Opioid CDS Recommendation 8 ECA Rule (id = "opioidcds-08")

<?xml version="1.0" encoding="UTF-8"?>

<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="opioidcds-08"/> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="cds"/> 
  </extension> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.11.10"/> 
  </identifier> 
  <identifier> 
    <use value="official"/> 
    <value value="cdc-opioid-guidance"/> 
  </identifier> 
  <version value="0.1.0"/> 
  <name value="Cdcopioid08"/> 
  <title value="CDC Opioid Prescribing Guideline Recommendation #8"/> 
  <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="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."/> 
  <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"/> 
    </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="Before starting and periodically during continuation of opioid therapy, clinicians
   should evaluate risk factors for opioid-related harms."/> 
  <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-chro
      nic-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-08"/> 
  <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 exhibits risk factors for opioid-related harms."/> 
    <description value="Checking if the trigger prescription meets the inclusion criteria for recommendation
     #8 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 exhibits risk factors for opioid-related harms,
         such as concurrent use with benzodiazepine, a history of substance abuse, and/or
         an average MME greater than 50 mg/day."/> 
        <language value="text/cql"/> 
        <expression value="Inclusion Criteria"/> 
      </expression> 
    </condition> 
    <groupingBehavior value="visual-group"/> 
    <selectionBehavior value="exactly-one"/> 
    <dynamicValue> 
      <path value="action.description"/> 
      <expression> 
        <language value="text/cql"/> 
        <expression value="Get Detail"/> 
      </expression> 
    </dynamicValue> 
    <dynamicValue> 
      <path value="action.title"/> 
      <expression> 
        <language value="text/cql"/> 
        <expression value="Get Summary"/> 
      </expression> 
    </dynamicValue> 
    <dynamicValue> 
      <path value="action.extension"/> 
      <expression> 
        <language value="text/cql"/> 
        <expression value="Get Indicator"/> 
      </expression> 
    </dynamicValue> 
    <action> 
      <description value="Will offer Naloxone instead"/> 
    </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>