CPG Opioid Prescribing Guideline Examples
1.0.0 - ci-build
CPG Opioid Prescribing Guideline Examples
1.0.0 - ci-build
CPG Opioid Prescribing Guideline Examples, published by HL7 International - Clinical Decision Support WG. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cpg-example-opioids/ and changes regularly. See the Directory of published versions
| Draft as of 2024-03-01 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="opioidcds-r4-recommendation-05"/>
<meta>
<profile
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<text>
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<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: PlanDefinition</b><a name="opioidcds-r4-recommendation-05"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PlanDefinition "opioidcds-r4-recommendation-05" </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/HL7/cqf-recommendations//StructureDefinition-cpg-computableplandefinition.html">CPG Computable Plan Definition</a></p></div><p><b>url</b>: <code>http://hl7.org/fhir/uv/cpg/opiods/PlanDefinition/opioidcds-r4-recommendation-05</code></p><p><b>version</b>: 1.0.0</p><p><b>name</b>: OpioidCDS_R4_Recommendation_05</p><p><b>title</b>: CDC Opioid Prescribing Guideline Recommendation #5</p><p><b>type</b>: ECA Rule <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-plan-definition-type.html">PlanDefinitionType</a>#eca-rule)</span></p><p><b>status</b>: draft</p><p><b>experimental</b>: true</p><p><b>date</b>: 2024-03-01 19:34:30+0000</p><p><b>publisher</b>: HL7 International - Clinical Decision Support WG</p><p><b>contact</b>: HL7 International - Clinical Decision Support WG: <a href="http://www.hl7.org/Special/committees/dss/index.cfm">http://www.hl7.org/Special/committees/dss/index.cfm</a></p><p><b>description</b>: When opioids are started, providers should prescribe the lowest effective dosage.</p><h3>UseContexts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td>Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')</td><td>Medication requested (situation) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#182888003)</span></td></tr><tr><td style="display: none">*</td><td>Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')</td><td>Chronic pain (finding) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#82423001)</span></td></tr></table><p><b>jurisdiction</b>: World <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (m49.htm#001)</span></p><p><b>purpose</b>: 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.</p><p><b>usage</b>: Providers should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to >90 MME/day</p><p><b>copyright</b>: CDC 2016+</p><p><b>topic</b>: Opioid Prescribing <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span></p><p><b>author</b>: Kensaku Kawamoto, MD, PhD, MHS: , Bryn Rhodes: , Floyd Eisenberg, MD, MPH: , Robert McClure, MD, MPH: </p><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: documentation</p><p><b>display</b>: MME Conversion Tables</p><p><b>url</b>: <a href="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf">https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf</a></p><blockquote><p><b>document</b></p></blockquote></blockquote><p><b>library</b>: <a href="Library-OpioidCDSR4Recommendation05.html">Opioid CDS R4 Logic for recommendation #5</a></p><blockquote><p><b>action</b></p><p><b>title</b>: High risk for opioid overdose.</p><p><b>description</b>: Total morphine milligram equivalent (MME) exceeds recommended amount. Taper to less than 50.</p><blockquote><p><b>documentation</b></p><p><b>type</b>: documentation</p><p><b>display</b>: CDC guideline for prescribing opioids for chronic pain</p><p><b>url</b>: <a href="https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm">https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm</a></p><blockquote><p><b>document</b></p></blockquote></blockquote><blockquote><p><b>documentation</b></p><p><b>type</b>: documentation</p></blockquote><h3>Triggers</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Name</b></td></tr><tr><td style="display: none">*</td><td>named-event</td><td>medication-prescribe</td></tr></table><blockquote><p><b>condition</b></p><p><b>kind</b>: applicability</p><h3>Expressions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>Is total MME >= 50?</td><td>text/cql</td><td>Inclusion Criteria</td></tr></table></blockquote><p><b>groupingBehavior</b>: visual-group</p><p><b>selectionBehavior</b>: exactly-one</p><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: action.title</p><h3>Expressions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>Get Summary</td></tr></table></blockquote><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: action.description</p><h3>Expressions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>Get Detail</td></tr></table></blockquote><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: activity.extension</p><h3>Expressions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style="display: none">*</td><td>text/cql</td><td>Get Indicator</td></tr></table></blockquote><h3>Actions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Description</b></td></tr><tr><td style="display: none">*</td><td>Will reduce dosage</td></tr><tr><td style="display: none">*</td><td>Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo</td></tr><tr><td style="display: none">*</td><td>Acute pain; snooze 1 mo</td></tr><tr><td style="display: none">*</td><td>N/A - see comment (will be reviewed by medical director); snooze 3 mo</td></tr></table></blockquote></div>
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<version value="1.0.0"/>
<name value="OpioidCDS_R4_Recommendation_05"/>
<title value="CDC Opioid Prescribing Guideline Recommendation #5"/>
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<date value="2024-03-01T19:34:30+00:00"/>
<publisher value="HL7 International - Clinical Decision Support WG"/>
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<name value="HL7 International - Clinical Decision Support WG"/>
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<value value="http://www.hl7.org/Special/committees/dss/index.cfm"/>
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<description
value="When opioids are started, providers should prescribe the lowest effective dosage."/>
<useContext>
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value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="focus"/>
<display value="Clinical Focus"/>
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<coding>
<system value="http://snomed.info/sct"/>
<code value="182888003"/>
<display value="Medication requested (situation)"/>
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<useContext>
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value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="focus"/>
<display value="Clinical Focus"/>
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<coding>
<system value="http://snomed.info/sct"/>
<code value="82423001"/>
<display value="Chronic pain (finding)"/>
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<jurisdiction>
<coding>
<system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
<code value="001"/>
<display value="World"/>
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<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="Providers should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to >90 MME/day"/>
<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="MME Conversion Tables"/>
<url
value="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"/>
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value="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"/>
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value="http://hl7.org/fhir/uv/cpg/opiods/Library/OpioidCDSR4Recommendation05"/>
<action>
<title value="High risk for opioid overdose."/>
<description
value="Total morphine milligram equivalent (MME) exceeds recommended amount. Taper to less than 50."/>
<documentation>
<type value="documentation"/>
<display
value="CDC guideline for prescribing opioids for chronic pain"/>
<url
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value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/>
<code value="strong"/>
<display value="Strong"/>
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<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"/>
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<url
value="https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm"/>
</document>
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<documentation>
<type value="documentation"/>
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<trigger>
<type value="named-event"/>
<name value="medication-prescribe"/>
</trigger>
<condition>
<kind value="applicability"/>
<expression>
<description value="Is total MME >= 50?"/>
<language value="text/cql"/>
<expression value="Inclusion Criteria"/>
</expression>
</condition>
<groupingBehavior value="visual-group"/>
<selectionBehavior value="exactly-one"/>
<dynamicValue>
<path value="action.title"/>
<expression>
<language value="text/cql"/>
<expression value="Get Summary"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="action.description"/>
<expression>
<language value="text/cql"/>
<expression value="Get Detail"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="activity.extension"/>
<expression>
<language value="text/cql"/>
<expression value="Get Indicator"/>
</expression>
</dynamicValue>
<action>
<description value="Will reduce dosage"/>
</action>
<action>
<description
value="Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"/>
</action>
<action>
<description value="Acute pain; snooze 1 mo"/>
</action>
<action>
<description
value="N/A - see comment (will be reviewed by medical director); snooze 3 mo"/>
</action>
</action>
</PlanDefinition>
IG © 2023+ The MITRE Corporation HL7 International - Clinical Decision Support WG. Package hl7.fhir.uv.cpg.opioids#1.0.0 based on FHIR 4.0.1. Generated 2024-03-01
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