HelloWorld Library

HelloWorldPatientView Library

CDCMMEClinicalConversionFactors Library

Common Routines Library

Common Logic Library

Common Configuration Library

OMTK Logic MK (2020) Library

OMTK Data (2020) Library

FHIR Helpers Library

FHIR ModelInfo Library

Common Logic Library for Recommendation #10 - Urine Drug Testing

Logic Library for Recommendation #1 (order-sign) - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration

Logic Library for Recommendation #2 (order-sign) - Opioid Therapy Goals Discussion

Logic Library for Recommendation #3 (order-sign) - Opioid Immediate Release Form When Starting Opioid Therapy

Logic Library for Recommendations #4 and #5 (order-sign) - Lowest Effective Dose

Logic Library for Recommendation #6 (order-sign) - Prescribe Lowest Effective Dose and Duration

Logic Library for Recommendation #7 (order-sign) - Opioid Therapy Risk Assessment

Logic Library for Recommendation #8 (order-sign) - Naloxone Consideration

Logic Library for Recommendation #9 (order-sign) - Consider Patient’s History of Controlled Substance Prescriptions

Logic Library for Recommendation #10 (order-sign) - Urine Drug Testing

Logic Library for Recommendation #10 (patient-view) - Urine Drug Testing

Logic Library for Recommendation #11 (order-select) - Concurrent Use of Opioids and Benzodiazepines

Logic Library for Recommendation #11 (patient-view) - Concurrent Use of Opioids and Benzodiazepines

Logic Library for Recommendation #12 (patient-view) - Evidence-based Treatment for Patients with Opioid Use Disorder

An ActivityDefinition for recommendation of risk assessment

An ActivityDefinition for recommendation of urine screening

Example CDS service used for testing purposes

Nonopioid therapies are at least as effective as opioids for many common types of acute pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy.

When prescribing opioids for subacute or chronic pain, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed medications as well as other prescribed and nonprescribed controlled substances.

When prescribing opioids for subacute or chronic pain, clinicians should consider the benefits and risks of toxicology testing to assess for prescribed medications as well as other prescribed and nonprescribed controlled substances.

Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other central nervous system depressants.

Clinicians should use particular caution when prescribing opioid pain medication and benzodiazepines concurrently and consider whether benefits outweigh risks of concurrent prescribing of opioids and other central nervous system depressants.

Clinicians should offer or arrange treatment with evidence-based medications to treat patients with opioid use disorder. Detoxification on its own, without medications for opioid use disorder, is not recommended for opioid use disorder because of increased risks for resuming drug use, overdose, and overdose death.

Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.

When starting opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release and long-acting (ER/LA) opioids.

When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.

Clinicians should evaluate benefits and risks with patients within 1-4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should regularly reevaluate benefits and risks of continued opioid therapy with patients.

Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk for opioid-related harms and discuss risk with patients. Clinicians should work with patients to incorporate into the management plan strategies to mitigate risk, including offering naloxone.

When prescribing initial opioid therapy for acute, subacute, or chronic pain, and periodically during opioid therapy for chronic pain, clinicians should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or combinations that put the patient at high risk for overdose.

Recommendation 4: When opioids are initiated for opioid-naïve patients with acute, subacute, or chronic pain, clinicians should prescribe the lowest effective dosage. If opioids are continued for subacute or chronic pain, clinicians should use caution when prescribing opioids at any dosage, should carefully evaluate individual benefits and risks when considering increasing dosage, and should avoid increasing dosage above levels likely to yield diminishing returns in benefits relative to risks to patients. Recommendation 5: For patients already receiving opioid therapy, clinicians should carefully weigh benefits and risks and exercise care when changing opioid dosage. If benefits outweigh risks of continued opioid therapy, clinicians should work closely with patients to optimize nonopioid therapies while continuing opioid therapy. If benefits do not outweigh risks of continued opioid therapy, clinicians should optimize other therapies and work closely with patients to gradually taper to lower dosages or, if warranted based on the individual circumstances of the patient, appropriately taper and discontinue opioids. Unless there are indications of a life-threatening issue such as warning signs of impending overdose (e.g., confusion, sedation, or slurred speech), opioid therapy should not be discontinued abruptly, and clinicians should not rapidly reduce opioid dosages from higher dosages.

This library is used to populate the prefetch template for Recommendation 10 (EPIC-specific)

This library contains logic to surface the MME calculation functionality provided by the OMTKLogic library by extracting appropriate information from FHIR R4 MedicationRequest resource.

This library contains logic to expose configurable conversion factors for the MME calculation functionality provided by the OMTKLogic library.

This library contains drug ingredient data for opioid ingredients of combinations drugs as determined using the RxNav API. The content was produced using the process described here.

This library provides functionality for calculating Morphine Milligram Equivalents (MME) for opioid medications, as described in the CDC Opioid Prescribing Guideline.

Profile of CarePlan for use with 2022 CDC Clinical Practice Guideline

Profile of MedicationRequest for use with 2022 CDC Clinical Practice Guideline

Profile of Observation for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors.

Profile of RequestGroup for use with 2022 CDC Clinical Practice Guideline

Profile of ValueSet for use with 2022 CDC Clinical Practice Guideline

Describes the clinical focus for the ValueSet.

Describes the data element scope for the ValueSet.

Describes the clinical focus for the ValueSet.

Describes the clinical focus for the ValueSet.

Declares the DateLastUpdated and Frequency arguments to be used by the Data Date Roller for maintaining/rolling test data dates to keep them from going stale.

A module definition library that contains the effective data requirements for the PlanDefinition (i.e. the calculated data requirements for the expressions referenced by the PlanDefinition structure).

Presumed general urine tests for barbiturates that are not specific to a particular substance.

Presumed general urine tests for benzodiazepines that are not specific to a particular substance.

Presumed general urine tests for buprenorphine.

Presumed general urine tests for heroin and metabolites.

Presumed general urine tests for oxycodone.

Includes requests for medications to be administered or consumed by the patient in their home (this would include long term care or nursing homes, hospices, etc.).

The prescription is ‘actionable’, but not all actions that are implied by it have occurred yet.

Indicates the urgency/importance of what this RequestGroup action conveys

Urine tests to all opioid and non-opioid drugs

Ambulatory Opioid MedicationDispense Example

Ambulatory Opioid MedicationRequest Example

Medications potentially used in ambulatory setting that are CNS depressants but not contain an opioid class medication, and also do not contain cough medications or bowl transit modifiers.

Amphetamine class medications based upon the mapping of SNOMED CT drug class to ingredient then linked to RXNorm

Urine tests, both quantitative and qualitative, including confirmatory, that detect Amphetamine-class drugs and metabolites

Barbiturate medications including amobarbital, butabarbital, butalbital, pentobarbital, phenobarbital and secobarbital. Includes concepts that represent generic, human use and prescribable medications

All benzodiazepine clinical drugs

All Buprenorphine medications

All Buprenorphine and Methadone medications

All neoplastic and malignant conditions, including pain due to neoplasm.

Medications considered to have an ingredient considered to be a CNS depressant, some of which may be mild. Removed from this set are cough medications and bowl transit modifiers.

Cancer Diagnosis Condition Example

Cancer Diagnosis Encounter Example

Cannabinoid, including synthetic and THC, urine tests

Urine tests for cocaine and cocaine metabolites

The subject is currently experiencing the condition or situation, there is evidence of the condition or situation, or considered to be a significant risk.

Any finding or condition that indicate problematic misuse of a substance other than tobacco or laxatives, including “history of” conditions.

Conditions that generally are thought to have terminal prognosis

Encounter Diagnosis condition category.

End of Life Condition Example

Urine tests to identify ethanol, metabolites, and disulfiram

All opioid clinical drugs except those restricted to surgical use only, and that are in an extended release dose form code

Fentanyl and similar medications (sufentanil, alfentanil, remifentanil)

Urine tests for fentanyl-type drugs and metabolites

Presumed general urine tests for naturally occurring opioids (i.e. opiates) that are not specific to a particular substance based upon the inclusion of the word ‘opiates’ in the long name.

This value set contains concepts that represent patients receiving hospice care outside of a hospital or long term care facility.

Finding codes for receiving hospice care

Procedure codes for referral, admission, or transfer to a hospice

A finding that documents a terminal prognosis

Medication codes representing methadone medications

Urine tests to identify methadone and metabolites

All naloxone medications

Individual tests and panels of tests of urine for illicit drugs EXCEPT those for opioids.

Medications derived from the opium plant that are not synthetically created . All metabolize to morphine.

Laboratory Observation Category

Procedure Observation Category

Codes specifying outpatient encounters

Oncology Participant Encounter Example

Oncology Specialist PractitionerRole Example

NUCC oncology provider types who may provide encounters to patients with cancer

Urine tests for naturally occurring opioids (i.e. opiates) that are specific to a particular naturally occurring opioid and therefore do not have the general word ‘opiates’ in the long name.

All opioid clinical drugs except cough medications, antispasmodics, or those restricted to surgical use only as identified by those using an injectable form.

Procedure for counseling on opioid use

Individual tests and panels of tests of urine for opioids

Procedure to assess the risk of opioid abuse occurring by a patient

Conditions indicating opioid misuse

Broad set of concepts that may represent a procedure to assess the risk of opioid abuse occurring by a patient

CarePlan Example

MedicationRequest Example

Observation Example

Patient Example

RequestGroup Example

All Oxycodone medications

Finding indicating that the Prescription Drug Monitoring Program (PDMP) data was reviewed

Procedure for Prescription Drug Monitoring Program (PDMP) review

Procedure for subacute or chronic pain control management

A Pain medicine Plan of care note

Palliative Care ServiceRequest Example

Urine tests for phencyclidine

Problem list condition category.

Sickle-cell disorders that cause painful crisis

Conditions associated with sleep-related breathing disorders.

Counseling and associated procedures for substance misuse

Opioid medications that are not exclusively and solely derived from the opium plant. These are synthetic or semisynthetic opioids.

Urine tests for synthetic and semi-synthetic (non-opiate) substances

Terminal Condition Example

Therapeutic activities indicating end of life. Include procedures or therapies specific to a terminal patient, exclude procedures or therapies performed on a deceased patient

US Core Health Concern Condition Category.

A Device that represents a CQF Tooling version.