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Example PlanDefinition/opioidcds-10 (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 10 ECA Rule (id = "opioidcds-10")

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

<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="opioidcds-10"/> 
  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: PlanDefinition</b> <a name="opioidcds-10"> </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-10&quot; </p> </div> <p> <b> url</b> : <code> http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-10</code> </p> <p> <b> identifier</b> : id: urn:oid:2.16.840.1.113883.4.642.11.3, id: cdc-opioid-guidance (use: OFFICIAL)</p> <p> <b> version</b> : 0.1.0</p> <p> <b> name</b> : cdc-opioid-10</p> <p> <b> title</b> : CDC Opioid Prescribing Guideline Recommendation #10</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> : 2017-04-23</p> <p> <b> publisher</b> : Centers for Disease Control and Prevention (CDC)</p> <p> <b> description</b> : 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.</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> : Providers should be aware if patients are taking other prescription drugs or
         illicit drugs that might increase their risk of an overdose.</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> <p> <b> library</b> : <a href="http://example.org/fhir/Library/opioidcds-recommendation-10">http://example.org/fhir/Library/opioidcds-recommendation-10</a> </p> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Annual Urine Screening Check</p> <p> <b> description</b> : Patient has not had a urine screening in the past 12 months</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> Patient has not had a urine screening in the past 12 months</td> <td> text/cql</td> <td> No Screenings in Past Year</td> </tr> </table> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : activity.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 perform urine screening</td> </tr> <tr> <td> *</td> <td> Not for chronic pain management. Snooze 3 months</td> </tr> </table> </blockquote> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Positive Urine Screening Check</p> <p> <b> description</b> : Patient has a urine screening testing positive for either unprescribed opioids
           or illicit drugs in the past 12 months</p> <blockquote> <p> <b> documentation</b> </p> <p> <b> type</b> : documentation</p> </blockquote> <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> Patient has a positive urine screening in the past 12 months</td> <td> text/cql</td> <td> Has Positive Screening?</td> </tr> </table> </blockquote> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Unprescribed Opioids Found In Urine Screening</p> <p> <b> description</b> : Patient has a positive urine screening in the past 12 months for opioid(s), which
             is not prescribed</p> </blockquote> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Prescribed Opioids Not Found In Urine Screening</p> <p> <b> description</b> : Patient has a positive urine screening in the past 12 months, which does not
             include prescribed opioids</p> </blockquote> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Illicit Drugs Found In Urine Screening</p> <p> <b> description</b> : Patient has a positive urine screening in the past 12 months for illicit drugs</p> </blockquote> </blockquote> </div> </text> <url value="http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-10"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.11.3"/> 
  </identifier> 
  <identifier> 
    <use value="official"/> 
    <value value="cdc-opioid-guidance"/> 
  </identifier> 
  <version value="0.1.0"/> 
  <name value="cdc-opioid-10"/> 
  <title value="CDC Opioid Prescribing Guideline Recommendation #10"/> 
  <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="2017-04-23"/> 
  <publisher value="Centers for Disease Control and Prevention (CDC)"/> 
  <description value="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."/> 
  <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="Providers should be aware if patients are taking other prescription drugs or illicit
   drugs that might increase their risk of an overdose."/> 
  <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> 
  <library value="http://example.org/fhir/Library/opioidcds-recommendation-10"/> 
  <action> 
    <title value="Annual Urine Screening Check"/> 
    <description value="Patient has not had a urine screening in the past 12 months"/> 
    <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="Patient has not had a urine screening in the past 12 months"/> 
          <language value="text/cql"/> 
              <expression value="No Screenings in Past Year"/> 
            </expression> 
    </condition> 
    <dynamicValue> 
      <path value="activity.extension"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Indicator"/> 
            </expression> 
    </dynamicValue> 
    <action> 
      <description value="Will perform urine screening"/> 
          <!--    Open Order Set, where available    -->
    </action> 
    <action> 
      <description value="Not for chronic pain management. Snooze 3 months"/> 
    </action> 
  </action> 
  <action> 
    <title value="Positive Urine Screening Check"/> 
    <description value="Patient has a urine screening testing positive for either unprescribed opioids
     or illicit drugs in the past 12 months"/> 
    <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> 
    <condition> 
      <kind value="applicability"/> 
            <expression> 
              <description value="Patient has a positive urine screening in the past 12 months"/> 
        <language value="text/cql"/> 
        <expression value="Has Positive Screening?"/> 
      </expression> 
    </condition> 
    <action> 
      <title value="Unprescribed Opioids Found In Urine Screening"/> 
      <description value="Patient has a positive urine screening in the past 12 months for opioid(s), which
       is not prescribed"/> 
      <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> 
      <condition> 
        <kind value="applicability"/> 
                <expression> 
                  <description value="Patient has a positive urine screening in the past 12 months for opioid(s), which
           is not prescribed"/> 
          <language value="text/cql"/> 
          <expression value="Has Unprescribed Opioids?"/> 
        </expression> 
      </condition> 
      <dynamicValue> 
        <path value="activity.extension"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Get Indicator"/> 
          </expression> 
      </dynamicValue> 
      <dynamicValue> 
        <path value="action.description"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Inconsistent Unprescribed Opioids"/> 
          </expression> 
      </dynamicValue> 
      <action> 
        <description value="Not for chronic pain management. Snooze 3 months"/> 
      </action> 
    </action> 
    <action> 
      <title value="Prescribed Opioids Not Found In Urine Screening"/> 
      <description value="Patient has a positive urine screening in the past 12 months, which does not include
       prescribed opioids"/> 
      <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> 
      <condition> 
        <kind value="applicability"/> 
                <expression> 
              <description value="Patient has a positive urine screening in the past 12 months, which does not include
           prescribed opioids"/> 
          <language value="text/cql"/> 
          <expression value="Has Missing Opioids?"/> 
        </expression> 
      </condition> 
      <dynamicValue> 
        <path value="activity.extension"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Get Indicator"/> 
          </expression> 
      </dynamicValue> 
      <dynamicValue> 
        <path value="action.description"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Inconsistent Missing Opioids"/> 
          </expression> 
      </dynamicValue> 
    </action> 
    <action> 
      <title value="Illicit Drugs Found In Urine Screening"/> 
      <description value="Patient has a positive urine screening in the past 12 months for illicit drugs"/> 
      <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> 
      <condition> 
        <kind value="applicability"/> 
                <expression> 
                  <description value="Patient has a positive urine screening in the past 12 months for illicit drugs"/> 
          <language value="text/cql"/> 
          <expression value="Has Illicit Drugs in Screening?"/> 
        </expression> 
      </condition> 
      <dynamicValue> 
        <path value="activity.extension"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Get Indicator"/> 
          </expression> 
      </dynamicValue> 
      <dynamicValue> 
        <path value="action.description"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Inconsistent Illicit Drugs"/> 
          </expression> 
      </dynamicValue> 
      <action> 
        <description value="Not for chronic pain management. Snooze 3 months"/> 
      </action> 
    </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.