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Example Library/opioidcds-recommendation-04 (Narrative)

Clinical Decision Support Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: No defined compartments

This is the narrative for the resource. See also the XML, JSON or Turtle format. This example conforms to the profile Library.

Generated Narrative: Library opioidcds-recommendation-04

Participants

AuthorKensaku Kawamoto, MD, PhD, MHS
Author Bryn Rhodes
Author Floyd Eisenberg, MD, MPH
Author Robert McClure, MD, MPH

Related Artifacts

documentationCDC guideline for prescribing opioids for chronic pain
depends-on http://example.org/fhir/Library/opioidcds-common

Data Requirements

Type: MedicationRequest
Filter Value
medicationCodeableConcept In ValueSet http://example.org/fhir/ValueSet/opioids-abused-in-ambulatory-care
Type: Encounter

Contents

application/elm+xml

<?xml version="1.0" encoding="UTF-8"?>
<library xmlns="urn:hl7-org:elm:r1" xmlns:t="urn:hl7-org:elm-types:r1" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:fhir="http://hl7.org/fhir" xmlns:qdm43="urn:healthit-gov:qdm:v4_3" xmlns:qdm53="urn:healthit-gov:qdm:v5_3" xmlns:a="urn:hl7-org:cql-annotations:r1">
   <annotation startLine="67" startChar="5" endLine="67" endChar="68" message="Could not resolve code path medicationCodeableConcept for the type of the retrieve FHIR.MedicationRequest." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation startLine="67" startChar="5" endLine="67" endChar="68" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation startLine="78" startChar="83" endLine="78" endChar="126" message="List-valued expression was demoted to a singleton." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <identifier id="OpioidCDS_STU4_REC_04" version="0.1.0"/>
   <schemaIdentifier id="urn:hl7-org:elm" version="r1"/>
   <usings>
      <def localIdentifier="System" uri="urn:hl7-org:elm-types:r1"/>
      <def localIdentifier="FHIR" uri="http://hl7.org/fhir" version="3.2.0"/>
   </usings>
   <includes>
      <def localIdentifier="Common" path="OpioidCDS_STU4_Common" version="0.1.0"/>
   </includes>
   <parameters>
      <def name="ContextPrescriptions" accessLevel="Public">
         <parameterTypeSpecifier xsi:type="ListTypeSpecifier">
            <elementType name="fhir:MedicationRequest" xsi:type="NamedTypeSpecifier"/>
         </parameterTypeSpecifier>
      </def>
   </parameters>
   <statements>
      <def name="Patient" context="Patient">
         <expression xsi:type="SingletonFrom">
            <operand dataType="fhir:Patient" xsi:type="Retrieve"/>
         </expression>
      </def>
      <def name="Inclusion Period" context="Patient" accessLevel="Public">
         <expression lowClosed="true" highClosed="true" xsi:type="Interval">
            <low xsi:type="Subtract">
               <operand xsi:type="Today"/>
               <operand value="91" unit="days" xsi:type="Quantity"/>
            </low>
            <high xsi:type="Subtract">
               <operand xsi:type="Today"/>
               <operand value="1" unit="days" xsi:type="Quantity"/>
            </high>
         </expression>
      </def>
      <def name="Encounter Period" context="Patient" accessLevel="Public">
         <expression lowClosed="true" highClosed="true" xsi:type="Interval">
            <low xsi:type="Subtract">
               <operand xsi:type="Subtract">
                  <operand xsi:type="Today"/>
                  <operand value="12" unit="months" xsi:type="Quantity"/>
               </operand>
               <operand value="1" unit="days" xsi:type="Quantity"/>
            </low>
            <high xsi:type="Subtract">
               <operand xsi:type="Today"/>
               <operand value="1" unit="days" xsi:type="Quantity"/>
            </high>
         </expression>
      </def>
      <def name="Get Trigger Event Prescriptions" context="Patient" accessLevel="Public">
         <expression xsi:type="Query">
            <source alias="triggerScripts">
               <expression name="ContextPrescriptions" xsi:type="ParameterRef"/>
            </source>
            <let identifier="rxNormCode">
               <expression name="ToCode" libraryName="Common" xsi:type="FunctionRef">
                  <operand xsi:type="Indexer">
                     <operand path="coding" xsi:type="Property">
                        <source path="medication" scope="triggerScripts" xsi:type="Property"/>
                     </operand>
                     <operand valueType="t:Integer" value="0" xsi:type="Literal"/>
                  </operand>
               </expression>
            </let>
            <where xsi:type="And">
               <operand name="IsOpioidWithAmbulatoryAbusePotential" libraryName="Common" xsi:type="FunctionRef">
                  <operand name="rxNormCode" xsi:type="QueryLetRef"/>
               </operand>
               <operand name="IsLongActingOpioid" libraryName="Common" xsi:type="FunctionRef">
                  <operand name="rxNormCode" xsi:type="QueryLetRef"/>
               </operand>
            </where>
         </expression>
      </def>
      <def name="Get Trigger Trigger Event Prescription Ids" context="Patient" accessLevel="Public">
         <expression xsi:type="Query">
            <source alias="triggerScripts">
               <expression name="Get Trigger Event Prescriptions" xsi:type="ExpressionRef"/>
            </source>
            <let identifier="codeString">
               <expression valueType="t:String" value="" xsi:type="Literal"/>
            </let>
            <return>
               <expression xsi:type="Concatenate">
                  <operand xsi:type="Concatenate">
                     <operand name="codeString" xsi:type="QueryLetRef"/>
                     <operand path="value" xsi:type="Property">
                        <source path="id" scope="triggerScripts" xsi:type="Property"/>
                     </operand>
                  </operand>
                  <operand valueType="t:String" value=" " xsi:type="Literal"/>
               </expression>
            </return>
         </expression>
      </def>
      <def name="Validate Trigger Event" context="Patient" accessLevel="Public">
         <expression xsi:type="Exists">
            <operand name="Get Trigger Event Prescriptions" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def name="Opioid with Ambulatory Care Abuse Potential in Past 90 Days" context="Patient" accessLevel="Public">
         <expression xsi:type="Exists">
            <operand xsi:type="Query">
               <source alias="orders">
                  <expression dataType="fhir:MedicationRequest" codeProperty="medicationCodeableConcept" xsi:type="Retrieve">
                     <codes name="Ambulatory Abuse Potential Opioids" libraryName="Common" xsi:type="ValueSetRef"/>
                  </expression>
               </source>
               <where xsi:type="In">
                  <operand xsi:type="DateFrom">
                     <operand path="value" xsi:type="Property">
                        <source path="authoredOn" scope="orders" xsi:type="Property"/>
                     </operand>
                  </operand>
                  <operand name="Inclusion Period" xsi:type="ExpressionRef"/>
               </where>
            </operand>
         </expression>
      </def>
      <def name="Inclusion Criteria" context="Patient" accessLevel="Public">
         <expression xsi:type="And">
            <operand xsi:type="And">
               <operand name="Validate Trigger Event" xsi:type="ExpressionRef"/>
               <operand xsi:type="Not">
                  <operand name="Opioid with Ambulatory Care Abuse Potential in Past 90 Days" xsi:type="ExpressionRef"/>
               </operand>
            </operand>
            <operand xsi:type="Exists">
               <operand xsi:type="Query">
                  <source alias="encounters">
                     <expression dataType="fhir:Encounter" xsi:type="Retrieve"/>
                  </source>
                  <where xsi:type="In">
                     <operand xsi:type="DateFrom">
                        <operand path="value" xsi:type="Property">
                           <source path="start" xsi:type="Property">
                              <source path="period" scope="encounters" xsi:type="Property"/>
                           </source>
                        </operand>
                     </operand>
                     <operand name="Encounter Period" xsi:type="ExpressionRef"/>
                  </where>
               </operand>
            </operand>
         </expression>
      </def>
      <def name="Get Indicator" context="Patient" accessLevel="Public">
         <expression valueType="t:String" value="warning" xsi:type="Literal"/>
      </def>
      <def name="Get Summary" context="Patient" accessLevel="Public">
         <expression valueType="t:String" value="Recommend use of immediate-release opioids instead of extended release/long acting opioids when starting patient on opioids." xsi:type="Literal"/>
      </def>
      <def name="Get Detail" context="Patient" accessLevel="Public">
         <expression xsi:type="Concatenate">
            <operand valueType="t:String" value="The following medication requests(s) release rates should be re-evaluated: " xsi:type="Literal"/>
            <operand xsi:type="SingletonFrom">
               <operand name="Get Trigger Trigger Event Prescription Ids" xsi:type="ExpressionRef"/>
            </operand>
         </expression>
      </def>
   </statements>
</library>

 

 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.