2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide
2022.1.0 - CI Build
2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide
2022.1.0 - CI Build
2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide, published by Centers for Disease Control and Prevention (CDC). This guide is not an authorized publication; it is the continuous build for version 2022.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/opioid-cds-r4/ and changes regularly. See the Directory of published versions
| Draft as of 2023-05-01 |
{
"resourceType" : "PlanDefinition",
"id" : "opioidcds-10-patient-view",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition"🔗 ,
"http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <table class=\"grid dict\">\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">opioidcds-10-patient-view</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Url: </b></th>\n <td style=\"padding-left: 4px;\"><a href=\"PlanDefinition-opioidcds-10-patient-view.html\">PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #10 (patient-view)</a></td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">2022.1.0</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Identifier: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>value: </b> <span>cdc-opioid-guidance</span>\n </p>\n \n </td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Name: </b></th>\n <td style=\"padding-left: 4px;\">PlanDefinition_Recommendation_10_Patient_View</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #10 (patient-view)</td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Status: </b></th>\n <td style=\"padding-left: 4px;\">draft</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Experimental: </b></th>\n <td style=\"padding-left: 4px;\">true</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <b>system: </b> <span><a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-plan-definition-type.html\">PlanDefinitionType</a></span>\n </p>\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>code: </b> <span>eca-rule</span>\n </p>\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>display: </b> <span>ECA Rule</span>\n </p>\n \n \n \n \n </td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Date: </b></th>\n <td style=\"padding-left: 4px;\">2023-05-01</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Publisher: </b></th>\n <td style=\"padding-left: 4px;\">Centers for Disease Control and Prevention (CDC)</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Description: </b></th>\n <td style=\"padding-left: 4px;\">When prescribing opioids for subacute or chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><a name=\"effective-data-requirements\"> </a><b>Logic Definitions: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Active Ambulatory Opioid Rx</td>\n \n \n <td>0</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Active Ambulatory Opioid Rx&quot;:\n if Config.&quot;Can the implementing EHR support queries for past medications by date range?&quot; then\n (\n &quot;Get MedicationRequest Medication as Code&quot;(&quot;Get Active Ambulatory Medication Requests&quot;([MedicationRequest]))\n ) Rx\n where date from Rx.authoredOn 2 years or less on or before Today()\n and Rx.medication in &quot;Opioid analgesics with ambulatory misuse potential&quot;\n else\n List&lt;FHIR.MedicationRequest&gt;{}</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10PatientView</td>\n \n \n <td>Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions</td>\n \n \n <td>1</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot;:\n Common.&quot;Active Ambulatory Opioid Rx&quot; AmbulatoryOpioidPrescription\n where Routines.&quot;Is Subacute or Chronic Pain Prescription?&quot;(AmbulatoryOpioidPrescription)</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10PatientView</td>\n \n \n <td>Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential</td>\n \n \n <td>2</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential&quot;:\n exists (&quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot;)</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Patient Age Less Than 18</td>\n \n \n <td>3</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Patient Age Less Than 18&quot;:\n if (Config.&quot;Age Less than 18 Years Is Enabled&quot;) then\n AgeInYearsAt(Today()) &lt; 18\n else\n false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Condition Positive for Sickle Cell</td>\n \n \n <td>4</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Condition Positive for Sickle Cell&quot;:\n if (Config.&quot;Sickle Cell Check Enabled&quot;) then\n exists(\n Common.&quot;Positive Sickle Cell Condition&quot;\n ) else\n false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>US Core-Categorized Conditions</td>\n \n \n <td>5</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">// 3. Medications indicating end of life\n /* or exists (\n &quot;Medications Indicating End of Life&quot;\n ) */\ndefine &quot;US Core-Categorized Conditions&quot;:\n [Condition: category in &quot;Encounter Diagnosis Condition Category&quot;]\n union [Condition: category in &quot;Problem List Condition Category&quot;]\n union [Condition: category in &quot;US Core Health Concern Condition Category&quot;]</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Conditions Indicating End Of Life Present</td>\n \n \n <td>6</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Conditions Indicating End Of Life Present&quot;:\n exists (\n Common.&quot;US Core-Categorized Conditions&quot; LLEC\n where LLEC.code in Common.&quot;Limited life expectancy conditions&quot;\n and LLEC.clinicalStatus in Common.&quot;Active Condition&quot;\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Service Requests</td>\n \n \n <td>7</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Service Requests&quot;:\n [ServiceRequest] SR\n return SR</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Palliative Care Lookback Period</td>\n \n \n <td>8</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">/*\n** Routine #1\n** Opioid Review Useful Routine\n**\n** Definition | Answer to Proceed | Details | Data (Terminology) Requirement\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Age &lt; 18 years? | No | Calculate age from date of birth; exclude | Date of birth\n** | | patients with age less than 18 years at the |\n** | | time of the prescription |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Evidence of | No | Look for documented findings consistent | Sickle cell disease conditions\n** sickle cell disease? | | with those listed in the sickle cell |\n** | | value set |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Limited life | No | Look for documented findings consistent | Limited life expectancy conditions\n** expectancy conditions | | with those listed in the limited life |\n** present? | | expectancy value set (terminal illness, bad |\n** | | prognosis, pre-terminal) |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Order for therapies | No | Look for patients with an existing order for | Therapies indicating end of life care\n** indicating end of life | | therapies indicating end of life care |\n** care in past 90 days? | | written within past 90 days |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Active cancer | No | See sub-routine 3 | See sub-routine 3\n** treatment? | | |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Conditions Likely | No | Look for patients with active conditions in | Conditions likely terminal for opioid\n** Terminal for opioid | | the value set end-of-life-conditions | prescribing\n** prescribing present? | | |\n** ------------------------------------------------------------------------------------------------------------------------------------\n**\n*/\ndefine &quot;Palliative Care Lookback Period&quot;:\n Interval[Today() - 90 days, Today()]</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Order For Palliative Care In Past 90 Days</td>\n \n \n <td>9</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Order For Palliative Care In Past 90 Days&quot;:\n exists (\n Common.&quot;Service Requests&quot; SR\n where SR.status in { 'active', 'completed'}\n and SR.intent in {'proposal', 'plan,', 'directive', 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}\n and FHIRHelpers.ToDateTime(SR.authoredOn) during day of &quot;Palliative Care Lookback Period&quot;\n and SR.code in Common.&quot;Therapies indicating end of life care&quot;\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Is Active Cancer Treatment?</td>\n \n \n <td>10</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Is Active Cancer Treatment?&quot;:\n if (Config.&quot;Active Cancer Treatment Encounters Condition Is Enabled&quot;) then\n &quot;Has Two or More Encounters with Cancer Diagnosis During Encounter Period&quot;\n else\n false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present</td>\n \n \n <td>11</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present&quot;:\n if (Config.&quot;End-Stage Disease Criteria Enabled&quot;) then\n exists (\n Common.&quot;US Core-Categorized Conditions&quot; EOLC\n where EOLC.code in Common.&quot;Conditions likely terminal for opioid prescribing&quot;\n and EOLC.clinicalStatus in Common.&quot;Active Condition&quot;\n )\n else\n false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Is Opioid Review Useful?</td>\n \n \n <td>12</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Is Opioid Review Useful?&quot;:\n not &quot;Patient Age Less Than 18&quot;\n and not &quot;Condition Positive for Sickle Cell&quot;\n and not &quot;Conditions Indicating End Of Life Present&quot;\n and not &quot;Order For Palliative Care In Past 90 Days&quot;\n and not &quot;Is Active Cancer Treatment?&quot;\n and not &quot;Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10Common</td>\n \n \n <td>Lookback Year</td>\n \n \n <td>13</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Lookback Year&quot;:\n Interval[Today() - 12 months - 1 days, Today() - 1 day]</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10Common</td>\n \n \n <td>Laboratory Observations</td>\n \n \n <td>14</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Laboratory Observations&quot;:\n [Observation: &quot;category&quot; in Common.&quot;Observation Category Laboratory&quot;]</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10Common</td>\n \n \n <td>Non-opioid Screenings</td>\n \n \n <td>15</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Non-opioid Screenings&quot;:\n GetRelevantScreenings(&quot;Laboratory Observations&quot; LabObservations\n where (LabObservations.code in Common.&quot;Non-opioid drug urine screening&quot;)\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10Common</td>\n \n \n <td>Cocaine Screenings</td>\n \n \n <td>16</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Cocaine Screenings&quot;:\n GetRelevantScreenings(&quot;Laboratory Observations&quot; LabObservations\n where (LabObservations.code in Common.&quot;Cocaine Urine Tests&quot;)\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10Common</td>\n \n \n <td>PCP Screenings</td>\n \n \n <td>17</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;PCP Screenings&quot;:\n GetRelevantScreenings(&quot;Laboratory Observations&quot; LabObservations\n where (LabObservations.code in Common.&quot;PCP Urine Tests&quot;)\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10Common</td>\n \n \n <td>Patient had Urine Screening in Last 12 Months</td>\n \n \n <td>18</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Patient had Urine Screening in Last 12 Months&quot;:\n (\n exists (&quot;Non-opioid Screenings&quot;)\n or exists (&quot;Cocaine Screenings&quot;)\n or exists (&quot;PCP Screenings&quot;)\n )\n or\n if Config.&quot;Opiate Urine Screening Check Enabled&quot; then\n exists (&quot;Opiate Screenings&quot;)\n else\n false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10Common</td>\n \n \n <td>Inclusion Criteria</td>\n \n \n <td>19</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Inclusion Criteria&quot;:\n Routines.&quot;Is Opioid Review Useful?&quot;\n and (not &quot;Patient had Urine Screening in Last 12 Months&quot;)</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Conditions Indicating End of Life or With Limited Life Expectancy</td>\n \n \n <td>20</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Conditions Indicating End of Life or With Limited Life Expectancy&quot;:\n (\n &quot;US Core-Categorized Conditions&quot; C\n where C.code in &quot;Conditions likely terminal for opioid prescribing&quot;\n and C.clinicalStatus in &quot;Active Condition&quot;\n )\n union\n (\n &quot;US Core-Categorized Conditions&quot; C\n where C.code in &quot;Limited life expectancy conditions&quot;\n and C.clinicalStatus in &quot;Active Condition&quot;\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Admitted/Referred/Discharged to Hospice Care</td>\n \n \n <td>21</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Admitted/Referred/Discharged to Hospice Care&quot;:\n (\n [Procedure: code in &quot;Hospice Procedure Codes&quot;] P\n where P.status.value in { 'in-progress', 'completed' }\n )\n union\n (\n &quot;Service Requests&quot; SR\n where SR.code in &quot;Hospice Procedure Codes&quot;\n and SR.status.value in { 'active', 'completed' }\n )\n union\n (\n if (Config.&quot;Hospice Findings Exclusion Enabled&quot;) then\n [Observation: code in &quot;Hospice Finding Codes&quot;] O\n where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })\n else\n {}\n )\n union\n (\n [Encounter] E\n where date from E.period.start 1 year or less on or before Today()\n and (\n if E.hospitalization.dischargeDisposition.coding is null\n or not exists (E.hospitalization.dischargeDisposition.coding)\n then false\n else E.hospitalization.dischargeDisposition in &quot;Hospice Disposition&quot;\n )\n and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>End of Life Assessment</td>\n \n \n <td>22</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;End of Life Assessment&quot;:\n // 1. Conditions indicating end of life or with limited life expectancy\n exists (\n &quot;Conditions Indicating End of Life or With Limited Life Expectancy&quot;\n )\n // 2. Admitted/referred/discharged to hospice care\n or exists (\n &quot;Admitted/Referred/Discharged to Hospice Care&quot;\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10Common</td>\n \n \n <td>Exclusion Criteria</td>\n \n \n <td>23</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Exclusion Criteria&quot;:\n Common.&quot;End of Life Assessment&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10PatientView</td>\n \n \n <td>Is Perform Drug Screen Recommendation Applicable?</td>\n \n \n <td>24</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Is Perform Drug Screen Recommendation Applicable?&quot;:\n &quot;Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential&quot;\n and Rec10Common.&quot;Inclusion Criteria&quot;\n and not Rec10Common.&quot;Exclusion Criteria&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10PatientView</td>\n \n \n <td>Summary</td>\n \n \n <td>25</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Summary&quot;:\n Rec10Common.&quot;Get Summary&quot; (&quot;Is Perform Drug Screen Recommendation Applicable?&quot;)</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10PatientView</td>\n \n \n <td>Detail</td>\n \n \n <td>26</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Detail&quot;:\n Rec10Common.&quot;Get Detail&quot; (&quot;Is Perform Drug Screen Recommendation Applicable?&quot;)</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10Common</td>\n \n \n <td>Indicator</td>\n \n \n <td>27</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Indicator&quot;:\n 'warning'</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10PatientView</td>\n \n \n <td>Indicator</td>\n \n \n <td>28</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Indicator&quot;:\n Rec10Common.&quot;Indicator&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10Common</td>\n \n \n <td>Applicable Because of Positive Cocaine or PCP or Opiates</td>\n \n \n <td>29</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Applicable Because of Positive Cocaine or PCP or Opiates&quot;:\n if exists (Common.&quot;Opioid Other Than Synthetic Ordered In Last 12 Months&quot;) then\n &quot;Has Positive Screening for Cocaine in Last 12 Months&quot;\n or &quot;Has Positive Screening for PCP in Last 12 Months&quot;\n else\n &quot;Has Positive Screening for Cocaine in Last 12 Months&quot;\n or &quot;Has Positive Screening for PCP in Last 12 Months&quot;\n or\n if Config.&quot;Opiate Urine Screening Check Enabled&quot; then\n &quot;Has Positive Screening for Opiates in Last 12 Months&quot;\n else false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC10PatientView</td>\n \n \n <td>Applicable Because of Positive Cocaine or PCP or Opiates</td>\n \n \n <td>30</td>\n \n </tr>\n </table>\n \n <pre><code class=\"language-cql\">define &quot;Applicable Because of Positive Cocaine or PCP or Opiates&quot;:\n Rec10Common.&quot;Applicable Because of Positive Cocaine or PCP or Opiates&quot;</code></pre>\n \n <br/><br/>\n \n </td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Knowledge Capability: </b></th>\n <td style=\"padding-left: 4px;\">\n shareable computable executable publishable \n </td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Use Context: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr><th><b>code</b></th><th><b>value</b></th><th><b>display</b></th></tr>\n \n <tr>\n <td>focus</td>\n <td>182888003</td>\n <td>Medication requested (situation)</td>\n </tr>\n \n <tr>\n <td>focus</td>\n <td>82423001</td>\n <td>Chronic pain (finding)</td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Jurisdiction: </b></th>\n <td style=\"padding-left: 4px;\">US</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Purpose: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for 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.</p>\n</div></td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Usage: </b></th>\n <td style=\"padding-left: 4px;\">Providers should be aware if patients are taking other prescription drugs or illicit drugs that might increase their risk of an overdose.</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Copyright: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>© CDC 2016+.</p>\n</div></td>\n </tr>\n \n \n \n \n \n \n\n \n <tr>\n <th scope=\"row\"><b>Libraries: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr><td><a href=\"Library-OpioidCDSREC10PatientView.html\">Library - Recommendation #10 Patient View - Urine Drug Testing</a></td></tr>\n \n </table>\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Actions: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr>\n <td>\n <b>Order Urine Screening Annual Urine Screening Check:</b> Patient has not had a urine screening in the past 12 months<br/>\n <b>When:</b> <i>named-event:</i> patient-view<br/>\n <b>If:</b> <i>applicability:</i> Patient has not had a urine screening in the past 12 months <i>(Is Perform Drug Screen Recommendation Applicable?)</i><br/>\n <b>Then:</b>\n \n <table class=\"grid-dict\">\n \n <tr>\n <td>\n <b> :</b> Will perform urine screening<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> Not for chronic pain management. Snooze 3 months<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> N/A - see comment, snooze 3 months<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n </table>\n \n </td>\n </tr>\n \n <tr>\n <td>\n <b>1. Tested Positive for Cocaine, Opiates, or PCP:</b> Urine screening showed positive for cocaine, opiates or PCP<br/>\n <b>When:</b> <i>named-event:</i> patient-view<br/>\n <b>If:</b> <i>applicability:</i> Urine screening tested positive for cocaine, opiates or PCP <i>(Applicable Because of Positive Cocaine or PCP or Opiates)</i><br/>\n <b>Then:</b>\n \n <table class=\"grid-dict\">\n \n <tr>\n <td>\n <b> :</b> Will repeat urine drug screen more frequently<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> Will assess patient for substance abuse disorder<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> Will access CDS quality improvement and care coordination for prescribing opioids for chronic pain https://www.cdc.gov/drugoverdose/pdf/prescribing/CDC-DUIP-QualityImprovementAndCareCoordination-508.pdf<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n </table>\n \n </td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n </table>\n</div>"
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},
{
"url" : "displaySequence",
"valueInteger" : 5
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSRoutines"
},
{
"url" : "name",
"valueString" : "Conditions Indicating End Of Life Present"
},
{
"url" : "statement",
"valueString" : "define \"Conditions Indicating End Of Life Present\":\n exists (\n Common.\"US Core-Categorized Conditions\" LLEC\n where LLEC.code in Common.\"Limited life expectancy conditions\"\n and LLEC.clinicalStatus in Common.\"Active Condition\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 6
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "Service Requests"
},
{
"url" : "statement",
"valueString" : "define \"Service Requests\":\n [ServiceRequest] SR\n return SR"
},
{
"url" : "displaySequence",
"valueInteger" : 7
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSRoutines"
},
{
"url" : "name",
"valueString" : "Palliative Care Lookback Period"
},
{
"url" : "statement",
"valueString" : "/*\n** Routine #1\n** Opioid Review Useful Routine\n**\n** Definition | Answer to Proceed | Details | Data (Terminology) Requirement\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Age < 18 years? | No | Calculate age from date of birth; exclude | Date of birth\n** | | patients with age less than 18 years at the |\n** | | time of the prescription |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Evidence of | No | Look for documented findings consistent | Sickle cell disease conditions\n** sickle cell disease? | | with those listed in the sickle cell |\n** | | value set |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Limited life | No | Look for documented findings consistent | Limited life expectancy conditions\n** expectancy conditions | | with those listed in the limited life |\n** present? | | expectancy value set (terminal illness, bad |\n** | | prognosis, pre-terminal) |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Order for therapies | No | Look for patients with an existing order for | Therapies indicating end of life care\n** indicating end of life | | therapies indicating end of life care |\n** care in past 90 days? | | written within past 90 days |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Active cancer | No | See sub-routine 3 | See sub-routine 3\n** treatment? | | |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Conditions Likely | No | Look for patients with active conditions in | Conditions likely terminal for opioid\n** Terminal for opioid | | the value set end-of-life-conditions | prescribing\n** prescribing present? | | |\n** ------------------------------------------------------------------------------------------------------------------------------------\n**\n*/\ndefine \"Palliative Care Lookback Period\":\n Interval[Today() - 90 days, Today()]"
},
{
"url" : "displaySequence",
"valueInteger" : 8
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSRoutines"
},
{
"url" : "name",
"valueString" : "Order For Palliative Care In Past 90 Days"
},
{
"url" : "statement",
"valueString" : "define \"Order For Palliative Care In Past 90 Days\":\n exists (\n Common.\"Service Requests\" SR\n where SR.status in { 'active', 'completed'}\n and SR.intent in {'proposal', 'plan,', 'directive', 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}\n and FHIRHelpers.ToDateTime(SR.authoredOn) during day of \"Palliative Care Lookback Period\"\n and SR.code in Common.\"Therapies indicating end of life care\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 9
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSRoutines"
},
{
"url" : "name",
"valueString" : "Is Active Cancer Treatment?"
},
{
"url" : "statement",
"valueString" : "define \"Is Active Cancer Treatment?\":\n if (Config.\"Active Cancer Treatment Encounters Condition Is Enabled\") then\n \"Has Two or More Encounters with Cancer Diagnosis During Encounter Period\"\n else\n false"
},
{
"url" : "displaySequence",
"valueInteger" : 10
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSRoutines"
},
{
"url" : "name",
"valueString" : "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present"
},
{
"url" : "statement",
"valueString" : "define \"Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present\":\n if (Config.\"End-Stage Disease Criteria Enabled\") then\n exists (\n Common.\"US Core-Categorized Conditions\" EOLC\n where EOLC.code in Common.\"Conditions likely terminal for opioid prescribing\"\n and EOLC.clinicalStatus in Common.\"Active Condition\"\n )\n else\n false"
},
{
"url" : "displaySequence",
"valueInteger" : 11
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSRoutines"
},
{
"url" : "name",
"valueString" : "Is Opioid Review Useful?"
},
{
"url" : "statement",
"valueString" : "define \"Is Opioid Review Useful?\":\n not \"Patient Age Less Than 18\"\n and not \"Condition Positive for Sickle Cell\"\n and not \"Conditions Indicating End Of Life Present\"\n and not \"Order For Palliative Care In Past 90 Days\"\n and not \"Is Active Cancer Treatment?\"\n and not \"Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present\""
},
{
"url" : "displaySequence",
"valueInteger" : 12
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10Common"
},
{
"url" : "name",
"valueString" : "Lookback Year"
},
{
"url" : "statement",
"valueString" : "define \"Lookback Year\":\n Interval[Today() - 12 months - 1 days, Today() - 1 day]"
},
{
"url" : "displaySequence",
"valueInteger" : 13
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10Common"
},
{
"url" : "name",
"valueString" : "Laboratory Observations"
},
{
"url" : "statement",
"valueString" : "define \"Laboratory Observations\":\n [Observation: \"category\" in Common.\"Observation Category Laboratory\"]"
},
{
"url" : "displaySequence",
"valueInteger" : 14
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10Common"
},
{
"url" : "name",
"valueString" : "Non-opioid Screenings"
},
{
"url" : "statement",
"valueString" : "define \"Non-opioid Screenings\":\n GetRelevantScreenings(\"Laboratory Observations\" LabObservations\n where (LabObservations.code in Common.\"Non-opioid drug urine screening\")\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 15
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10Common"
},
{
"url" : "name",
"valueString" : "Cocaine Screenings"
},
{
"url" : "statement",
"valueString" : "define \"Cocaine Screenings\":\n GetRelevantScreenings(\"Laboratory Observations\" LabObservations\n where (LabObservations.code in Common.\"Cocaine Urine Tests\")\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 16
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10Common"
},
{
"url" : "name",
"valueString" : "PCP Screenings"
},
{
"url" : "statement",
"valueString" : "define \"PCP Screenings\":\n GetRelevantScreenings(\"Laboratory Observations\" LabObservations\n where (LabObservations.code in Common.\"PCP Urine Tests\")\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 17
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10Common"
},
{
"url" : "name",
"valueString" : "Patient had Urine Screening in Last 12 Months"
},
{
"url" : "statement",
"valueString" : "define \"Patient had Urine Screening in Last 12 Months\":\n (\n exists (\"Non-opioid Screenings\")\n or exists (\"Cocaine Screenings\")\n or exists (\"PCP Screenings\")\n )\n or\n if Config.\"Opiate Urine Screening Check Enabled\" then\n exists (\"Opiate Screenings\")\n else\n false"
},
{
"url" : "displaySequence",
"valueInteger" : 18
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10Common"
},
{
"url" : "name",
"valueString" : "Inclusion Criteria"
},
{
"url" : "statement",
"valueString" : "define \"Inclusion Criteria\":\n Routines.\"Is Opioid Review Useful?\"\n and (not \"Patient had Urine Screening in Last 12 Months\")"
},
{
"url" : "displaySequence",
"valueInteger" : 19
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "Conditions Indicating End of Life or With Limited Life Expectancy"
},
{
"url" : "statement",
"valueString" : "define \"Conditions Indicating End of Life or With Limited Life Expectancy\":\n (\n \"US Core-Categorized Conditions\" C\n where C.code in \"Conditions likely terminal for opioid prescribing\"\n and C.clinicalStatus in \"Active Condition\"\n )\n union\n (\n \"US Core-Categorized Conditions\" C\n where C.code in \"Limited life expectancy conditions\"\n and C.clinicalStatus in \"Active Condition\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 20
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "Admitted/Referred/Discharged to Hospice Care"
},
{
"url" : "statement",
"valueString" : "define \"Admitted/Referred/Discharged to Hospice Care\":\n (\n [Procedure: code in \"Hospice Procedure Codes\"] P\n where P.status.value in { 'in-progress', 'completed' }\n )\n union\n (\n \"Service Requests\" SR\n where SR.code in \"Hospice Procedure Codes\"\n and SR.status.value in { 'active', 'completed' }\n )\n union\n (\n if (Config.\"Hospice Findings Exclusion Enabled\") then\n [Observation: code in \"Hospice Finding Codes\"] O\n where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })\n else\n {}\n )\n union\n (\n [Encounter] E\n where date from E.period.start 1 year or less on or before Today()\n and (\n if E.hospitalization.dischargeDisposition.coding is null\n or not exists (E.hospitalization.dischargeDisposition.coding)\n then false\n else E.hospitalization.dischargeDisposition in \"Hospice Disposition\"\n )\n and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 21
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "End of Life Assessment"
},
{
"url" : "statement",
"valueString" : "define \"End of Life Assessment\":\n // 1. Conditions indicating end of life or with limited life expectancy\n exists (\n \"Conditions Indicating End of Life or With Limited Life Expectancy\"\n )\n // 2. Admitted/referred/discharged to hospice care\n or exists (\n \"Admitted/Referred/Discharged to Hospice Care\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 22
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10Common"
},
{
"url" : "name",
"valueString" : "Exclusion Criteria"
},
{
"url" : "statement",
"valueString" : "define \"Exclusion Criteria\":\n Common.\"End of Life Assessment\""
},
{
"url" : "displaySequence",
"valueInteger" : 23
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10PatientView"
},
{
"url" : "name",
"valueString" : "Is Perform Drug Screen Recommendation Applicable?"
},
{
"url" : "statement",
"valueString" : "define \"Is Perform Drug Screen Recommendation Applicable?\":\n \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential\"\n and Rec10Common.\"Inclusion Criteria\"\n and not Rec10Common.\"Exclusion Criteria\""
},
{
"url" : "displaySequence",
"valueInteger" : 24
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10PatientView"
},
{
"url" : "name",
"valueString" : "Summary"
},
{
"url" : "statement",
"valueString" : "define \"Summary\":\n Rec10Common.\"Get Summary\" (\"Is Perform Drug Screen Recommendation Applicable?\")"
},
{
"url" : "displaySequence",
"valueInteger" : 25
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10PatientView"
},
{
"url" : "name",
"valueString" : "Detail"
},
{
"url" : "statement",
"valueString" : "define \"Detail\":\n Rec10Common.\"Get Detail\" (\"Is Perform Drug Screen Recommendation Applicable?\")"
},
{
"url" : "displaySequence",
"valueInteger" : 26
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10Common"
},
{
"url" : "name",
"valueString" : "Indicator"
},
{
"url" : "statement",
"valueString" : "define \"Indicator\":\n 'warning'"
},
{
"url" : "displaySequence",
"valueInteger" : 27
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10PatientView"
},
{
"url" : "name",
"valueString" : "Indicator"
},
{
"url" : "statement",
"valueString" : "define \"Indicator\":\n Rec10Common.\"Indicator\""
},
{
"url" : "displaySequence",
"valueInteger" : 28
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10Common"
},
{
"url" : "name",
"valueString" : "Applicable Because of Positive Cocaine or PCP or Opiates"
},
{
"url" : "statement",
"valueString" : "define \"Applicable Because of Positive Cocaine or PCP or Opiates\":\n if exists (Common.\"Opioid Other Than Synthetic Ordered In Last 12 Months\") then\n \"Has Positive Screening for Cocaine in Last 12 Months\"\n or \"Has Positive Screening for PCP in Last 12 Months\"\n else\n \"Has Positive Screening for Cocaine in Last 12 Months\"\n or \"Has Positive Screening for PCP in Last 12 Months\"\n or\n if Config.\"Opiate Urine Screening Check Enabled\" then\n \"Has Positive Screening for Opiates in Last 12 Months\"\n else false"
},
{
"url" : "displaySequence",
"valueInteger" : 29
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC10PatientView"
},
{
"url" : "name",
"valueString" : "Applicable Because of Positive Cocaine or PCP or Opiates"
},
{
"url" : "statement",
"valueString" : "define \"Applicable Because of Positive Cocaine or PCP or Opiates\":\n Rec10Common.\"Applicable Because of Positive Cocaine or PCP or Opiates\""
},
{
"url" : "displaySequence",
"valueInteger" : 30
}
],
"url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
},
{
"id" : "effective-data-requirements",
"url" : "http://fhir.org/guides/cdc/opioid-cds/StructureDefinition/effectiveDataRequirements",
"valueReference" : {
"reference" : "#effective-data-requirements"
}
}
],
"url" : "http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-10-patient-view",
"identifier" : [
{
"use" : "official",
"value" : "cdc-opioid-guidance"
}
],
"version" : "2022.1.0",
"name" : "PlanDefinition_Recommendation_10_Patient_View",
"title" : "PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #10 (patient-view)",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
"code" : "eca-rule",
"display" : "ECA Rule"
}
]
},
"status" : "draft",
"experimental" : true,
"date" : "2023-05-01",
"publisher" : "Centers for Disease Control and Prevention (CDC)",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "https://www.cdc.gov"
}
]
}
],
"description" : "When prescribing opioids for subacute or chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.",
"useContext" : [
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "182888003",
"display" : "Medication requested (situation)"
}
]
}
},
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "82423001",
"display" : "Chronic pain (finding)"
}
]
}
}
],
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US",
"display" : "United States of America"
}
]
}
],
"purpose" : "The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for 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" : "Providers should be aware if patients are taking other prescription drugs or illicit drugs that might increase their risk of an overdose.",
"copyright" : "© CDC 2016+.",
"topic" : [
{
"text" : "Opioid Prescribing"
}
],
"author" : [
{
"name" : "Kensaku Kawamoto, MD, PhD, MHS"
},
{
"name" : "Bryn Rhodes"
},
{
"name" : "Floyd Eisenberg, MD, MPH"
},
{
"name" : "Robert McClure, MD, MPH"
}
],
"library" : [
🔗 "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC10PatientView"
],
"action" : [
{
"prefix" : "Order Urine Screening",
"title" : "Annual Urine Screening Check",
"description" : "Patient has not had a urine screening in the past 12 months",
"documentation" : [
{
"type" : "documentation",
"display" : "2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain",
"url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm",
"document" : {
"url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm"
}
},
{
"type" : "documentation",
"url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation10:~:text=nonprescribed%20controlled%20substances-,(recommendation%20category%3A%20B%3B%20evidence%20type%3A%204).,-Implementation%20Considerations",
"document" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/recommendation-strength",
"code" : "weak",
"display" : "Weak"
}
]
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/evidence-quality",
"code" : "very-low",
"display" : "Very Low quality"
}
]
}
}
],
"url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation10:~:text=nonprescribed%20controlled%20substances-,(recommendation%20category%3A%20B%3B%20evidence%20type%3A%204).,-Implementation%20Considerations"
}
}
],
"trigger" : [
{
"type" : "named-event",
"name" : "patient-view"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "Patient has not had a urine screening in the past 12 months",
"language" : "text/cql.identifier",
"expression" : "Is Perform Drug Screen Recommendation Applicable?"
}
}
],
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/action-type",
"code" : "create",
"display" : "Create"
}
]
},
"definitionCanonical" : "http://fhir.org/guides/cdc/opioid-cds/ActivityDefinition/opioidcds-urine-screening-request",
"dynamicValue" : [
{
"path" : "action.description",
"expression" : {
"language" : "text/cql.identifier",
"expression" : "Detail"
}
},
{
"path" : "action.title",
"expression" : {
"language" : "text/cql.identifier",
"expression" : "Summary"
}
},
{
"path" : "action.extension",
"expression" : {
"language" : "text/cql.identifier",
"expression" : "Indicator"
}
}
],
"action" : [
{
"description" : "Will perform urine screening"
},
{
"description" : "Not for chronic pain management. Snooze 3 months"
},
{
"description" : "N/A - see comment, snooze 3 months"
}
]
},
{
"prefix" : "1.",
"title" : "Tested Positive for Cocaine, Opiates, or PCP",
"description" : "Urine screening showed positive for cocaine, opiates or PCP",
"documentation" : [
{
"type" : "documentation",
"display" : "2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain",
"url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm",
"document" : {
"url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm"
}
},
{
"type" : "documentation",
"url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation10:~:text=nonprescribed%20controlled%20substances-,(recommendation%20category%3A%20B%3B%20evidence%20type%3A%204).,-Implementation%20Considerations",
"document" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/recommendation-strength",
"code" : "weak",
"display" : "Weak"
}
]
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/evidence-quality",
"code" : "very-low",
"display" : "Very Low quality"
}
]
}
}
],
"url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation10:~:text=nonprescribed%20controlled%20substances-,(recommendation%20category%3A%20B%3B%20evidence%20type%3A%204).,-Implementation%20Considerations"
}
}
],
"trigger" : [
{
"type" : "named-event",
"name" : "patient-view"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "Urine screening tested positive for cocaine, opiates or PCP",
"language" : "text/cql.identifier",
"expression" : "Applicable Because of Positive Cocaine or PCP or Opiates"
}
}
],
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/action-type",
"code" : "create",
"display" : "Create"
}
]
},
"definitionCanonical" : "http://fhir.org/guides/cdc/opioid-cds/ActivityDefinition/opioidcds-urine-screening-request",
"dynamicValue" : [
{
"path" : "action.description",
"expression" : {
"language" : "text/cql.identifier",
"expression" : "Detail"
}
},
{
"path" : "action.title",
"expression" : {
"language" : "text/cql.identifier",
"expression" : "Summary"
}
},
{
"path" : "action.extension",
"expression" : {
"language" : "text/cql.identifier",
"expression" : "Indicator"
}
}
],
"action" : [
{
"description" : "Will repeat urine drug screen more frequently"
},
{
"description" : "Will assess patient for substance abuse disorder"
},
{
"description" : "Will access CDS quality improvement and care coordination for prescribing opioids for chronic pain https://www.cdc.gov/drugoverdose/pdf/prescribing/CDC-DUIP-QualityImprovementAndCareCoordination-508.pdf"
}
]
}
]
}