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 analgesic with ambulatory misuse potential	Yes	Order for opioid analgesics with ambulatory misuse potential	Opioid analgesics with ambulatory misuse potential	MedicationRequest	MedicationRequest.medication, and MedicationRequest.category
Opioid review useful?	Yes	See Opioid Review Useful sub-routine
PDMP review procedure in past 90 days?	No	Look for evidence of a prescription drug monitoring program (PDMP) review procedure (may need to modify time interval for review based on local practice / regulation) [Evidence for the PDMP review procedure may potentially originate in a PDMP Smart App that provides the code once PDMP review procedure has been completed]	PDMP review procedure	Procedure	Procedure.code, Procedure.status, and Procedure.performed
PDMP data reviewed finding in past 90 days?	No	Documentation (i.e., a finding that PDMP review has occurred) in last 90 days (may need to modify time interval for review based on local practice / regulation)	PDMP data reviewed finding	Observation	Observation.status, Observation.code, and Observation.effective

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 #9	PlanDefinition	Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #9
Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions	Library	Defines the data requirements to support evaluation of recommendation #9
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 Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) Patients "Dosage Instructions" are 1 FIlm per day for 30 days. This will trigger the message "PDMP Data Review"	Request JSON	Response JSON
Patient is 18 or older. Patient has been prescribed Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) Patients "Dosage Instructions" are 1 Film per day for 30 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned.	Request JSON	Response JSON

• When
• Provider is prescribing an opioid analgesic with ambulatory misuse potential in the outpatient setting
• 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
• PDMP data has not been reviewed in the past 90 days or
• PDMP review procedure has not been performed in the past 90 days
• Then
• Before Ordering Opioids, Review PDMP Data:
• Access Data - Launch app to review PDMP data
• Document - PDMP data reviewed, 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 analgesic with ambulatory misuse potential	Yes	Order for opioid analgesics with ambulatory misuse potential	Opioid analgesics with ambulatory misuse potential	MedicationRequest	MedicationRequest.medication, and MedicationRequest.category
Opioid review useful?	Yes	See Opioid Review Useful sub-routine
PDMP review procedure in past 90 days?	No	Look for evidence of a prescription drug monitoring program (PDMP) review procedure (may need to modify time interval for review based on local practice / regulation) [Evidence for the PDMP review procedure may potentially originate in a PDMP Smart App that provides the code once PDMP review procedure has been completed]	PDMP review procedure	Procedure	Procedure.code, Procedure.status, and Procedure.performed
PDMP data reviewed finding in past 90 days?	No	Documentation (i.e., a finding that PDMP review has occurred) in last 90 days (may need to modify time interval for review based on local practice / regulation)	PDMP data reviewed finding	Observation	Observation.status, Observation.code, and Observation.effective

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 #9	PlanDefinition	Event-Condition-Action rule that implements behavior for 2022 CDC Clinical Practice Guideline Recommendation #9
Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions	Library	Defines the data requirements to support evaluation of recommendation #9
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 Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) Patients "Dosage Instructions" are 1 FIlm per day for 30 days. This will trigger the message "PDMP Data Review"	Request JSON	Response JSON
Patient is 18 or older. Patient has been prescribed Suboxone 2 MG / 0.5 MG Sublingual Film (RXNorm 1010603) Patients "Dosage Instructions" are 1 Film per day for 30 days. The patient will be excluded and no message will be triggered - an empty set of cards will be returned.	Request JSON	Response JSON