Opioid Prescribing Support Implementation Guide
4.0.0 - CI Build

Opioid Prescribing Support Implementation Guide, published by Centers for Disease Control and Prevention (CDC). This is not an authorized publication; it is the continuous build for version 4.0.0). 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

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Structures: Resource Profiles

These define constraints on FHIR resources that need to be complied with by conformant implementations

CDC_CarePlan Profile of CarePlan for use with CDC Opioid Prescribing Guidelines
CDC_MedicationRequest Profile of MedicationRequest for use with CDC Opioid Prescribing Guidelines
CDC_Observation Profile of Observation for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.
CDC_RequestGroup Profile of RequestGroup for use with CDC Opioid Prescribing Guidelines

Structures: Extension Definitions

These define constraints on FHIR data types that need to be complied with by conformant implementations

CDC Opioid Guidance Inclusion Extension Describes the inclusion criteria for the ValueSet.
OpioidCDSIndicator Used for construction of CDS Hooks response cards. Indicates urgency/importance of what the RequestGroup action conveys.
CDC Opioid Guidance Query Extension Captures the narrative, language, and expression query elements necessary to build valueset from CodeSystem
CDC Opioid Guidance Exclusion Extension Describes the exclusion criteria for the ValueSet.
Action_indicator

Terminology: Value Sets

These define sets of codes used by systems conforming with this implementation guide

Opioid Misuse Assessment Procedure Procedure to assess the risk of opioid abuse occurring by a patient
Oncology Specialty Designations (nucc) NUCC oncology provider types who may provide encounters to patients with cancer
Pdmp Data Reviewed Finding Finding indicating that the Prescription Drug Monitoring Program (PDMP) data was reviewed
Naloxone Medications All naloxone medications
Non-opioid Drug Urine Screening Individual tests and panels of tests of urine for illicit drugs EXCEPT those for opioids.
ValueSet/opioidcds-indicator
Therapies Indicating End Of Life Care Therapeutic activities indicating end of life. Include procedures or therapies specific to a terminal patient, exclude procedures or therapies performed on a deceased patient
ValueSet/hospice-procedure
Pdmp Review Procedure Procedure for Prescription Drug Monitoring Program (PDMP) review
ValueSet/hospice-finding
Conditions Likely Terminal For Opioid Prescribing Conditions that generally are thought to have terminal prognosis
Snomed Discharge to Hospice ValueSet containing procedure discharging a patient to some form of hospice care codes.
Pain Management Procedure Procedure for chronic pain control management
Opioid Analgesics With Ambulatory Misuse Potential All opioid clinical drugs except cough medications, antisapasmodics, or those restricted to surgical use only as identified by those using an injectable form.
Buprenorphine And Methadone Medications All Buprenorphine and Methadone medications
Pain Treatment Plan A Pain medicine Plan of care note
Office Visit Codes specifying outpatient encounters
Substance Misuse Behavioral Counseling Counseling and associated procedures for substance misuse
Extended Release Opioid With Ambulatory Misuse Potential All opioid clinical drugs except those restricted to surgical use only, and that are in an extended release dose form code
Cdc Malignant Cancer Conditions All neoplastic and malignant conditions, including pain due to neoplasm.
Opioid Misuse Disorders Conditions indicating opioid misuse
Limited Life Expectancy Conditions A finding that documents a terminal prognosis
Conditions Documenting Substance Misuse Any finding or condition that indicate problematic misuse of a substance other than tobacco
Opioid Counseling Procedure Procedure for couseling on opioid use
Benzodiazepine Medications All benzodiazepine clinical drugs
Opioid Drug Urine Screening Individual tests and panels of tests of urine for opioids

Terminology: Code Systems

These define new code systems used by systems conforming with this implementation guide

CodeSystem/opioidcds-indicator Indicates the urgency/importance of what this RequestGroup action conveys

Other

These are resources that are used within this implementation guide that don't fit into one of the other categories

CDC Opioid Prescribing Guideline Recommendation #7 - Risk Assessment ServiceRequest As part of the workflow for recommendation 7, it is recommended that a risk assessment be conducted if the inclusion criteria is met.
Library/opioidcds-rec-03
Library/opioidcds-rec-11-patient-view
OMTK Logic Opioid Management Terminology Knowledge Base Logic for use in implementing CDC Opioid Prescribing Guidelines.
Library/opioidcds-opioidnaive
Library/opioidcds-rec-04
Library/fhirhelpers
Library/opioidcds-rec-09
Library/opioidcds-rec-12
Library/opioidcds-rec-10-patient-view
Library/opioidcds-rec-02
Library/opioidcds-rec-05
Library/opioidcds-activecancertreatment
Library/opioidcds-rec-01
Library/opioidcds-rec-07
Library/opioidcds-opioidreviewuseful
Library/opioidcds-common
Library/omtklogic
OMTK Data Opioid Management Terminology Knowledge Base Logic for use in implementing CDC Opioid Prescribing Guidelines.
Library/omtkdata
Library/opioidcds-rec-10
Library/opioidcds-rec-11
OMTK Logic Opioid Management Terminology Knowledge Base Logic for use in implementing CDC Opioid Prescribing Guidelines.
Library/opioidcds-common-config
OMTK Logic Opioid Management Terminology Knowledge Base Logic for use in implementing CDC Opioid Prescribing Guidelines.
Library/opioidcds-rec-08
OMTK Model Info Opioid Management Terminology Knowledge Base Model Definition for use in implementing CDC Opioid Prescribing Guidelines.
Library/opioidcds-rec-06
CDC Opioid Prescribing Guideline Recommendation #2 Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.
CDC Opioid Prescribing Guideline Recommendation #10 When prescribing opioids for 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.
CDC Opioid Prescribing Guideline Recommendation #11 Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.
CDC Opioid Prescribing Guideline Recommendation #12 Arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder.
CDC Opioid Prescribing Guideline Recommendation #4 When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.
CDC Opioid Prescribing Guideline Recommendation #1 Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.
CDC Opioid Prescribing Guideline Recommendation #8 Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present.
CDC Opioid Prescribing Guideline Recommendation #3 Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy.
CDC Opioid Prescribing Guideline Recommendation #9 Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically during opioid therapy for chronic pain.
CDC Opioid Prescribing Guideline Recommendation #6 When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.
PlanDefinition - CDC Opioid Prescribing Guideline Recommendation #11 (patient-view) Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.
PlanDefinition - CDC Opioid Prescribing Guideline Recommendation #10 (patient-view) When prescribing opioids for 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.
CDC Opioid Prescribing Guideline Recommendation #5 When opioids are started, providers should prescribe the lowest effective dosage.
CDC Opioid Prescribing Guideline Recommendation #7 Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently.
Chest Pain (CP) - Coronary Artery Disease (CAD) Order Set KNART The Cardiology chest pain (CP) and coronary artery disease (CAD) group of KNARTs are intended to assist primary care providers in the management of adult patients with stable chest pain (with or without known CAD); aid in determining when a cardiology consultation is appropriate; provide guidance for initial noninvasive diagnostic orders (stress testing) and provide a structured documentation template for the process. Stable patients with cardiac chest pain require risk stratification, office-based workup, initiation of disease-specific medications, and subspecialty referral to a cardiologist.
Procedure/example-rec-07-risk-assessment-prefetch
Encounter/example-rec-05-mme-greater-than-fifty-context
Encounter/example-rec-11-benzo-trigger-with-opioid-prefetch
Patient/example-rec-07-sixtytwo-of-past-ninety-days
Patient/example-rec-11-benzo-trigger-with-opioid
Bundle/example-rec-09-false-due-to-PDMP-review-within-90-days
Patient/example-rec-08-mme-greater-than-fifty
Observation/example-rec-10-missing-prescribed-opioids-prefetch
Bundle/example-rec-07-sixtythree-of-past-ninety-days
Encounter/example-rec-07-sixtythree-of-past-ninety-days-prefetch
Encounter/example-rec-04-not-long-acting-opioid-prefetch
Patient/example-rec-07-end-of-life-exclusion
Bundle/MMI-09e36d34-fb22-4837-affa-85b60793ec94
Bundle/MMI-c4c3c99d-bad8-4cc8-b94f-8b9ff287afad
Encounter/example-rec-11-benzo-trigger-with-opioid-context
Bundle/example-rec-10-unprescribed-opioids
Bundle/MMI-c846e1fb-b178-4c70-8f6c-64cd51717f10
Patient/example-rec-04-opioid-with-abuse-potential
Bundle/example-rec-05-mme-greater-than-fifty
MedicationRequest/example-rec-04-opioid-with-abuse-potential-prefetch
MedicationRequest/example-rec-10-not-missing-prescribed-opioids-prefetch
Bundle/MMI-97464c57-6a16-4a11-8852-7efcc947c160
Encounter/example-rec-10-unprescribed-opioids-context
Patient/example-rec-10-no-screenings
Encounter/example-rec-07-risk-assessment-prefetch
Encounter/example-rec-10-unprescribed-opioids-prefetch
Encounter/example-rec-08-mme-greater-than-fifty-context
Encounter/example-rec-04-opioid-with-abuse-potential-prefetch
Encounter/example-rec-08-on-naloxone-prefetch
Patient/example-rec-05-mme-less-than-fifty
MedicationRequest/example-rec-07-end-of-life-exclusion-prefetch
MedicationRequest/example-rec-10-no-screenings-prefetch
Observation/example-rec-10-unprescribed-opioids-prefetch-codeine
Patient/example-rec-10-missing-prescribed-opioids
MedicationRequest/example-rec-08-on-benzodiazepine-prefetch
Encounter/example-rec-10-not-missing-prescribed-opioids-context
Bundle/example-rec-08-mme-less-than-fifty
Patient/example-rec-04-not-long-acting-opioid
Bundle/example-rec-08-on-benzodiazepine
MedicationRequest/example-rec-11-opioid-trigger-with-benzo-prefetch
Encounter/example-rec-08-on-benzodiazepine-prefetch
Encounter/example-rec-07-six-of-past-ten-days-prefetch
Bundle/example-rec-04-long-acting-opioid
Encounter/example-rec-10-illicit-drugs-context
Bundle/example-rec-10-not-missing-prescribed-opioids
Encounter/example-rec-07-six-of-past-ten-days-context
Bundle/example-rec-12-criteria-invalid
Encounter/example-rec-08-mme-less-than-fifty-context
Encounter/example-rec-07-risk-assessment-context
Bundle/example-rec-04-opioid-with-abuse-potential
Bundle/example-rec-04-not-long-acting-opioid
Bundle/example-rec-08-substance-abuse
Patient/example-opioidcds
Patient/example-rec-08-on-benzodiazepine
MedicationRequest/example-opioidcds
Bundle/example-rec-05-mme-less-than-fifty
Encounter/example-rec-10-no-screenings-context
Bundle/example-rec-12-criteria-valid
Bundle/example-rec-07-sixtytwo-of-past-ninety-days
Bundle/example-rec-10-end-of-life-med-exclusion
Encounter/example-rec-11-opioid-trigger-with-benzo-prefetch
Encounter/example-rec-10-end-of-life-med-exclusion-context
Encounter/example-rec-08-on-benzodiazepine-context
Encounter/example-rec-07-end-of-life-exclusion-context
Encounter/example-rec-04-long-acting-opioid-context
Encounter/example-rec-07-seven-of-past-ten-days-context
MedicationRequest/example-rec-10-illicit-drugs-prefetch
Encounter/example-rec-07-end-of-life-exclusion-prefetch
Encounter/example-rec-04-opioid-with-abuse-potential-context
Encounter/example-rec-10-missing-prescribed-opioids-context
Patient/example-rec-08-mme-less-than-fifty
Encounter/example-rec-07-sixtytwo-of-past-ninety-days-context
Encounter/example-rec-07-seven-of-past-ten-days-prefetch
Patient/example-rec-10-end-of-life-med-exclusion
Encounter/example-rec-04-new-patient-context
Patient/example-rec-04-long-acting-opioid
MedicationRequest/example-rec-11-benzo-trigger-with-opioid-prefetch
Bundle/example-rec-04-new-patient
Encounter/example-rec-08-substance-abuse-context
Bundle/example-rec-07-seven-of-past-ten-days
Bundle/example-rec-07-end-of-life-exclusion
Bundle/MMI-7c879193-8739-48d7-9079-25cfb554b0d1
Patient/example-rec-07-six-of-past-ten-days
Patient/example-rec-11-opioid-trigger-without-benzo
MedicationRequest/example-rec-10-unprescribed-opioids-prefetch
Bundle/example-rec-11-opioid-trigger-without-benzo
Bundle/MMI-b88c8fdf-4b84-4a3a-a102-135792e7486a
CarePlan/example-opioidcds
Bundle/example-rec-10-missing-prescribed-opioids
Bundle/MMI-69809346-0c30-4acb-841c-812f52c870e0
Bundle/example-rec-02-false-due-to-careplan-within-90-days
Encounter/example-rec-10-missing-prescribed-opioids-prefetch
Patient/example-rec-08-on-naloxone
Bundle/example-rec-07-risk-assessment
Bundle/example-rec-03-false-due-to-discussion-within-90-days
RequestGroup/example-opioidcds
Observation/example-rec-10-illicit-drugs-prefetch
Bundle/example-rec-11-opioid-trigger-with-benzo
Bundle/example-rec-09-true-return-recommendations
Patient/example-rec-05-mme-greater-than-fifty
Encounter/example-rec-04-long-acting-opioid-prefetch
Bundle/example-rec-11-benzo-trigger-without-opioid
Bundle/example-rec-07-six-of-past-ten-days
Bundle/example-rec-06-criteria-valid
Encounter/example-rec-11-opioid-trigger-with-benzo-context
Bundle/example-rec-01-false-due-to-inpatient-opioid
Bundle/MMI-765a7e93-629b-4fc3-a5e5-9210e088fc58
Patient/example-rec-04-new-patient
Patient/example-rec-11-opioid-trigger-with-benzo
Bundle/MMI-3448a694-f7ff-4ae5-b04b-9085e979c6d1
Bundle/example-rec-06-with-extended-release-for-27-days
Bundle/example-rec-10-illicit-drugs
Bundle/MMI-f23978a3-1c5b-48b3-b620-bc297e37e9f3
Encounter/example-rec-04-not-long-acting-opioid-context
Patient/example-rec-08-substance-abuse
Bundle/MMI-36ce4c36-3f6f-4ba0-8e2d-d55225aae0d6
MedicationRequest/example-rec-08-on-naloxone-prefetch
Bundle/example-rec-01-true-make-recommendations
Bundle/example-rec-08-mme-greater-than-fifty
Bundle/example-rec-10-no-screenings
Observation/example-opioidcds
Bundle/example-rec-03-true-make-recommendations
MedicationRequest/example-rec-07-six-of-past-ten-days-prefetch
Bundle/example-rec-02-true-make-recommendations
Observation/example-rec-10-unprescribed-opioids-prefetch-oxycodone
MedicationRequest/example-rec-04-long-acting-opioid-prefetch
Patient/example-rec-11-benzo-trigger-without-opioid
Bundle/MMI-6786477b-0719-4e6a-a27e-e72fa61a19b3
Encounter/example-rec-07-sixtytwo-of-past-ninety-days-prefetch
Patient/example-rec-07-seven-of-past-ten-days
Patient/example-rec-07-sixtythree-of-past-ninety-days
Encounter/example-rec-08-on-naloxone-context
MedicationRequest/example-rec-07-sixtytwo-of-past-ninety-days-prefetch
Patient/example-rec-10-illicit-drugs
Encounter/example-rec-10-no-screenings-prefetch
Patient/example-rec-10-not-missing-prescribed-opioids
Encounter/example-rec-10-not-missing-prescribed-opioids-prefetch
MedicationRequest/example-rec-07-seven-of-past-ten-days-prefetch
MedicationRequest/example-rec-10-missing-prescribed-opioids-prefetch
Encounter/example-rec-07-sixtythree-of-past-ninety-days-context
Patient/example-rec-10-unprescribed-opioids
Observation/example-rec-10-not-missing-prescribed-opioids-prefetch
Bundle/example-rec-11-benzo-trigger-with-opioid
Patient/example-rec-07-risk-assessment
MedicationRequest/example-rec-04-not-long-acting-opioid-prefetch
Encounter/example-rec-11-benzo-trigger-without-opioid-context
MedicationRequest/example-rec-07-sixtythree-of-past-ninety-days-prefetch
Encounter/example-rec-05-mme-less-than-fifty-context
Bundle/example-rec-08-on-naloxone
Encounter/example-rec-10-illicit-drugs-prefetch
Encounter/example-rec-11-opioid-trigger-without-benzo-context