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Example PlanDefinition/opioidcds-07 (XML)

Clinical Decision Support Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Not linked to any defined compartments

Raw XML (canonical form + also see XML Format Specification)

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Opioid CDS Recommendation 7 ECA Rule (id = "opioidcds-07")

<?xml version="1.0" encoding="UTF-8"?>

<PlanDefinition xmlns="http://hl7.org/fhir">
    <id value="opioidcds-07"/> 
    <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: PlanDefinition</b> <a name="opioidcds-07"> </a> </p> <div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border:
       1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PlanDefinition &quot;opioidcds-07&quot; </p> </div> <p> <b> url</b> : <code> http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-07</code> </p> <p> <b> identifier</b> : id: urn:oid:2.16.840.1.113883.4.642.11.6, id: cdc-opioid-guidance (use: OFFICIAL)</p> <p> <b> version</b> : 0.1.0</p> <p> <b> name</b> : cdc-opioid-07</p> <p> <b> title</b> : CDC Opioid Prescribing Guideline Recommendation #7</p> <p> <b> type</b> : ECA Rule <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-plan-definition-type.html">PlanDefinitionType</a> #eca-rule)</span> </p> <p> <b> status</b> : draft</p> <p> <b> date</b> : 2018-03-19</p> <p> <b> publisher</b> : Centers for Disease Control and Prevention (CDC)</p> <p> <b> description</b> : 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.</p> <h3> UseContexts</h3> <table class="grid"><tr> <td> -</td> <td> <b> Code</b> </td> <td> <b> Value[x]</b> </td> </tr> <tr> <td> *</td> <td> Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type
             code focus = 'Clinical Focus', stated as 'Clinical Focus')</td> <td> Medication requested (situation) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #182888003)</span> </td> </tr> <tr> <td> *</td> <td> Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type
             code focus = 'Clinical Focus', stated as 'Clinical Focus')</td> <td> Chronic pain (finding) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #82423001)</span> </td> </tr> </table> <p> <b> jurisdiction</b> : United States of America <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-ISO3166Part1.html">ISO 3166-1 Codes for the representation of names of countries and their subdivisions
             — Part 1: Country code</a> #US)</span> </p> <p> <b> purpose</b> : CDC’s Guideline for Prescribing Opioids for Chronic 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> <p> <b> usage</b> : If benefits do not outweigh harms of continued opioid therapy, clinicians should
         optimize other therapies and work with patients to taper opioids to lower dosages
         or to taper and discontinue opioids.</p> <p> <b> copyright</b> : © CDC 2016+.</p> <p> <b> topic</b> : Opioid Prescribing <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span> </p> <p> <b> author</b> : Kensaku Kawamoto, MD, PhD, MHS: , Bryn Rhodes: , Floyd Eisenberg, MD, MPH: ,
         Robert McClure, MD, MPH: </p> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : documentation</p> <p> <b> display</b> : CDC guideline for prescribing opioids for chronic pain</p> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : documentation</p> <p> <b> display</b> : MME Conversion Tables</p> </blockquote> <p> <b> library</b> : <a href="http://example.org/fhir/Library/opioidcds-recommendation-07">http://example.org/fhir/Library/opioidcds-recommendation-07</a> </p> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : <span title="  non-dynamic card summary  ">Existing patient should be evaluated for risk of continued opioid therapy.</span> </p> <p> <b> description</b> : Checking if the trigger prescription meets the inclusion criteria for recommendation
           #7 workflow.</p> <blockquote> <p> <b> documentation</b> </p> <p> <b> type</b> : documentation</p> </blockquote> <h3> Triggers</h3> <table class="grid"><tr> <td> -</td> <td> <b> Type</b> </td> <td> <b> Name</b> </td> </tr> <tr> <td> *</td> <td> named-event</td> <td> medication-prescribe</td> </tr> </table> <blockquote> <p> <b> condition</b> </p> <p> <b> kind</b> : applicability</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Description</b> </td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> Check whether the existing patient, without an end of life condition or risk assessment
                 in the past 90 days, has taken an opioid-with-abuse-potential for 7 of the past
                 10 days or 63 of the past 90 days.</td> <td> text/cql</td> <td> Inclusion Criteria</td> </tr> </table> </blockquote> <p> <b> groupingBehavior</b> : visual-group</p> <p> <b> selectionBehavior</b> : exactly-one</p> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : action.title</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> text/cql</td> <td> Get Summary</td> </tr> </table> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : action.description</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> text/cql</td> <td> Get Detail</td> </tr> </table> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : action.extension</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> text/cql</td> <td> Get Indicator</td> </tr> </table> </blockquote> <h3> Actions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Description</b> </td> </tr> <tr> <td> *</td> <td> Will schedule assessment of risk for opioid use for the patient</td> </tr> <tr> <td> *</td> <td> Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo</td> </tr> <tr> <td> *</td> <td> N/A - see comment; snooze 3 mo</td> </tr> </table> </blockquote> </div> </text> <url value="http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-07"/> 
    <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.11.6"/> 
  </identifier> 
  <identifier> 
        <use value="official"/> 
        <value value="cdc-opioid-guidance"/> 
    </identifier> 
    <version value="0.1.0"/> 
    <name value="cdc-opioid-07"/> 
    <title value="CDC Opioid Prescribing Guideline Recommendation #7"/> 
    <type> 
        <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/> 
            <code value="eca-rule"/> 
            <display value="ECA Rule"/> 
        </coding> 
    </type> 
    <status value="draft"/> 
    <date value="2018-03-19"/> 
    <publisher value="Centers for Disease Control and Prevention (CDC)"/> 
    <description value="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."/> 
    <useContext> 
        <code> 
            <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> 
            <code value="focus"/> 
            <display value="Clinical Focus"/> 
        </code> 
        <valueCodeableConcept> 
            <coding> 
                <system value="http://snomed.info/sct"/> 
                <code value="182888003"/> 
                <display value="Medication requested (situation)"/> 
            </coding> 
        </valueCodeableConcept> 
    </useContext> 
    <useContext> 
        <code> 
            <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> 
            <code value="focus"/> 
            <display value="Clinical Focus"/> 
        </code> 
        <valueCodeableConcept> 
            <coding> 
                <system value="http://snomed.info/sct"/> 
                <code value="82423001"/> 
                <display value="Chronic pain (finding)"/> 
            </coding> 
        </valueCodeableConcept> 
    </useContext> 
    <jurisdiction> 
        <coding> 
            <system value="urn:iso:std:iso:3166"/> 
            <code value="US"/> 
            <display value="United States of America"/> 
        </coding> 
    </jurisdiction> 
    <purpose value="CDC’s Guideline for Prescribing Opioids for Chronic 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."/> 
    <usage value="If benefits do not outweigh harms of continued opioid therapy, clinicians should
   optimize other therapies and work with patients to taper opioids to lower dosages
   or to taper and discontinue opioids."/> 
    <copyright value="© CDC 2016+."/> 
    <topic> 
        <text value="Opioid Prescribing"/> 
    </topic> 
    <author> 
        <name value="Kensaku Kawamoto, MD, PhD, MHS"/> 
    </author> 
    <author> 
        <name value="Bryn Rhodes"/> 
    </author> 
    <author> 
        <name value="Floyd Eisenberg, MD, MPH"/> 
    </author> 
    <author> 
        <name value="Robert McClure, MD, MPH"/> 
    </author> 
    <relatedArtifact> 
        <type value="documentation"/> 
        <display value="CDC guideline for prescribing opioids for chronic pain"/> 
        <document> 
          <url value="https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chro
      nic-pain---united-states-2016#420"/> 
        </document> 
    </relatedArtifact> 
    <relatedArtifact> 
        <type value="documentation"/> 
        <display value="MME Conversion Tables"/> 
        <document> 
          <url value="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"/> 
        </document> 
    </relatedArtifact> 
    <library value="http://example.org/fhir/Library/opioidcds-recommendation-07"/> 
    <action> 
            <!--    non-dynamic card summary    -->
        <title value="Existing patient should be evaluated for risk of continued opioid therapy."/> 
        <description value="Checking if the trigger prescription meets the inclusion criteria for recommendation
     #7 workflow."/> 
        <documentation> 
            <type value="documentation"/> 
            <document> 
                    <!--    We can use the example code systems from the FHIR CLinical Reasoning Module,
         or we can define GRADE specific code systems and use those here    -->
                <extension url="http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation">
                    <valueCodeableConcept> 
                        <coding> 
                            <system value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/> 
                            <code value="strong"/> 
                            <display value="Strong"/> 
                        </coding> 
                    </valueCodeableConcept> 
                </extension> 
                <extension url="http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence">
                    <valueCodeableConcept> 
                        <coding> 
                            <system value="http://terminology.hl7.org/CodeSystem/evidence-quality"/> 
                            <code value="low"/> 
                            <display value="Low quality"/> 
                        </coding> 
                    </valueCodeableConcept> 
                </extension> 
            </document> 
        </documentation> 
        <trigger> 
            <type value="named-event"/> 
            <name value="medication-prescribe"/> 
        </trigger> 
        <condition> 
            <kind value="applicability"/> 
            <expression> 
              <description value="Check whether the existing patient, without an end of life condition or risk assessment
         in the past 90 days, has taken an opioid-with-abuse-potential for 7 of the past
         10 days or 63 of the past 90 days."/> 
              <language value="text/cql"/> 
              <expression value="Inclusion Criteria"/> 
        </expression> 
        </condition> 
        <groupingBehavior value="visual-group"/> 
        <selectionBehavior value="exactly-one"/> 
            <!--    dynamic card elements    -->
        <dynamicValue> 
            <path value="action.title"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Summary"/> 
            </expression> 
        </dynamicValue> 
        <dynamicValue> 
            <path value="action.description"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Detail"/> 
            </expression> 
        </dynamicValue> 
        <dynamicValue> 
            <path value="action.extension"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Indicator"/> 
            </expression> 
        </dynamicValue> 
        <action> 
            <description value="Will schedule assessment of risk for opioid use for the patient"/> 
                <!--    Open Order Set, where available    -->
        </action> 
        <action> 
            <description value="Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"/> 
        </action> 
        <action> 
            <description value="N/A - see comment; snooze 3 mo"/> 
        </action> 
    </action> 
</PlanDefinition> 

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.