<?xml version="1.0" encoding="UTF-8"?><PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="opioidcds-11"/>
  <meta>
    <security>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <code value="HTEST"/>
      <display value="test health data"/>
    </security>
  </meta>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="cds"/>
  </extension>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.11.2"/>
  </identifier>
  <identifier>
    <use value="official"/>
    <value value="cdc-opioid-guidance"/>
  </identifier>
  <version value="0.1.0"/>
  <name value="Cdcopioid11"/>
  <title value="CDC Opioid Prescribing Guideline Recommendation #11"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
      <code value="eca-rule"/>
      <display value="ECA Rule"/>
    </coding>
  </type>
  <status value="draft"/>
  <date value="2018-03-19"/>
  <publisher value="HL7 International / Clinical Decision Support"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/dss"/>
    </telecom>
  </contact>
  <description value="Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient."/>
  <useContext>
    <code>
      <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
      <code value="focus"/>
      <display value="Clinical Focus"/>
    </code>
    <valueCodeableConcept>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="182888003"/>
        <display value="Medication requested (situation)"/>
      </coding>
    </valueCodeableConcept>
  </useContext>
  <useContext>
    <code>
      <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
      <code value="focus"/>
      <display value="Clinical Focus"/>
    </code>
    <valueCodeableConcept>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="82423001"/>
        <display value="Chronic pain (finding)"/>
      </coding>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
      <display value="United States of America (the)"/>
    </coding>
  </jurisdiction>
  <purpose value="CDC’s Guideline for Prescribing Opioids for Chronic Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care."/>
  <usage value="Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible."/>
  <copyright value="© CDC 2016+."/>
  <topic>
    <text value="Opioid Prescribing"/>
  </topic>
  <author>
    <name value="Kensaku Kawamoto, MD, PhD, MHS"/>
  </author>
  <author>
    <name value="Bryn Rhodes"/>
  </author>
  <author>
    <name value="Floyd Eisenberg, MD, MPH"/>
  </author>
  <author>
    <name value="Robert McClure, MD, MPH"/>
  </author>
  <relatedArtifact>
    <type value="documentation"/>
    <display value="CDC guideline for prescribing opioids for chronic pain"/>
    <document>
      <url value="https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420"/>
    </document>
  </relatedArtifact>
  <relatedArtifact>
    <type value="documentation"/>
    <display value="MME Conversion Tables"/>
    <document>
      <url value="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"/>
    </document>
  </relatedArtifact>
  <library value="http://example.org/fhir/Library/opioidcds-recommendation-11"/>
  <action>
    <extension url="http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation">
      <valueCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/>
          <code value="strong"/>
          <display value="Strong"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence">
      <valueCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/evidence-quality"/>
          <code value="low"/>
          <display value="Low quality"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <title value="Existing patient has concurrent opioid and benzodiazepine prescriptions."/>
    <description value="Checking if the trigger prescription meets the inclusion criteria for recommendation #11 workflow."/>
    <documentation>
      <type value="documentation"/>
    </documentation>
    <trigger>
      <type value="named-event"/>
      <name value="medication-prescribe"/>
    </trigger>
    <condition>
      <kind value="applicability"/>
      <expression>
        <description value="Check whether the existing patient is using opioids concurrently with benzodiazepines."/>
        <language value="text/cql-identifier"/>
        <expression value="Inclusion Criteria"/>
      </expression>
    </condition>
    <groupingBehavior value="visual-group"/>
    <selectionBehavior value="exactly-one"/>
    <dynamicValue>
      <path value="action.description"/>
      <expression>
        <language value="text/cql-identifier"/>
        <expression value="Get Detail"/>
      </expression>
    </dynamicValue>
    <dynamicValue>
      <path value="action.title"/>
      <expression>
        <language value="text/cql-identifier"/>
        <expression value="Get Summary"/>
      </expression>
    </dynamicValue>
    <dynamicValue>
      <path value="action.extension"/>
      <expression>
        <language value="text/cql-identifier"/>
        <expression value="Get Indicator"/>
      </expression>
    </dynamicValue>
    <action>
      <description value="Will revise"/>
    </action>
    <action>
      <description value="Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"/>
    </action>
    <action>
      <description value="N/A - see comment; snooze 3 mo"/>
    </action>
  </action>
</PlanDefinition>