2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide
2022.1.0 - CI Build
2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide
2022.1.0 - CI Build
2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide, published by Centers for Disease Control and Prevention (CDC). This guide is not an authorized publication; it is the continuous build for version 2022.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/opioid-cds-r4/ and changes regularly. See the Directory of published versions
| Draft as of 2025-08-06 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="opioidcds-01"/>
<meta>
<profile
value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition"/>
<profile
value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<table class="grid dict">
<tr>
<th scope="row"><b>Id: </b></th>
<td style="padding-left: 4px;">opioidcds-01</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="PlanDefinition-opioidcds-01.html">Recommendation #1 - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration</a></td>
</tr>
<tr>
<th scope="row"><b>Version: </b></th>
<td style="padding-left: 4px;">2022.1.0</td>
</tr>
<tr>
<th scope="row"><b>Identifier: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<b>value: </b> <span>cdc-opioid-guidance</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Name: </b></th>
<td style="padding-left: 4px;">PlanDefinition_Recommendation_01_Order_Sign</td>
</tr>
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">Recommendation #1 - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration</td>
</tr>
<tr>
<th scope="row"><b>Status: </b></th>
<td style="padding-left: 4px;">draft</td>
</tr>
<tr>
<th scope="row"><b>Experimental: </b></th>
<td style="padding-left: 4px;">true</td>
</tr>
<tr>
<th scope="row"><b>Type: </b></th>
<td style="padding-left: 4px;">
<p style="margin-bottom: 5px;">
<b>system: </b> <span><a href="http://terminology.hl7.org/6.5.0/CodeSystem-plan-definition-type.html">http://terminology.hl7.org/CodeSystem/plan-definition-type</a></span>
</p>
<p style="margin-bottom: 5px;">
<b>code: </b> <span>eca-rule</span>
</p>
<p style="margin-bottom: 5px;">
<b>display: </b> <span>ECA Rule</span>
</p>
</td>
</tr>
<tr>
<th scope="row"><b>Date: </b></th>
<td style="padding-left: 4px;">2025-08-06</td>
</tr>
<tr>
<th scope="row"><b>Publisher: </b></th>
<td style="padding-left: 4px;">Centers for Disease Control and Prevention (CDC)</td>
</tr>
<tr>
<th scope="row"><b>Description: </b></th>
<td style="padding-left: 4px;">Nonopioid therapies are at least as effective as opioids for many common types of acute pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy.</td>
</tr>
<tr>
<th scope="row"><a name="effective-data-requirements"> </a><b>Logic Definitions: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC01</td>
<td>Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions</td>
<td>0</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription )</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC01</td>
<td>Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential</td>
<td>1</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
exists( "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommonConfig</td>
<td>Age Less than 18 Years Is Enabled</td>
<td>2</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// CDC 2022 General Inclusion Criteria
define "Age Less than 18 Years Is Enabled":
true</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Patient Age Less Than 18</td>
<td>3</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Patient Age Less Than 18":
if (Config."Age Less than 18 Years Is Enabled") then
AgeInYearsAt(Today()) < 18
else false</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommonConfig</td>
<td>Sickle Cell Check Enabled</td>
<td>4</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// Sickle Cell
define "Sickle Cell Check Enabled":
true</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommonConfig</td>
<td>Sickle Cell Assumed Active</td>
<td>5</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Sickle Cell Assumed Active":
true</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>US Core-Categorized Conditions</td>
<td>6</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// 3. Medications indicating end of life
/* or exists (
"Medications Indicating End of Life"
) */
define "US Core-Categorized Conditions":
[Condition: category in "Encounter Diagnosis Condition Category"]
union [Condition: category in "Problem List Condition Category"]
union [Condition: category in "US Core Health Concern Condition Category"]</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>Positive Sickle Cell Condition</td>
<td>7</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Positive Sickle Cell Condition":
if Config."Sickle Cell Check Enabled" and not Config."Sickle Cell Assumed Active"
then (
"US Core-Categorized Conditions" C
where C.code in "Sickle Cell Diseases"
and C.clinicalStatus in "Active Condition"
) else if Config."Sickle Cell Check Enabled" and Config."Sickle Cell Assumed Active"
then (
"US Core-Categorized Conditions" C
where C.code in "Sickle Cell Diseases"
)
else null</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Condition Positive for Sickle Cell</td>
<td>8</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Condition Positive for Sickle Cell":
if (Config."Sickle Cell Check Enabled") then
exists(
Common."Positive Sickle Cell Condition"
)
else false</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommonConfig</td>
<td>Active Cancer Treatment Encounters Condition Is Enabled</td>
<td>9</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// Active Cancer Treatment
define "Active Cancer Treatment Encounters Condition Is Enabled":
true</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Encounter Period</td>
<td>10</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// End of Opioid Naive Routine
/*
** Routine #3
** Active Cancer Treatment Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** ---------------------------------------------------------------------------------------------------------------------------------
** Two office visits within the | No | Look for a minimum of two distinct | Office Visit
** past 12 months | | encounters within 12 months of the date |
** | | of the current visit for which each of the |
** | | following is true: |
** | | - the encounter diagnosis (primary or |
** | | secondary or co-morbidity diagnosis) |
** | | is listed in the CDC Malignant Cancer |
** | | Conditions value set |
** ---------------------------------------------------------------------------------------------------------------------------------
** Office visits with an | No | The encounter is performed by an | Oncology specialty
** oncology specialist | | oncologist as defined in the oncology | designations (NUCC)
** present | | specialty designations using the |
** | | National Uniform Claim Committee |
** | | (NUCC) classifications |
** ---------------------------------------------------------------------------------------------------------------------------------
** Office visits including CDC | No | The encounter diagnosis (primary or | CDC malignant cancer
** malignant cancer | | secondary or co-morbidity diagnosis) | conditions
** condition | | is listed in the CDC Malignant Cancer |
** | | Conditions value set |
** ----------------------------------------------------------------------------------------------------------------------------------
**
*/
define "Encounter Period":
Interval[Today() - 12 months, Today())</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>USCore Encounter Cancer Diagnoses</td>
<td>11</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "USCore Encounter Cancer Diagnoses":
[Condition: category in "Encounter Diagnosis Condition Category"] CancerDiagnoses
where CancerDiagnoses.code in "CDC malignant cancer conditions"</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Encounters with Cancer Diagnosis During Encounter Period</td>
<td>12</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// encounter-diagnosis, problem-list and health-concern Conditions
// define "US Core-Categorized Cancer Diagnoses":
// Common."US Core-Categorized Conditions" C
// where C.code in Common."CDC malignant cancer conditions"
// define "Encounters with Cancer Diagnosis During Encounter Period":
// [Encounter] Encounter
// with "US Core-Categorized Cancer Diagnoses" CancerDiagnosis
// such that date from Encounter.period."start".value in day of "Encounter Period"
// and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id)
define "Encounters with Cancer Diagnosis During Encounter Period":
[Encounter] Encounters
where date from Encounters.period."start" in day of "Encounter Period"
and exists (
Common."USCore Encounter Cancer Diagnoses" CancerDiagnoses
where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id)
)</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Number of Encounters with Cancer Diagnosis During Encounter Period</td>
<td>13</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Number of Encounters with Cancer Diagnosis During Encounter Period":
Count ("Encounters with Cancer Diagnosis During Encounter Period")</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Has Two or More Encounters with Cancer Diagnosis During Encounter Period</td>
<td>14</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Has Two or More Encounters with Cancer Diagnosis During Encounter Period":
"Number of Encounters with Cancer Diagnosis During Encounter Period" >= 2</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>USCore Problem List Cancer Diagnoses</td>
<td>15</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "USCore Problem List Cancer Diagnoses":
[Condition: category in "Problem List Condition Category"] CancerDiagnoses
where CancerDiagnoses.code in "CDC malignant cancer conditions"</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Has Active Cancer Diagnosis on Problem List</td>
<td>16</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Has Active Cancer Diagnosis on Problem List":
exists (
Common."USCore Problem List Cancer Diagnoses" CancerDiagnoses
where CancerDiagnoses.category in Common."Problem List Condition Category"
and exists(
CancerDiagnoses.clinicalStatus.coding ClinicalStatus
where ClinicalStatus.code ~ 'active'
)
)</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Is Active Cancer Treatment?</td>
<td>17</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Is Active Cancer Treatment?":
if (Config."Active Cancer Treatment Encounters Condition Is Enabled")
then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period"
or "Has Active Cancer Diagnosis on Problem List"
else false</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommonConfig</td>
<td>End-Stage Disease Criteria Enabled</td>
<td>18</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// CDC 2022 General Inclusion Criteria
define "End-Stage Disease Criteria Enabled":
true</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Conditions Likely Terminal for Opioid Prescribing</td>
<td>19</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Conditions Likely Terminal for Opioid Prescribing":
if (Config."End-Stage Disease Criteria Enabled") then
exists (
Common."US Core-Categorized Conditions" EOLC
where EOLC.code in Common."Conditions likely terminal for opioid prescribing"
// and EOLC.clinicalStatus in Common."Active Condition"
)
else false</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>CDC 2022 Guideline General Inclusion Criteria</td>
<td>20</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "CDC 2022 Guideline General Inclusion Criteria":
not "Patient Age Less Than 18"
and not "Condition Positive for Sickle Cell"
and not "Is Active Cancer Treatment?"
and not "Conditions Likely Terminal for Opioid Prescribing"</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommonConfig</td>
<td>Opioid Naive Prescription Condition Is Enabled</td>
<td>21</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// Opioid Naive
define "Opioid Naive Prescription Condition Is Enabled":
true</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommonConfig</td>
<td>Can the implementing EHR support queries for past medications by date range?</td>
<td>22</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// Subroutine 2 - Past Medications
define "Can the implementing EHR support queries for past medications by date range?":
true</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>Active Ambulatory Opioid Rx</td>
<td>23</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Active Ambulatory Opioid Rx":
if Config."Can the implementing EHR support queries for past medications by date range?" then
(
"Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest]))
) Rx
where date from Rx.authoredOn 2 years or less on or before Today()
and Rx.medication in "Opioid analgesics with ambulatory misuse potential"
else
List<FHIR.MedicationRequest>{}</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Prescription/Dispense Inclusion Period</td>
<td>24</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// End of CDC 2022 General Inclusion Criteria Routine
/*
** Routine #2
** Opioid Naive Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** ----------------------------------------------------------------------------------------------------------------------------------------
** Opioid analgesics with | No | Look for an existing prescription (order) for | Opioid analgesics with
** ambulatory misuse potential | | opioid that is in the value set for opioid with | ambulatory misuse potential
** prescription in past 90 days | | ambulatory abuse potential authored |
** excluding the previous 24 | | within the past 90 days (excluding previous 24 |
** hours | | hours) |
** ----------------------------------------------------------------------------------------------------------------------------------------
** Opioid analgesics with | No | Look for evidence of active medication on | Opioid analgesics with
** ambulatory misuse potential | | the medication list that is in the value set | ambulatory misuse potential
** reported in past 90 days | | for opioid with ambulatory care abuse |
** excluding previous 24 hours* | | potential |
** ----------------------------------------------------------------------------------------------------------------------------------------
** Opioid analgesics with | No | Look for evidence of a dispensing event for | Opioid analgesics with
** ambulatory misuse potential | | medication that is in the value set for opioid | ambulatory misuse potential
** dispensing event in past 90 | | with ambulatory use potential occurring |
** days excluding previous 24 | | within the past 90 days (excluding previous 24 |
** hours | | hours) |
** ----------------------------------------------------------------------------------------------------------------------------------------
** *Future consideration: Current algorithm addresses only orders (prescriptions).
**
** Note – orders use RxNorm, but medication lists and dispensed medication will
** require an NDC value set and/or local mapping of NDC to RxNorm to enable this element
**
*/
define "Prescription/Dispense Inclusion Period":
Interval[Now() - 90 days, Now() - 24 hours]</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Opioid RX with Ambulatory Abuse Potential In Past 90 Days</td>
<td>25</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Opioid RX with Ambulatory Abuse Potential In Past 90 Days":
Common."Active Ambulatory Opioid Rx" Rx
where Rx.authoredOn during day of "Prescription/Dispense Inclusion Period"</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days</td>
<td>26</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days":
if (Config."Opioid Naive Prescription Condition Is Enabled") then
exists ("Opioid RX with Ambulatory Abuse Potential In Past 90 Days")
else false</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days</td>
<td>27</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// NOTE: 2020-02-05: Review direction of MedicationStatement resource (US-Core focusing on MedicationRequest i/o Statement)
// NOTE: 2020-04-21: MedicationStatement a) Shouldn't be use since guidance/direction from USCore is targeting MedicationUse in R5, and b) Breaks in the publisher
/* define "Reports of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days":
[MedicationStatement: Common."Opioid analgesics with ambulatory misuse potential"] Statement
where Statement.status in {'active', 'completed'}
and Statement.effective during day of "Report Inclusion Period" */
/* define "Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days":
Config."Opioid Naive Report Condition Is Enabled"
and exists ("Reports of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days") */
define "Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days":
[MedicationDispense: Common."Opioid analgesics with ambulatory misuse potential"] OpioidDispense
where OpioidDispense.whenHandedOver during day of "Prescription/Dispense Inclusion Period"
and OpioidDispense.status = 'completed'</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days</td>
<td>28</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days":
if (Config."Opioid Naive Prescription Condition Is Enabled") then
exists ("Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days")
else false</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Is Opioid Naive?</td>
<td>29</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// NOTE: MedicationStatement-dependent logic comment out due to bug in Publisher not supporting MedicationStatement in AllTypes.
define "Is Opioid Naive?":
not ("Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days")
/* and not ("Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days") */
and not ("Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days")</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC01</td>
<td>Inclusion Criteria</td>
<td>30</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Inclusion Criteria":
"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
and Routines."CDC 2022 Guideline General Inclusion Criteria"
and Routines."Is Opioid Naive?"</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC01</td>
<td>Exclusion Criteria</td>
<td>31</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Exclusion Criteria":
false</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSREC01</td>
<td>Is Recommendation Applicable?</td>
<td>32</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Is Recommendation Applicable?":
"Inclusion Criteria"
and not "Exclusion Criteria"</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>Is Opioid Analgesic with Ambulatory Misuse Potential?</td>
<td>33</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>):
("Get MedicationRequest Medication as Code"(value)) Rx
where Rx.medication in "Opioid analgesics with ambulatory misuse potential"
and Rx.category in "Community"</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>Get MedicationRequest Medication as Code</td>
<td>34</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>):
value Rx
let Med:
if Rx.medication is Reference then singleton from (
[Medication] M
where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))
) else null
return
MedicationRequest {
id: Rx.id,
status: Rx.status,
intent: Rx.intent,
category: Rx.category,
medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,
subject: Rx.subject,
authoredOn: Rx.authoredOn,
recorder: Rx.recorder,
dosageInstruction: Rx.dosageInstruction,
dispenseRequest: Rx.dispenseRequest
}</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>FHIRHelpers</td>
<td>ToString</td>
<td>35</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define function ToString(value string): value.value</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>FHIRHelpers</td>
<td>ToConcept</td>
<td>36</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>FHIRHelpers</td>
<td>ToCode</td>
<td>37</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSRoutines</td>
<td>Is Acute Pain Prescription?</td>
<td>38</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">// End of For Subacute or Chronic Pain Routine
/*
** Routine #5
** For Acute Pain Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** -----------------------------------------------------------------------------------------------------------------------------------
** Order for opioid analgesics | Yes | Look for an existing prescription (order) for | Opioid analgesics with
** with ambulatory misuse | | opioid analgesics with ambulatory abuse | ambulatory misuse potential
** potential of duration < 28 | | potential of duration < 28 days |
** days | | |
** -----------------------------------------------------------------------------------------------------------------------------------
**
*/
// should allow DateTime precision, but not working in the Ruler specifically
define function "Is Acute Pain Prescription?"(prescription FHIR.MedicationRequest):
prescription.dispenseRequest is not null
and prescription.dispenseRequest.expectedSupplyDuration is not null
and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>GetDurationInDays</td>
<td>39</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define function GetDurationInDays(value FHIR.Duration):
if value is null then null
else
case
when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' }
when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' }
when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' }
when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' }
when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' }
when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' }
when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' }
when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' }
when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null')
else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value)
end</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>FHIRHelpers</td>
<td>ToDateTime</td>
<td>40</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define function ToDateTime(value dateTime): value.value</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>OpioidCDSCommon</td>
<td>Get Active Ambulatory Medication Requests</td>
<td>41</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define function "Get Active Ambulatory Medication Requests" (value List<MedicationRequest>) returns List<MedicationRequest>:
value Rx
where Rx.status.value = 'active'
and Rx.category in "Community"</code></pre>
<br/><br/>
<table class="grid-dict">
<tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>
<tr>
<td>FHIRHelpers</td>
<td>ToString</td>
<td>42</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define function ToString(value MedicationDispenseStatus): value.value</code></pre>
<br/><br/>
</td>
</tr>
<tr>
<th scope="row"><b>Knowledge Capability: </b></th>
<td style="padding-left: 4px;">
shareable computable executable publishable
</td>
</tr>
<tr>
<th scope="row"><b>Use Context: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr><th><b>code</b></th><th><b>value</b></th><th><b>display</b></th></tr>
<tr>
<td>focus</td>
<td>182888003</td>
<td>Medication requested (situation)</td>
</tr>
<tr>
<td>focus</td>
<td>274663001</td>
<td>Acute pain (finding)</td>
</tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Purpose: </b></th>
<td style="padding-left: 4px;"><div><p>The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for 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></td>
</tr>
<tr>
<th scope="row"><b>Usage: </b></th>
<td style="padding-left: 4px;">Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.</td>
</tr>
<tr>
<th scope="row"><b>Copyright: </b></th>
<td style="padding-left: 4px;"><div><p>© CDC 2016+.</p>
</div></td>
</tr>
<tr>
<th scope="row"><b>Related Artifacts: </b></th>
<td style="padding-left: 4px;">
<p><b>Documentation</b></p>
<ul>
<li>
<a href="https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm"> 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain</a>
</li>
</ul>
</td>
</tr>
<tr>
<th scope="row"><b>Libraries: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr><td><a href="Library-OpioidCDSREC01.html">Library - Recommendation #1 - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration</a></td></tr>
</table>
</td>
</tr>
<tr>
<th scope="row"><b>Actions: </b></th>
<td style="padding-left: 4px;">
<table class="grid-dict">
<tr>
<td>
<b> Consider Nonopioid Treatment Options for Acute Pain:</b> For many types of acute pain, clinicians should maximize the use of nonpharmacologic (for example, physical therapy) and nonopioid pharmacologic therapies (for example, NSAIDs), as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy.
[Recommendation 1 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation1) provides nonopioid therapy options for common acute pain conditions.
**Nonopioid Pharmacological Therapy**
- [Dental pain (acute)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=The%20American%20Dental%20Association%20(ADA)%20recommends%20NSAIDs%20as%20first%2Dline%20treatment%20for%20acute%20dental%20pain%20management)
- [Dental pain (surgical)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=NSAIDs%20have%20been%20found%20to%20be%20more%20effective%20than%20opioids%20for%20surgical%20dental%20pain)
- [Kidney stone pain (acute)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20acute%20kidney%20stone%20pain%2C%20NSAIDs%20are%20at%20least%20as%20effective%20as%20opioids%20(124%E2%80%93127)%2C%20can%20decrease%20the%20ureteral%20smooth%20muscle%20tone%20and%20ureteral%20spasm%20(128)%20causing%20kidney%20stone%20pain%2C%20and%20are%20preferred%20for%20kidney%20stone%20pain%20if%20not%20contraindicated.)
- [Low back pain (acute)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=NSAIDs%20have%20been%20found%20to%20be%20more%20effective%20than%20opioids%20for%20surgical%20dental%20pain%20and%20kidney%20stone%20pain%20and%20similarly%20effective%20to%20opioids%20for%20low%20back%20pain)
- [Migraine pain (episodic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20episodic%20migraine%2C%20triptans%2C%20NSAIDs%2C%20antiemetics%2C%20dihydroergotamine%2C%20calcitonin%20gene%2Drelated%20peptide%20antagonists%20(gepants)%2C%20and%20lasmiditan%20are%20associated%20with%20improved%20pain%20and%20function%20with%20usually%20mild%20and%20transient%20adverse%20events)
- [Musculoskeletal pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=A%20systematic%20review%20found%20that%20for%20musculoskeletal%20injuries%20such%20as%20sprains%2C%20whiplash%2C%20and%20muscle%20strains%2C%20topical%20NSAIDs%20provided%20the%20greatest%20benefit%2Dharm%20ratio%2C%20followed%20by%20oral%20NSAIDs%20or%20acetaminophen%20with%20or%20without%20diclofenac)
- [Postpartum pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Pain%20Management%20for%20Pregnant%20and%20Postpartum%20Persons)
**Nonpharmacologic Treatments**
- [Back pain (acute)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=The%20American%20College%20of%20Physicians%20(ACP)%20recommends%20nonpharmacologic%20treatment%20with%20superficial%20heat%2C%20massage%2C%20acupuncture%2C%20or%20spinal%20manipulation%20as%20a%20cornerstone%20of%20treatment%20for%20acute%20low%20back%20pain)
- [Migraine pain (episodic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=remote%20electrical%20neuromodulation%20for%20acute%20pain%20related%20to%20episodic%20migraine)
- [Musculoskeletal pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=acupressure%20for%20acute%20musculoskeletal%20pain)
- [Postoperative pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=massage%20for%20postoperative%20pain)<br/>
<b>When:</b> <i>Named Event:</i> order-sign<br/>
<b>If:</b> <i>Applicability:</i> Check whether the current order is for an opioid with ambulatory misuse potential, the patient is opioid naive and if the 2022 CDC guideline general inclusion criteria is met <i>(Is Recommendation Applicable?)</i><br/>
<b>Then:</b>
<table class="grid-dict">
<tr>
<td>
<b> :</b> Document - Record reason for opioid therapy<br/>
<b>Then:</b>
</td>
</tr>
<tr>
<td>
<b> :</b> Snooze* - Attempt alternative therapy, snooze 3 months<br/>
<b>Then:</b>
</td>
</tr>
<tr>
<td>
<b> :</b> Order - Select alternative therapies from order set<br/>
<b>Then:</b>
</td>
</tr>
<tr>
<td>
<b> :</b> Snooze* - N/A see comment, snooze 3 months<br/>
<b>Then:</b>
</td>
</tr>
<tr>
<td>
<b> :</b> Remove - Will remove triggering medication order<br/>
<b>Then:</b>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<name value="EffectiveDataRequirements"/>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/library-type"/>
<code value="module-definition"/>
</coding>
</type>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Common"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommon|2022.1.0"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library FHIRHelpers"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Routines"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines|2022.1.0"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Library Config"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommonConfig|2022.1.0"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Opioid analgesics with ambulatory misuse potential"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Community"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Encounter Diagnosis Condition Category"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Problem List Condition Category"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set US Core Health Concern Condition Category"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Sickle Cell Diseases"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/sickle-cell-diseases"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Active Condition"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-clinical-status-active"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set CDC malignant cancer conditions"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/cdc-malignant-cancer-conditions"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display
value="Value set Conditions likely terminal for opioid prescribing"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/conditions-likely-terminal-for-opioid-prescribing"/>
</relatedArtifact>
<parameter>
<name value="ContextPrescriptions"/>
<use value="in"/>
<min value="0"/>
<max value="*"/>
<type value="MedicationRequest"/>
</parameter>
<parameter>
<name value="Is Recommendation Applicable?"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<dataRequirement>
<type value="Medication"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Medication"/>
<mustSupport value="id"/>
<mustSupport value="code"/>
</dataRequirement>
<dataRequirement>
<type value="Patient"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Patient"/>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="category"/>
<mustSupport value="code"/>
<mustSupport value="clinicalStatus"/>
<codeFilter>
<path value="category"/>
<valueSet
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="category"/>
<mustSupport value="code"/>
<mustSupport value="clinicalStatus"/>
<mustSupport value="encounter"/>
<mustSupport value="encounter.reference"/>
<codeFilter>
<path value="category"/>
<valueSet
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="category"/>
<mustSupport value="code"/>
<mustSupport value="clinicalStatus"/>
<mustSupport value="clinicalStatus.coding"/>
<codeFilter>
<path value="category"/>
<valueSet
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="period"/>
<mustSupport value="period.start"/>
<mustSupport value="id"/>
</dataRequirement>
<dataRequirement>
<type value="MedicationRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationRequest"/>
<mustSupport value="authoredOn"/>
<mustSupport value="medication"/>
<mustSupport value="medication.reference"/>
<mustSupport value="id"/>
<mustSupport value="status"/>
<mustSupport value="intent"/>
<mustSupport value="category"/>
<mustSupport value="subject"/>
<mustSupport value="recorder"/>
<mustSupport value="dosageInstruction"/>
<mustSupport value="dispenseRequest"/>
<mustSupport value="status.value"/>
</dataRequirement>
<dataRequirement>
<type value="MedicationDispense"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationDispense"/>
<mustSupport value="medication"/>
<mustSupport value="whenHandedOver"/>
<mustSupport value="status"/>
<codeFilter>
<path value="medication"/>
<valueSet
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="MedicationDispense"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/MedicationDispense"/>
<mustSupport value="medication.reference"/>
<mustSupport value="whenHandedOver"/>
<mustSupport value="status"/>
</dataRequirement>
</Library>
</contained>
<extension
url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
<valueCode value="shareable"/>
</extension>
<extension
url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
<valueCode value="computable"/>
</extension>
<extension
url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
<valueCode value="executable"/>
</extension>
<extension
url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
<valueCode value="publishable"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC01"/>
</extension>
<extension url="name">
<valueString
value="Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions"/>
</extension>
<extension url="statement">
<valueString
value="define "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC01"/>
</extension>
<extension url="name">
<valueString
value="Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"/>
</extension>
<extension url="statement">
<valueString
value="define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
exists( "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommonConfig"/>
</extension>
<extension url="name">
<valueString value="Age Less than 18 Years Is Enabled"/>
</extension>
<extension url="statement">
<valueString
value="// CDC 2022 General Inclusion Criteria
define "Age Less than 18 Years Is Enabled":
true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Patient Age Less Than 18"/>
</extension>
<extension url="statement">
<valueString
value="define "Patient Age Less Than 18":
if (Config."Age Less than 18 Years Is Enabled") then
AgeInYearsAt(Today()) < 18
else false"/>
</extension>
<extension url="displaySequence">
<valueInteger value="3"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommonConfig"/>
</extension>
<extension url="name">
<valueString value="Sickle Cell Check Enabled"/>
</extension>
<extension url="statement">
<valueString
value="// Sickle Cell
define "Sickle Cell Check Enabled":
true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommonConfig"/>
</extension>
<extension url="name">
<valueString value="Sickle Cell Assumed Active"/>
</extension>
<extension url="statement">
<valueString
value="define "Sickle Cell Assumed Active":
true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="US Core-Categorized Conditions"/>
</extension>
<extension url="statement">
<valueString
value="// 3. Medications indicating end of life
/* or exists (
"Medications Indicating End of Life"
) */
define "US Core-Categorized Conditions":
[Condition: category in "Encounter Diagnosis Condition Category"]
union [Condition: category in "Problem List Condition Category"]
union [Condition: category in "US Core Health Concern Condition Category"]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="Positive Sickle Cell Condition"/>
</extension>
<extension url="statement">
<valueString
value="define "Positive Sickle Cell Condition":
if Config."Sickle Cell Check Enabled" and not Config."Sickle Cell Assumed Active"
then (
"US Core-Categorized Conditions" C
where C.code in "Sickle Cell Diseases"
and C.clinicalStatus in "Active Condition"
) else if Config."Sickle Cell Check Enabled" and Config."Sickle Cell Assumed Active"
then (
"US Core-Categorized Conditions" C
where C.code in "Sickle Cell Diseases"
)
else null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Condition Positive for Sickle Cell"/>
</extension>
<extension url="statement">
<valueString
value="define "Condition Positive for Sickle Cell":
if (Config."Sickle Cell Check Enabled") then
exists(
Common."Positive Sickle Cell Condition"
)
else false"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommonConfig"/>
</extension>
<extension url="name">
<valueString
value="Active Cancer Treatment Encounters Condition Is Enabled"/>
</extension>
<extension url="statement">
<valueString
value="// Active Cancer Treatment
define "Active Cancer Treatment Encounters Condition Is Enabled":
true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Encounter Period"/>
</extension>
<extension url="statement">
<valueString
value="// End of Opioid Naive Routine
/*
** Routine #3
** Active Cancer Treatment Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** ---------------------------------------------------------------------------------------------------------------------------------
** Two office visits within the | No | Look for a minimum of two distinct | Office Visit
** past 12 months | | encounters within 12 months of the date |
** | | of the current visit for which each of the |
** | | following is true: |
** | | - the encounter diagnosis (primary or |
** | | secondary or co-morbidity diagnosis) |
** | | is listed in the CDC Malignant Cancer |
** | | Conditions value set |
** ---------------------------------------------------------------------------------------------------------------------------------
** Office visits with an | No | The encounter is performed by an | Oncology specialty
** oncology specialist | | oncologist as defined in the oncology | designations (NUCC)
** present | | specialty designations using the |
** | | National Uniform Claim Committee |
** | | (NUCC) classifications |
** ---------------------------------------------------------------------------------------------------------------------------------
** Office visits including CDC | No | The encounter diagnosis (primary or | CDC malignant cancer
** malignant cancer | | secondary or co-morbidity diagnosis) | conditions
** condition | | is listed in the CDC Malignant Cancer |
** | | Conditions value set |
** ----------------------------------------------------------------------------------------------------------------------------------
**
*/
define "Encounter Period":
Interval[Today() - 12 months, Today())"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="USCore Encounter Cancer Diagnoses"/>
</extension>
<extension url="statement">
<valueString
value="define "USCore Encounter Cancer Diagnoses":
[Condition: category in "Encounter Diagnosis Condition Category"] CancerDiagnoses
where CancerDiagnoses.code in "CDC malignant cancer conditions""/>
</extension>
<extension url="displaySequence">
<valueInteger value="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString
value="Encounters with Cancer Diagnosis During Encounter Period"/>
</extension>
<extension url="statement">
<valueString
value="// encounter-diagnosis, problem-list and health-concern Conditions
// define "US Core-Categorized Cancer Diagnoses":
// Common."US Core-Categorized Conditions" C
// where C.code in Common."CDC malignant cancer conditions"
// define "Encounters with Cancer Diagnosis During Encounter Period":
// [Encounter] Encounter
// with "US Core-Categorized Cancer Diagnoses" CancerDiagnosis
// such that date from Encounter.period."start".value in day of "Encounter Period"
// and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id)
define "Encounters with Cancer Diagnosis During Encounter Period":
[Encounter] Encounters
where date from Encounters.period."start" in day of "Encounter Period"
and exists (
Common."USCore Encounter Cancer Diagnoses" CancerDiagnoses
where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString
value="Number of Encounters with Cancer Diagnosis During Encounter Period"/>
</extension>
<extension url="statement">
<valueString
value="define "Number of Encounters with Cancer Diagnosis During Encounter Period":
Count ("Encounters with Cancer Diagnosis During Encounter Period")"/>
</extension>
<extension url="displaySequence">
<valueInteger value="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString
value="Has Two or More Encounters with Cancer Diagnosis During Encounter Period"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Two or More Encounters with Cancer Diagnosis During Encounter Period":
"Number of Encounters with Cancer Diagnosis During Encounter Period" >= 2"/>
</extension>
<extension url="displaySequence">
<valueInteger value="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="USCore Problem List Cancer Diagnoses"/>
</extension>
<extension url="statement">
<valueString
value="define "USCore Problem List Cancer Diagnoses":
[Condition: category in "Problem List Condition Category"] CancerDiagnoses
where CancerDiagnoses.code in "CDC malignant cancer conditions""/>
</extension>
<extension url="displaySequence">
<valueInteger value="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Has Active Cancer Diagnosis on Problem List"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Active Cancer Diagnosis on Problem List":
exists (
Common."USCore Problem List Cancer Diagnoses" CancerDiagnoses
where CancerDiagnoses.category in Common."Problem List Condition Category"
and exists(
CancerDiagnoses.clinicalStatus.coding ClinicalStatus
where ClinicalStatus.code ~ 'active'
)
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Is Active Cancer Treatment?"/>
</extension>
<extension url="statement">
<valueString
value="define "Is Active Cancer Treatment?":
if (Config."Active Cancer Treatment Encounters Condition Is Enabled")
then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period"
or "Has Active Cancer Diagnosis on Problem List"
else false"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommonConfig"/>
</extension>
<extension url="name">
<valueString value="End-Stage Disease Criteria Enabled"/>
</extension>
<extension url="statement">
<valueString
value="// CDC 2022 General Inclusion Criteria
define "End-Stage Disease Criteria Enabled":
true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Conditions Likely Terminal for Opioid Prescribing"/>
</extension>
<extension url="statement">
<valueString
value="define "Conditions Likely Terminal for Opioid Prescribing":
if (Config."End-Stage Disease Criteria Enabled") then
exists (
Common."US Core-Categorized Conditions" EOLC
where EOLC.code in Common."Conditions likely terminal for opioid prescribing"
// and EOLC.clinicalStatus in Common."Active Condition"
)
else false"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="CDC 2022 Guideline General Inclusion Criteria"/>
</extension>
<extension url="statement">
<valueString
value="define "CDC 2022 Guideline General Inclusion Criteria":
not "Patient Age Less Than 18"
and not "Condition Positive for Sickle Cell"
and not "Is Active Cancer Treatment?"
and not "Conditions Likely Terminal for Opioid Prescribing""/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommonConfig"/>
</extension>
<extension url="name">
<valueString value="Opioid Naive Prescription Condition Is Enabled"/>
</extension>
<extension url="statement">
<valueString
value="// Opioid Naive
define "Opioid Naive Prescription Condition Is Enabled":
true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommonConfig"/>
</extension>
<extension url="name">
<valueString
value="Can the implementing EHR support queries for past medications by date range?"/>
</extension>
<extension url="statement">
<valueString
value="// Subroutine 2 - Past Medications
define "Can the implementing EHR support queries for past medications by date range?":
true"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="Active Ambulatory Opioid Rx"/>
</extension>
<extension url="statement">
<valueString
value="define "Active Ambulatory Opioid Rx":
if Config."Can the implementing EHR support queries for past medications by date range?" then
(
"Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest]))
) Rx
where date from Rx.authoredOn 2 years or less on or before Today()
and Rx.medication in "Opioid analgesics with ambulatory misuse potential"
else
List<FHIR.MedicationRequest>{}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Prescription/Dispense Inclusion Period"/>
</extension>
<extension url="statement">
<valueString
value="// End of CDC 2022 General Inclusion Criteria Routine
/*
** Routine #2
** Opioid Naive Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** ----------------------------------------------------------------------------------------------------------------------------------------
** Opioid analgesics with | No | Look for an existing prescription (order) for | Opioid analgesics with
** ambulatory misuse potential | | opioid that is in the value set for opioid with | ambulatory misuse potential
** prescription in past 90 days | | ambulatory abuse potential authored |
** excluding the previous 24 | | within the past 90 days (excluding previous 24 |
** hours | | hours) |
** ----------------------------------------------------------------------------------------------------------------------------------------
** Opioid analgesics with | No | Look for evidence of active medication on | Opioid analgesics with
** ambulatory misuse potential | | the medication list that is in the value set | ambulatory misuse potential
** reported in past 90 days | | for opioid with ambulatory care abuse |
** excluding previous 24 hours* | | potential |
** ----------------------------------------------------------------------------------------------------------------------------------------
** Opioid analgesics with | No | Look for evidence of a dispensing event for | Opioid analgesics with
** ambulatory misuse potential | | medication that is in the value set for opioid | ambulatory misuse potential
** dispensing event in past 90 | | with ambulatory use potential occurring |
** days excluding previous 24 | | within the past 90 days (excluding previous 24 |
** hours | | hours) |
** ----------------------------------------------------------------------------------------------------------------------------------------
** *Future consideration: Current algorithm addresses only orders (prescriptions).
**
** Note – orders use RxNorm, but medication lists and dispensed medication will
** require an NDC value set and/or local mapping of NDC to RxNorm to enable this element
**
*/
define "Prescription/Dispense Inclusion Period":
Interval[Now() - 90 days, Now() - 24 hours]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="24"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString
value="Opioid RX with Ambulatory Abuse Potential In Past 90 Days"/>
</extension>
<extension url="statement">
<valueString
value="define "Opioid RX with Ambulatory Abuse Potential In Past 90 Days":
Common."Active Ambulatory Opioid Rx" Rx
where Rx.authoredOn during day of "Prescription/Dispense Inclusion Period""/>
</extension>
<extension url="displaySequence">
<valueInteger value="25"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString
value="Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days":
if (Config."Opioid Naive Prescription Condition Is Enabled") then
exists ("Opioid RX with Ambulatory Abuse Potential In Past 90 Days")
else false"/>
</extension>
<extension url="displaySequence">
<valueInteger value="26"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString
value="Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days"/>
</extension>
<extension url="statement">
<valueString
value="// NOTE: 2020-02-05: Review direction of MedicationStatement resource (US-Core focusing on MedicationRequest i/o Statement)
// NOTE: 2020-04-21: MedicationStatement a) Shouldn't be use since guidance/direction from USCore is targeting MedicationUse in R5, and b) Breaks in the publisher
/* define "Reports of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days":
[MedicationStatement: Common."Opioid analgesics with ambulatory misuse potential"] Statement
where Statement.status in {'active', 'completed'}
and Statement.effective during day of "Report Inclusion Period" */
/* define "Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days":
Config."Opioid Naive Report Condition Is Enabled"
and exists ("Reports of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days") */
define "Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days":
[MedicationDispense: Common."Opioid analgesics with ambulatory misuse potential"] OpioidDispense
where OpioidDispense.whenHandedOver during day of "Prescription/Dispense Inclusion Period"
and OpioidDispense.status = 'completed'"/>
</extension>
<extension url="displaySequence">
<valueInteger value="27"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString
value="Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days"/>
</extension>
<extension url="statement">
<valueString
value="define "Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days":
if (Config."Opioid Naive Prescription Condition Is Enabled") then
exists ("Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days")
else false"/>
</extension>
<extension url="displaySequence">
<valueInteger value="28"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Is Opioid Naive?"/>
</extension>
<extension url="statement">
<valueString
value="// NOTE: MedicationStatement-dependent logic comment out due to bug in Publisher not supporting MedicationStatement in AllTypes.
define "Is Opioid Naive?":
not ("Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days")
/* and not ("Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days") */
and not ("Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days")"/>
</extension>
<extension url="displaySequence">
<valueInteger value="29"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC01"/>
</extension>
<extension url="name">
<valueString value="Inclusion Criteria"/>
</extension>
<extension url="statement">
<valueString
value="define "Inclusion Criteria":
"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
and Routines."CDC 2022 Guideline General Inclusion Criteria"
and Routines."Is Opioid Naive?""/>
</extension>
<extension url="displaySequence">
<valueInteger value="30"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC01"/>
</extension>
<extension url="name">
<valueString value="Exclusion Criteria"/>
</extension>
<extension url="statement">
<valueString value="define "Exclusion Criteria":
false"/>
</extension>
<extension url="displaySequence">
<valueInteger value="31"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC01"/>
</extension>
<extension url="name">
<valueString value="Is Recommendation Applicable?"/>
</extension>
<extension url="statement">
<valueString
value="define "Is Recommendation Applicable?":
"Inclusion Criteria"
and not "Exclusion Criteria""/>
</extension>
<extension url="displaySequence">
<valueInteger value="32"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString
value="Is Opioid Analgesic with Ambulatory Misuse Potential?"/>
</extension>
<extension url="statement">
<valueString
value="define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>):
("Get MedicationRequest Medication as Code"(value)) Rx
where Rx.medication in "Opioid analgesics with ambulatory misuse potential"
and Rx.category in "Community""/>
</extension>
<extension url="displaySequence">
<valueInteger value="33"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="Get MedicationRequest Medication as Code"/>
</extension>
<extension url="statement">
<valueString
value="define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>):
value Rx
let Med:
if Rx.medication is Reference then singleton from (
[Medication] M
where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))
) else null
return
MedicationRequest {
id: Rx.id,
status: Rx.status,
intent: Rx.intent,
category: Rx.category,
medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,
subject: Rx.subject,
authoredOn: Rx.authoredOn,
recorder: Rx.recorder,
dosageInstruction: Rx.dosageInstruction,
dispenseRequest: Rx.dispenseRequest
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="34"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value string): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="35"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToConcept"/>
</extension>
<extension url="statement">
<valueString
value="define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="36"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToCode"/>
</extension>
<extension url="statement">
<valueString
value="define function ToCode(coding FHIR.Coding):
if coding is null then
null
else
System.Code {
code: coding.code.value,
system: coding.system.value,
version: coding.version.value,
display: coding.display.value
}"/>
</extension>
<extension url="displaySequence">
<valueInteger value="37"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Is Acute Pain Prescription?"/>
</extension>
<extension url="statement">
<valueString
value="// End of For Subacute or Chronic Pain Routine
/*
** Routine #5
** For Acute Pain Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** -----------------------------------------------------------------------------------------------------------------------------------
** Order for opioid analgesics | Yes | Look for an existing prescription (order) for | Opioid analgesics with
** with ambulatory misuse | | opioid analgesics with ambulatory abuse | ambulatory misuse potential
** potential of duration < 28 | | potential of duration < 28 days |
** days | | |
** -----------------------------------------------------------------------------------------------------------------------------------
**
*/
// should allow DateTime precision, but not working in the Ruler specifically
define function "Is Acute Pain Prescription?"(prescription FHIR.MedicationRequest):
prescription.dispenseRequest is not null
and prescription.dispenseRequest.expectedSupplyDuration is not null
and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days"/>
</extension>
<extension url="displaySequence">
<valueInteger value="38"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="GetDurationInDays"/>
</extension>
<extension url="statement">
<valueString
value="define function GetDurationInDays(value FHIR.Duration):
if value is null then null
else
case
when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' }
when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' }
when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' }
when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' }
when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' }
when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' }
when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' }
when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' }
when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null')
else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value)
end"/>
</extension>
<extension url="displaySequence">
<valueInteger value="39"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToDateTime"/>
</extension>
<extension url="statement">
<valueString
value="define function ToDateTime(value dateTime): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="40"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="Get Active Ambulatory Medication Requests"/>
</extension>
<extension url="statement">
<valueString
value="define function "Get Active Ambulatory Medication Requests" (value List<MedicationRequest>) returns List<MedicationRequest>:
value Rx
where Rx.status.value = 'active'
and Rx.category in "Community""/>
</extension>
<extension url="displaySequence">
<valueInteger value="41"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition">
<extension url="libraryName">
<valueString value="FHIRHelpers"/>
</extension>
<extension url="name">
<valueString value="ToString"/>
</extension>
<extension url="statement">
<valueString
value="define function ToString(value MedicationDispenseStatus): value.value"/>
</extension>
<extension url="displaySequence">
<valueInteger value="42"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements" id="effective-data-requirements">
<valueCanonical value="#effective-data-requirements"/>
</extension>
<extension
url="http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem">
<valueReference>🔗
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<url
value="http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-01"/>
<identifier>
<use value="official"/>
<value value="cdc-opioid-guidance"/>
</identifier>
<version value="2022.1.0"/>
<name value="PlanDefinition_Recommendation_01_Order_Sign"/>
<title
value="Recommendation #1 - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration"/>
<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"/>
<experimental value="true"/>
<date value="2025-08-06"/>
<publisher value="Centers for Disease Control and Prevention (CDC)"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.cdc.gov"/>
</telecom>
</contact>
<description
value="Nonopioid therapies are at least as effective as opioids for many common types of acute pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy."/>
<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="274663001"/>
<display value="Acute pain (finding)"/>
</coding>
</valueCodeableConcept>
</useContext>
<purpose
value="The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for 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="Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient."/>
<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="2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain"/>
<url value="https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm"/>
<document>
<url value="https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm"/>
</document>
</relatedArtifact>
<library
value="http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC01"/>
<action>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/>
<code value="weak"/>
<display value="Weak"/>
</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="Consider Nonopioid Treatment Options for Acute Pain"/>
<description
value="For many types of acute pain, clinicians should maximize the use of nonpharmacologic (for example, physical therapy) and nonopioid pharmacologic therapies (for example, NSAIDs), as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy.
[Recommendation 1 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation1) provides nonopioid therapy options for common acute pain conditions.
**Nonopioid Pharmacological Therapy**
- [Dental pain (acute)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=The%20American%20Dental%20Association%20(ADA)%20recommends%20NSAIDs%20as%20first%2Dline%20treatment%20for%20acute%20dental%20pain%20management)
- [Dental pain (surgical)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=NSAIDs%20have%20been%20found%20to%20be%20more%20effective%20than%20opioids%20for%20surgical%20dental%20pain)
- [Kidney stone pain (acute)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20acute%20kidney%20stone%20pain%2C%20NSAIDs%20are%20at%20least%20as%20effective%20as%20opioids%20(124%E2%80%93127)%2C%20can%20decrease%20the%20ureteral%20smooth%20muscle%20tone%20and%20ureteral%20spasm%20(128)%20causing%20kidney%20stone%20pain%2C%20and%20are%20preferred%20for%20kidney%20stone%20pain%20if%20not%20contraindicated.)
- [Low back pain (acute)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=NSAIDs%20have%20been%20found%20to%20be%20more%20effective%20than%20opioids%20for%20surgical%20dental%20pain%20and%20kidney%20stone%20pain%20and%20similarly%20effective%20to%20opioids%20for%20low%20back%20pain)
- [Migraine pain (episodic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20episodic%20migraine%2C%20triptans%2C%20NSAIDs%2C%20antiemetics%2C%20dihydroergotamine%2C%20calcitonin%20gene%2Drelated%20peptide%20antagonists%20(gepants)%2C%20and%20lasmiditan%20are%20associated%20with%20improved%20pain%20and%20function%20with%20usually%20mild%20and%20transient%20adverse%20events)
- [Musculoskeletal pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=A%20systematic%20review%20found%20that%20for%20musculoskeletal%20injuries%20such%20as%20sprains%2C%20whiplash%2C%20and%20muscle%20strains%2C%20topical%20NSAIDs%20provided%20the%20greatest%20benefit%2Dharm%20ratio%2C%20followed%20by%20oral%20NSAIDs%20or%20acetaminophen%20with%20or%20without%20diclofenac)
- [Postpartum pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Pain%20Management%20for%20Pregnant%20and%20Postpartum%20Persons)
**Nonpharmacologic Treatments**
- [Back pain (acute)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=The%20American%20College%20of%20Physicians%20(ACP)%20recommends%20nonpharmacologic%20treatment%20with%20superficial%20heat%2C%20massage%2C%20acupuncture%2C%20or%20spinal%20manipulation%20as%20a%20cornerstone%20of%20treatment%20for%20acute%20low%20back%20pain)
- [Migraine pain (episodic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=remote%20electrical%20neuromodulation%20for%20acute%20pain%20related%20to%20episodic%20migraine)
- [Musculoskeletal pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=acupressure%20for%20acute%20musculoskeletal%20pain)
- [Postoperative pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=massage%20for%20postoperative%20pain)"/>
<priority value="urgent"/>
<trigger>
<type value="named-event"/>
<name value="order-sign"/>
</trigger>
<condition>
<kind value="applicability"/>
<expression>
<description
value="Check whether the current order is for an opioid with ambulatory misuse potential, the patient is opioid naive and if the 2022 CDC guideline general inclusion criteria is met"/>
<language value="text/cql.identifier"/>
<expression value="Is Recommendation Applicable?"/>
</expression>
</condition>
<groupingBehavior value="visual-group"/>
<selectionBehavior value="any"/>
<action>
<description value="Document - Record reason for opioid therapy"/>
</action>
<action>
<description
value="Snooze* - Attempt alternative therapy, snooze 3 months"/>
</action>
<action>
<description
value="Order - Select alternative therapies from order set"/>
</action>
<action>
<description value="Snooze* - N/A see comment, snooze 3 months"/>
</action>
<action>
<description value="Remove - Will remove triggering medication order"/>
</action>
</action>
</PlanDefinition>