Clinical Decision Support for Chronic Pain Management and Shared Decision-Making IG
0.1.0 - CI Build International flag

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

Terminology

Terminology

This page provides a summary of all terminology used by the CDS4CPM MyPAIN and PainManager applications and details how these value sets are processed and prepared for inclusion and usage in the applications.

Value Sets

The CQL library ChronicPainConcepts, version 2.0.0 defines the complete set of terminology concepts used by the Pain Manager logic. It is completely aligned with the terminology concepts used by the original AHRQ Pain Management Summary (Factors To Consider, or F2C) to maximize reuse of the content from that application.

Note that several of the concepts defined and used by the Pain Management Summary are not used by Pain Manager. These concepts use the Empty value set.

Conditions associated with chronic pain replaces the “Conditions associated with chronic pain” value set from F2C (2.16.840.1.113762.1.4.1032.37).

valueset "Conditions associated with chronic pain": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.95'

Opioids Replaces the “Opioid Pain Medications” value set from F2C (2.16.840.1.113762.1.4.1032.34)

valueset "Opioid Pain Medications": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioids'

Empty Replaces the “Adjuvant Analgesic Medications” value set from F2C (2.16.840.1.113762.1.4.1032.54)

valueset "Adjuvant Analgesic Medications": 'http://fhir.org/guides/cqf/cds4cpm/ValueSet/empty'

Major Depression This is the same as the “Major Depression” value set from F2C (2.16.840.1.113883.3.464.1003.105.12.1007)

valueset "Major Depression": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.105.12.1007'

Empty Replaces the “Depression Diagnosis ICD9” value set from F2C (2.16.840.1.113883.3.600.143/expansion)

valueset "Depression Diagnosis ICD9": 'http://fhir.org/guides/cqf/cds4cpm/ValueSet/empty'

Anxiety Replaces F2C valueset Anxiety: 2.16.840.1.113762.1.4.1032.52

valueset "Anxiety": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.94'

// Empty Replaces the “Anxiety Disorders ICD9” value set from F2C (2.16.840.1.113883.3.1240.2017.3.2.1015/expansion)

valueset "Anxiety Disorders ICD9": 'http://fhir.org/guides/cqf/cds4cpm/ValueSet/empty'

// Empty Replaces the “Substance use disorder” value set from F2C (2.16.840.1.113883.3.464.1003.106.12.1004)

valueset "Substance use disorder": 'http://fhir.org/guides/cqf/cds4cpm/ValueSet/empty'

Substance Abuse Replaces the “Substance Abuse” value set from F2C (2.16.840.1.113883.3.464.1003.106.11.1010)

valueset "Substance Abuse": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/substance-abuse'

Empty Replaces the “Suicide Attempt” value set from F2C (2.16.840.1.113762.1.4.1032.102)

valueset "Suicide Attempt": 'http://fhir.org/guides/cqf/cds4cpm/ValueSet/empty'

Sleep disordered breathing Replaces F2C valueset Sleep disordered breathing: 2.16.840.1.113762.1.4.1032.53

valueset "Sleep-disordered breathing": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.93'

Kidney Failure This is the same as the “Kidney failure” value set from F2C (2.16.840.1.113883.3.464.1003.109.12.1028)

valueset "Kidney Failure": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.109.12.1028'

Chronic liver disease This is the same as the “Chronic liver disease” value set from F2C (2.16.840.1.113883.3.464.1003.199.12.1035)

valueset "Chronic Liver Disease": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.199.12.1035'

Liver disease This is the same as the “Liver disease” value set from F2C (2.16.840.1.113762.1.4.1047.42)

valueset "Liver Disease": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.42'

Pregnancy This is the same as the Pregnancy value set from F2C (2.16.840.1.113883.3.526.3.378)

valueset "Pregnancy": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.378'

Pregnancy (New ICD10 codes published between 2018 and 2020) Replaces F2C valueset Pregnancy (New ICD10 codes published between 2018 and 2019): 2.16.840.1.113762.1.4.1032.80

valueset "Pregnancy (New ICD10 codes published in 2018 or later)": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.74'

Non opioid pain medications Replaces F2C valueset Non opioid pain medications: 2.16.840.1.113762.1.4.1032.26

valueset "Non opioid pain medications": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.73'

Empty Replaces the “Non pharmacologic treatments for chronic pain”: ‘2.16.840.1.113762.1.4.1032.36’ from F2C

valueset "Non pharmacologic treatments for chronic pain": 'http://fhir.org/guides/cqf/cds4cpm/ValueSet/empty'

Empty Replaces the “Risk assessments relevant to pain management”: ‘2.16.840.1.113762.1.4.1032.55’ from F2C

valueset "Risk assessments relevant to pain management": 'http://fhir.org/guides/cqf/cds4cpm/ValueSet/empty'

Benzodiazepine medications Replaces the “Benzodiazepine medications” value set from F2C (2.16.840.1.113762.1.4.1032.43)

valueset "Benzodiazepine medications": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/benzodiazepine-medications'

Naloxone medications Replaces the “Naloxone medications” value set from F2C (2.16.840.1.113762.1.4.1032.42)

valueset "Naloxone medications": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/naloxone-medications'

Drug Urine Screening Replaces the “Urine drug screen for pain management” value set from F2C (‘2.16.840.1.113762.1.4.1032.28’) NOTE: This valueset is defined as a compose of these two value sets, and is not available yet at the Opioid Prescribing Support IG site Non-opioid Illicit Drug Urine Screening Opioid Drug Urine Screening NOTE: Concept is still called “Urine drug screen for pain management”, is that okay, or does this need refactoring at the F2C level?

valueset "Urine drug screen for pain management": 'http://fhir.org/guides/cdc/opioid-cds/ValueSet/drug-urine-screening'

Empty Replaces the “Stool softeners and laxatives”: ‘2.16.840.1.113762.1.4.1032.44’ from F2C

valueset "Stool softeners and laxatives": 'http://fhir.org/guides/cqf/cds4cpm/ValueSet/empty'

Terminology Processing

There are three sources for value set definitions used by the MyPAIN and PainManager applications:

  1. Value sets defined in and available from the Value Set Authority Center (VSAC)
  2. Value sets defined in and available as part of the CDC Guideline for Prescribing Opioids implementation guide
  3. Value sets defined in and available as part of this implementation guide (IG)

All these value sets need to be available in at least three places:

  1. As part of the published content made available in this IG
  2. As part of the testing capabilities used to validate content in the IG development environment
  3. As part of the valueset-db.json file in the PainManager application

NOTE: As an architectural decision, we are specifically avoiding any run-time use of the value sets in the FHIR Facade. If that decision changes, it would add a 4th location where these value sets would need to be deployed, the FHIR Facade.

Gather

The first step in the processing pipeline is to gather the source for all value sets.

For value sets defined in the VSAC:

  1. Download the VSAC spreadsheet for the latest expansion.
  2. Use CQF Tooling to produce the FHIR ValueSet resource, conforming to the CPGExecutableValueSet profile.
  3. Include the resulting ValueSet resource in the vocabulary/ValueSet folder for inclusion in the IG.
java -jar CQFTooling.jar -VsacXlsxToValueSetBatch -ptsd="C:\Users\Bryn\Documents\Src\RTI\cds4cpm\input\vocabulary\valueset\spreadsheets" -burl="http://cts.nlm.nih.gov/fhir/ValueSet/"

For value sets defined in the Opioid IG,

  1. Copy the published FHIR ValueSet resource from the Opioid IG site into the vocabulary/ValueSet folder.

For value sets defined locally,

  1. Include the source of the ValueSet in the vocabulary/ValueSet folder.
Ensure Executable

The next step is to ensure that all the input value sets are Executable (i.e., have an expansion). For each published value set,

  1. If the ValueSet does not have an expansion element, use the compose element to produce the expansion.

Note that this will only work for ValueSets with simple compose definitions. If a value set has a complex compose, the expansion will need to be included in the expression of the ValueSet used in the Gather step.

java -jar CQFTooling.jar -EnsureExecutableValueSet -path="C:\Users\Bryn\Documents\Src\RTI\cds4cpm\input\vocabulary\valueset"
Publish

The next step is to run the IG publisher to publish all value sets in the CDS4CPM IG.

ToSVSJson

The PainManager application uses a JSON representation of the Sharing Value Set (SVS) profile ValueSetResponse obtained from the SVS API endpoint provided by the VSAC. To make the value sets available to the PainManager, the published value sets from this IG need to be transformed to that format and the resulting format provided to PainManager.

The structure of this valueset-db.json file is as follows:

{
  "<value-set-id-or-url>": {
    "<value-set-version>": [
      {
        "code": "<code-1>",
        "system": "<code-1-system-url>",
        "version": "<code-1-system-version>"
      },
      {
        "code": "<code-2>",
        "system": "<code-2-system-url>",
        "version": "<code-2-system-version>"
      },
      ...
    ]
  },
  "<value-set-id-or-url>": {
    "<value-set-version>": [
      ...
    ]
  },
  ...
}

Where <value-set-id-or-url> is the value set ID (as an OID) or the URL of the value set, and <value-set-version> is the value set version,

java -jar CQFTooling.jar -ToJsonValueSetDb -path="C:\Users\Bryn\Documents\Src\RTI\cds4cpm\output"