CDC Opioid Prescribing Guideline Recommendation #5 - XML Representation - CPG Opioid Prescribing Guideline Examples v1.0.0

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
: CDC Opioid Prescribing Guideline Recommendation #5 - XML Representation

Draft as of 2024-08-23
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<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="opioidcds-r4-recommendation-05"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-computableplandefinition"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: PlanDefinition opioidcds-r4-recommendation-05</b></p><a name="opioidcds-r4-recommendation-05"> </a><a name="hcopioidcds-r4-recommendation-05"> </a><a name="opioidcds-r4-recommendation-05-en-US"> </a><p><b>url</b>: <a href="PlanDefinition-opioidcds-r4-recommendation-05.html">PlanDefinition CDC Opioid Prescribing Guideline Recommendation #5</a></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>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/plan-definition-type eca-rule}">ECA Rule</span></p><p><b>status</b>: Draft</p><p><b>experimental</b>: true</p><p><b>date</b>: 2024-08-23 15:50:14+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>: </p><div><p>When opioids are started, providers should prescribe the lowest effective dosage.</p>
</div><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><a href="http://terminology.hl7.org/5.5.0/CodeSystem-usage-context-type.html#usage-context-type-focus">UsageContextType</a> focus: Clinical Focus</td><td><span title="Codes:{http://snomed.info/sct 182888003}">Medication requested (situation)</span></td></tr><tr><td style="display: none">*</td><td><a href="http://terminology.hl7.org/5.5.0/CodeSystem-usage-context-type.html#usage-context-type-focus">UsageContextType</a> focus: Clinical Focus</td><td><span title="Codes:{http://snomed.info/sct 82423001}">Chronic pain (finding)</span></td></tr></table><p><b>jurisdiction</b>: <span title="Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}">World</span></p><p><b>purpose</b>: </p><div><p>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>
</div><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 &gt;90 MME/day</p><p><b>copyright</b>: </p><div><p>CDC 2016+</p>
</div><p><b>topic</b>: <span title="Codes:">Opioid Prescribing</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></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></blockquote><blockquote><p><b>documentation</b></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 &gt;= 50?</td><td>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>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>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>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>
  </text>
  <url
       value="http://hl7.org/fhir/uv/cpg/opiods/PlanDefinition/opioidcds-r4-recommendation-05"/>
  <version value="1.0.0"/>
  <name value="OpioidCDS_R4_Recommendation_05"/>
  <title value="CDC Opioid Prescribing Guideline Recommendation #5"/>
  <type>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
      <code value="eca-rule"/>
      <display value="ECA Rule"/>
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  <status value="draft"/>
  <experimental value="true"/>
  <date value="2024-08-23T15:50:14+00:00"/>
  <publisher value="HL7 International - Clinical Decision Support WG"/>
  <contact>
    <name value="HL7 International - Clinical Decision Support WG"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/dss/index.cfm"/>
    </telecom>
  </contact>
  <description
               value="When opioids are started, providers should prescribe the lowest effective dosage."/>
  <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="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </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="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 &gt;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"/>
    <document>
      <url
           value="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"/>
    </document>
  </relatedArtifact>
  <library
           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
           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>
        <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>
        <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>
    </documentation>
    <documentation>
      <type value="documentation"/>
    </documentation>
    <trigger>
      <type value="named-event"/>
      <name value="medication-prescribe"/>
    </trigger>
    <condition>
      <kind value="applicability"/>
      <expression>
        <description value="Is total MME &gt;= 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>