu, 20 Feb 2020 16:22:16 -0500 Subject: [PATCH 2/3] Update .env to disable source maps for the static build --- .env | 3 ++- 1 file changed, 2 insertions(+), 1 deletion(-) diff --git a/.env b/.env index 8489603ee..af9bcbce6 100644 --- a/.env +++ b/.env @@ -1,2 +1,3 @@ PORT=8000 -REACT_APP_EPIC_SUPPORTED_QUERIES=false \ No newline at end of file +REACT_APP_EPIC_SUPPORTED_QUERIES=false +GENERATE_SOURCEMAP=false \ No newline at end of file From 8021d0d97e5a764b3518390d4b9b9601fba20912 Mon Sep 17 00:00:00 2001 From: Chris Moesel Date: Thu, 20 Feb 2020 16:23:51 -0500 Subject: [PATCH 3/3] v0.3.0 --- package.json | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/package.json b/package.json index 21d9afb05..d91dd09b0 100644 --- a/package.json +++ b/package.json @@ -1,6 +1,6 @@ { "name": "pain-management-factors", - "version": "0.2.1", + "version": "0.3.0", "description": "Pain Management Factors SMART-on-FHIR App", "homepage": "https://ahrq-cds.github.io/AHRQ-CDS-Connect-PAIN-MANAGEMENT-SUMMARY", "license": "Apache-2.0",