Opioid Prescribing Support Implementation Guide
2016.4.0 - CI Build
Opioid Prescribing Support 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 2016.4.0 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
Contents:
This page provides a list of the FHIR artifacts defined as part of this implementation guide.
HelloWorld |
HelloWorld Library |
HelloWorldPatientView |
HelloWorldPatientView Library |
CDCMMEClinicalConversionFactors |
CDCMMEClinicalConversionFactors Library |
OpioidCDSRoutines |
Common Routines Library |
OpioidCDSCommon |
Common Logic Library |
OpioidCDSCommonConfig |
Common Configuration Library |
OpioidLogicMK2020 |
OMTK Logic MK (2020) Library |
OpioidData2020 |
OMTK Data (2020) Library |
OpioidLogicMK2019 |
OMTK Logic MK (2019) Library |
OpioidData2019 |
OMTK Data (2019) Library |
FHIRHelpers |
FHIR Helpers Library |
FHIRModelInfo |
FHIR ModelInfo Library |
OpioidCDSREC10CommonLibrary |
Common Logic Library for Recommendation #10 - Urine Drug Testing |
OpioidCDSREC01Library |
Logic Library for Recommendation #1 (order-select) - Nonpharmacologic and Nonopioid Pharmacologic Therapy Consideration |
OpioidCDSREC01Library |
Logic Library for Recommendation #2 (order-select) - Opioid Therapy Goals Discussion |
OpioidCDSREC03Library |
Logic Library for Recommendation #3 (order-select) - Opioid Therapy Risk/Benefit Discussion |
OpioidCDSREC04Library |
Logic Library for Recommendation #4 (order-select) - Opioid Immediate Release Form When Starting Opioid Therapy |
OpioidCDSREC04PatientViewLibrary |
Logic Library for Recommendation #4 (patient-view) - Opioid Immediate Release Form When Starting Opioid Therapy |
OpioidCDSREC05Library |
Logic Library for Recommendation #5 (order-select) - Lowest Effective Dose |
OpioidCDSREC06Library |
Logic Library for Recommendation #6 (order-select) - Prescribe Lowest Effective Dose and Duration |
OpioidCDSREC07Library |
Logic Library for Recommendation #7 (order-select) - Opioid Therapy Risk Assessment |
OpioidCDSREC08Library |
Logic Library for Recommendation #8 (order-select) - Naloxone Consideration |
OpioidCDSREC09Library |
Logic Library for Recommendation #9 (order-select) - Consider Patient’s History of Controlled Substance Prescriptions |
OpioidCDSREC10Library |
Logic Library for Recommendation #10 (order-select) - Urine Drug Testing |
OpioidCDSREC10PatientViewLibrary |
Logic Library for Recommendation #10 (patient-view) - Urine Drug Testing |
OpioidCDSREC11Library |
Logic Library for Recommendation #11 (order-select) - Concurrent Use of Opioids and Benzodiazepines |
OpioidCDSREC11PatientViewLibrary |
Logic Library for Recommendation #11 (patient-view) - Concurrent Use of Opioids and Benzodiazepines |
OpioidCDSREC12PatientViewLibrary |
Logic Library for Recommendation #12 (patient-view) - Evidence-based Treatment for Patients with Opioid Use Disorder |
OpioidRiskAssessmentActivityDefinition |
An ActivityDefinition for recommendation of risk assessment |
OpioidUrineScreeningActivityDefinition |
An ActivityDefinition for recommendation of urine screening |
These define workflows, rules, strategies, or protocols as part of content in this implementation guide.
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #1 |
Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #10 |
When prescribing opioids for chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #10 (order-sign) |
When prescribing opioids for chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #10 (patient-view) |
When prescribing opioids for chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #11 |
Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #11 (patient-view) |
Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #12 (patient-view) |
Arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #2 |
Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #3 |
Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #4 |
When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #4 (patient view) |
When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #5 |
When opioids are started, providers should prescribe the lowest effective dosage. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #6 |
When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #7 |
Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #8 |
Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #8 (order-sign) |
Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present. |
PlanDefinition - CDC 2016 Opioid Prescribing Guideline Recommendation #9 |
Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically during opioid therapy for chronic pain. |
These define logic, asset collections and other libraries as part of content in this implementation guide.
Morphine Milligram Equivalent (MME) Calculator for FHIR R4 |
This library contains logic to surface the MME calculation functionality provided by the OMTKLogic library by extracting appropriate information from FHIR R4 MedicationRequest resource. |
Morphine Milligram Equivalent (MME) Conversion Factors for FHIR R4 |
This library contains logic to expose configurable conversion factors for the MME calculation functionality provided by the OMTKLogic library. |
Opioid Management Terminology Knowledge Data |
This library contains drug ingredient data for opioid ingredients of combinations drugs as determined using the RxNav API. The content was produced using the process described here. |
Opioid Management Terminology Knowledge Logic |
This library provides functionality for calculating Morphine Milligram Equivalents (MME) for opioid medications, as described in the CDC 2016 Opioid Prescribing Guideline. |
These define constraints on FHIR resources for systems conforming to this implementation guide.
CDC-ValueSet |
Profile of ValueSet for use with CDC 2016 Opioid Prescribing Guideline |
CDC_CarePlan |
Profile of CarePlan for use with CDC 2016 Opioid Prescribing Guideline |
CDC_MedicationRequest |
Profile of MedicationRequest for use with CDC 2016 Opioid Prescribing Guideline |
CDC_Observation |
Profile of Observation for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors. |
CDC_RequestGroup |
Profile of RequestGroup for use with CDC 2016 Opioid Prescribing Guideline |
These define constraints on FHIR data types for systems conforming to this implementation guide.
Action_indicator |
Indicator value for CDS Hooks responses. |
CDC 2016 Opioid Guidance Clinical Focus Extension |
Describes the clinical focus for the ValueSet. |
CDC 2016 Opioid Guidance Data Element Extension |
Describes the data element scope for the ValueSet. |
CDC 2016 Opioid Guidance Inclusion Criteria Extension |
Describes the clinical focus for the ValueSet. |
CDC 2016 Opioid Guidance exclusion Criteria Extension |
Describes the clinical focus for the ValueSet. |
DataDateRollerExtension |
Declares the DateLastUpdated and Frequency arguments to be used by the Data Date Roller for maintaining/rolling test data dates to keep them from going stale. |
OpioidCDSIndicator |
Used for construction of CDS Hooks response cards. Indicates urgency/importance of what the RequestGroup action conveys. |
These define sets of codes used by systems conforming to this implementation guide.
Buprenorphine and Methadone medications |
All Buprenorphine and Methadone medications |
CDC malignant cancer conditions |
All neoplastic and malignant conditions, including pain due to neoplasm. |
Cocaine urine drug screening tests |
Urine tests for cocaine and cocaine metabolites |
Conditions documenting substance misuse |
Any finding or condition that indicate problematic misuse of a substance other than tobacco or laxatives, including “history of” conditions. |
Conditions likely terminal for opioid prescribing |
Conditions that generally are thought to have terminal prognosis |
Extended release opioid with ambulatory misuse potential |
All opioid clinical drugs except those restricted to surgical use only, and that are in an extended release dose form code |
Fentanyl-type medications |
Fenatnyl and similar medications (sufentanil, alfentanil, remifentanil ) |
Fentanyl-type urine drug screening tests |
Urine tests for fentanyl-type drugs and metabolites |
General opiate urine drug screening tests |
Presumed general urine tests for naturally occuring opioids (i.e. opiates) that are not specific to a particular substance based upon the inclusion of the word ‘opiates’ in the long name. |
Hospice Finding |
Finding codes for receiving hospice care |
Hospice Procedure |
Procedure codes for referral, admission, or transfer to a hospice |
Limited life expectancy conditions |
A finding that documents a terminal prognosis |
Non-opioid drug urine screening |
Individual tests and panels of tests of urine for illicit drugs EXCEPT those for opioids. |
Non-synthetic opioid medications |
Medications derived from the opium plant that are not synthetically created . All metabolize to morphine. |
Oncology specialty designations (NUCC) |
NUCC oncology provider types who may provide encounters to patients with cancer |
Opiate specific urine drug screening tests |
Urine tests for naturally occuring opioids (i.e. opiates) that are specific to a particular natually occurring opioid and therefore do not have the general word ‘opiates’ in the long name. |
Opioid analgesics with ambulatory misuse potential |
All opioid clinical drugs except cough medications, antisapasmodics, or those restricted to surgical use only as identified by those using an injectable form. |
Opioid counseling procedure |
Procedure for couseling on opioid use |
Opioid drug urine screening |
Individual tests and panels of tests of urine for opioids |
Opioid misuse assessment procedure |
Procedure to assess the risk of opioid abuse occurring by a patient |
Opioid misuse disorders |
Conditions indicating opioid misuse |
PDMP data reviewed finding |
Finding indicating that the Prescription Drug Monitoring Program (PDMP) data was reviewed |
PDMP review procedure |
Procedure for Prescription Drug Monitoring Program (PDMP) review |
Pain management procedure |
Procedure for chronic pain control management |
Pain treatment plan |
A Pain medicine Plan of care note |
Phencyclidine urine drug screening tests |
Urine tests for phencyclidine |
Substance misuse behavioral counseling |
Counseling and associated procedures for substance misuse |
Synthetic opioid urine drug screening tests |
Urine tests for synthetic and semi-synthetic (non-opiate) substances |
Therapies indicating end of life care |
Therapeutic activities indicating end of life. Include procedures or therapies specific to a terminal patient, exclude procedures or therapies performed on a deceased patient |
Urine drug screening tests |
Individual tests and panels of tests of urine for drugs of misuse |
ValueSet - Condition Clinical Status Active |
The subject is currently experiencing the condition or situation, there is evidence of the condition or situation, or considered to be a significant risk. |
ValueSet - Encounter Diagnosis Condition Categories |
Encounter Diagnosis condition category. |
ValueSet - Hospice Disposition |
This value set contains concepts that represent patients receiving hospice care outside of a hospital or long term care facility. |
ValueSet - Medication Request Category Community |
Includes requests for medications to be administered or consumed by the patient in their home (this would include long term care or nursing homes, hospices, etc.). |
ValueSet - Medication Request Status Active |
The prescription is ‘actionable’, but not all actions that are implied by it have occurred yet. |
ValueSet - Observation Category Laboratory |
Laboratory Observation Category |
ValueSet - Observation Category Procedure |
Procedure Observation Category |
ValueSet - Office Visit |
Codes specifying outpatient encounters |
ValueSet - Opioid Indicator |
Identifies the level of importance to be assigned to actioning the request |
ValueSet - Problem List Condition Category |
Problem list condition category. |
ValueSet - US Core Health Concern Condition Category |
US Core Health Concern Condition Category. |
benzodiazepine medications |
All benzodiazepine clinical drugs |
naloxone medications |
All naloxone medications |
These define new code systems used by systems conforming to this implementation guide.
CodeSystem - CDC 2016 Opioid Indicator |
Indicates the urgency/importance of what this RequestGroup action conveys |
These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.
Ambulatory Opioid MedicationDispense |
Ambulatory Opioid MedicationDispense Example |
Ambulatory Opioid MedicationRequest |
Ambulatory Opioid MedicationRequest Example |
Cancer Diagnosis Condition |
Cancer Diagnosis Condition Example |
Cancer Diagnosis Encounter |
Cancer Diagnosis Encounter Example |
End of Life Condition |
End of Life Condition Example |
Oncology Participant Encounter |
Oncology Participant Encounter Example |
Oncology Specialist PractitionerRole |
Oncology Specialist PractitionerRole Example |
OpioidCDS CarePlan |
CarePlan Example |
OpioidCDS MedicationRequest |
MedicationRequest Example |
OpioidCDS Observation |
Observation Example |
OpioidCDS Patient |
Patient Example |
OpioidCDS RequestGroup |
RequestGroup Example |
Palliative Care ServiceRequest |
Palliative Care ServiceRequest Example |
Recommendation 10 Patient View Context Encounter Example |
Recommendation 10 Patient View Context Example for quick start documentation |
Recommendation 10 Patient View Context MedicationRequest Example |
Recommendation 10 Patient View Context Example for quick start documentation |
Recommendation 10 Patient View Prefetch Encounter Example |
Recommendation 10 Patient View Prefetch Example for quick start documentation |
Recommendation 10 Patient View Prefetch MedicationRequest Example |
Recommendation 10 Patient View Prefetch Example for quick start documentation |
Recommendation 10 Patient View Prefetch Patient Example |
Recommendation 10 Patient View Prefetch Example for quick start documentation |
Terminal Condition |
Terminal Condition Example |
These are resources that are used within this implementation guide that do not fit into one of the other categories.
CQFToolingDevice |
A Device that represents a CQF Tooling version. |