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library OMTKLogic version '0.1.0'
using OMTK version '0.1.0'
codesystem RxNorm: 'http://www.nlm.nih.gov/research/umls/rxnorm'
//define MED_DOSE_FORMS: [MED_DOSE_FORM]
// Given an RxNorm Code:
// NON_SURGICAL_OPIOID_TO_INCLUDE.DRUG_RXCUI
// MED_DRUG.DRUG_RXCUI
// MED_SCDC_FOR_DRUG.DRUG_RXCUI -> SCDC_RXCUI
// MED_SCDC.SCDC_RXCUI (STRENGTH, STRENGTH_VALUE, STRENGTH_UNIT)
// MED_INGREDIENT_FOR_SCDC.SCDC_RXCUI -> INGREDIENT_RXCUI
// MED_INGREDIENT.INGREDIENT_RXCUI
// MED_INGREDIENT_TYPE.INGREDIENT_RXCUI (INGREDIENT_TYPE = 'NonSurgicalOpioid')
/*
 SQL ->
select D.DRUG_RXCUI, D.DRUG_NAME, DF.DOSE_FORM_NAME, SCDCD.SCDC_RXCUI, SCDC.SCDC_NAME, SCDC.STRENGTH, SCDC.STRENGTH_VALUE, SCDC.STRENGTH_UNIT, I.INGREDIENT_RXCUI, I.INGREDIENT_NAME
 from MED_DRUG D
 join NON_SURGICAL_OPIOID_TO_INCLUDE NSO on D.DRUG_RXCUI = NSO.DRUG_RXCUI
 join MED_SCDC_FOR_DRUG SCDCD on D.DRUG_RXCUI = SCDCD.DRUG_RXCUI
 join MED_SCDC SCDC on SCDCD.SCDC_RXCUI = SCDC.SCDC_RXCUI
 join MED_INGREDIENT_FOR_SCDC SCDCI on SCDC.SCDC_RXCUI = SCDCI.SCDC_RXCUI
 join MED_INGREDIENT I on SCDCI.INGREDIENT_RXCUI = I.INGREDIENT_RXCUI
 join MED_INGREDIENT_TYPE IT on I.INGREDIENT_RXCUI = IT.INGREDIENT_RXCUI
	left join MED_DRUG_DOSE_FORM DDF on D.DRUG_RXCUI = DDF.DRUG_RXCUI
	left join MED_DOSE_FORM DF on DDF.DOSE_FORM_RXCUI = DF.DOSE_FORM_RXCUI
	--Most of the drugs have multiple dose form groups...
	--left join MED_DRUG_DOSE_FORM_GROUP DDFG on D.DRUG_RXCUI = DDFG.DRUG_RXCUI
	--left join MED_DOSE_FORM_GROUP DFG on DDFG.DOSE_FORM_GROUP_RXCUI = DFG.DOSE_FORM_GROUP_RXCUI
 where D.DRUG_RXCUI = @RxNormCode // 197696
 and IT.INGREDIENT_TYPE = 'NonSurgicalOpioid'
*/
/*
 CQL, assuming translation to SQL:
 from
 [MED_DRUG: rxNormCode] D,
 [NON_SURGICAL_OPIOID_TO_INCLUDE] NSO,
 [MED_SCDC_FOR_DRUG] SCDCD,
 [MED_SCDC] SCDC,
 [MED_INGREDIENT_FOR_SCDC] SCDCI,
 [MED_INGREDIENT] I,
 [MED_INGREDIENT_TYPE] IT,
 [MED_DRUG_DOSE_FORM] DDF,
 [MED_DOSE_FORM] DF
 where D.DRUG_RXCUI = NSO.DRUG_RXCUI
 and D.DRUG_RXCUI = SCDCD.DRUG_RXCUI
 and SCDCD.SCDC_RXCUI = SCDC.SCDC_RXCUI
 and SCDC.SCDC_RXCUI = SCDCI.SCDC_RXCUI
 and SDCDI.INGREDIENT_RXCUI = I.INGREDIENT_RXCUI
 and I.INGREDIENT_RXCUI = IT.INGREDIENT_RXCUI
 and D.DRUG_RXCUI = DDF.DRUG_RXCUI
 and DDF.DOSE_FORM_RXCUI = DF.DOSE_FORM_RXCUI
 and IT.INGREDIENT_TYPE = 'NonSurgicalOpioid'
*/
/*
An engine with a naive implementation for multi-source queries would perform
pretty horribly here, so rewrite it using "syntactic optimization" :)
*/
/*
 Normalizes the input units to UCUM units
 
 Note guidance for UCUM presentation of medication units from SNOMED here:
 https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjU3vLpicPTAhWFMGMKHRpOBUAQFggiMAA&url=https%3A%2F%2Fconfluence.ihtsdotools.org%2Fdownload%2Fattachments%2F17859188%2FExpressing%2520Units%2520of%2520Measure%2520for%2520Medicinal%2520Products.doc%3Fapi%3Dv2&usg=AFQjCNE5sboicqvJDUyXJ2im8VzBpgHE8A
 
 The values listed here are the only ones currently present in the OMTK data
 
 Based on the HL7 UCUM subset here:
 http://download.hl7.de/documents/ucum/ucumdata.html
*/
define function ToUCUM(unit String):
 case unit
 when 'MG' then 'mg'
 when 'MG/ACTUAT' then 'mg/{actuat}'
 when 'MG/HR' then 'mg/h'
 when 'MG/ML' then 'mg/mL'
 else 'unknown{' + unit + '}' // Should probably be an error
 end
/*
 Calculates daily frequency given frequency within a period
*/
define function ToDaily(frequency Integer, period System.Quantity):
 case period.unit
 when 'h' then frequency * (24.0 / period.value)
 when 'min' then frequency * (24.0 / period.value) * 60
 when 's' then frequency * (24.0 / period.value) * 60 * 60
 when 'd' then frequency * (24.0 / period.value) / 24
 when 'wk' then frequency * (24.0 / period.value) / (24 * 7)
 when 'mo' then frequency * (24.0 / period.value) / (24 * 30) // assuming 30 days in month
 when 'a' then frequency * (24.0 / period.value) / (24 * 365) // assuming 365 days in year
 else null
 end
/*
 Returns true if the given dose form is a patch (transdermal system)
*/
define function IsPatch(doseFormCode Code):
 ToInteger(doseFormCode.code) = 316987
/*
 Returns the conversion factor for the given ingredient
Opioid (strength in mg except where noted)	MME Conversion Factor*
Buprenorphine, transdermal patch (MCG/HR)	12.6
Buprenorphine, tablet or film	30
Buprenorphine, film (MCG)	0.03
Butorphanol	7
Codeine	0.15
Dihydrocodeine	0.25
Fentanyl, buccal/SL tabet or lozenge/troche (MCG)	0.13
Fentanyl, film or oral spray (MCG)	0.18
Fentanyl, nasal spray (MCG)	0.16
Fentanyl, transdermal patch (MCG/HR)	7.2
Hydrocodone	1
Hydromorphone	4
Levomethadyl acetate	8
Levorphanol tartrate	11
Meperidine 	0.1
Methadone	3
 1-20 mg/d 4
 21-40 mg/d 8
 41-60 mg/d 10
 61-80 mg/d 12
Morphine	1
Opium	1 // NOTE: Not present as an ingredient in the RxNorm data
Oxycodone	1.5
Oxymorphone	3
Pentazocine	0.37
Tapentadol	0.4
Tramadol	0.1
*/
define function GetConversionFactor(ingredientCode Code, dailyDose Quantity, doseFormCode Code):
 case ToInteger(ingredientCode.code)
 when 161 then 0 //	Acetaminophen
 when 1191 then 0 //	Aspirin
 when 1223 then 0 //	Atropine
 when 1767 then 0 //	Brompheniramine
 when 1819 then ( //	Buprenorphine
 case 
 when ToInteger(doseFormCode.code) = 316987 then 12.6 // Transdermal system
 else 30 // Tablet or Film (or Film in MCG)
 end
 ) 
 when 1841 then 7 //	Butorphanol
 when 1886 then 0 //	Caffeine
 when 2101 then 0 //	Carisoprodol
 when 2354 then 0 //	chlorcyclizine
 when 2400 then 0 //	Chlorpheniramine
 when 2670 then 0.15 //	Codeine
 when 3423 then 4 //	Hydromorphone
 when 3498 then 0 //	Diphenhydramine
 when 4337 then ( //	Fentanyl
 case
 when ToInteger(doseFormCode.code) in { 970789, 317007, 316992 } then 0.13 // Buccal Tablet, Sublingual Tablet, Oral Lozenge
 when ToInteger(doseFormCode.code) = 346163 then 0.18 // Buccal Film
 when ToInteger(doseFormCode.code) in { 126542, 346163 } then 0.16 // Nasal Spray, Mucosal Spray
 when IsPatch(doseFormCode) then 7.2 // Transdermal system
 else 1000 // Really ought to be an error because it represents a previously unencountered dose form....
 end
 )
 when 5032 then 0 //	Guaifenesin
 when 5489 then 1 //	Hydrocodone
 when 5640 then 0 //	Ibuprofen
 when 6102 then 0 //	Kaolin
 when 6378 then 11 //	Levorphanol (NOTE: Given as Levorphanol tartrate in the CDC conversion table)
 when 6754 then 0.1 //	Meperidine
 when 6813 then ( //	Methadone
 case
 when dailyDose.value between 1 and 20 then 4
 when dailyDose.value between 21 and 40 then 8
 when dailyDose.value between 41 and 60 then 10
 when dailyDose.value >= 61 then 12
 else 1000 // Really ought to be an error because it represents an unexpected dose range...
 end
 )
 when 7052 then 1 //	Morphine
 when 7242 then 0 //	Naloxone
 when 7243 then 0 //	Naltrexone
 when 7804 then 1.5 //	Oxycodone
 when 7814 then 3 //	Oxymorphone
 when 8001 then 0.37 //	Pentazocine
 when 8163 then 0 //	Phenylephrine
 when 8175 then 0 //	Phenylpropanolamine
 when 8745 then 0 //	Promethazine
 when 8896 then 0 //	Pseudoephedrine
 when 9009 then 0 //	Pyrilamine
 when 10689 then 0.1 //	Tramadol
 when 10849 then 0 //	Triprolidine
 when 19759 then 0 //	bromodiphenhydramine
 when 19860 then 0 //	butalbital
 when 22696 then 0 //	dexbrompheniramine
 when 22697 then 0 //	dexchlorpheniramine
 when 23088 then 0.25 //	dihydrocodeine
 when 27084 then 0 //	homatropine
 when 35780 then 0 //	ropivacaine
 when 237005 then 8 //	Levomethadyl (NOTE: given as Levomethadyl acetate in the CDC conversion table)
 when 636827 then 0 //	guaiacolsulfonate
 when 787390 then 0.4 //	tapentadol
 else 0
 end
define function EnsureMicrogramQuantity(strength Quantity):
 if strength.value < 0.1 and (PositionOf('mg', strength.unit) = 0) then
 Quantity {
 value: strength.value * 1000,
 unit: 'mcg' + Substring(strength.unit, 2)
 }
 else
 strength
/*
 Returns the non-surgical opioid ingredients and their strengths that
 make up the drug identified by the given rxNormCode as a list of tuples:
 List<Tuple {
 rxNormCode Code,
 doseFormCode Code,
 doseFormName String,
 ingredientCode Code,
 ingredientName String,
 strength Quantity
 }>
*/
define function GetIngredients(rxNormCode Code):
 (
 [MED_SCDC_FOR_DRUG: DRUG_RXCUI in rxNormCode] SD
 where exists ([MED_DRUG_VALUE_SET: DRUG_RXCUI in SD.DRUG_RXCUI])
 return {
 rxNormCode: rxNormCode,
 component: SingletonFrom([MED_SCDC: SCDC_RXCUI in SD.SCDC_RXCUI]),
 ingredientCode: SingletonFrom([MED_SCDC: SCDC_RXCUI in SD.SCDC_RXCUI]).INGREDIENT_RXCUI,
 doseFormCode: SingletonFrom([MED_DRUG: DRUG_RXCUI in SD.DRUG_RXCUI]).DOSE_FORM_RXCUI // Could potentially look this up only once...
 }
 ) C
 let
 ingredient: SingletonFrom([MED_INGREDIENT: INGREDIENT_RXCUI in C.ingredientCode]),
 doseForm: SingletonFrom([MED_DOSE_FORM: DOSE_FORM_RXCUI in C.doseFormCode])
 where exists (
 [MED_INGREDIENT_TYPE: INGREDIENT_RXCUI in C.ingredientCode] IT
 where IT.INGREDIENT_TYPE = 'Opioid_NonSurgical'
 )
 return {
 rxNormCode: rxNormCode,
 doseFormCode: C.doseFormCode,
 doseFormName: doseForm.DOSE_FORM_NAME,
 ingredientCode: C.ingredientCode,
 ingredientName: ingredient.INGREDIENT_NAME,
 strength:
 EnsureMicrogramQuantity(
 Quantity {
 value: C.component.STRENGTH_VALUE,
 unit: ToUCUM(C.component.STRENGTH_UNIT)
 }
 )
 }
/*
 Calculates daily dose for a specific ingredient based on the ingredient strength, dose form, dose quantity, and daily frequency
*/
define function GetDailyDose(ingredientCode Code, strength Quantity, doseFormCode Code, doseQuantity Quantity, dosesPerDay Decimal):
 case
	 // if patch --> daily dose = dose value (e.g, number patches with doseQuantity unit = "patch") * per-hour strength
 when IsPatch(doseFormCode) then
 // buprenorphine or fentanyl patch
 if ToInteger(ingredientCode.code) in { 1819, 4337 } then
 Quantity { value: dosesPerDay * doseQuantity.value * strength.value, unit: strength.unit }
 else
 null
 // if dose unit in actual mass units (mg or mcg -- when it's a single med) --> daily dose = numTimesPerDay * dose
 when doseQuantity.unit in { 'mg', 'mcg' } then
 Quantity { value: dosesPerDay * doseQuantity.value, unit: doseQuantity.unit }
 // if doseQuantity is in actual volume units (mL) --> daily dose = numTimesPerDay * dose * strength
 when doseQuantity.unit = 'mL' and (PositionOf('/mL', strength.unit) = Length(strength.unit) - 3) then
 Quantity { value: dosesPerDay * doseQuantity.value * strength.value, unit: Substring(strength.unit, 0, PositionOf('/', strength.unit)) }
		// if doseQuantity is not in actual units (e.g., 1 tab, 1 spray -- when it's a combo med with a unit of tablet, or it's mg/actuat) --> daily dose = numTimesPerDay * dose value * strength value
 else
 Quantity { value: dosesPerDay * doseQuantity.value * strength.value, unit: Substring(strength.unit, 0, PositionOf('/', strength.unit)) }
 end
 
define function GetMedicationName(rxNormCode Code):
 SingletonFrom([MED_DRUG: DRUG_RXCUI in rxNormCode]).DRUG_NAME
/*
 Builds a description for the daily dose for an ingredient
*/
define function GetDailyDoseDescription(ingredientCode Code, ingredientName String, strength Quantity, doseFormCode Code, doseFormName String, doseQuantity Quantity, dosesPerDay Decimal, dailyDose Quantity):
 case
 // if patch
 when IsPatch(doseFormCode) then
 // buprenorphine or fentanyl patch
 if ToInteger(ingredientCode.code) in { 1819, 4337 } then
 ingredientName + ' patch: ' + ToString(doseQuantity.value) + ' * ' + ToString(strength) + ' = ' + ToString(dailyDose)
 else
 null
 // if dose unit in actual mass units (mg or mcg -- when it's a single med)
 when doseQuantity.unit in { 'mg', 'mcg' } then
 ingredientName + ' ' + doseFormName + ': ' + ToString(dosesPerDay) + '/d * ' + ToString(doseQuantity) + ' = ' + ToString(dailyDose)
 // if doseQuantity in actual volume units (mL) or not in actual units (e.g. 1 tab, 1 spray)
 else
 ingredientName + ' ' + doseFormName + ': ' + ToString(dosesPerDay) + '/d * ' + ToString(doseQuantity) + ' * ' + ToString(strength) + ' = ' + ToString(dailyDose)
 end
/*
 Calculates MMEs for the given input prescription information and returns it
 as a list of tuples:
 List<Tuple {
 rxNormCode Code,
 doseFormCode Code,
 doseQuantity Quantity,
 dosesPerDay Decimal,
 ingredientCode Code,
 ingredientName String,
 strength Quantity,
 dailyDose Quantity,
 dailyDoseDescription String,
 conversionFactor Decimal,
 mme Quantity
 }>
*/
define function CalculateMMEs(medications List<Tuple { rxNormCode Code, doseQuantity Quantity, dosesPerDay Decimal }>):
 Flatten(
 medications M
 let Ingredients: GetIngredients(M.rxNormCode)
 return
 Ingredients I
 let
 adjustedDoseQuantity: EnsureMicrogramQuantity(M.doseQuantity),
 dailyDose: GetDailyDose(I.ingredientCode, I.strength, I.doseFormCode, adjustedDoseQuantity, M.dosesPerDay),
 factor: GetConversionFactor(I.ingredientCode, dailyDose, I.doseFormCode)
 return {
 rxNormCode: M.rxNormCode,
 doseFormCode: I.doseFormCode,
 doseQuantity: adjustedDoseQuantity,
 dosesPerDay: M.dosesPerDay,
 ingredientCode: I.ingredientCode,
 ingredientName: I.ingredientName,
 strength: I.strength,
 dailyDose: dailyDose,
 dailyDoseDescription: GetDailyDoseDescription(I.ingredientCode, I.ingredientName, I.strength, I.doseFormCode, I.doseFormName, adjustedDoseQuantity, M.dosesPerDay, dailyDose),
 conversionFactor: factor,
 mme: Quantity {
 value: dailyDose.value * factor,
 unit: dailyDose.unit + '/d'
 }
 }
 )
define TestCalculateMMEs:
 CalculateMMEs({ { rxNormCode: Code '388508' from RxNorm, doseQuantity: Quantity { value: 1, unit: 'patch' }, dosesPerDay: 0.33 } })

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