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FHIR IG Statistics: PlanDefinition/opioidcds-03

Packagefhir.cdc.opioid-cds-r4
Resource TypePlanDefinition
Idopioidcds-03
FHIR VersionR4
Sourcehttp://fhir.org/guides/cdc/opioid-cds/https://build.fhir.org/ig/cqframework/opioid-cds-r4/PlanDefinition-opioidcds-03.html
URLhttp://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-03
Version2022.1.0
Statusdraft
Date2025-08-06
NamePlanDefinition_Recommendation_03_Order_Sign
TitleRecommendation #3 - Opioid Immediate Release Form When Starting Opioid Therapy
Realmus
Authorityhl7
DescriptionWhen starting opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release and long-acting (ER/LA) opioids.
PurposeThe 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.
Copyright© CDC 2016+.

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Id: opioidcds-03
Url: Recommendation #3 - Opioid Immediate Release Form When Starting Opioid Therapy
Version: 2022.1.0
Identifier:

value: cdc-opioid-guidance

Name: PlanDefinition_Recommendation_03_Order_Sign
Title: Recommendation #3 - Opioid Immediate Release Form When Starting Opioid Therapy
Status: draft
Experimental: true
Type:

system: http://terminology.hl7.org/CodeSystem/plan-definition-type

code: eca-rule

display: ECA Rule

Date: 2025-08-06
Publisher: Centers for Disease Control and Prevention (CDC)
Description: When starting opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release and long-acting (ER/LA) opioids.
Logic Definitions:
Library NameNamesequence
OpioidCDSREC03 Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0 
define "Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
  ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
    where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )
      and AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential"


Library NameNamesequence
OpioidCDSREC03 Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential 1 
define "Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential":
  exists( "Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )


Library NameNamesequence
OpioidCDSCommonConfig Age Less than 18 Years Is Enabled 2 
// CDC 2022 General Inclusion Criteria
define "Age Less than 18 Years Is Enabled":
  true


Library NameNamesequence
OpioidCDSRoutines Patient Age Less Than 18 3 
define "Patient Age Less Than 18":
  if (Config."Age Less than 18 Years Is Enabled") then
    AgeInYearsAt(Today()) < 18
  else false


Library NameNamesequence
OpioidCDSCommonConfig Sickle Cell Check Enabled 4 
// Sickle Cell
define "Sickle Cell Check Enabled":
  true


Library NameNamesequence
OpioidCDSCommonConfig Sickle Cell Assumed Active 5 
define "Sickle Cell Assumed Active":
  true


Library NameNamesequence
OpioidCDSCommon US Core-Categorized Conditions 6 
// 3. Medications indicating end of life
    /* or exists (
      "Medications Indicating End of Life"
    ) */

define "US Core-Categorized Conditions":
  [Condition: category in "Encounter Diagnosis Condition Category"]
    union [Condition: category in "Problem List Condition Category"]
    union [Condition: category in "US Core Health Concern Condition Category"]


Library NameNamesequence
OpioidCDSCommon Positive Sickle Cell Condition 7 
define "Positive Sickle Cell Condition":
  if Config."Sickle Cell Check Enabled" and not Config."Sickle Cell Assumed Active"
    then (
      "US Core-Categorized Conditions" C
        where C.code in "Sickle Cell Diseases"
          and C.clinicalStatus in "Active Condition"
    ) else if Config."Sickle Cell Check Enabled" and Config."Sickle Cell Assumed Active"
        then (
          "US Core-Categorized Conditions" C
            where C.code in "Sickle Cell Diseases"
        )
      else null


Library NameNamesequence
OpioidCDSRoutines Condition Positive for Sickle Cell 8 
define "Condition Positive for Sickle Cell":
  if (Config."Sickle Cell Check Enabled") then
    exists(
      Common."Positive Sickle Cell Condition"
    ) 
  else false


Library NameNamesequence
OpioidCDSCommonConfig Active Cancer Treatment Encounters Condition Is Enabled 9 
// Active Cancer Treatment
define "Active Cancer Treatment Encounters Condition Is Enabled":
  true


Library NameNamesequence
OpioidCDSRoutines Encounter Period 10 
// End of Opioid Naive Routine

/*
**  Routine #3
**  Active Cancer Treatment Routine
**
**  Definition                    | Answer to Proceed   | Details                                    | Data (Terminology) Requirement
**  ---------------------------------------------------------------------------------------------------------------------------------
**  Two office visits within the  | No                  | Look for a minimum of two distinct         | Office Visit
**  past 12 months                |                     | encounters within 12 months of the date    |
**                                |                     | of the current visit for which each of the |
**                                |                     | following is true:                         |
**                                |                     |   - the encounter diagnosis (primary or    |
**                                |                     |     secondary or co-morbidity diagnosis)   |
**                                |                     |     is listed in the CDC Malignant Cancer  |
**                                |                     |     Conditions value set                   |
**  ---------------------------------------------------------------------------------------------------------------------------------
**  Office visits with an         | No                  | The encounter is performed by an           | Oncology specialty
**  oncology specialist           |                     | oncologist as defined in the oncology      | designations (NUCC)
**  present                       |                     | specialty designations using the           |
**                                |                     | National Uniform Claim Committee           |
**                                |                     | (NUCC) classifications                     |
**  ---------------------------------------------------------------------------------------------------------------------------------
**  Office visits including CDC   | No                  | The encounter diagnosis (primary or        | CDC malignant cancer
**  malignant cancer              |                     | secondary or co-morbidity diagnosis)       | conditions
**  condition                     |                     | is listed in the CDC Malignant Cancer      |
**                                |                     | Conditions value set                       |
**  ----------------------------------------------------------------------------------------------------------------------------------
**
*/

define "Encounter Period":
  Interval[Today() - 12 months, Today())


Library NameNamesequence
OpioidCDSCommon USCore Encounter Cancer Diagnoses 11 
define "USCore Encounter Cancer Diagnoses":
  [Condition: category in "Encounter Diagnosis Condition Category"] CancerDiagnoses
    where CancerDiagnoses.code in "CDC malignant cancer conditions"


Library NameNamesequence
OpioidCDSRoutines Encounters with Cancer Diagnosis During Encounter Period 12 
// encounter-diagnosis, problem-list and health-concern Conditions
// define "US Core-Categorized Cancer Diagnoses":
//   Common."US Core-Categorized Conditions" C
//     where C.code in Common."CDC malignant cancer conditions"

// define "Encounters with Cancer Diagnosis During Encounter Period":
//   [Encounter] Encounter
//     with "US Core-Categorized Cancer Diagnoses" CancerDiagnosis
//     such that date from Encounter.period."start".value in day of "Encounter Period"
//       and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id)

define "Encounters with Cancer Diagnosis During Encounter Period":
  [Encounter] Encounters
    where date from Encounters.period."start" in day of "Encounter Period"
      and exists (
        Common."USCore Encounter Cancer Diagnoses" CancerDiagnoses
          where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id)
      )


Library NameNamesequence
OpioidCDSRoutines Number of Encounters with Cancer Diagnosis During Encounter Period 13 
define "Number of Encounters with Cancer Diagnosis During Encounter Period":
  Count ("Encounters with Cancer Diagnosis During Encounter Period")


Library NameNamesequence
OpioidCDSRoutines Has Two or More Encounters with Cancer Diagnosis During Encounter Period 14 
define "Has Two or More Encounters with Cancer Diagnosis During Encounter Period":
  "Number of Encounters with Cancer Diagnosis During Encounter Period" >= 2


Library NameNamesequence
OpioidCDSCommon USCore Problem List Cancer Diagnoses 15 
define "USCore Problem List Cancer Diagnoses":
  [Condition: category in "Problem List Condition Category"] CancerDiagnoses
    where CancerDiagnoses.code in "CDC malignant cancer conditions"


Library NameNamesequence
OpioidCDSRoutines Has Active Cancer Diagnosis on Problem List 16 
define "Has Active Cancer Diagnosis on Problem List":
  exists (
    Common."USCore Problem List Cancer Diagnoses" CancerDiagnoses
      where CancerDiagnoses.category in Common."Problem List Condition Category"
        and exists(
          CancerDiagnoses.clinicalStatus.coding ClinicalStatus
            where ClinicalStatus.code ~ 'active'
        )
  )


Library NameNamesequence
OpioidCDSRoutines Is Active Cancer Treatment? 17 
define "Is Active Cancer Treatment?":
  if (Config."Active Cancer Treatment Encounters Condition Is Enabled") 
    then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period"
      or "Has Active Cancer Diagnosis on Problem List"
  else false


Library NameNamesequence
OpioidCDSCommonConfig End-Stage Disease Criteria Enabled 18 
// CDC 2022 General Inclusion Criteria
define "End-Stage Disease Criteria Enabled":
  true


Library NameNamesequence
OpioidCDSRoutines Conditions Likely Terminal for Opioid Prescribing 19 
define "Conditions Likely Terminal for Opioid Prescribing":
  if (Config."End-Stage Disease Criteria Enabled") then
    exists (
      Common."US Core-Categorized Conditions" EOLC
        where EOLC.code in Common."Conditions likely terminal for opioid prescribing"
          // and EOLC.clinicalStatus in Common."Active Condition"
    )
  else false


Library NameNamesequence
OpioidCDSRoutines CDC 2022 Guideline General Inclusion Criteria 20 
define "CDC 2022 Guideline General Inclusion Criteria":
  not "Patient Age Less Than 18"
    and not "Condition Positive for Sickle Cell"
    and not "Is Active Cancer Treatment?"
    and not "Conditions Likely Terminal for Opioid Prescribing"


Library NameNamesequence
OpioidCDSCommonConfig Opioid Naive Prescription Condition Is Enabled 21 
// Opioid Naive
define "Opioid Naive Prescription Condition Is Enabled":
  true


Library NameNamesequence
OpioidCDSCommonConfig Can the implementing EHR support queries for past medications by date range? 22 
// Subroutine 2 - Past Medications
define "Can the implementing EHR support queries for past medications by date range?":
  true


Library NameNamesequence
OpioidCDSCommon Active Ambulatory Opioid Rx 23 
define "Active Ambulatory Opioid Rx":
    if Config."Can the implementing EHR support queries for past medications by date range?" then
      (
        "Get MedicationRequest Medication as Code"("Get Active Ambulatory Medication Requests"([MedicationRequest]))
      ) Rx
        where date from Rx.authoredOn 2 years or less on or before Today()
          and Rx.medication in "Opioid analgesics with ambulatory misuse potential"
    else
        List<FHIR.MedicationRequest>{}


Library NameNamesequence
OpioidCDSRoutines Prescription/Dispense Inclusion Period 24 
// End of CDC 2022 General Inclusion Criteria Routine

/*
**  Routine #2
**  Opioid Naive Routine
**
**  Definition                    | Answer to Proceed   | Details                                           | Data (Terminology) Requirement
**  ----------------------------------------------------------------------------------------------------------------------------------------
**  Opioid analgesics with        | No                  | Look for an existing prescription (order) for     | Opioid analgesics with
**  ambulatory misuse potential   |                     | opioid that is in the value set for opioid with   | ambulatory misuse potential
**  prescription in past 90 days  |                     | ambulatory abuse potential authored               |
**  excluding the previous 24     |                     | within the past 90 days (excluding previous 24    |
**  hours                         |                     | hours)                                            |
**  ----------------------------------------------------------------------------------------------------------------------------------------
**  Opioid analgesics with        | No                  | Look for evidence of active medication on         | Opioid analgesics with
**  ambulatory misuse potential   |                     | the medication list that is in the value set      | ambulatory misuse potential
**  reported in past 90 days      |                     | for opioid with ambulatory care abuse             |
**  excluding previous 24 hours*  |                     | potential                                         |
**  ----------------------------------------------------------------------------------------------------------------------------------------
**  Opioid analgesics with        | No                  | Look for evidence of a dispensing event for       | Opioid analgesics with
**  ambulatory misuse potential   |                     | medication that is in the value set for opioid    | ambulatory misuse potential
**  dispensing event in past 90   |                     | with ambulatory use potential occurring           |
**  days excluding previous 24    |                     | within the past 90 days (excluding previous 24    |
**  hours                         |                     | hours)                                            |
**  ----------------------------------------------------------------------------------------------------------------------------------------
**  *Future consideration: Current algorithm addresses only orders (prescriptions).
**
**  Note – orders use RxNorm, but medication lists and dispensed medication will
**  require an NDC value set and/or local mapping of NDC to RxNorm to enable this element
**
*/

define "Prescription/Dispense Inclusion Period":
  Interval[Now() - 90 days, Now() - 24 hours]


Library NameNamesequence
OpioidCDSRoutines Opioid RX with Ambulatory Abuse Potential In Past 90 Days 25 
define "Opioid RX with Ambulatory Abuse Potential In Past 90 Days":
  Common."Active Ambulatory Opioid Rx" Rx
      where Rx.authoredOn during day of "Prescription/Dispense Inclusion Period"


Library NameNamesequence
OpioidCDSRoutines Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days 26 
define "Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days":
    if (Config."Opioid Naive Prescription Condition Is Enabled") then
      exists ("Opioid RX with Ambulatory Abuse Potential In Past 90 Days")
    else false


Library NameNamesequence
OpioidCDSRoutines Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days 27 
// NOTE: 2020-02-05: Review direction of MedicationStatement resource (US-Core focusing on MedicationRequest i/o Statement)
// NOTE: 2020-04-21: MedicationStatement a) Shouldn't be use since guidance/direction from USCore is targeting MedicationUse in R5, and b) Breaks in the publisher
/* define "Reports of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days":
    [MedicationStatement: Common."Opioid analgesics with ambulatory misuse potential"] Statement
        where Statement.status in {'active', 'completed'}
            and Statement.effective during day of "Report Inclusion Period" */

/* define "Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days":
    Config."Opioid Naive Report Condition Is Enabled"
        and exists ("Reports of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days") */

define "Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days":
    [MedicationDispense: Common."Opioid analgesics with ambulatory misuse potential"] OpioidDispense
        where OpioidDispense.whenHandedOver during day of "Prescription/Dispense Inclusion Period"
            and OpioidDispense.status = 'completed'


Library NameNamesequence
OpioidCDSRoutines Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days 28 
define "Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days":
  if (Config."Opioid Naive Prescription Condition Is Enabled") then
    exists ("Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days")
  else false


Library NameNamesequence
OpioidCDSRoutines Is Opioid Naive? 29 
// NOTE: MedicationStatement-dependent logic comment out due to bug in Publisher not supporting MedicationStatement in AllTypes.
define "Is Opioid Naive?":
    not ("Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days")
    /* and not ("Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days") */
    and not ("Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days")


Library NameNamesequence
OpioidCDSREC03 Inclusion Criteria 30 
define "Inclusion Criteria":
  "Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential"
      and Routines."CDC 2022 Guideline General Inclusion Criteria"
      and Routines."Is Opioid Naive?"


Library NameNamesequence
OpioidCDSCommon Conditions Indicating End of Life or With Limited Life Expectancy 31 
define "Conditions Indicating End of Life or With Limited Life Expectancy":
  (
    "US Core-Categorized Conditions" C
      where C.code in "Conditions likely terminal for opioid prescribing"
        and C.clinicalStatus in "Active Condition"
  )
  union
  (
    "US Core-Categorized Conditions" C
      where C.code in "Limited life expectancy conditions"
        and C.clinicalStatus in "Active Condition"
  )


Library NameNamesequence
OpioidCDSCommonConfig Hospice Findings Exclusion Enabled 32 
// OpioidCDSCommon
define "Hospice Findings Exclusion Enabled":
  false


Library NameNamesequence
OpioidCDSCommon Admitted/Referred/Discharged to Hospice Care 33 
define "Admitted/Referred/Discharged to Hospice Care":
  (
    if (Config."Hospice Findings Exclusion Enabled") then
      [Observation: code in "Hospice Finding Codes"] O
        where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })
    else
      {}
  )
  union
  (
    [Encounter] E
      where date from E.period.start 1 year or less on or before Today()
        and (
          if E.hospitalization.dischargeDisposition.coding is null
              or not exists (E.hospitalization.dischargeDisposition.coding)
            then false
          else E.hospitalization.dischargeDisposition in "Hospice Disposition"
        )
        and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }
  )


Library NameNamesequence
OpioidCDSCommon End of Life Assessment 34 
define "End of Life Assessment":
    // 1. Conditions indicating end of life or with limited life expectancy
    exists (
      "Conditions Indicating End of Life or With Limited Life Expectancy"
    )
    // 2. Admitted/referred/discharged to hospice care
    or exists (
      "Admitted/Referred/Discharged to Hospice Care"
    )


Library NameNamesequence
OpioidCDSREC03 Exclusion Criteria 35 
define "Exclusion Criteria":
  Common."End of Life Assessment"


Library NameNamesequence
OpioidCDSREC03 Is Recommendation Applicable? 36 
define "Is Recommendation Applicable?":
  "Inclusion Criteria"
    and not "Exclusion Criteria"


Library NameNamesequence
OpioidCDSCommon Is Opioid Analgesic with Ambulatory Misuse Potential? 37 
define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>):
  ("Get MedicationRequest Medication as Code"(value)) Rx
    where Rx.medication in "Opioid analgesics with ambulatory misuse potential" 
      and Rx.category in "Community"


Library NameNamesequence
OpioidCDSCommon Get MedicationRequest Medication as Code 38 
define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>):
  value Rx
    let Med: 
      if Rx.medication is Reference then singleton from (
        [Medication] M
          where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))
      ) else null
    return 
      MedicationRequest {
        id: Rx.id,
        status: Rx.status,
        intent: Rx.intent,
        category: Rx.category,
        medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,
        subject: Rx.subject,
        authoredOn: Rx.authoredOn,
        recorder: Rx.recorder,
        dosageInstruction: Rx.dosageInstruction,
        dispenseRequest: Rx.dispenseRequest
      }


Library NameNamesequence
FHIRHelpers ToString 39 
define function ToString(value string): value.value


Library NameNamesequence
FHIRHelpers ToConcept 40 
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }


Library NameNamesequence
FHIRHelpers ToCode 41 
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }


Library NameNamesequence
OpioidCDSRoutines Is Subacute or Chronic Pain Prescription? 42 
// End of Active Cancer Treatment Routine

/*
**  Routine #4
**  For Subacute or Chronic Pain Routine
**
**  Definition                  | Answer to Proceed   | Details                                        | Data (Terminology) Requirement
**  -----------------------------------------------------------------------------------------------------------------------------------
**  Order for opioid analgesic  | Yes                 | Order for opioid analgesics with ambulatory    | Opioid analgesics with
**  with expected supply        |                     | misuse potential with a supply duration of >=  | ambulatory misuse potential
**  duration >= 28 days         |                     | 28 days                                        |
**                              |                     |                                                |
**                              |                     | - Subacute definition = order for opioid       |
**                              |                     |   analgesics with ambulatory misuse            |
**                              |                     |   potential with a supply duration of one to   |
**                              |                     |   two months.                                  |
**                              |                     | - Chronic pain definition = order for opioid   |
**                              |                     |   analgesics with ambulatory misuse            |
**                              |                     |   potential with a supply duration of >= two   |
**                              |                     |   months.                                      |
**  -----------------------------------------------------------------------------------------------------------------------------------
**
*/

define function "Is Subacute or Chronic Pain Prescription?"(prescription FHIR.MedicationRequest):
  "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription)
    or "Is Subacute or Chronic Pain Using Validity Period"(prescription)


Library NameNamesequence
OpioidCDSRoutines Is Subacute or Chronic Pain Using Expected Supply Duration 43 
define function "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription FHIR.MedicationRequest):
  (
    prescription.dispenseRequest is not null
      and prescription.dispenseRequest.expectedSupplyDuration is not null
      and (
        Common.GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration) >= 28 days 
      )
  )


Library NameNamesequence
OpioidCDSCommon GetDurationInDays 44 
define function GetDurationInDays(value FHIR.Duration):
  if value is null then null
  else
    case
      when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' }
      when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' }
      when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' }
      when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' }
      when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' }
      when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' }
      when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' }
      when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' }
      when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null')
      else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value)
end


Library NameNamesequence
OpioidCDSRoutines Is Subacute or Chronic Pain Using Validity Period 45 
define function "Is Subacute or Chronic Pain Using Validity Period"(prescription FHIR.MedicationRequest):
  (
    prescription.dispenseRequest is not null
      and prescription.dispenseRequest.validityPeriod is not null
      and (
        days between prescription.dispenseRequest.validityPeriod.start and prescription.dispenseRequest.validityPeriod.end >= 28 
      )
  )


Library NameNamesequence
FHIRHelpers ToDateTime 46 
define function ToDateTime(value dateTime): value.value


Library NameNamesequence
OpioidCDSCommon Get Active Ambulatory Medication Requests 47 
define function "Get Active Ambulatory Medication Requests" (value List<MedicationRequest>) returns List<MedicationRequest>:
  value Rx
    where Rx.status.value = 'active'
      and Rx.category in "Community"


Library NameNamesequence
FHIRHelpers ToString 48 
define function ToString(value MedicationDispenseStatus): value.value
Knowledge Capability: shareable computable executable publishable
Use Context:
codevaluedisplay
focus 182888003 Medication requested (situation)
focus 82423001 Chronic pain (finding)
focus 274663001 Acute pain (finding)
focus
Purpose:

The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.
Usage: Clinicians should not treat acute pain with ER/LA opioids or initiate opioid treatment for subacute or chronic pain with extended-release and long-acting (ER/LA) opioids, and clinicians should not prescribe ER/LA opioids for intermittent or as-needed use.
Copyright:

© CDC 2016+.
Related Artifacts:

Documentation
Libraries:
Library - Recommendation #3 - Opioid Immediate Release Form When Starting Opioid Therapy
Actions:
When Initiating Opioid Therapy, Utilize Immediate Release Opioids: Recommend prescribing immediate release opioids instead of extended-release or long-acting opioids [For guidance regarding prescribing extended release/ long-acting opioids, see Recommendation 3 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation3).
When: Named Event: order-sign
If: Applicability: Check whether the current order is for an extended-release opioid with ambulatory misuse potential, the patient is opioid naive and if the 2022 CDC guideline general inclusion criteria is met (Is Recommendation Applicable?)
Then:
: Document - Will prescribe immediate release opioid
Then:
: Snooze* - Benefits outweigh risks, snooze 3 months
Then:
: Snooze* N/A see comment, snooze 3 months
Then:

Source

{
  "resourceType": "PlanDefinition",
  "id": "opioidcds-03",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition",
      "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library Common",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommon|2022.1.0"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1"
        },
        {
          "type": "depends-on",
          "display": "Library Routines",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines|2022.1.0"
        },
        {
          "type": "depends-on",
          "display": "Library Config",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommonConfig|2022.1.0"
        },
        {
          "type": "depends-on",
          "display": "Value set Opioid analgesics with ambulatory misuse potential",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential"
        },
        {
          "type": "depends-on",
          "display": "Value set Community",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community"
        },
        {
          "type": "depends-on",
          "display": "Value set Extended release opioid with ambulatory misuse potential",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/extended-release-opioid-with-ambulatory-misuse-potential"
        },
        {
          "type": "depends-on",
          "display": "Value set Encounter Diagnosis Condition Category",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"
        },
        {
          "type": "depends-on",
          "display": "Value set Problem List Condition Category",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"
        },
        {
          "type": "depends-on",
          "display": "Value set US Core Health Concern Condition Category",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"
        },
        {
          "type": "depends-on",
          "display": "Value set Sickle Cell Diseases",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/sickle-cell-diseases"
        },
        {
          "type": "depends-on",
          "display": "Value set Active Condition",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-clinical-status-active"
        },
        {
          "type": "depends-on",
          "display": "Value set CDC malignant cancer conditions",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/cdc-malignant-cancer-conditions"
        },
        {
          "type": "depends-on",
          "display": "Value set Conditions likely terminal for opioid prescribing",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/conditions-likely-terminal-for-opioid-prescribing"
        },
        {
          "type": "depends-on",
          "display": "Value set Limited life expectancy conditions",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/limited-life-expectancy-conditions"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice Finding Codes",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-finding"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice Disposition",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-disposition"
        }
      ],
      "parameter": [
        {
          "name": "ContextPrescriptions",
          "use": "in",
          "min": 0,
          "max": "*",
          "type": "MedicationRequest"
        },
        {
          "name": "Is Recommendation Applicable?",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "boolean"
        }
      ],
      "dataRequirement": [
        {
          "type": "Medication",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Medication"
          ],
          "mustSupport": [
            "id",
            "code"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Patient"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "category",
            "code",
            "clinicalStatus"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "category",
            "code",
            "clinicalStatus",
            "encounter",
            "encounter.reference"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "category",
            "code",
            "clinicalStatus",
            "clinicalStatus.coding"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "period",
            "period.start",
            "id",
            "hospitalization",
            "hospitalization.dischargeDisposition",
            "hospitalization.dischargeDisposition.coding",
            "status",
            "status.value"
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/MedicationRequest"
          ],
          "mustSupport": [
            "authoredOn",
            "medication",
            "medication.reference",
            "id",
            "status",
            "intent",
            "category",
            "subject",
            "recorder",
            "dosageInstruction",
            "dispenseRequest",
            "status.value"
          ]
        },
        {
          "type": "MedicationDispense",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/MedicationDispense"
          ],
          "mustSupport": [
            "medication",
            "whenHandedOver",
            "status"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential"
            }
          ]
        },
        {
          "type": "MedicationDispense",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/MedicationDispense"
          ],
          "mustSupport": [
            "medication.reference",
            "whenHandedOver",
            "status"
          ]
        },
        {
          "type": "Observation",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/hospice-finding"
            }
          ]
        }
      ]
    }
  ],
  "extension": [
    {
      "url": "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode": "shareable"
    },
    {
      "url": "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode": "computable"
    },
    {
      "url": "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode": "executable"
    },
    {
      "url": "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode": "publishable"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSREC03"
        },
        {
          "url": "name",
          "valueString": "Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions"
        },
        {
          "url": "statement",
          "valueString": "define \"Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\":\n  ( Common.\"Is Opioid Analgesic with Ambulatory Misuse Potential?\"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription\n    where Routines.\"Is Subacute or Chronic Pain Prescription?\"( AmbulatoryOpioidPrescription )\n      and AmbulatoryOpioidPrescription.medication in Common.\"Extended release opioid with ambulatory misuse potential\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 0
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSREC03"
        },
        {
          "url": "name",
          "valueString": "Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential"
        },
        {
          "url": "statement",
          "valueString": "define \"Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential\":\n  exists( \"Chronic Pain Extended Release Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" )"
        },
        {
          "url": "displaySequence",
          "valueInteger": 1
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommonConfig"
        },
        {
          "url": "name",
          "valueString": "Age Less than 18 Years Is Enabled"
        },
        {
          "url": "statement",
          "valueString": "// CDC 2022 General Inclusion Criteria\ndefine \"Age Less than 18 Years Is Enabled\":\n  true"
        },
        {
          "url": "displaySequence",
          "valueInteger": 2
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Patient Age Less Than 18"
        },
        {
          "url": "statement",
          "valueString": "define \"Patient Age Less Than 18\":\n  if (Config.\"Age Less than 18 Years Is Enabled\") then\n    AgeInYearsAt(Today()) < 18\n  else false"
        },
        {
          "url": "displaySequence",
          "valueInteger": 3
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommonConfig"
        },
        {
          "url": "name",
          "valueString": "Sickle Cell Check Enabled"
        },
        {
          "url": "statement",
          "valueString": "// Sickle Cell\ndefine \"Sickle Cell Check Enabled\":\n  true"
        },
        {
          "url": "displaySequence",
          "valueInteger": 4
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommonConfig"
        },
        {
          "url": "name",
          "valueString": "Sickle Cell Assumed Active"
        },
        {
          "url": "statement",
          "valueString": "define \"Sickle Cell Assumed Active\":\n  true"
        },
        {
          "url": "displaySequence",
          "valueInteger": 5
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "US Core-Categorized Conditions"
        },
        {
          "url": "statement",
          "valueString": "// 3. Medications indicating end of life\n    /* or exists (\n      \"Medications Indicating End of Life\"\n    ) */\n\ndefine \"US Core-Categorized Conditions\":\n  [Condition: category in \"Encounter Diagnosis Condition Category\"]\n    union [Condition: category in \"Problem List Condition Category\"]\n    union [Condition: category in \"US Core Health Concern Condition Category\"]"
        },
        {
          "url": "displaySequence",
          "valueInteger": 6
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "Positive Sickle Cell Condition"
        },
        {
          "url": "statement",
          "valueString": "define \"Positive Sickle Cell Condition\":\n  if Config.\"Sickle Cell Check Enabled\" and not Config.\"Sickle Cell Assumed Active\"\n    then (\n      \"US Core-Categorized Conditions\" C\n        where C.code in \"Sickle Cell Diseases\"\n          and C.clinicalStatus in \"Active Condition\"\n    ) else if Config.\"Sickle Cell Check Enabled\" and Config.\"Sickle Cell Assumed Active\"\n        then (\n          \"US Core-Categorized Conditions\" C\n            where C.code in \"Sickle Cell Diseases\"\n        )\n      else null"
        },
        {
          "url": "displaySequence",
          "valueInteger": 7
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Condition Positive for Sickle Cell"
        },
        {
          "url": "statement",
          "valueString": "define \"Condition Positive for Sickle Cell\":\n  if (Config.\"Sickle Cell Check Enabled\") then\n    exists(\n      Common.\"Positive Sickle Cell Condition\"\n    ) \n  else false"
        },
        {
          "url": "displaySequence",
          "valueInteger": 8
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommonConfig"
        },
        {
          "url": "name",
          "valueString": "Active Cancer Treatment Encounters Condition Is Enabled"
        },
        {
          "url": "statement",
          "valueString": "// Active Cancer Treatment\ndefine \"Active Cancer Treatment Encounters Condition Is Enabled\":\n  true"
        },
        {
          "url": "displaySequence",
          "valueInteger": 9
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Encounter Period"
        },
        {
          "url": "statement",
          "valueString": "// End of Opioid Naive Routine\n\n/*\n**  Routine #3\n**  Active Cancer Treatment Routine\n**\n**  Definition                    | Answer to Proceed   | Details                                    | Data (Terminology) Requirement\n**  ---------------------------------------------------------------------------------------------------------------------------------\n**  Two office visits within the  | No                  | Look for a minimum of two distinct         | Office Visit\n**  past 12 months                |                     | encounters within 12 months of the date    |\n**                                |                     | of the current visit for which each of the |\n**                                |                     | following is true:                         |\n**                                |                     |   - the encounter diagnosis (primary or    |\n**                                |                     |     secondary or co-morbidity diagnosis)   |\n**                                |                     |     is listed in the CDC Malignant Cancer  |\n**                                |                     |     Conditions value set                   |\n**  ---------------------------------------------------------------------------------------------------------------------------------\n**  Office visits with an         | No                  | The encounter is performed by an           | Oncology specialty\n**  oncology specialist           |                     | oncologist as defined in the oncology      | designations (NUCC)\n**  present                       |                     | specialty designations using the           |\n**                                |                     | National Uniform Claim Committee           |\n**                                |                     | (NUCC) classifications                     |\n**  ---------------------------------------------------------------------------------------------------------------------------------\n**  Office visits including CDC   | No                  | The encounter diagnosis (primary or        | CDC malignant cancer\n**  malignant cancer              |                     | secondary or co-morbidity diagnosis)       | conditions\n**  condition                     |                     | is listed in the CDC Malignant Cancer      |\n**                                |                     | Conditions value set                       |\n**  ----------------------------------------------------------------------------------------------------------------------------------\n**\n*/\n\ndefine \"Encounter Period\":\n  Interval[Today() - 12 months, Today())"
        },
        {
          "url": "displaySequence",
          "valueInteger": 10
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "USCore Encounter Cancer Diagnoses"
        },
        {
          "url": "statement",
          "valueString": "define \"USCore Encounter Cancer Diagnoses\":\n  [Condition: category in \"Encounter Diagnosis Condition Category\"] CancerDiagnoses\n    where CancerDiagnoses.code in \"CDC malignant cancer conditions\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 11
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Encounters with Cancer Diagnosis During Encounter Period"
        },
        {
          "url": "statement",
          "valueString": "// encounter-diagnosis, problem-list and health-concern Conditions\n// define \"US Core-Categorized Cancer Diagnoses\":\n//   Common.\"US Core-Categorized Conditions\" C\n//     where C.code in Common.\"CDC malignant cancer conditions\"\n\n// define \"Encounters with Cancer Diagnosis During Encounter Period\":\n//   [Encounter] Encounter\n//     with \"US Core-Categorized Cancer Diagnoses\" CancerDiagnosis\n//     such that date from Encounter.period.\"start\".value in day of \"Encounter Period\"\n//       and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id)\n\ndefine \"Encounters with Cancer Diagnosis During Encounter Period\":\n  [Encounter] Encounters\n    where date from Encounters.period.\"start\" in day of \"Encounter Period\"\n      and exists (\n        Common.\"USCore Encounter Cancer Diagnoses\" CancerDiagnoses\n          where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id)\n      )"
        },
        {
          "url": "displaySequence",
          "valueInteger": 12
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Number of Encounters with Cancer Diagnosis During Encounter Period"
        },
        {
          "url": "statement",
          "valueString": "define \"Number of Encounters with Cancer Diagnosis During Encounter Period\":\n  Count (\"Encounters with Cancer Diagnosis During Encounter Period\")"
        },
        {
          "url": "displaySequence",
          "valueInteger": 13
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Has Two or More Encounters with Cancer Diagnosis During Encounter Period"
        },
        {
          "url": "statement",
          "valueString": "define \"Has Two or More Encounters with Cancer Diagnosis During Encounter Period\":\n  \"Number of Encounters with Cancer Diagnosis During Encounter Period\" >= 2"
        },
        {
          "url": "displaySequence",
          "valueInteger": 14
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "USCore Problem List Cancer Diagnoses"
        },
        {
          "url": "statement",
          "valueString": "define \"USCore Problem List Cancer Diagnoses\":\n  [Condition: category in \"Problem List Condition Category\"] CancerDiagnoses\n    where CancerDiagnoses.code in \"CDC malignant cancer conditions\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 15
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Has Active Cancer Diagnosis on Problem List"
        },
        {
          "url": "statement",
          "valueString": "define \"Has Active Cancer Diagnosis on Problem List\":\n  exists (\n    Common.\"USCore Problem List Cancer Diagnoses\" CancerDiagnoses\n      where CancerDiagnoses.category in Common.\"Problem List Condition Category\"\n        and exists(\n          CancerDiagnoses.clinicalStatus.coding ClinicalStatus\n            where ClinicalStatus.code ~ 'active'\n        )\n  )"
        },
        {
          "url": "displaySequence",
          "valueInteger": 16
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Is Active Cancer Treatment?"
        },
        {
          "url": "statement",
          "valueString": "define \"Is Active Cancer Treatment?\":\n  if (Config.\"Active Cancer Treatment Encounters Condition Is Enabled\") \n    then \"Has Two or More Encounters with Cancer Diagnosis During Encounter Period\"\n      or \"Has Active Cancer Diagnosis on Problem List\"\n  else false"
        },
        {
          "url": "displaySequence",
          "valueInteger": 17
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommonConfig"
        },
        {
          "url": "name",
          "valueString": "End-Stage Disease Criteria Enabled"
        },
        {
          "url": "statement",
          "valueString": "// CDC 2022 General Inclusion Criteria\ndefine \"End-Stage Disease Criteria Enabled\":\n  true"
        },
        {
          "url": "displaySequence",
          "valueInteger": 18
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Conditions Likely Terminal for Opioid Prescribing"
        },
        {
          "url": "statement",
          "valueString": "define \"Conditions Likely Terminal for Opioid Prescribing\":\n  if (Config.\"End-Stage Disease Criteria Enabled\") then\n    exists (\n      Common.\"US Core-Categorized Conditions\" EOLC\n        where EOLC.code in Common.\"Conditions likely terminal for opioid prescribing\"\n          // and EOLC.clinicalStatus in Common.\"Active Condition\"\n    )\n  else false"
        },
        {
          "url": "displaySequence",
          "valueInteger": 19
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "CDC 2022 Guideline General Inclusion Criteria"
        },
        {
          "url": "statement",
          "valueString": "define \"CDC 2022 Guideline General Inclusion Criteria\":\n  not \"Patient Age Less Than 18\"\n    and not \"Condition Positive for Sickle Cell\"\n    and not \"Is Active Cancer Treatment?\"\n    and not \"Conditions Likely Terminal for Opioid Prescribing\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 20
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommonConfig"
        },
        {
          "url": "name",
          "valueString": "Opioid Naive Prescription Condition Is Enabled"
        },
        {
          "url": "statement",
          "valueString": "// Opioid Naive\ndefine \"Opioid Naive Prescription Condition Is Enabled\":\n  true"
        },
        {
          "url": "displaySequence",
          "valueInteger": 21
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommonConfig"
        },
        {
          "url": "name",
          "valueString": "Can the implementing EHR support queries for past medications by date range?"
        },
        {
          "url": "statement",
          "valueString": "// Subroutine 2 - Past Medications\ndefine \"Can the implementing EHR support queries for past medications by date range?\":\n  true"
        },
        {
          "url": "displaySequence",
          "valueInteger": 22
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "Active Ambulatory Opioid Rx"
        },
        {
          "url": "statement",
          "valueString": "define \"Active Ambulatory Opioid Rx\":\n    if Config.\"Can the implementing EHR support queries for past medications by date range?\" then\n      (\n        \"Get MedicationRequest Medication as Code\"(\"Get Active Ambulatory Medication Requests\"([MedicationRequest]))\n      ) Rx\n        where date from Rx.authoredOn 2 years or less on or before Today()\n          and Rx.medication in \"Opioid analgesics with ambulatory misuse potential\"\n    else\n        List<FHIR.MedicationRequest>{}"
        },
        {
          "url": "displaySequence",
          "valueInteger": 23
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Prescription/Dispense Inclusion Period"
        },
        {
          "url": "statement",
          "valueString": "// End of CDC 2022 General Inclusion Criteria Routine\n\n/*\n**  Routine #2\n**  Opioid Naive Routine\n**\n**  Definition                    | Answer to Proceed   | Details                                           | Data (Terminology) Requirement\n**  ----------------------------------------------------------------------------------------------------------------------------------------\n**  Opioid analgesics with        | No                  | Look for an existing prescription (order) for     | Opioid analgesics with\n**  ambulatory misuse potential   |                     | opioid that is in the value set for opioid with   | ambulatory misuse potential\n**  prescription in past 90 days  |                     | ambulatory abuse potential authored               |\n**  excluding the previous 24     |                     | within the past 90 days (excluding previous 24    |\n**  hours                         |                     | hours)                                            |\n**  ----------------------------------------------------------------------------------------------------------------------------------------\n**  Opioid analgesics with        | No                  | Look for evidence of active medication on         | Opioid analgesics with\n**  ambulatory misuse potential   |                     | the medication list that is in the value set      | ambulatory misuse potential\n**  reported in past 90 days      |                     | for opioid with ambulatory care abuse             |\n**  excluding previous 24 hours*  |                     | potential                                         |\n**  ----------------------------------------------------------------------------------------------------------------------------------------\n**  Opioid analgesics with        | No                  | Look for evidence of a dispensing event for       | Opioid analgesics with\n**  ambulatory misuse potential   |                     | medication that is in the value set for opioid    | ambulatory misuse potential\n**  dispensing event in past 90   |                     | with ambulatory use potential occurring           |\n**  days excluding previous 24    |                     | within the past 90 days (excluding previous 24    |\n**  hours                         |                     | hours)                                            |\n**  ----------------------------------------------------------------------------------------------------------------------------------------\n**  *Future consideration: Current algorithm addresses only orders (prescriptions).\n**\n**  Note – orders use RxNorm, but medication lists and dispensed medication will\n**  require an NDC value set and/or local mapping of NDC to RxNorm to enable this element\n**\n*/\n\ndefine \"Prescription/Dispense Inclusion Period\":\n  Interval[Now() - 90 days, Now() - 24 hours]"
        },
        {
          "url": "displaySequence",
          "valueInteger": 24
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Opioid RX with Ambulatory Abuse Potential In Past 90 Days"
        },
        {
          "url": "statement",
          "valueString": "define \"Opioid RX with Ambulatory Abuse Potential In Past 90 Days\":\n  Common.\"Active Ambulatory Opioid Rx\" Rx\n      where Rx.authoredOn during day of \"Prescription/Dispense Inclusion Period\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 25
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days"
        },
        {
          "url": "statement",
          "valueString": "define \"Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days\":\n    if (Config.\"Opioid Naive Prescription Condition Is Enabled\") then\n      exists (\"Opioid RX with Ambulatory Abuse Potential In Past 90 Days\")\n    else false"
        },
        {
          "url": "displaySequence",
          "valueInteger": 26
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days"
        },
        {
          "url": "statement",
          "valueString": "// NOTE: 2020-02-05: Review direction of MedicationStatement resource (US-Core focusing on MedicationRequest i/o Statement)\n// NOTE: 2020-04-21: MedicationStatement a) Shouldn't be use since guidance/direction from USCore is targeting MedicationUse in R5, and b) Breaks in the publisher\n/* define \"Reports of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days\":\n    [MedicationStatement: Common.\"Opioid analgesics with ambulatory misuse potential\"] Statement\n        where Statement.status in {'active', 'completed'}\n            and Statement.effective during day of \"Report Inclusion Period\" */\n\n/* define \"Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days\":\n    Config.\"Opioid Naive Report Condition Is Enabled\"\n        and exists (\"Reports of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days\") */\n\ndefine \"Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days\":\n    [MedicationDispense: Common.\"Opioid analgesics with ambulatory misuse potential\"] OpioidDispense\n        where OpioidDispense.whenHandedOver during day of \"Prescription/Dispense Inclusion Period\"\n            and OpioidDispense.status = 'completed'"
        },
        {
          "url": "displaySequence",
          "valueInteger": 27
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days"
        },
        {
          "url": "statement",
          "valueString": "define \"Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days\":\n  if (Config.\"Opioid Naive Prescription Condition Is Enabled\") then\n    exists (\"Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days\")\n  else false"
        },
        {
          "url": "displaySequence",
          "valueInteger": 28
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Is Opioid Naive?"
        },
        {
          "url": "statement",
          "valueString": "// NOTE: MedicationStatement-dependent logic comment out due to bug in Publisher not supporting MedicationStatement in AllTypes.\ndefine \"Is Opioid Naive?\":\n    not (\"Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days\")\n    /* and not (\"Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days\") */\n    and not (\"Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days\")"
        },
        {
          "url": "displaySequence",
          "valueInteger": 29
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSREC03"
        },
        {
          "url": "name",
          "valueString": "Inclusion Criteria"
        },
        {
          "url": "statement",
          "valueString": "define \"Inclusion Criteria\":\n  \"Patient Is Being Prescribed Extended Release Opioid Analgesic with Ambulatory Misuse Potential\"\n      and Routines.\"CDC 2022 Guideline General Inclusion Criteria\"\n      and Routines.\"Is Opioid Naive?\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 30
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "Conditions Indicating End of Life or With Limited Life Expectancy"
        },
        {
          "url": "statement",
          "valueString": "define \"Conditions Indicating End of Life or With Limited Life Expectancy\":\n  (\n    \"US Core-Categorized Conditions\" C\n      where C.code in \"Conditions likely terminal for opioid prescribing\"\n        and C.clinicalStatus in \"Active Condition\"\n  )\n  union\n  (\n    \"US Core-Categorized Conditions\" C\n      where C.code in \"Limited life expectancy conditions\"\n        and C.clinicalStatus in \"Active Condition\"\n  )"
        },
        {
          "url": "displaySequence",
          "valueInteger": 31
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommonConfig"
        },
        {
          "url": "name",
          "valueString": "Hospice Findings Exclusion Enabled"
        },
        {
          "url": "statement",
          "valueString": "// OpioidCDSCommon\ndefine \"Hospice Findings Exclusion Enabled\":\n  false"
        },
        {
          "url": "displaySequence",
          "valueInteger": 32
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "Admitted/Referred/Discharged to Hospice Care"
        },
        {
          "url": "statement",
          "valueString": "define \"Admitted/Referred/Discharged to Hospice Care\":\n  (\n    if (Config.\"Hospice Findings Exclusion Enabled\") then\n      [Observation: code in \"Hospice Finding Codes\"] O\n        where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })\n    else\n      {}\n  )\n  union\n  (\n    [Encounter] E\n      where date from E.period.start 1 year or less on or before Today()\n        and (\n          if E.hospitalization.dischargeDisposition.coding is null\n              or not exists (E.hospitalization.dischargeDisposition.coding)\n            then false\n          else E.hospitalization.dischargeDisposition in \"Hospice Disposition\"\n        )\n        and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }\n  )"
        },
        {
          "url": "displaySequence",
          "valueInteger": 33
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "End of Life Assessment"
        },
        {
          "url": "statement",
          "valueString": "define \"End of Life Assessment\":\n    // 1. Conditions indicating end of life or with limited life expectancy\n    exists (\n      \"Conditions Indicating End of Life or With Limited Life Expectancy\"\n    )\n    // 2. Admitted/referred/discharged to hospice care\n    or exists (\n      \"Admitted/Referred/Discharged to Hospice Care\"\n    )"
        },
        {
          "url": "displaySequence",
          "valueInteger": 34
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSREC03"
        },
        {
          "url": "name",
          "valueString": "Exclusion Criteria"
        },
        {
          "url": "statement",
          "valueString": "define \"Exclusion Criteria\":\n  Common.\"End of Life Assessment\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 35
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSREC03"
        },
        {
          "url": "name",
          "valueString": "Is Recommendation Applicable?"
        },
        {
          "url": "statement",
          "valueString": "define \"Is Recommendation Applicable?\":\n  \"Inclusion Criteria\"\n    and not \"Exclusion Criteria\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 36
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "Is Opioid Analgesic with Ambulatory Misuse Potential?"
        },
        {
          "url": "statement",
          "valueString": "define function \"Is Opioid Analgesic with Ambulatory Misuse Potential?\"(value List<MedicationRequest>):\n  (\"Get MedicationRequest Medication as Code\"(value)) Rx\n    where Rx.medication in \"Opioid analgesics with ambulatory misuse potential\" \n      and Rx.category in \"Community\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 37
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "Get MedicationRequest Medication as Code"
        },
        {
          "url": "statement",
          "valueString": "define function \"Get MedicationRequest Medication as Code\"(value List<MedicationRequest>):\n  value Rx\n    let Med: \n      if Rx.medication is Reference then singleton from (\n        [Medication] M\n          where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))\n      ) else null\n    return \n      MedicationRequest {\n        id: Rx.id,\n        status: Rx.status,\n        intent: Rx.intent,\n        category: Rx.category,\n        medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,\n        subject: Rx.subject,\n        authoredOn: Rx.authoredOn,\n        recorder: Rx.recorder,\n        dosageInstruction: Rx.dosageInstruction,\n        dispenseRequest: Rx.dispenseRequest\n      }"
        },
        {
          "url": "displaySequence",
          "valueInteger": 38
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "FHIRHelpers"
        },
        {
          "url": "name",
          "valueString": "ToString"
        },
        {
          "url": "statement",
          "valueString": "define function ToString(value string): value.value"
        },
        {
          "url": "displaySequence",
          "valueInteger": 39
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "FHIRHelpers"
        },
        {
          "url": "name",
          "valueString": "ToConcept"
        },
        {
          "url": "statement",
          "valueString": "define function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
        },
        {
          "url": "displaySequence",
          "valueInteger": 40
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "FHIRHelpers"
        },
        {
          "url": "name",
          "valueString": "ToCode"
        },
        {
          "url": "statement",
          "valueString": "define function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
        },
        {
          "url": "displaySequence",
          "valueInteger": 41
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Is Subacute or Chronic Pain Prescription?"
        },
        {
          "url": "statement",
          "valueString": "// End of Active Cancer Treatment Routine\n\n/*\n**  Routine #4\n**  For Subacute or Chronic Pain Routine\n**\n**  Definition                  | Answer to Proceed   | Details                                        | Data (Terminology) Requirement\n**  -----------------------------------------------------------------------------------------------------------------------------------\n**  Order for opioid analgesic  | Yes                 | Order for opioid analgesics with ambulatory    | Opioid analgesics with\n**  with expected supply        |                     | misuse potential with a supply duration of >=  | ambulatory misuse potential\n**  duration >= 28 days         |                     | 28 days                                        |\n**                              |                     |                                                |\n**                              |                     | - Subacute definition = order for opioid       |\n**                              |                     |   analgesics with ambulatory misuse            |\n**                              |                     |   potential with a supply duration of one to   |\n**                              |                     |   two months.                                  |\n**                              |                     | - Chronic pain definition = order for opioid   |\n**                              |                     |   analgesics with ambulatory misuse            |\n**                              |                     |   potential with a supply duration of >= two   |\n**                              |                     |   months.                                      |\n**  -----------------------------------------------------------------------------------------------------------------------------------\n**\n*/\n\ndefine function \"Is Subacute or Chronic Pain Prescription?\"(prescription FHIR.MedicationRequest):\n  \"Is Subacute or Chronic Pain Using Expected Supply Duration\"(prescription)\n    or \"Is Subacute or Chronic Pain Using Validity Period\"(prescription)"
        },
        {
          "url": "displaySequence",
          "valueInteger": 42
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Is Subacute or Chronic Pain Using Expected Supply Duration"
        },
        {
          "url": "statement",
          "valueString": "define function \"Is Subacute or Chronic Pain Using Expected Supply Duration\"(prescription FHIR.MedicationRequest):\n  (\n    prescription.dispenseRequest is not null\n      and prescription.dispenseRequest.expectedSupplyDuration is not null\n      and (\n        Common.GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration) >= 28 days \n      )\n  )"
        },
        {
          "url": "displaySequence",
          "valueInteger": 43
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "GetDurationInDays"
        },
        {
          "url": "statement",
          "valueString": "define function GetDurationInDays(value FHIR.Duration):\n  if value is null then null\n  else\n    case\n      when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' }\n      when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' }\n      when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' }\n      when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' }\n      when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' }\n      when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' }\n      when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' }\n      when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' }\n      when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null')\n      else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value)\nend"
        },
        {
          "url": "displaySequence",
          "valueInteger": 44
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSRoutines"
        },
        {
          "url": "name",
          "valueString": "Is Subacute or Chronic Pain Using Validity Period"
        },
        {
          "url": "statement",
          "valueString": "define function \"Is Subacute or Chronic Pain Using Validity Period\"(prescription FHIR.MedicationRequest):\n  (\n    prescription.dispenseRequest is not null\n      and prescription.dispenseRequest.validityPeriod is not null\n      and (\n        days between prescription.dispenseRequest.validityPeriod.start and prescription.dispenseRequest.validityPeriod.end >= 28 \n      )\n  )"
        },
        {
          "url": "displaySequence",
          "valueInteger": 45
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "FHIRHelpers"
        },
        {
          "url": "name",
          "valueString": "ToDateTime"
        },
        {
          "url": "statement",
          "valueString": "define function ToDateTime(value dateTime): value.value"
        },
        {
          "url": "displaySequence",
          "valueInteger": 46
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSCommon"
        },
        {
          "url": "name",
          "valueString": "Get Active Ambulatory Medication Requests"
        },
        {
          "url": "statement",
          "valueString": "define function \"Get Active Ambulatory Medication Requests\" (value List<MedicationRequest>) returns List<MedicationRequest>:\n  value Rx\n    where Rx.status.value = 'active'\n      and Rx.category in \"Community\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 47
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "FHIRHelpers"
        },
        {
          "url": "name",
          "valueString": "ToString"
        },
        {
          "url": "statement",
          "valueString": "define function ToString(value MedicationDispenseStatus): value.value"
        },
        {
          "url": "displaySequence",
          "valueInteger": 48
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "id": "effective-data-requirements",
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
      "valueCanonical": "#effective-data-requirements"
    },
    {
      "url": "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
      "valueReference": {
        "reference": "Device/cqf-tooling"
      }
    }
  ],
  "url": "http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-03",
  "identifier": [
    {
      "use": "official",
      "value": "cdc-opioid-guidance"
    }
  ],
  "version": "2022.1.0",
  "name": "PlanDefinition_Recommendation_03_Order_Sign",
  "title": "Recommendation #3 - Opioid Immediate Release Form When Starting Opioid Therapy",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/plan-definition-type",
        "code": "eca-rule",
        "display": "ECA Rule"
      }
    ]
  },
  "status": "draft",
  "experimental": true,
  "date": "2025-08-06",
  "publisher": "Centers for Disease Control and Prevention (CDC)",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.cdc.gov"
        }
      ]
    }
  ],
  "description": "When starting opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release and long-acting (ER/LA) opioids.",
  "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)"
          }
        ]
      }
    },
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "focus",
        "display": "Clinical Focus"
      },
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://snomed.info/sct",
            "code": "274663001",
            "display": "Acute pain (finding)"
          }
        ]
      }
    },
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "focus",
        "display": "Clinical Focus"
      },
      "valueCodeableConcept": {
        "text": "Subacute pain"
      }
    }
  ],
  "purpose": "The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.",
  "usage": "Clinicians should not treat acute pain with ER/LA opioids or initiate opioid treatment for subacute or chronic pain with extended-release and long-acting (ER/LA) opioids, and clinicians should not prescribe ER/LA opioids for intermittent or as-needed use.",
  "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": "2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain",
      "url": "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm",
      "document": {
        "url": "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm"
      }
    }
  ],
  "library": [
    "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC03"
  ],
  "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": "very-low",
                "display": "Very Low quality"
              }
            ]
          }
        }
      ],
      "title": "When Initiating Opioid Therapy, Utilize Immediate Release Opioids",
      "description": "Recommend prescribing immediate release opioids instead of extended-release or long-acting opioids\r\n\r\n[For guidance regarding prescribing extended release/ long-acting opioids, see Recommendation 3 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation3).",
      "priority": "urgent",
      "trigger": [
        {
          "type": "named-event",
          "name": "order-sign"
        }
      ],
      "condition": [
        {
          "kind": "applicability",
          "expression": {
            "description": "Check whether the current order is for an extended-release opioid with ambulatory misuse potential, the patient is opioid naive and if the 2022 CDC guideline general inclusion criteria is met",
            "language": "text/cql.identifier",
            "expression": "Is Recommendation Applicable?"
          }
        }
      ],
      "groupingBehavior": "visual-group",
      "selectionBehavior": "any",
      "action": [
        {
          "description": "Document - Will prescribe immediate release opioid"
        },
        {
          "description": "Snooze* - Benefits outweigh risks, snooze 3 months"
        },
        {
          "description": "Snooze* N/A see comment, snooze 3 months"
        }
      ]
    }
  ]
}