FHIR IG Statistics: PlanDefinition/opioidcds-06
| Package | fhir.cdc.opioid-cds-r4 |
| Resource Type | PlanDefinition |
| Id | opioidcds-06 |
| FHIR Version | R4 |
| Source | http://fhir.org/guides/cdc/opioid-cds/https://build.fhir.org/ig/cqframework/opioid-cds-r4/PlanDefinition-opioidcds-06.html |
| URL | http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-06 |
| Version | 2022.1.0 |
| Status | draft |
| Date | 2025-08-06 |
| Name | PlanDefinition_Recommendation_06_Order_Sign |
| Title | Recommendation #6 - Prescribe Lowest Effective Dose and Duration |
| Realm | us |
| Authority | hl7 |
| Description | When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. |
| 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. |
| Copyright | © CDC 2016+. |
Resources that use this resource
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Narrative
Note: links and images are rebased to the (stated) source
| Id: |
opioidcds-06 |
| Url: |
Recommendation #6 - Prescribe Lowest Effective Dose and Duration |
| Version: |
2022.1.0 |
| Identifier: |
value: cdc-opioid-guidance
|
| Name: |
PlanDefinition_Recommendation_06_Order_Sign |
| Title: |
Recommendation #6 - Prescribe Lowest Effective Dose and Duration |
| 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 opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. |
| Logic Definitions: |
| Library Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions |
0 |
define "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription )
and Routines."Acute Pain Prescription Greater Than 7 Days?"(AmbulatoryOpioidPrescription)
| Library Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain |
1 |
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain":
exists( "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )
| Library Name | Name | sequence |
|---|
| OpioidCDSCommonConfig |
Age Less than 18 Years Is Enabled |
2 |
// CDC 2022 General Inclusion Criteria
define "Age Less than 18 Years Is Enabled":
true
| Library Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| OpioidCDSCommonConfig |
Sickle Cell Check Enabled |
4 |
// Sickle Cell
define "Sickle Cell Check Enabled":
true
| Library Name | Name | sequence |
|---|
| OpioidCDSCommonConfig |
Sickle Cell Assumed Active |
5 |
define "Sickle Cell Assumed Active":
true
| Library Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| OpioidCDSCommonConfig |
Active Cancer Treatment Encounters Condition Is Enabled |
9 |
// Active Cancer Treatment
define "Active Cancer Treatment Encounters Condition Is Enabled":
true
| Library Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| OpioidCDSCommonConfig |
End-Stage Disease Criteria Enabled |
18 |
// CDC 2022 General Inclusion Criteria
define "End-Stage Disease Criteria Enabled":
true
| Library Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Order is for Long-Acting Opioid |
21 |
define "Order is for Long-Acting Opioid":
exists (
"Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" AmbulatoryOpioidPrescription
where AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential"
or Common.GetDurationInDays( AmbulatoryOpioidPrescription.dispenseRequest.expectedSupplyDuration ) > 7 days
)
| Library Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Inclusion Criteria |
22 |
define "Inclusion Criteria":
"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain"
and Routines."CDC 2022 Guideline General Inclusion Criteria"
and "Order is for Long-Acting Opioid"
| Library Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Exclusion Criteria |
23 |
define "Exclusion Criteria":
false
| Library Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Is Recommendation Applicable? |
24 |
define "Is Recommendation Applicable?":
"Inclusion Criteria"
and not "Exclusion Criteria"
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Is Opioid Analgesic with Ambulatory Misuse Potential? |
25 |
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 Name | Name | sequence |
|---|
| OpioidCDSCommon |
Get MedicationRequest Medication as Code |
26 |
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 Name | Name | sequence |
|---|
| FHIRHelpers |
ToString |
27 |
define function ToString(value string): value.value
| Library Name | Name | sequence |
|---|
| FHIRHelpers |
ToConcept |
28 |
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 Name | Name | sequence |
|---|
| FHIRHelpers |
ToCode |
29 |
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 Name | Name | sequence |
|---|
| OpioidCDSRoutines |
Is Acute Pain Prescription? |
30 |
// End of For Subacute or Chronic Pain Routine
/*
** Routine #5
** For Acute Pain Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** -----------------------------------------------------------------------------------------------------------------------------------
** Order for opioid analgesics | Yes | Look for an existing prescription (order) for | Opioid analgesics with
** with ambulatory misuse | | opioid analgesics with ambulatory abuse | ambulatory misuse potential
** potential of duration < 28 | | potential of duration < 28 days |
** days | | |
** -----------------------------------------------------------------------------------------------------------------------------------
**
*/
// should allow DateTime precision, but not working in the Ruler specifically
define function "Is Acute Pain Prescription?"(prescription FHIR.MedicationRequest):
prescription.dispenseRequest is not null
and prescription.dispenseRequest.expectedSupplyDuration is not null
and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
GetDurationInDays |
31 |
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 Name | Name | sequence |
|---|
| OpioidCDSRoutines |
Acute Pain Prescription Greater Than 7 Days? |
32 |
// should allow DateTime precision, but not working in the Ruler specifically
define function "Acute Pain Prescription Greater Than 7 Days?"(prescription FHIR.MedicationRequest):
prescription.dispenseRequest is not null
and prescription.dispenseRequest.expectedSupplyDuration is not null
and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) > 7 days
and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days
| Library Name | Name | sequence |
|---|
| FHIRHelpers |
ToDateTime |
33 |
define function ToDateTime(value dateTime): value.value
|
| Knowledge Capability: |
shareable computable executable publishable
|
| Use Context: |
| code | value | display |
|---|
| focus |
182888003 |
Medication requested (situation) |
| focus |
274663001 |
Acute pain (finding) |
|
| 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: |
When the diagnosis and severity of acute pain warrant use of opioids, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. For many common causes of nontraumatic, nonsurgical pain, when opioids are needed, a few days or less are often sufficient, and shorter courses can minimize the need to taper opioids to prevent withdrawal symptoms at the end of a course of opioids. However, durations should be individualized to the patient's clinical circumstances. |
| Copyright: |
|
| Related Artifacts: |
Documentation
|
| Libraries: |
|
| Actions: |
When Treating Acute Pain, Prescribe No More Opioids Than Needed: Please verify that the opioid order quantity and duration are no more than needed for the expected duration of pain severe enough to require opioids.
For guidance regarding prescribing opioids for acute pain, see [Recommendation 6 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation6).
When: Named Event: order-sign
If: Applicability: Check whether the current order is for an opioid with ambulatory misuse potential for acute pain with an intended duration of more than 7 days and if the 2022 CDC guideline general inclusion criteria is met (Is Recommendation Applicable?)
Then:
: Document - Will adjust opioid order
Then:
|
: Snooze* - Benefits of opioid therapy duration outweigh risks, snooze 3 months
Then:
|
: Snooze* - N/A see comment, snooze 3 months
Then:
|
|
|
Source
{
"resourceType": "PlanDefinition",
"id": "opioidcds-06",
"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",
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"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 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 Extended release opioid with ambulatory misuse potential",
"resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/extended-release-opioid-with-ambulatory-misuse-potential"
}
],
"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": [
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],
"mustSupport": [
"id",
"code"
]
},
{
"type": "Patient",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Patient"
]
},
{
"type": "Condition",
"profile": [
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],
"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": [
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],
"mustSupport": [
"category",
"code",
"clinicalStatus",
"encounter",
"encounter.reference"
],
"codeFilter": [
{
"path": "category",
"valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"
}
]
},
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],
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],
"codeFilter": [
{
"path": "category",
"valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"
}
]
},
{
"type": "Encounter",
"profile": [
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],
"mustSupport": [
"period",
"period.start",
"id"
]
}
]
}
],
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"valueCode": "shareable"
},
{
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"valueCode": "computable"
},
{
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},
{
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"valueCode": "publishable"
},
{
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"valueString": "OpioidCDSREC06"
},
{
"url": "name",
"valueString": "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions"
},
{
"url": "statement",
"valueString": "define \"Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\":\n ( Common.\"Is Opioid Analgesic with Ambulatory Misuse Potential?\"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription\n where Routines.\"Is Acute Pain Prescription?\"( AmbulatoryOpioidPrescription )\n and Routines.\"Acute Pain Prescription Greater Than 7 Days?\"(AmbulatoryOpioidPrescription)"
},
{
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"valueInteger": 0
}
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},
{
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},
{
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},
{
"url": "statement",
"valueString": "define \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain\":\n exists( \"Acute Pain 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": "OpioidCDSREC06"
},
{
"url": "name",
"valueString": "Order is for Long-Acting Opioid"
},
{
"url": "statement",
"valueString": "define \"Order is for Long-Acting Opioid\":\n exists (\n \"Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" AmbulatoryOpioidPrescription\n where AmbulatoryOpioidPrescription.medication in Common.\"Extended release opioid with ambulatory misuse potential\"\n or Common.GetDurationInDays( AmbulatoryOpioidPrescription.dispenseRequest.expectedSupplyDuration ) > 7 days\n )"
},
{
"url": "displaySequence",
"valueInteger": 21
}
],
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "OpioidCDSREC06"
},
{
"url": "name",
"valueString": "Inclusion Criteria"
},
{
"url": "statement",
"valueString": "define \"Inclusion Criteria\":\n \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain\"\n and Routines.\"CDC 2022 Guideline General Inclusion Criteria\"\n and \"Order is for Long-Acting Opioid\""
},
{
"url": "displaySequence",
"valueInteger": 22
}
],
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "OpioidCDSREC06"
},
{
"url": "name",
"valueString": "Exclusion Criteria"
},
{
"url": "statement",
"valueString": "define \"Exclusion Criteria\":\n false"
},
{
"url": "displaySequence",
"valueInteger": 23
}
],
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "OpioidCDSREC06"
},
{
"url": "name",
"valueString": "Is Recommendation Applicable?"
},
{
"url": "statement",
"valueString": "define \"Is Recommendation Applicable?\":\n \"Inclusion Criteria\"\n and not \"Exclusion Criteria\""
},
{
"url": "displaySequence",
"valueInteger": 24
}
],
"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": 25
}
],
"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": 26
}
],
"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": 27
}
],
"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": 28
}
],
"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": 29
}
],
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "OpioidCDSRoutines"
},
{
"url": "name",
"valueString": "Is Acute Pain Prescription?"
},
{
"url": "statement",
"valueString": "// End of For Subacute or Chronic Pain Routine\n\n/*\n** Routine #5\n** For Acute Pain Routine\n**\n** Definition | Answer to Proceed | Details | Data (Terminology) Requirement\n** -----------------------------------------------------------------------------------------------------------------------------------\n** Order for opioid analgesics | Yes | Look for an existing prescription (order) for | Opioid analgesics with\n** with ambulatory misuse | | opioid analgesics with ambulatory abuse | ambulatory misuse potential\n** potential of duration < 28 | | potential of duration < 28 days |\n** days | | |\n** -----------------------------------------------------------------------------------------------------------------------------------\n**\n*/\n\n// should allow DateTime precision, but not working in the Ruler specifically\ndefine function \"Is Acute Pain Prescription?\"(prescription FHIR.MedicationRequest):\n prescription.dispenseRequest is not null\n and prescription.dispenseRequest.expectedSupplyDuration is not null\n and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days"
},
{
"url": "displaySequence",
"valueInteger": 30
}
],
"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": 31
}
],
"url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension": [
{
"url": "libraryName",
"valueString": "OpioidCDSRoutines"
},
{
"url": "name",
"valueString": "Acute Pain Prescription Greater Than 7 Days?"
},
{
"url": "statement",
"valueString": "// should allow DateTime precision, but not working in the Ruler specifically\ndefine function \"Acute Pain Prescription Greater Than 7 Days?\"(prescription FHIR.MedicationRequest):\n prescription.dispenseRequest is not null\n and prescription.dispenseRequest.expectedSupplyDuration is not null\n and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) > 7 days\n and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days"
},
{
"url": "displaySequence",
"valueInteger": 32
}
],
"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": 33
}
],
"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-06",
"identifier": [
{
"use": "official",
"value": "cdc-opioid-guidance"
}
],
"version": "2022.1.0",
"name": "PlanDefinition_Recommendation_06_Order_Sign",
"title": "Recommendation #6 - Prescribe Lowest Effective Dose and Duration",
"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 opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require 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": "274663001",
"display": "Acute pain (finding)"
}
]
}
}
],
"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": "When the diagnosis and severity of acute pain warrant use of opioids, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. For many common causes of nontraumatic, nonsurgical pain, when opioids are needed, a few days or less are often sufficient, and shorter courses can minimize the need to taper opioids to prevent withdrawal symptoms at the end of a course of opioids. However, durations should be individualized to the patient's clinical circumstances.",
"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/OpioidCDSREC06"
],
"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 Treating Acute Pain, Prescribe No More Opioids Than Needed",
"description": "Please verify that the opioid order quantity and duration are no more than needed for the expected duration of pain severe enough to require opioids.\r\n\r\nFor guidance regarding prescribing opioids for acute pain, see [Recommendation 6 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation6).",
"priority": "urgent",
"trigger": [
{
"type": "named-event",
"name": "order-sign"
}
],
"condition": [
{
"kind": "applicability",
"expression": {
"description": "Check whether the current order is for an opioid with ambulatory misuse potential for acute pain with an intended duration of more than 7 days 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 adjust opioid order"
},
{
"description": "Snooze* - Benefits of opioid therapy duration outweigh risks, snooze 3 months"
},
{
"description": "Snooze* - N/A see comment, snooze 3 months"
}
]
}
]
}
FHIR