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Example PlanDefinition/opioidcds-11 (JSON)

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

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

Opioid CDS Recommendation 11 ECA Rule

{
  "resourceType" : "PlanDefinition",
  "id" : "opioidcds-11",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: PlanDefinition</b><a name=\"opioidcds-11\"> </a><a name=\"hcopioidcds-11\"> </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-11&quot; </p></div><p><b>StructureDefinition Work Group</b>: cds</p><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.0.0/NamingSystem-uri.html\" title=\"As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt \r\n\r\nThis oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid: \r\n\r\nNote that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.\r\n\r\nThis OID may also be used in CD.codeSystem.\">Uniform Resource Identifier (URI)</a>/urn:oid:2.16.840.1.113883.4.642.11.2, cdc-opioid-guidance\u00a0(use:\u00a0OFFICIAL)</p><p><b>version</b>: 0.1.0</p><p><b>name</b>: Cdcopioid11</p><p><b>title</b>: CDC Opioid Prescribing Guideline Recommendation #11</p><p><b>type</b>: ECA Rule <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/6.0.0/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>: HL7 International / Clinical Decision Support</p><p><b>contact</b>: </p><p><b>description</b>: Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.</p><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</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 style=\"display: none\">*</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/6.0.0/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>: Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.</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>document</b></p></blockquote></blockquote><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: documentation</p><p><b>display</b>: MME Conversion Tables</p><blockquote><p><b>document</b></p></blockquote></blockquote><p><b>library</b>: <a href=\"http://example.org/fhir/Library/opioidcds-recommendation-11\">http://example.org/fhir/Library/opioidcds-recommendation-11</a></p><blockquote><p><b>action</b></p><p><b>Strength of recommendation</b>: Strong <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/6.0.0/CodeSystem-recommendation-strength.html\">StrengthOfRecommendationRating</a>#strong)</span></p><p><b>Quality of evidence</b>: Low quality <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/6.0.0/CodeSystem-evidence-quality.html\">QualityOfEvidenceRating</a>#low)</span></p><p><b>title</b>: Existing patient has concurrent opioid and benzodiazepine prescriptions.</p><p><b>description</b>: Checking if the trigger prescription meets the inclusion criteria for recommendation #11 workflow.</p><h3>Documentations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>documentation</td></tr></table><h3>Triggers</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Name</b></td></tr><tr><td style=\"display: none\">*</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 style=\"display: none\">-</td><td><b>Description</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style=\"display: none\">*</td><td>Check whether the existing patient is using opioids concurrently with benzodiazepines.</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.description</p><h3>Expressions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style=\"display: none\">*</td><td>text/cql</td><td>Get Detail</td></tr></table></blockquote><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: action.title</p><h3>Expressions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style=\"display: none\">*</td><td>text/cql</td><td>Get Summary</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 style=\"display: none\">-</td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td style=\"display: none\">*</td><td>text/cql</td><td>Get Indicator</td></tr></table></blockquote><h3>Actions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Description</b></td></tr><tr><td style=\"display: none\">*</td><td>Will revise</td></tr><tr><td style=\"display: none\">*</td><td>Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo</td></tr><tr><td style=\"display: none\">*</td><td>N/A - see comment; snooze 3 mo</td></tr></table></blockquote></div>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cds"
  }],
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.11.2"
  },
  {
    "use" : "official",
    "value" : "cdc-opioid-guidance"
  }],
  "version" : "0.1.0",
  "name" : "Cdcopioid11",
  "title" : "CDC Opioid Prescribing Guideline Recommendation #11",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
      "code" : "eca-rule",
      "display" : "ECA Rule"
    }]
  },
  "status" : "draft",
  "date" : "2018-03-19",
  "publisher" : "HL7 International / Clinical Decision Support",
  "contact" : [{
    "telecom" : [{
      "system" : "url"
    }]
  }],
  "description" : "Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.",
  "useContext" : [{
    "code" : {
      "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code" : "focus",
      "display" : "Clinical Focus"
    },
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://snomed.info/sct",
        "code" : "182888003",
        "display" : "Medication requested (situation)"
      }]
    }
  },
  {
    "code" : {
      "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code" : "focus",
      "display" : "Clinical Focus"
    },
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://snomed.info/sct",
        "code" : "82423001",
        "display" : "Chronic pain (finding)"
      }]
    }
  }],
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    }]
  }],
  "purpose" : "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" : "Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.",
  "copyright" : "© CDC 2016+.",
  "topic" : [{
    "text" : "Opioid Prescribing"
  }],
  "author" : [{
    "name" : "Kensaku Kawamoto, MD, PhD, MHS"
  },
  {
    "name" : "Bryn Rhodes"
  },
  {
    "name" : "Floyd Eisenberg, MD, MPH"
  },
  {
    "name" : "Robert McClure, MD, MPH"
  }],
  "relatedArtifact" : [{
    "type" : "documentation",
    "display" : "CDC guideline for prescribing opioids for chronic pain",
    "document" : {
      "url" : "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420"
    }
  },
  {
    "type" : "documentation",
    "display" : "MME Conversion Tables",
    "document" : {
      "url" : "https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"
    }
  }],
  "library" : ["http://example.org/fhir/Library/opioidcds-recommendation-11"],
  "action" : [{
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/recommendation-strength",
          "code" : "strong",
          "display" : "Strong"
        }]
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/evidence-quality",
          "code" : "low",
          "display" : "Low quality"
        }]
      }
    }],
    "title" : "Existing patient has concurrent opioid and benzodiazepine prescriptions.",
    "description" : "Checking if the trigger prescription meets the inclusion criteria for recommendation #11 workflow.",
    "documentation" : [{
      "type" : "documentation"
    }],
    "trigger" : [{
      "type" : "named-event",
      "name" : "medication-prescribe"
    }],
    "condition" : [{
      "kind" : "applicability",
      "expression" : {
        "description" : "Check whether the existing patient is using opioids concurrently with benzodiazepines.",
        "language" : "text/cql",
        "expression" : "Inclusion Criteria"
      }
    }],
    "groupingBehavior" : "visual-group",
    "selectionBehavior" : "exactly-one",
    "dynamicValue" : [{
      "path" : "action.description",
      "expression" : {
        "language" : "text/cql",
        "expression" : "Get Detail"
      }
    },
    {
      "path" : "action.title",
      "expression" : {
        "language" : "text/cql",
        "expression" : "Get Summary"
      }
    },
    {
      "path" : "action.extension",
      "expression" : {
        "language" : "text/cql",
        "expression" : "Get Indicator"
      }
    }],
    "action" : [{
      "description" : "Will revise"
    },
    {
      "description" : "Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"
    },
    {
      "description" : "N/A - see comment; snooze 3 mo"
    }]
  }]
}

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.