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 |
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix sct: <http://snomed.info/id/> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- a fhir:PlanDefinition ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "opioidcds-09"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition> ] [ fhir:v "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <table class=\"grid dict\">\n \n <tr>\n <th scope=\"row\"><b>Id: </b></th>\n <td style=\"padding-left: 4px;\">opioidcds-09</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Url: </b></th>\n <td style=\"padding-left: 4px;\"><a href=\"PlanDefinition-opioidcds-09.html\">PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #9</a></td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Version: </b></th>\n <td style=\"padding-left: 4px;\">2022.1.0</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Identifier: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>value: </b> <span>cdc-opioid-guidance</span>\n </p>\n \n </td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Name: </b></th>\n <td style=\"padding-left: 4px;\">CDC_opioid_09</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #9</td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Status: </b></th>\n <td style=\"padding-left: 4px;\">draft</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Experimental: </b></th>\n <td style=\"padding-left: 4px;\">true</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Type: </b></th>\n <td style=\"padding-left: 4px;\">\n \n \n \n <p style=\"margin-bottom: 5px;\">\n <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>\n </p>\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>code: </b> <span>eca-rule</span>\n </p>\n \n \n <p style=\"margin-bottom: 5px;\">\n <b>display: </b> <span>ECA Rule</span>\n </p>\n \n \n \n \n </td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Date: </b></th>\n <td style=\"padding-left: 4px;\">2023-05-01</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Publisher: </b></th>\n <td style=\"padding-left: 4px;\">Centers for Disease Control and Prevention (CDC)</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Description: </b></th>\n <td style=\"padding-left: 4px;\">Clinicians should review PDMP data when starting opioid therapy for subacute or chronic pain and periodically during opioid therapy for chronic pain.</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><a name=\"effective-data-requirements\"> </a><b>Logic Definitions: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Get Summary</td>\n \n \n <td>0</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Get Summary":\n if "Is Recommendation Applicable?"\n then 'Notify: PDMP data for this patient has not been reviewed in the past 90 days.'\n else null</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions</td>\n \n \n <td>1</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":\n ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription\n where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential</td>\n \n \n <td>2</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":\n exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Patient Age Less Than 18</td>\n \n \n <td>3</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Patient Age Less Than 18":\n if (Config."Age Less than 18 Years Is Enabled") then\n AgeInYearsAt(Today()) < 18\n else\n false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Condition Positive for Sickle Cell</td>\n \n \n <td>4</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Condition Positive for Sickle Cell":\n if (Config."Sickle Cell Check Enabled") then\n exists(\n Common."Positive Sickle Cell Condition"\n ) else\n false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>US Core-Categorized Conditions</td>\n \n \n <td>5</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// 3. Medications indicating end of life\n /* or exists (\n "Medications Indicating End of Life"\n ) */\ndefine "US Core-Categorized Conditions":\n [Condition: category in "Encounter Diagnosis Condition Category"]\n union [Condition: category in "Problem List Condition Category"]\n union [Condition: category in "US Core Health Concern Condition Category"]</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Conditions Indicating End Of Life Present</td>\n \n \n <td>6</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Conditions Indicating End Of Life Present":\n exists (\n Common."US Core-Categorized Conditions" LLEC\n where LLEC.code in Common."Limited life expectancy conditions"\n and LLEC.clinicalStatus in Common."Active Condition"\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Service Requests</td>\n \n \n <td>7</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Service Requests":\n [ServiceRequest] SR\n return SR</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Palliative Care Lookback Period</td>\n \n \n <td>8</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">/*\n** Routine #1\n** Opioid Review Useful Routine\n**\n** Definition | Answer to Proceed | Details | Data (Terminology) Requirement\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Age < 18 years? | No | Calculate age from date of birth; exclude | Date of birth\n** | | patients with age less than 18 years at the |\n** | | time of the prescription |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Evidence of | No | Look for documented findings consistent | Sickle cell disease conditions\n** sickle cell disease? | | with those listed in the sickle cell |\n** | | value set |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Limited life | No | Look for documented findings consistent | Limited life expectancy conditions\n** expectancy conditions | | with those listed in the limited life |\n** present? | | expectancy value set (terminal illness, bad |\n** | | prognosis, pre-terminal) |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Order for therapies | No | Look for patients with an existing order for | Therapies indicating end of life care\n** indicating end of life | | therapies indicating end of life care |\n** care in past 90 days? | | written within past 90 days |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Active cancer | No | See sub-routine 3 | See sub-routine 3\n** treatment? | | |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Conditions Likely | No | Look for patients with active conditions in | Conditions likely terminal for opioid\n** Terminal for opioid | | the value set end-of-life-conditions | prescribing\n** prescribing present? | | |\n** ------------------------------------------------------------------------------------------------------------------------------------\n**\n*/\ndefine "Palliative Care Lookback Period":\n Interval[Today() - 90 days, Today()]</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Order For Palliative Care In Past 90 Days</td>\n \n \n <td>9</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Order For Palliative Care In Past 90 Days":\n exists (\n Common."Service Requests" SR\n where SR.status in { 'active', 'completed'}\n and SR.intent in {'proposal', 'plan,', 'directive', 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}\n and FHIRHelpers.ToDateTime(SR.authoredOn) during day of "Palliative Care Lookback Period"\n and SR.code in Common."Therapies indicating end of life care"\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Is Active Cancer Treatment?</td>\n \n \n <td>10</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Is Active Cancer Treatment?":\n if (Config."Active Cancer Treatment Encounters Condition Is Enabled") then\n "Has Two or More Encounters with Cancer Diagnosis During Encounter Period"\n else\n false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present</td>\n \n \n <td>11</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present":\n if (Config."End-Stage Disease Criteria Enabled") then\n exists (\n Common."US Core-Categorized Conditions" EOLC\n where EOLC.code in Common."Conditions likely terminal for opioid prescribing"\n and EOLC.clinicalStatus in Common."Active Condition"\n )\n else\n false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Is Opioid Review Useful?</td>\n \n \n <td>12</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Is Opioid Review Useful?":\n not "Patient Age Less Than 18"\n and not "Condition Positive for Sickle Cell"\n and not "Conditions Indicating End Of Life Present"\n and not "Order For Palliative Care In Past 90 Days"\n and not "Is Active Cancer Treatment?"\n and not "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present"</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommonConfig</td>\n \n \n <td>PDMP Data Not Reviewed in Past 90 Days Criteria Enabled</td>\n \n \n <td>13</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// Recommendation 9\ndefine "PDMP Data Not Reviewed in Past 90 Days Criteria Enabled":\n true</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Look Back 90 Days</td>\n \n \n <td>14</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Look Back 90 Days":\n Interval[Today() - 90 days, Today()]</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>PDMP Data Not Reviewed in Past 90 Days</td>\n \n \n <td>15</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "PDMP Data Not Reviewed in Past 90 Days":\n Config."PDMP Data Not Reviewed in Past 90 Days Criteria Enabled"\n and not (\n exists (\n [Procedure: Common."PDMP review procedure"] P\n where P.status ~ 'completed'\n and P.performed during "Look Back 90 Days"\n )\n or exists (\n [Observation: Common."PDMP data reviewed finding"] O\n where O.status in { 'final', 'amended' }\n and (\n if O.effective is FHIR.Period\n then (O.effective as FHIR.Period) during day of "Look Back 90 Days"\n else if O.effective is FHIR.dateTime\n then date from O.effective in day of "Look Back 90 Days"\n else false\n )\n )\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Inclusion Criteria</td>\n \n \n <td>16</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Inclusion Criteria":\n "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"\n and Routines."Is Opioid Review Useful?"\n and "PDMP Data Not Reviewed in Past 90 Days"</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Exclusion Criteria</td>\n \n \n <td>17</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Exclusion Criteria":\n false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Is Recommendation Applicable?</td>\n \n \n <td>18</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Is Recommendation Applicable?":\n "Inclusion Criteria"\n and not "Exclusion Criteria"</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Get Detail</td>\n \n \n <td>19</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Get Detail":\n if "Is Recommendation Applicable?"\n then 'Review PDMP data for this patient before completing an opioid order\n\n[Recommendation 9 of the 2022 CDC Clinical Practice Guideline provides guidance about utilizing PDMP information to improve patient safety](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20take,see%20Recommendation%2010).)\n\n[CDC advises not to dismiss patients from your practice on the basis of PDMP information](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20not%20dismiss,Recommendations%208%20and%2012%5D).)'\n else null</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Get Indicator</td>\n \n \n <td>20</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Get Indicator":\n if "Is Recommendation Applicable?"\n then 'warning'\n else null</code></pre>\n \n <br/><br/>\n \n </td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Knowledge Capability: </b></th>\n <td style=\"padding-left: 4px;\">\n shareable computable executable publishable \n </td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Use Context: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr><th><b>code</b></th><th><b>value</b></th><th><b>display</b></th></tr>\n \n <tr>\n <td>focus</td>\n <td>182888003</td>\n <td>Medication requested (situation)</td>\n </tr>\n \n <tr>\n <td>focus</td>\n <td>82423001</td>\n <td>Chronic pain (finding)</td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Purpose: </b></th>\n <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>\n</div></td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Usage: </b></th>\n <td style=\"padding-left: 4px;\">Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically during opioid therapy for chronic pain.</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Copyright: </b></th>\n <td style=\"padding-left: 4px;\"><div><p>© CDC 2016+.</p>\n</div></td>\n </tr>\n \n \n \n \n \n \n <tr>\n <th scope=\"row\"><b>Related Artifacts: </b></th>\n <td style=\"padding-left: 4px;\">\n \n <p><b>Documentation</b></p>\n <ul>\n \n <li>\n <a href=\"https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm\"> 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain</a>\n </li>\n \n </ul>\n \n \n \n \n \n \n \n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Libraries: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr><td><a href=\"Library-OpioidCDSREC09.html\">Library - Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions</a></td></tr>\n \n </table>\n </td>\n </tr>\n \n\n \n <tr>\n <th scope=\"row\"><b>Actions: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n \n <tr>\n <td>\n <b> Current Order is for Opioid With Ambulatory Misuse Potential.:</b> Checking if the trigger prescription meets the inclusion criteria for recommendation #9 workflow.<br/>\n <b>When:</b> <i>Named Event:</i> order-sign<br/>\n <b>If:</b> <i>Applicability:</i> Check whether the current Order is for Opioid With Ambulatory Misuse Potential. <i>(Is Recommendation Applicable?)</i><br/>\n <b>Then:</b>\n \n <table class=\"grid-dict\">\n \n <tr>\n <td>\n <b> :</b> Access Data - Launch app to review PDMP data<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> Document - PDMP data reviewed, snooze 3 months<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> Snooze* - N/A see comment, snooze 3 months<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n </table>\n \n </td>\n </tr>\n \n </table>\n </td>\n </tr>\n \n </table>\n</div>" ] ; # fhir:contained ( [ a fhir:Library ; fhir:id [ fhir:v "effective-data-requirements" ] ; fhir:status [ fhir:v "active" ] ; fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/library-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "module-definition" ] ] ) ] ; ( fhir:relatedArtifact [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Library Common" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommon|2022.1.0"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommon|2022.1.0> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Library FHIRHelpers" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Library Routines" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines|2022.1.0"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines|2022.1.0> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Library Config" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommonConfig|2022.1.0"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommonConfig|2022.1.0> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Value set Opioid analgesics with ambulatory misuse potential" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Value set Community" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Value set Encounter Diagnosis Condition Category" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Value set Problem List Condition Category" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Value set US Core Health Concern Condition Category" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Value set Limited life expectancy conditions" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/limited-life-expectancy-conditions"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/limited-life-expectancy-conditions> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Value set Active Condition" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-clinical-status-active"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-clinical-status-active> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Value set Therapies indicating end of life care" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/therapies-indicating-end-of-life-care"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/therapies-indicating-end-of-life-care> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Value set PDMP review procedure" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-review-procedure"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-review-procedure> ] ] [ fhir:type [ fhir:v "depends-on" ] ; fhir:display [ fhir:v "Value set PDMP data reviewed finding" ] ; fhir:resource [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-data-reviewed-finding"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-data-reviewed-finding> ] ] ) ; ( fhir:parameter [ fhir:name [ fhir:v "ContextPrescriptions" ] ; fhir:use [ fhir:v "in" ] ; fhir:min [ fhir:v "0"^^xsd:integer ] ; fhir:max [ fhir:v "*" ] ; fhir:type [ fhir:v "MedicationRequest" ] ] [ fhir:name [ fhir:v "Get Summary" ] ; fhir:use [ fhir:v "out" ] ; fhir:min [ fhir:v "0"^^xsd:integer ] ; fhir:max [ fhir:v "1" ] ; fhir:type [ fhir:v "string" ] ] [ fhir:name [ fhir:v "Is Recommendation Applicable?" ] ; fhir:use [ fhir:v "out" ] ; fhir:min [ fhir:v "0"^^xsd:integer ] ; fhir:max [ fhir:v "1" ] ; fhir:type [ fhir:v "boolean" ] ] [ fhir:name [ fhir:v "Get Detail" ] ; fhir:use [ fhir:v "out" ] ; fhir:min [ fhir:v "0"^^xsd:integer ] ; fhir:max [ fhir:v "1" ] ; fhir:type [ fhir:v "string" ] ] [ fhir:name [ fhir:v "Get Indicator" ] ; fhir:use [ fhir:v "out" ] ; fhir:min [ fhir:v "0"^^xsd:integer ] ; fhir:max [ fhir:v "1" ] ; fhir:type [ fhir:v "string" ] ] ) ; ( fhir:dataRequirement [ fhir:type [ fhir:v "Medication" ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/StructureDefinition/Medication"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/StructureDefinition/Medication> ] ) ; ( fhir:mustSupport [ fhir:v "id" ] ) ; ( fhir:codeFilter [ fhir:path [ fhir:v "id" ] ] ) ] [ fhir:type [ fhir:v "Condition" ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/StructureDefinition/Condition"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/StructureDefinition/Condition> ] ) ; ( fhir:mustSupport [ fhir:v "category" ] ) ; ( fhir:codeFilter [ fhir:path [ fhir:v "category" ] ; fhir:valueSet [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category> ] ] ) ] [ fhir:type [ fhir:v "Condition" ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/StructureDefinition/Condition"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/StructureDefinition/Condition> ] ) ; ( fhir:mustSupport [ fhir:v "category" ] ) ; ( fhir:codeFilter [ fhir:path [ fhir:v "category" ] ; fhir:valueSet [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category> ] ] ) ] [ fhir:type [ fhir:v "Condition" ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/StructureDefinition/Condition"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/StructureDefinition/Condition> ] ) ; ( fhir:mustSupport [ fhir:v "category" ] ) ; ( fhir:codeFilter [ fhir:path [ fhir:v "category" ] ; fhir:valueSet [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category> ] ] ) ] [ fhir:type [ fhir:v "ServiceRequest" ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/StructureDefinition/ServiceRequest"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/StructureDefinition/ServiceRequest> ] ) ] [ fhir:type [ fhir:v "ServiceRequest" ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/StructureDefinition/ServiceRequest"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/StructureDefinition/ServiceRequest> ] ) ; ( fhir:mustSupport [ fhir:v "status" ] [ fhir:v "intent" ] [ fhir:v "authoredOn" ] [ fhir:v "code" ] ) ] [ fhir:type [ fhir:v "Procedure" ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/StructureDefinition/Procedure"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/StructureDefinition/Procedure> ] ) ; ( fhir:mustSupport [ fhir:v "code" ] [ fhir:v "status" ] [ fhir:v "performed" ] ) ; ( fhir:codeFilter [ fhir:path [ fhir:v "code" ] ; fhir:valueSet [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-review-procedure"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-review-procedure> ] ] ) ] [ fhir:type [ fhir:v "Observation" ] ; ( fhir:profile [ fhir:v "http://hl7.org/fhir/StructureDefinition/Observation"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/StructureDefinition/Observation> ] ) ; ( fhir:mustSupport [ fhir:v "code" ] [ fhir:v "status" ] ) ; ( fhir:codeFilter [ fhir:path [ fhir:v "code" ] ; fhir:valueSet [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-data-reviewed-finding"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-data-reviewed-finding> ] ] ) ] ) ] ) ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability"^^xsd:anyURI ] ; fhir:value [ fhir:v "shareable" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability"^^xsd:anyURI ] ; fhir:value [ fhir:v "computable" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability"^^xsd:anyURI ] ; fhir:value [ fhir:v "executable" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability"^^xsd:anyURI ] ; fhir:value [ fhir:v "publishable" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem"^^xsd:anyURI ] ; fhir:value [ a fhir:Reference ; fhir:reference [ fhir:v "Device/cqf-tooling" ] ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSREC09" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Get Summary" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Get Summary\":\n if \"Is Recommendation Applicable?\"\n then 'Notify: PDMP data for this patient has not been reviewed in the past 90 days.'\n else null" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "0"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSREC09" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\":\n ( Common.\"Is Opioid Analgesic with Ambulatory Misuse Potential?\"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription\n where Routines.\"Is Subacute or Chronic Pain Prescription?\"( AmbulatoryOpioidPrescription )" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "1"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSREC09" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential\":\n exists( \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" )" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "2"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSRoutines" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Patient Age Less Than 18" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Patient Age Less Than 18\":\n if (Config.\"Age Less than 18 Years Is Enabled\") then\n AgeInYearsAt(Today()) < 18\n else\n false" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "3"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSRoutines" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Condition Positive for Sickle Cell" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Condition Positive for Sickle Cell\":\n if (Config.\"Sickle Cell Check Enabled\") then\n exists(\n Common.\"Positive Sickle Cell Condition\"\n ) else\n false" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "4"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSCommon" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "US Core-Categorized Conditions" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "// 3. Medications indicating end of life\n /* or exists (\n \"Medications Indicating End of Life\"\n ) */\ndefine \"US Core-Categorized Conditions\":\n [Condition: category in \"Encounter Diagnosis Condition Category\"]\n union [Condition: category in \"Problem List Condition Category\"]\n union [Condition: category in \"US Core Health Concern Condition Category\"]" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "5"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSRoutines" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Conditions Indicating End Of Life Present" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Conditions Indicating End Of Life Present\":\n exists (\n Common.\"US Core-Categorized Conditions\" LLEC\n where LLEC.code in Common.\"Limited life expectancy conditions\"\n and LLEC.clinicalStatus in Common.\"Active Condition\"\n )" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "6"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSCommon" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Service Requests" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Service Requests\":\n [ServiceRequest] SR\n return SR" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "7"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSRoutines" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Palliative Care Lookback Period" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "/*\n** Routine #1\n** Opioid Review Useful Routine\n**\n** Definition | Answer to Proceed | Details | Data (Terminology) Requirement\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Age < 18 years? | No | Calculate age from date of birth; exclude | Date of birth\n** | | patients with age less than 18 years at the |\n** | | time of the prescription |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Evidence of | No | Look for documented findings consistent | Sickle cell disease conditions\n** sickle cell disease? | | with those listed in the sickle cell |\n** | | value set |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Limited life | No | Look for documented findings consistent | Limited life expectancy conditions\n** expectancy conditions | | with those listed in the limited life |\n** present? | | expectancy value set (terminal illness, bad |\n** | | prognosis, pre-terminal) |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Order for therapies | No | Look for patients with an existing order for | Therapies indicating end of life care\n** indicating end of life | | therapies indicating end of life care |\n** care in past 90 days? | | written within past 90 days |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Active cancer | No | See sub-routine 3 | See sub-routine 3\n** treatment? | | |\n** ------------------------------------------------------------------------------------------------------------------------------------\n** Conditions Likely | No | Look for patients with active conditions in | Conditions likely terminal for opioid\n** Terminal for opioid | | the value set end-of-life-conditions | prescribing\n** prescribing present? | | |\n** ------------------------------------------------------------------------------------------------------------------------------------\n**\n*/\ndefine \"Palliative Care Lookback Period\":\n Interval[Today() - 90 days, Today()]" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "8"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSRoutines" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Order For Palliative Care In Past 90 Days" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Order For Palliative Care In Past 90 Days\":\n exists (\n Common.\"Service Requests\" SR\n where SR.status in { 'active', 'completed'}\n and SR.intent in {'proposal', 'plan,', 'directive', 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}\n and FHIRHelpers.ToDateTime(SR.authoredOn) during day of \"Palliative Care Lookback Period\"\n and SR.code in Common.\"Therapies indicating end of life care\"\n )" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "9"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSRoutines" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Is Active Cancer Treatment?" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Is Active Cancer Treatment?\":\n if (Config.\"Active Cancer Treatment Encounters Condition Is Enabled\") then\n \"Has Two or More Encounters with Cancer Diagnosis During Encounter Period\"\n else\n false" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "10"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSRoutines" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present\":\n if (Config.\"End-Stage Disease Criteria Enabled\") then\n exists (\n Common.\"US Core-Categorized Conditions\" EOLC\n where EOLC.code in Common.\"Conditions likely terminal for opioid prescribing\"\n and EOLC.clinicalStatus in Common.\"Active Condition\"\n )\n else\n false" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "11"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSRoutines" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Is Opioid Review Useful?" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Is Opioid Review Useful?\":\n not \"Patient Age Less Than 18\"\n and not \"Condition Positive for Sickle Cell\"\n and not \"Conditions Indicating End Of Life Present\"\n and not \"Order For Palliative Care In Past 90 Days\"\n and not \"Is Active Cancer Treatment?\"\n and not \"Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present\"" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "12"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSCommonConfig" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "PDMP Data Not Reviewed in Past 90 Days Criteria Enabled" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "// Recommendation 9\ndefine \"PDMP Data Not Reviewed in Past 90 Days Criteria Enabled\":\n true" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "13"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSREC09" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Look Back 90 Days" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Look Back 90 Days\":\n Interval[Today() - 90 days, Today()]" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "14"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSREC09" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "PDMP Data Not Reviewed in Past 90 Days" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"PDMP Data Not Reviewed in Past 90 Days\":\n Config.\"PDMP Data Not Reviewed in Past 90 Days Criteria Enabled\"\n and not (\n exists (\n [Procedure: Common.\"PDMP review procedure\"] P\n where P.status ~ 'completed'\n and P.performed during \"Look Back 90 Days\"\n )\n or exists (\n [Observation: Common.\"PDMP data reviewed finding\"] O\n where O.status in { 'final', 'amended' }\n and (\n if O.effective is FHIR.Period\n then (O.effective as FHIR.Period) during day of \"Look Back 90 Days\"\n else if O.effective is FHIR.dateTime\n then date from O.effective in day of \"Look Back 90 Days\"\n else false\n )\n )\n )" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "15"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSREC09" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Inclusion Criteria" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Inclusion Criteria\":\n \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential\"\n and Routines.\"Is Opioid Review Useful?\"\n and \"PDMP Data Not Reviewed in Past 90 Days\"" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "16"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSREC09" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Exclusion Criteria" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Exclusion Criteria\":\n false" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "17"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSREC09" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Is Recommendation Applicable?" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Is Recommendation Applicable?\":\n \"Inclusion Criteria\"\n and not \"Exclusion Criteria\"" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "18"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSREC09" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Get Detail" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Get Detail\":\n if \"Is Recommendation Applicable?\"\n then 'Review PDMP data for this patient before completing an opioid order\n\n[Recommendation 9 of the 2022 CDC Clinical Practice Guideline provides guidance about utilizing PDMP information to improve patient safety](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20take,see%20Recommendation%2010).)\n\n[CDC advises not to dismiss patients from your practice on the basis of PDMP information](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20not%20dismiss,Recommendations%208%20and%2012%5D).)'\n else null" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "19"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "libraryName"^^xsd:anyURI ] ; fhir:value [ fhir:v "OpioidCDSREC09" ] ] [ fhir:url [ fhir:v "name"^^xsd:anyURI ] ; fhir:value [ fhir:v "Get Indicator" ] ] [ fhir:url [ fhir:v "statement"^^xsd:anyURI ] ; fhir:value [ fhir:v "define \"Get Indicator\":\n if \"Is Recommendation Applicable?\"\n then 'warning'\n else null" ] ] [ fhir:url [ fhir:v "displaySequence"^^xsd:anyURI ] ; fhir:value [ fhir:v "20"^^xsd:integer ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"^^xsd:anyURI ] ] [ fhir:id [ fhir:v "effective-data-requirements" ] ; fhir:url [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/StructureDefinition/effectiveDataRequirements"^^xsd:anyURI ] ; fhir:value [ a fhir:Reference ; fhir:reference [ fhir:v "#effective-data-requirements" ] ] ] ) ; # fhir:url [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-09"^^xsd:anyURI] ; # fhir:identifier ( [ fhir:use [ fhir:v "official" ] ; fhir:value [ fhir:v "cdc-opioid-guidance" ] ] ) ; # fhir:version [ fhir:v "2022.1.0"] ; # fhir:name [ fhir:v "CDC_opioid_09"] ; # fhir:title [ fhir:v "PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #9"] ; # fhir:type [ ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/plan-definition-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "eca-rule" ] ; fhir:display [ fhir:v "ECA Rule" ] ] ) ] ; # fhir:status [ fhir:v "draft"] ; # fhir:experimental [ fhir:v "true"^^xsd:boolean] ; # fhir:date [ fhir:v "2023-05-01"^^xsd:date] ; # fhir:publisher [ fhir:v "Centers for Disease Control and Prevention (CDC)"] ; # fhir:contact ( [ ( fhir:telecom [ fhir:system [ fhir:v "url" ] ; fhir:value [ fhir:v "https://www.cdc.gov" ] ] ) ] ) ; # fhir:description [ fhir:v "Clinicians should review PDMP data when starting opioid therapy for subacute or chronic pain and periodically during opioid therapy for chronic pain."] ; # fhir:useContext ( [ fhir:code [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/usage-context-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "focus" ] ; fhir:display [ fhir:v "Clinical Focus" ] ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ a sct:182888003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "182888003" ] ; fhir:display [ fhir:v "Medication requested (situation)" ] ] ) ] ] [ fhir:code [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/usage-context-type"^^xsd:anyURI ] ; fhir:code [ fhir:v "focus" ] ; fhir:display [ fhir:v "Clinical Focus" ] ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ a sct:82423001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ; fhir:code [ fhir:v "82423001" ] ; fhir:display [ fhir:v "Chronic pain (finding)" ] ] ) ] ] ) ; # fhir:purpose [ fhir:v "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."] ; # fhir:usage [ fhir:v "Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically during opioid therapy for chronic pain."] ; # fhir:copyright [ fhir:v "© CDC 2016+."] ; # fhir:topic ( [ fhir:text [ fhir:v "Opioid Prescribing" ] ] ) ; # fhir:author ( [ fhir:name [ fhir:v "Kensaku Kawamoto, MD, PhD, MHS" ] ] [ fhir:name [ fhir:v "Bryn Rhodes" ] ] [ fhir:name [ fhir:v "Floyd Eisenberg, MD, MPH" ] ] [ fhir:name [ fhir:v "Robert McClure, MD, MPH" ] ] ) ; # fhir:relatedArtifact ( [ fhir:type [ fhir:v "documentation" ] ; fhir:display [ fhir:v "2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain" ] ; fhir:url [ fhir:v "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm"^^xsd:anyURI ] ; fhir:document [ fhir:url [ fhir:v "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm"^^xsd:anyURI ] ] ] ) ; # fhir:library ( [ fhir:v "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC09"^^xsd:anyURI ; fhir:link <http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC09> ] ) ; # fhir:action ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/recommendation-strength"^^xsd:anyURI ] ; fhir:code [ fhir:v "weak" ] ; fhir:display [ fhir:v "Weak" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/evidence-quality"^^xsd:anyURI ] ; fhir:code [ fhir:v "very-low" ] ; fhir:display [ fhir:v "Very low quality" ] ] ) ] ] ) ; fhir:title [ fhir:v "Current Order is for Opioid With Ambulatory Misuse Potential." ] ; fhir:description [ fhir:v "Checking if the trigger prescription meets the inclusion criteria for recommendation #9 workflow." ] ; ( fhir:trigger [ fhir:type [ fhir:v "named-event" ] ; fhir:name [ fhir:v "order-sign" ] ] ) ; ( fhir:condition [ fhir:kind [ fhir:v "applicability" ] ; fhir:expression [ fhir:description [ fhir:v "Check whether the current Order is for Opioid With Ambulatory Misuse Potential." ] ; fhir:language [ fhir:v "text/cql.identifier" ] ; fhir:expression [ fhir:v "Is Recommendation Applicable?" ] ] ] ) ; fhir:groupingBehavior [ fhir:v "visual-group" ] ; fhir:selectionBehavior [ fhir:v "any" ] ; ( fhir:dynamicValue [ fhir:path [ fhir:v "action.title" ] ; fhir:expression [ fhir:language [ fhir:v "text/cql.identifier" ] ; fhir:expression [ fhir:v "Get Summary" ] ] ] [ fhir:path [ fhir:v "action.description" ] ; fhir:expression [ fhir:language [ fhir:v "text/cql.identifier" ] ; fhir:expression [ fhir:v "Get Detail" ] ] ] [ fhir:path [ fhir:v "activity.extension" ] ; fhir:expression [ fhir:language [ fhir:v "text/cql.identifier" ] ; fhir:expression [ fhir:v "Get Indicator" ] ] ] ) ; ( fhir:action [ fhir:description [ fhir:v "Access Data - Launch app to review PDMP data" ] ] [ fhir:description [ fhir:v "Document - PDMP data reviewed, snooze 3 months" ] ] [ fhir:description [ fhir:v "Snooze* - N/A see comment, snooze 3 months" ] ] ) ] ) . #
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
Links: Table of Contents |
QA Report
| New Issue | Issues
| Version History 
|