Clinical Decision Support for Chronic Pain Management and Shared Decision-Making IG, published by CQF. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cds4cpm/ and changes regularly. See the Directory of published versions

Operational Scenarios

Scenarios

This folder contains user testing scenarios for the MyPAIN and PainManager applications.

https://cds.ahrq.gov/collaboration/pages/viewpage.action?pageId=83132464

Chronic Lower Back Pain;No Recent Opioid Use

When a chronic lower back pain patient with no history of recent opioid use schedules a pain-related appointment with their primary care provider: Mr. Delta, a 43-year-old patient with a recent history of chronic lower back pain schedules a visit with Dr. Charlie and cites his back pain as his primary reason for the visit. The system identifies Mr. Delta, who has no history of recent opioid use [1, see p. 24 for definition used for PMD], as a candidate to receive an invitation to MyPAIN. Before his visit, Mr. Delta receives an invitation to MyPAIN via the local EHR patient portal, MyChart. Mr. Delta accesses MyPAIN and spends about 15 minutes or less reviewing educational material and completing assessments, including indicating how ready he is for his upcoming SDM encounter with Dr. Charlie. When Mr. Delta finishes and exits MyPain or the linked materials, the system automatically sends Dr. Charlie a secure message that Mr. Delta’s materials from MyPAIN are ready for review. Just prior to his visit with Mr. Delta, Dr. Charlie spends a few minutes reviewing the information assembled for his SDM encounter in PainManager which includes all of the information Mr. Delta submitted via MyPAIN. Dr. Charlie notes that Mr. Delta’s pain functional status has been unacceptably low, and his pain level has remained elevated over the past 6 months. When Mr. Delta arrives for his visit, Dr. Charlie discusses possible therapeutic approaches with Mr. Delta using the SHARE framework for SDM. Noting that no non-pharmacologic treatments have been ordered for Mr. Delta in the past 6 months, Dr. Charlie recommends physical therapy to Mr. Delta to help improve his functional status as well as acupuncture to reduce his level of pain. Mr. Delta agrees to both options for treatment and this information is documented by Dr. Charlie.

Chronic Osteoarthritic Knee and Hip Pain;Recent Opioid Use

When a patient that has chronic osteoarthritic knee and hip pain has a history of recent opioid use schedules a pain-related appointment with their primary care provider: Ms. Echo, a 65 year old patient with a 5 year history of chronic osteoarthritic knee and hip pain schedules a visit with Dr. Alpha and references how her knee and hip pain continue to make dressing difficult and sometimes makes it hard to fall asleep at night. The system identifies Ms. Echo, who has a history of recent opioid use [1, see p. 24 for definition used for PMD], as a candidate to receive an invitation to MyPAIN. Before her visit, Ms. Echo receives an invitation to MyPAIN via the local EHR patient portal, MyChart. Ms. Echo accesses MyPAIN and spends about 15 minutes reviewing educational material including an information sheet on alternative therapies to opioids and completing assessments, including indicating how ready she is for her upcoming SDM encounter with Dr. Alpha. When Ms. Echo finishes, the system automatically sends Dr. Alpha a secure message that Ms. Echo’s materials from MyPAIN are ready for review. Just prior to her visit with Ms. Echo, Dr. Alpha spends a few minutes reviewing the information assembled for her SDM encounter in PainManager which includes all of the information Ms. Echo submitted via MyPAIN and reviews the SHARE-based shared decision making information [15] provided in PainManager to prepare for that aspect of the upcoming visit as well. Dr. Alpha notes that Ms. Echo’s pain functional status has been unacceptably low, and her pain level has remained elevated over the past 6 months. Dr. Alpha checks on the status of any recent physical therapy order for Ms. Echo. Using PDMP information, Dr. Alpha also notes that Ms. Echo’s use of opioids for therapy have remained steady over the last 6 months. When Ms. Echo arrives for her visit, Dr. Alpha discusses possible therapeutic approaches with Ms. Echo using the SHARE framework for SDM. Noting that only pharmacologic treatments have been ordered for Ms. Echo in the past 6 months, Dr. Alpha recommends increasing physical therapy for Ms. Echo to help improve her functional status and asks Ms. Echo if she would like to consider a custom brace to also help reduce her level of knee pain [16]. Ms. Echo details her concerns about any increase in opioid therapy and supports recommendations that provide alternatives to opioids to help with her pain. They also discuss whether or not Ms. Echo has previously discussed surgical options with a specialist. Ms. Echo agrees to both options for treatment and this information is documented by Dr. Alpha.

8-year History of Chronic Hip Pain

Ms. Bravo, a 58 year old patient with an 8-year history of chronic hip pain has an upcoming visit with Dr. Stevens. After Ms. Bravo completes MyPAIN, Dr. Stevens receives a secure message that Ms. Bravo has entered materials in MyPAIN that are ready for review. Before Ms. Bravo’s office visit, Dr. Stevens spends a few minutes reviewing the record of Ms. Bravo, and specifically reviews the Pain Management Summary for Ms. Bravo. He compares Ms. Bravo’s medication history, self-reported pain levels, and functional status, noting that while her condition initially improved on a low dose of a non-opioid medication, her improvement has since plateaued. Dr. Stevens decides to recommend increasing the dose of the non-opioid pain medication to attempt to achieve further improvements in functional status.

2-year History of Lower Back Pain

Mr. Ford, a 42 year old patient with a 2-year history of lower back pain receives an invitation to MyPAIN via the local EHR patient portal, MyChart in advance of his upcoming visit with Dr. Clark. After Mr. Ford reviews educational materials and completes related assessments within MyPAIN, Dr. Clark receives a secure message indicating that Mr. Ford’s materials from MyPAIN are ready for review. As Dr. Clark reviews the record of Mr. Ford, including the Pain Management, he reviews Mr. Ford’s self-reported pain levels and functional status, noting that his pain functional status has been unacceptably low, and his pain level remained elevated over the past 6 months. Noting that no non-pharmacologic treatments have been ordered for Mr. Ford in the past 6 months, Dr. Clark decides to recommend physical therapy to Mr. Ford to help improve his functional status as well as acupuncture to reduce his level of pain and Mr. Ford agrees.

Fibromyalgia

Ms. Ellis, a 63 year old patient with fibromyalgia receives an invitation to MyPAIN via the local EHR patient portal, MyChart, in advance of her upcoming visit with Dr. Abbott. After Ms. Ellis reviews educational materials and completes related assessments within MyPAIN, Dr. Abbott receives a secure message indicating that Ms. Ellis’s materials from MyPAIN are ready for review. Dr. Abbott reviews the Pain Management Summary data submitted by Ms. Ellis. As she reviews Ms. Ellis’s entry for medications taken, Dr. Abbott also reviews the Prescription Drug Monitoring Program (PDMP) database data for Ms. Ellis within PainManager to determine whether Ms. Ellis has been presecribed other medications of concern from another medical professional. Dr. Abbott finds a recent codeine prescription issued by a provider outside of their health system. Dr. Abbott discusses these results with Ms. Ellis to assess whether her use of an additional opioid is related to misuse, pseudo addiction, diversion, or other underlying conditions, to help determine whether opioid therapy should be continued or tapered.

Out-of-age-range

Donnie Marks, a 14 year old male should not be given an invitation, since they are outside the age range