The following table describes the flowchart decisions and sub-routines for the recommendation

Definition	Answer to Proceed	Details	Data (Terminology) Requirement	Profile	Path
Order for opioid analgesics with with ambulatory misuse potential?	Yes	Trigger based on a new prescription (order) for opioids in the relevant value set - ideally the prescription should be selected prior to being committed to the system	Opioid analgesics with ambulatory misuse potential	MedicationRequest	MedicationRequest.medication, and MedicationRequest.category
Opioid order for acute pain?	Yes	See For Acute Pain sub-routine
Opioid review useful?	Yes	See Opioid Review Useful sub-routine
Order for opioid analgesics with ambulatory misuse potential for > 7 days?	Yes	Determine if the new prescription (order) has an intended duration of > 7 days	Opioid analgesics with ambulatory misuse potential	MedicationRequest	MedicationRequest.medication, and MedicationRequest.dispenseRequest.expectedSupplyDuration

Effective Data Requirements

The following artifacts formalize the description of the logic and behavior defined by this recommendation.

Resource	Type	Description
2022 CDC Clinical Practice Guideline Recommendation #6	PlanDefinition	Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #6
Recommendation #6 - Prescribe Lowest Effective Dose and Duration	Library	Defines the data requirements to support evaluation of recommendation #6
Opioid Terminology Management Knowledge-base Data (OMTK) Library	Library	CQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Opioid Terminology Management Knowledge-base (OMTK) Library	Library	CQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Common Opioid Decision Support Logic	Library	CQL Library that provides common logic for the recommendations
Common OpioidCDS Configuration Logic	Library	CQL Library that provides common configuration logic for the recommendations
Common OpioidCDS Routines Logic	Library	CQL Library that provides common routines logic for the recommendations
FHIRHelpers Conversion Logic	Library	CQL Library that defines functions to convert between FHIR data types and CQL system-defined types, as well as functions to support FHIRPath implementation

Description	CDS Hooks Request	Expected Response
Patient is 18 or older. Patient has been prescribed oxyCODONE HCl 10 MG 12HR Extended Release Oral Tablet (RXNorm 1049502). Patients "Dosage Instructions" are 1 Tablet per day for 5 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned.	Request JSON	Response JSON
Patient is 18 or older. Patient has been prescribed oxyCODONE HCl 10 MG 12HR Extended Release Oral Tablet (RXNorm 1049502).Patients "Dosage Instructions" are 1 Tablet per day for 27 days. The patient will be included and the following message will be triggered - "Recommend limit therapy to ≤ 3 days to maximum of ≤ 7 days and to limit to immediate release opioids".	Request JSON	Response JSON

• When
• Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting
• Prescription is for treating acute pain.
• Opioid review is useful for this patient:
• Patient is 18 or over
• Patient does not have evidence of sickle cell disease
• Patient does not have findings indicating limited life expectancy
• Patient does not have orders for therapies indicating end of life care
• Patient is not undergoing active cancer treatment:
• Patient has had at least 2 office visits within the past 12 months with an oncology specialist present, or
• Patient has had at least 2 office visits within the past 12 months with a CDC malignant cancer condition diagnosis
• Patient does not have conditions likely terminal for opioid prescribing present
• Prescription is for more than 7 days
• Then
• When Treating Acute Pain, Prescribe No Greater Quantity Than Needed:
• Document - Will adjust opioid order
• Snooze - Benefits of opioid therapy duration outweigh risks, snooze 3 months
• Snooze - N/A see comment, snooze 3 months

The following table describes the flowchart decisions and sub-routines for the recommendation

Definition	Answer to Proceed	Details	Data (Terminology) Requirement	Profile	Path
Order for opioid analgesics with with ambulatory misuse potential?	Yes	Trigger based on a new prescription (order) for opioids in the relevant value set - ideally the prescription should be selected prior to being committed to the system	Opioid analgesics with ambulatory misuse potential	MedicationRequest	MedicationRequest.medication, and MedicationRequest.category
Opioid order for acute pain?	Yes	See For Acute Pain sub-routine
Opioid review useful?	Yes	See Opioid Review Useful sub-routine
Order for opioid analgesics with ambulatory misuse potential for > 7 days?	Yes	Determine if the new prescription (order) has an intended duration of > 7 days	Opioid analgesics with ambulatory misuse potential	MedicationRequest	MedicationRequest.medication, and MedicationRequest.dispenseRequest.expectedSupplyDuration

Effective Data Requirements

The following artifacts formalize the description of the logic and behavior defined by this recommendation.

Resource	Type	Description
2022 CDC Clinical Practice Guideline Recommendation #6	PlanDefinition	Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #6
Recommendation #6 - Prescribe Lowest Effective Dose and Duration	Library	Defines the data requirements to support evaluation of recommendation #6
Opioid Terminology Management Knowledge-base Data (OMTK) Library	Library	CQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Opioid Terminology Management Knowledge-base (OMTK) Library	Library	CQL Library that provides logic for implementation of opioid management functionality including Milligram Morphine Equivalents (MME).
Common Opioid Decision Support Logic	Library	CQL Library that provides common logic for the recommendations
Common OpioidCDS Configuration Logic	Library	CQL Library that provides common configuration logic for the recommendations
Common OpioidCDS Routines Logic	Library	CQL Library that provides common routines logic for the recommendations
FHIRHelpers Conversion Logic	Library	CQL Library that defines functions to convert between FHIR data types and CQL system-defined types, as well as functions to support FHIRPath implementation

Description	CDS Hooks Request	Expected Response
Patient is 18 or older. Patient has been prescribed oxyCODONE HCl 10 MG 12HR Extended Release Oral Tablet (RXNorm 1049502). Patients "Dosage Instructions" are 1 Tablet per day for 5 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned.	Request JSON	Response JSON
Patient is 18 or older. Patient has been prescribed oxyCODONE HCl 10 MG 12HR Extended Release Oral Tablet (RXNorm 1049502).Patients "Dosage Instructions" are 1 Tablet per day for 27 days. The patient will be included and the following message will be triggered - "Recommend limit therapy to ≤ 3 days to maximum of ≤ 7 days and to limit to immediate release opioids".	Request JSON	Response JSON