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 2023-05-01 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="opioidcds-03"/>
<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-03</td>
</tr>
<tr>
<th scope="row"><b>Url: </b></th>
<td style="padding-left: 4px;"><a href="PlanDefinition-opioidcds-03.html">PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #3</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;">CDC_opioid_03</td>
</tr>
<tr>
<th scope="row"><b>Title: </b></th>
<td style="padding-left: 4px;">PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #3</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://hl7.org/fhir/R4/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;">2023-05-01</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;">When starting opioid therapy for subacute or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.</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>OpioidCDSREC03</td>
<td>Get Summary</td>
<td>0</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Get Summary":
if "Is Recommendation Applicable?"
then 'When Initiating Opioid Therapy, Utilize Immediate Release Opioids'
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>OpioidCDSREC03</td>
<td>Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions</td>
<td>1</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )
and AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential"</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>OpioidCDSREC03</td>
<td>Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential</td>
<td>2</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential":
exists( "Chronic Pain Extended Release 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>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>OpioidCDSRoutines</td>
<td>Condition Positive for Sickle Cell</td>
<td>4</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>OpioidCDSCommon</td>
<td>US Core-Categorized Conditions</td>
<td>5</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>OpioidCDSRoutines</td>
<td>Conditions Indicating End Of Life Present</td>
<td>6</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Conditions Indicating End Of Life Present":
exists (
Common."US Core-Categorized Conditions" LLEC
where LLEC.code in Common."Limited life expectancy conditions"
and LLEC.clinicalStatus in Common."Active Condition"
)</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>Service Requests</td>
<td>7</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Service Requests":
[ServiceRequest] SR
return SR</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>Palliative Care Lookback Period</td>
<td>8</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">/*
** Routine #1
** Opioid Review Useful Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** ------------------------------------------------------------------------------------------------------------------------------------
** Age < 18 years? | No | Calculate age from date of birth; exclude | Date of birth
** | | patients with age less than 18 years at the |
** | | time of the prescription |
** ------------------------------------------------------------------------------------------------------------------------------------
** Evidence of | No | Look for documented findings consistent | Sickle cell disease conditions
** sickle cell disease? | | with those listed in the sickle cell |
** | | value set |
** ------------------------------------------------------------------------------------------------------------------------------------
** Limited life | No | Look for documented findings consistent | Limited life expectancy conditions
** expectancy conditions | | with those listed in the limited life |
** present? | | expectancy value set (terminal illness, bad |
** | | prognosis, pre-terminal) |
** ------------------------------------------------------------------------------------------------------------------------------------
** Order for therapies | No | Look for patients with an existing order for | Therapies indicating end of life care
** indicating end of life | | therapies indicating end of life care |
** care in past 90 days? | | written within past 90 days |
** ------------------------------------------------------------------------------------------------------------------------------------
** Active cancer | No | See sub-routine 3 | See sub-routine 3
** treatment? | | |
** ------------------------------------------------------------------------------------------------------------------------------------
** Conditions Likely | No | Look for patients with active conditions in | Conditions likely terminal for opioid
** Terminal for opioid | | the value set end-of-life-conditions | prescribing
** prescribing present? | | |
** ------------------------------------------------------------------------------------------------------------------------------------
**
*/
define "Palliative Care Lookback Period":
Interval[Today() - 90 days, 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>OpioidCDSRoutines</td>
<td>Order For Palliative Care In Past 90 Days</td>
<td>9</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Order For Palliative Care In Past 90 Days":
exists (
Common."Service Requests" SR
where SR.status in { 'active', 'completed'}
and SR.intent in {'proposal', 'plan,', 'directive', 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}
and FHIRHelpers.ToDateTime(SR.authoredOn) during day of "Palliative Care Lookback Period"
and SR.code in Common."Therapies indicating end of life care"
)</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>10</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"
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>Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present</td>
<td>11</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present":
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>Is Opioid Review Useful?</td>
<td>12</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Is Opioid Review Useful?":
not "Patient Age Less Than 18"
and not "Condition Positive for Sickle Cell"
and not "Conditions Indicating End Of Life Present"
and not "Order For Palliative Care In Past 90 Days"
and not "Is Active Cancer Treatment?"
and not "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present"</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>13</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>Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days</td>
<td>14</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>15</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>OpioidCDSREC03</td>
<td>Inclusion Criteria</td>
<td>16</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Inclusion Criteria":
"Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential"
and Routines."Is Opioid Review Useful?"
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>OpioidCDSCommon</td>
<td>Conditions Indicating End of Life or With Limited Life Expectancy</td>
<td>17</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Conditions Indicating End of Life or With Limited Life Expectancy":
(
"US Core-Categorized Conditions" C
where C.code in "Conditions likely terminal for opioid prescribing"
and C.clinicalStatus in "Active Condition"
)
union
(
"US Core-Categorized Conditions" C
where C.code in "Limited life expectancy conditions"
and C.clinicalStatus in "Active Condition"
)</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>Admitted/Referred/Discharged to Hospice Care</td>
<td>18</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Admitted/Referred/Discharged to Hospice Care":
(
[Procedure: code in "Hospice Procedure Codes"] P
where P.status.value in { 'in-progress', 'completed' }
)
union
(
"Service Requests" SR
where SR.code in "Hospice Procedure Codes"
and SR.status.value in { 'active', 'completed' }
)
union
(
if (Config."Hospice Findings Exclusion Enabled") then
[Observation: code in "Hospice Finding Codes"] O
where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })
else
{}
)
union
(
[Encounter] E
where date from E.period.start 1 year or less on or before Today()
and (
if E.hospitalization.dischargeDisposition.coding is null
or not exists (E.hospitalization.dischargeDisposition.coding)
then false
else E.hospitalization.dischargeDisposition in "Hospice Disposition"
)
and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }
)</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>End of Life Assessment</td>
<td>19</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "End of Life Assessment":
// 1. Conditions indicating end of life or with limited life expectancy
exists (
"Conditions Indicating End of Life or With Limited Life Expectancy"
)
// 2. Admitted/referred/discharged to hospice care
or exists (
"Admitted/Referred/Discharged to Hospice Care"
)</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>OpioidCDSREC03</td>
<td>Exclusion Criteria</td>
<td>20</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Exclusion Criteria":
Common."End of Life Assessment"</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>OpioidCDSREC03</td>
<td>Is Recommendation Applicable?</td>
<td>21</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>OpioidCDSREC03</td>
<td>Get Detail</td>
<td>22</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Get Detail":
if "Is Recommendation Applicable?"
then 'Recommend prescribing immediate release opioids instead of extended release or long-acting opioids
[For guidance regarding prescribing extended release/ long-acting opioids, see Recommendation 3 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%204).-,Implementation%20Considerations,to%20educate%20their%20patients%20about%20its%20use%20should%20consider%20prescribing%20it.,-Supporting%20Rationale)'
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>OpioidCDSREC03</td>
<td>Get Indicator</td>
<td>23</td>
</tr>
</table>
<pre style="max-width: 990px;"><code class="language-cql">define "Get Indicator":
if "Is Recommendation Applicable?"
then 'warning'
else null</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>82423001</td>
<td>Chronic 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;">Providers should use caution when prescribing extended-release/long-acting (ER/LA) opioids as they carry a higher risk and negligible benefit compared to immediate-release opioids.</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>
<li>
<a href="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"> MME Conversion Tables</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-OpioidCDSREC03.html">Library - Recommendation #3 - Opioid Immediate Release Form When Starting Opioid Therapy</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> Extended-release opioid prescription triggered.:</b> Checking if the trigger prescription meets the inclusion criteria for recommendation #4 workflow.<br/>
<b>When:</b> <i>Named Event:</i> order-sign<br/>
<b>If:</b> <i>Applicability:</i> Check whether the opioid prescription for the existing patient is extended-release without any opioids-with-abuse-potential prescribed in the past 90 days. <i>(Is Recommendation Applicable?)</i><br/>
<b>Then:</b>
<table class="grid-dict">
<tr>
<td>
<b> :</b> Document - Will prescribe immediate release opioid<br/>
<b>Then:</b>
</td>
</tr>
<tr>
<td>
<b> :</b> Snooze* - Benefits outweigh risks, snooze 3 months<br/>
<b>Then:</b>
</td>
</tr>
<tr>
<td>
<b> :</b> Snooze* N/A see comment, snooze 3 months<br/>
<b>Then:</b>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</text>
<contained>
<Library>
<id value="effective-data-requirements"/>
<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="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 Extended release opioid with ambulatory misuse potential"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/extended-release-opioid-with-ambulatory-misuse-potential"/>
</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 Limited life expectancy conditions"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/limited-life-expectancy-conditions"/>
</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 Therapies indicating end of life care"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/therapies-indicating-end-of-life-care"/>
</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>
<relatedArtifact>
<type value="depends-on"/>
<display value="Value set Hospice Procedure Codes"/>
<resource
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-procedure"/>
</relatedArtifact>
<parameter>
<name value="ContextPrescriptions"/>
<use value="in"/>
<min value="0"/>
<max value="*"/>
<type value="MedicationRequest"/>
</parameter>
<parameter>
<name value="Get Summary"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="string"/>
</parameter>
<parameter>
<name value="Is Recommendation Applicable?"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="boolean"/>
</parameter>
<parameter>
<name value="Get Detail"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="string"/>
</parameter>
<parameter>
<name value="Get Indicator"/>
<use value="out"/>
<min value="0"/>
<max value="1"/>
<type value="string"/>
</parameter>
<dataRequirement>
<type value="Medication"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Medication"/>
<mustSupport value="id"/>
<codeFilter>
<path value="id"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="category"/>
<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"/>
<codeFilter>
<path value="category"/>
<valueSet
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="Condition"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Condition"/>
<mustSupport value="category"/>
<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="ServiceRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
</dataRequirement>
<dataRequirement>
<type value="ServiceRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
<mustSupport value="status"/>
<mustSupport value="intent"/>
<mustSupport value="authoredOn"/>
<mustSupport value="code"/>
</dataRequirement>
<dataRequirement>
<type value="Procedure"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Procedure"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
<codeFilter>
<path value="code"/>
<valueSet
value="http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-procedure"/>
</codeFilter>
</dataRequirement>
<dataRequirement>
<type value="ServiceRequest"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
<mustSupport value="code"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
</dataRequirement>
<dataRequirement>
<type value="Encounter"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Encounter"/>
<mustSupport value="period"/>
<mustSupport value="period.start"/>
<mustSupport value="status"/>
<mustSupport value="status.value"/>
</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/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem">
<valueReference>🔗
<reference value="Device/cqf-tooling"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC03"/>
</extension>
<extension url="name">
<valueString value="Get Summary"/>
</extension>
<extension url="statement">
<valueString
value="define "Get Summary":
if "Is Recommendation Applicable?"
then 'When Initiating Opioid Therapy, Utilize Immediate Release Opioids'
else null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="0"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC03"/>
</extension>
<extension url="name">
<valueString
value="Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions"/>
</extension>
<extension url="statement">
<valueString
value="define "Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )
and AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential""/>
</extension>
<extension url="displaySequence">
<valueInteger value="1"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC03"/>
</extension>
<extension url="name">
<valueString
value="Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential"/>
</extension>
<extension url="statement">
<valueString
value="define "Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential":
exists( "Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )"/>
</extension>
<extension url="displaySequence">
<valueInteger value="2"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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/us/cqfmeasures/StructureDefinition/cqfm-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="4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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="5"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Conditions Indicating End Of Life Present"/>
</extension>
<extension url="statement">
<valueString
value="define "Conditions Indicating End Of Life Present":
exists (
Common."US Core-Categorized Conditions" LLEC
where LLEC.code in Common."Limited life expectancy conditions"
and LLEC.clinicalStatus in Common."Active Condition"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="6"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="Service Requests"/>
</extension>
<extension url="statement">
<valueString
value="define "Service Requests":
[ServiceRequest] SR
return SR"/>
</extension>
<extension url="displaySequence">
<valueInteger value="7"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Palliative Care Lookback Period"/>
</extension>
<extension url="statement">
<valueString
value="/*
** Routine #1
** Opioid Review Useful Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** ------------------------------------------------------------------------------------------------------------------------------------
** Age < 18 years? | No | Calculate age from date of birth; exclude | Date of birth
** | | patients with age less than 18 years at the |
** | | time of the prescription |
** ------------------------------------------------------------------------------------------------------------------------------------
** Evidence of | No | Look for documented findings consistent | Sickle cell disease conditions
** sickle cell disease? | | with those listed in the sickle cell |
** | | value set |
** ------------------------------------------------------------------------------------------------------------------------------------
** Limited life | No | Look for documented findings consistent | Limited life expectancy conditions
** expectancy conditions | | with those listed in the limited life |
** present? | | expectancy value set (terminal illness, bad |
** | | prognosis, pre-terminal) |
** ------------------------------------------------------------------------------------------------------------------------------------
** Order for therapies | No | Look for patients with an existing order for | Therapies indicating end of life care
** indicating end of life | | therapies indicating end of life care |
** care in past 90 days? | | written within past 90 days |
** ------------------------------------------------------------------------------------------------------------------------------------
** Active cancer | No | See sub-routine 3 | See sub-routine 3
** treatment? | | |
** ------------------------------------------------------------------------------------------------------------------------------------
** Conditions Likely | No | Look for patients with active conditions in | Conditions likely terminal for opioid
** Terminal for opioid | | the value set end-of-life-conditions | prescribing
** prescribing present? | | |
** ------------------------------------------------------------------------------------------------------------------------------------
**
*/
define "Palliative Care Lookback Period":
Interval[Today() - 90 days, Today()]"/>
</extension>
<extension url="displaySequence">
<valueInteger value="8"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Order For Palliative Care In Past 90 Days"/>
</extension>
<extension url="statement">
<valueString
value="define "Order For Palliative Care In Past 90 Days":
exists (
Common."Service Requests" SR
where SR.status in { 'active', 'completed'}
and SR.intent in {'proposal', 'plan,', 'directive', 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}
and FHIRHelpers.ToDateTime(SR.authoredOn) during day of "Palliative Care Lookback Period"
and SR.code in Common."Therapies indicating end of life care"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="9"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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"
else
false"/>
</extension>
<extension url="displaySequence">
<valueInteger value="10"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString
value="Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present"/>
</extension>
<extension url="statement">
<valueString
value="define "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present":
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="11"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSRoutines"/>
</extension>
<extension url="name">
<valueString value="Is Opioid Review Useful?"/>
</extension>
<extension url="statement">
<valueString
value="define "Is Opioid Review Useful?":
not "Patient Age Less Than 18"
and not "Condition Positive for Sickle Cell"
and not "Conditions Indicating End Of Life Present"
and not "Order For Palliative Care In Past 90 Days"
and not "Is Active Cancer Treatment?"
and not "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present""/>
</extension>
<extension url="displaySequence">
<valueInteger value="12"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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="13"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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="14"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-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="15"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC03"/>
</extension>
<extension url="name">
<valueString value="Inclusion Criteria"/>
</extension>
<extension url="statement">
<valueString
value="define "Inclusion Criteria":
"Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential"
and Routines."Is Opioid Review Useful?"
and Routines."Is Opioid Naive?""/>
</extension>
<extension url="displaySequence">
<valueInteger value="16"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString
value="Conditions Indicating End of Life or With Limited Life Expectancy"/>
</extension>
<extension url="statement">
<valueString
value="define "Conditions Indicating End of Life or With Limited Life Expectancy":
(
"US Core-Categorized Conditions" C
where C.code in "Conditions likely terminal for opioid prescribing"
and C.clinicalStatus in "Active Condition"
)
union
(
"US Core-Categorized Conditions" C
where C.code in "Limited life expectancy conditions"
and C.clinicalStatus in "Active Condition"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="17"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="Admitted/Referred/Discharged to Hospice Care"/>
</extension>
<extension url="statement">
<valueString
value="define "Admitted/Referred/Discharged to Hospice Care":
(
[Procedure: code in "Hospice Procedure Codes"] P
where P.status.value in { 'in-progress', 'completed' }
)
union
(
"Service Requests" SR
where SR.code in "Hospice Procedure Codes"
and SR.status.value in { 'active', 'completed' }
)
union
(
if (Config."Hospice Findings Exclusion Enabled") then
[Observation: code in "Hospice Finding Codes"] O
where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })
else
{}
)
union
(
[Encounter] E
where date from E.period.start 1 year or less on or before Today()
and (
if E.hospitalization.dischargeDisposition.coding is null
or not exists (E.hospitalization.dischargeDisposition.coding)
then false
else E.hospitalization.dischargeDisposition in "Hospice Disposition"
)
and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="18"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSCommon"/>
</extension>
<extension url="name">
<valueString value="End of Life Assessment"/>
</extension>
<extension url="statement">
<valueString
value="define "End of Life Assessment":
// 1. Conditions indicating end of life or with limited life expectancy
exists (
"Conditions Indicating End of Life or With Limited Life Expectancy"
)
// 2. Admitted/referred/discharged to hospice care
or exists (
"Admitted/Referred/Discharged to Hospice Care"
)"/>
</extension>
<extension url="displaySequence">
<valueInteger value="19"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC03"/>
</extension>
<extension url="name">
<valueString value="Exclusion Criteria"/>
</extension>
<extension url="statement">
<valueString
value="define "Exclusion Criteria":
Common."End of Life Assessment""/>
</extension>
<extension url="displaySequence">
<valueInteger value="20"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC03"/>
</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="21"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC03"/>
</extension>
<extension url="name">
<valueString value="Get Detail"/>
</extension>
<extension url="statement">
<valueString
value="define "Get Detail":
if "Is Recommendation Applicable?"
then 'Recommend prescribing immediate release opioids instead of extended release or long-acting opioids
[For guidance regarding prescribing extended release/ long-acting opioids, see Recommendation 3 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=evidence%20type%3A%204).-,Implementation%20Considerations,to%20educate%20their%20patients%20about%20its%20use%20should%20consider%20prescribing%20it.,-Supporting%20Rationale)'
else null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="22"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition">
<extension url="libraryName">
<valueString value="OpioidCDSREC03"/>
</extension>
<extension url="name">
<valueString value="Get Indicator"/>
</extension>
<extension url="statement">
<valueString
value="define "Get Indicator":
if "Is Recommendation Applicable?"
then 'warning'
else null"/>
</extension>
<extension url="displaySequence">
<valueInteger value="23"/>
</extension>
</extension>
<extension
url="http://fhir.org/guides/cdc/opioid-cds/StructureDefinition/effectiveDataRequirements" id="effective-data-requirements">
<valueReference>
<reference value="#effective-data-requirements"/>
</valueReference>
</extension>
<url
value="http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-03"/>
<identifier>
<use value="official"/>
<value value="cdc-opioid-guidance"/>
</identifier>
<version value="2022.1.0"/>
<name value="CDC_opioid_03"/>
<title
value="PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #3"/>
<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="2023-05-01"/>
<publisher value="Centers for Disease Control and Prevention (CDC)"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.cdc.gov"/>
</telecom>
</contact>
<description
value="When starting opioid therapy for subacute or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids."/>
<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>
<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="Providers should use caution when prescribing extended-release/long-acting (ER/LA) opioids as they carry a higher risk and negligible benefit compared to immediate-release opioids."/>
<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>
<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://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC03"/>
<action>
<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="very-low"/>
<display value="Very Low quality"/>
</coding>
</valueCodeableConcept>
</extension>
<title value="Extended-release opioid prescription triggered."/>
<description
value="Checking if the trigger prescription meets the inclusion criteria for recommendation #4 workflow."/>
<trigger>
<type value="named-event"/>
<name value="order-sign"/>
</trigger>
<condition>
<kind value="applicability"/>
<expression>
<description
value="Check whether the opioid prescription for the existing patient is extended-release without any opioids-with-abuse-potential prescribed in the past 90 days."/>
<language value="text/cql.identifier"/>
<expression value="Is Recommendation Applicable?"/>
</expression>
</condition>
<groupingBehavior value="visual-group"/>
<selectionBehavior value="any"/>
<dynamicValue>
<path value="action.title"/>
<expression>
<language value="text/cql.identifier"/>
<expression value="Get Summary"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="action.description"/>
<expression>
<language value="text/cql.identifier"/>
<expression value="Get Detail"/>
</expression>
</dynamicValue>
<dynamicValue>
<path value="activity.extension"/>
<expression>
<language value="text/cql.identifier"/>
<expression value="Get Indicator"/>
</expression>
</dynamicValue>
<action>
<description
value="Document - Will prescribe immediate release opioid"/>
</action>
<action>
<description
value="Snooze* - Benefits outweigh risks, snooze 3 months"/>
</action>
<action>
<description value="Snooze* N/A see comment, snooze 3 months"/>
</action>
</action>
</PlanDefinition>
IG © 2019+ Centers for Disease Control and Prevention (CDC). Package fhir.cdc.opioid-cds-r4#2022.1.0 based on FHIR 4.0.1. Generated 2024-08-29
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