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Resource PlanDefinition/FHIR Server from package fhir.cdc.opioid-cds-r4#current (125 ms)

Package fhir.cdc.opioid-cds-r4
Type PlanDefinition
Id Id
FHIR Version R4
Source http://fhir.org/guides/cdc/opioid-cds/https://build.fhir.org/ig/cqframework/opioid-cds-r4/PlanDefinition-opioidcds-02.html
Url http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-02
Version 2022.1.0
Status draft
Date 2025-04-24
Name PlanDefinition_Recommendation_02_Order_Sign
Title Recommendation #2 - Opioid Therapy Goals Discussion
Experimental True
Realm us
Authority hl7
Description Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.
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+.

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Narrative

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Id: opioidcds-02
Url: Recommendation #2 - Opioid Therapy Goals Discussion
Version: 2022.1.0
Identifier:

value: cdc-opioid-guidance

Name: PlanDefinition_Recommendation_02_Order_Sign
Title: Recommendation #2 - Opioid Therapy Goals Discussion
Status: draft
Experimental: true
Type:

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

code: eca-rule

display: ECA Rule

Date: 2025-04-24
Publisher: Centers for Disease Control and Prevention (CDC)
Description: Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.
Logic Definitions:
Library NameNamesequence
OpioidCDSREC02 Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0 
define "Chronic Pain 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 )


Library NameNamesequence
OpioidCDSREC02 Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential 1 
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
  exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )


Library NameNamesequence
OpioidCDSRoutines Patient Age Less Than 18 2 
define "Patient Age Less Than 18":
  if (Config."Age Less than 18 Years Is Enabled") then
    AgeInYearsAt(Today()) < 18
  else false


Library NameNamesequence
OpioidCDSRoutines Condition Positive for Sickle Cell 3 
define "Condition Positive for Sickle Cell":
  if (Config."Sickle Cell Check Enabled") then
    exists(
      Common."Positive Sickle Cell Condition"
    ) 
  else false


Library NameNamesequence
OpioidCDSRoutines Is Active Cancer Treatment? 4 
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
OpioidCDSRoutines Conditions Likely Terminal for Opioid Prescribing 5 
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 Is Opioid Review Useful? 6 
define "Is Opioid Review Useful?":
  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
OpioidCDSRoutines Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days 7 
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 Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days 8 
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? 9 
// 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
OpioidCDSCommonConfig Opioid Treatment Plan Verification Enabled 10 
// Recommendation 2
define "Opioid Treatment Plan Verification Enabled":
  true


Library NameNamesequence
OpioidCDSREC02 Treatment Plan Lookback Period 11 
define "Treatment Plan Lookback Period":
  Interval[Today() - 90 days, Today()]


Library NameNamesequence
OpioidCDSREC02 Opioid Treatment Plan Creation or Update in Past 90 Days 12 
define "Opioid Treatment Plan Creation or Update in Past 90 Days":
  [CarePlan: category in Common."Pain treatment plan"] PainTreatmentPlan
    where PainTreatmentPlan.status in { 'active', 'completed' }
      and (
        FHIRHelpers.ToDateTime( PainTreatmentPlan.created ) during day of "Treatment Plan Lookback Period"
          or PainTreatmentPlan.meta.lastUpdated during day of "Treatment Plan Lookback Period"
      )
      and exists(
        "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions".recorder Recorder
          where Recorder ~ PainTreatmentPlan.author
      )


Library NameNamesequence
OpioidCDSREC02 Had Opioid Treatment Plan Reviewed in Past 90 Days 13 
define "Had Opioid Treatment Plan Reviewed in Past 90 Days":
  exists (
    [Procedure: Common."Pain management procedure"] PainManagementProcedure
      where PainManagementProcedure.performed during day of "Treatment Plan Lookback Period"
        and exists (
          PainManagementProcedure.performer Performer
            with "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ChronicPainScript
            such that Performer.actor ~ ChronicPainScript.recorder
        )
  )


Library NameNamesequence
OpioidCDSREC02 No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days? 14 
define "No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?":
  Config."Opioid Treatment Plan Verification Enabled"
    and not (
      exists ( "Opioid Treatment Plan Creation or Update in Past 90 Days" )
        or "Had Opioid Treatment Plan Reviewed in Past 90 Days"
    )


Library NameNamesequence
OpioidCDSREC02 Inclusion Criteria 15 
define "Inclusion Criteria":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
    and Routines."Is Opioid Review Useful?"
    and Routines."Is Opioid Naive?"
    and "No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?"


Library NameNamesequence
OpioidCDSREC02 Is Recommendation Applicable? 16 
define "Is Recommendation Applicable?":
  "Inclusion Criteria"


Library NameNamesequence
OpioidCDSCommon Is Opioid Analgesic with Ambulatory Misuse Potential? 17 
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 18 
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 ToConcept 19 
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
OpioidCDSRoutines Is Subacute or Chronic Pain Prescription? 20 
// 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 21 
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 22 
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 23 
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 24 
define function ToDateTime(value dateTime): value.value


Library NameNamesequence
FHIRHelpers ToString 25 
define function ToString(value CarePlanStatus): value.value
Knowledge Capability: shareable computable executable publishable
Use Context:
codevaluedisplay
focus 182888003 Medication requested (situation)
focus 82423001 Chronic 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: Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.
Copyright:

© CDC 2016+.
Related Artifacts:

Documentation
Libraries:
Library - Recommendation #2 - Opioid Therapy Goals Discussion
Actions:
Maximize Nonopioid Therapies as Appropriate: For many types of subacute and chronic pain, consider maximizing the use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate. [Recommendation 2 of the CDC 2022 Clinical Prescribing Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation2) provides nonopioid therapy recommendations for common subacute and acute pain conditions. **Nonopioid Pharmacological Therapy** - [Back pain (chronic, moderate to severe)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20moderate%20to%20severe%20chronic%20back%20pain%20or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74)) - [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=In%20patients%20with%20fibromyalgia%2C%20multiple,effectiveness%20is%20limited%20(8).) - [Hip or knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74).) - [Neuropathic pain syndromes](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Tricyclic%20antidepressants%2C%20SNRI%20antidepressants%2C%20selected%20anticonvulsants%2C%20or%20transdermal%20lidocaine%20are%20recommended%20for%20neuropathic%20pain%20syndromes%20(e.g.%2C%20diabetic%20neuropathy%20or%20postherpetic%20neuralgia)%20(156).) - [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%20that%20is%20not%20sufficiently%20improved%20with%20nonpharmacologic%20interventions%2C%20NSAIDs%20can%20be%20effective%20(179%2C180).) **Nonpharmacologic Treatments** - [Back pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20recommend%20appropriate%20noninvasive%20nonpharmacologic%20approaches%20to%20help%20manage%20chronic%20pain%2C%20such%20as%20exercise%20(e.g.%2C%20aerobic%2C%20aquatic%2C%20or%20resistance%20exercises)%20or%20exercise%20therapy%20(a%20prominent%20modality%20in%20physical%20therapy)%20for%20back%20pain) - [Back pain (low back, chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=loss%20for%20knee%20osteoarthritis%3B%20manual%20therapies%20for%20hip%20osteoarthritis%3B-,psychological%20therapy%2C%20spinal%20manipulation%2C%20low%2Dlevel%20laser%20therapy%2C%20massage%2C%20mindfulness%2Dbased%20stress%20reduction%2C%20yoga%2C%20acupuncture%2C%20and%20multidisciplinary%20rehabilitation%20for%20low%20back%20pain,-%3B%20mind%2Dbody%20practices%20(e.g.%2C%20yoga%2C%20tai%20chi%2C%20or) - [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=massage%2C%20and%20acupuncture%20for%20neck%20pain%3B%20cognitive-,behavioral%20therapy%2C%20myofascial%20release%20massage%2C%20mindfulness%20practices%2C%20tai%20chi%2C%20qigong%2C%20acupuncture%2C%20and%20multidisciplinary%20rehabilitation%20for%20fibromyalgia,-%3B%20and%20spinal%20manipulation%20for%20tension%20headache%20() - [Headache (tension)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=and%20spinal%20manipulation%20for%20tension%20headache.) - [Knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Many%20noninvasive%20nonpharmacologic,for%20hip%20osteoarthritis%3B) - [Neck pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=mind%2Dbody%20practices%20(e.g.%2C%20yoga%2C%20tai%20chi%2C%20or%20qigong)%2C%20massage%2C%20and%20acupuncture%20for%20neck%20pain%3B) - [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%2C%20patient%20education%20and%20self%2Dcare%20can%20be%20effective%2C%20as%20can%20occlusal%20splints%20for%20some%20patients%20and%20biobehavioral%20therapy%20for%20prevention%20of%20disabling%20symptoms%20(172%2C173).)
When: Named Event: order-sign
If: Applicability: Check whether the current order is for an opioid with ambulatory misuse potential, a pain treatment plan has been established or edited within the past 90 days, a pain management procedure occurred within the past 90 days, the patient is opioid naive and if an opioid review is appropriate for the patient (Is Recommendation Applicable?)
Then:
: Document - Collaborated with patient to identify treatment goals
Then:
: Snooze* - Attempting alternate therapy, snooze 3 months
Then:
: Order - Select alternative therapies from order select
Then:
: Snooze* - N/A see comment, snooze 3 months
Then:
: Remove - Will remove triggering medication order
Then:

Source

{
  "resourceType" : "PlanDefinition",
  "id" : "opioidcds-02",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition",
      "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n        <tr>\n            <th scope=\"row\"><b>Id: </b></th>\n            <td style=\"padding-left: 4px;\">opioidcds-02</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Url: </b></th>\n            <td style=\"padding-left: 4px;\"><a href=\"PlanDefinition-opioidcds-02.html\">Recommendation #2 - Opioid Therapy Goals Discussion</a></td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Version: </b></th>\n            <td style=\"padding-left: 4px;\">2022.1.0</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Identifier: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                <p style=\"margin-bottom: 5px;\">\n                    <b>value: </b> <span>cdc-opioid-guidance</span>\n                </p>\n                \n            </td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Name: </b></th>\n            <td style=\"padding-left: 4px;\">PlanDefinition_Recommendation_02_Order_Sign</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Title: </b></th>\n            <td style=\"padding-left: 4px;\">Recommendation #2 - Opioid Therapy Goals Discussion</td>\n        </tr>\n        \n        \n        \n        <tr>\n            <th scope=\"row\"><b>Status: </b></th>\n            <td style=\"padding-left: 4px;\">draft</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Experimental: </b></th>\n            <td style=\"padding-left: 4px;\">true</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Type: </b></th>\n            <td style=\"padding-left: 4px;\">\n                \n                    \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>system: </b> <span><a href=\"http://terminology.hl7.org/6.4.0/CodeSystem-plan-definition-type.html\">http://terminology.hl7.org/CodeSystem/plan-definition-type</a></span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>code: </b> <span>eca-rule</span>\n                        </p>\n                        \n                        \n                        <p style=\"margin-bottom: 5px;\">\n                            <b>display: </b> <span>ECA Rule</span>\n                        </p>\n                        \n                    \n                \n                \n            </td>\n        </tr>\n        \n        \n        \n        <tr>\n            <th scope=\"row\"><b>Date: </b></th>\n            <td style=\"padding-left: 4px;\">2025-04-24</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Publisher: </b></th>\n            <td style=\"padding-left: 4px;\">Centers for Disease Control and Prevention (CDC)</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Description: </b></th>\n            <td style=\"padding-left: 4px;\">Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.</td>\n        </tr>\n        \n        \n            <tr>\n                <th scope=\"row\"><a name=\"effective-data-requirements\"> </a><b>Logic Definitions: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSREC02</td>\n                                \n                                \n                                    <td>Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions</td>\n                                \n                                \n                                    <td>0</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot;:\n  ( Common.&quot;Is Opioid Analgesic with Ambulatory Misuse Potential?&quot;( ContextPrescriptions ) ) AmbulatoryOpioidPrescription\n    where Routines.&quot;Is Subacute or Chronic Pain Prescription?&quot;( AmbulatoryOpioidPrescription )</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSREC02</td>\n                                \n                                \n                                    <td>Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential</td>\n                                \n                                \n                                    <td>1</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential&quot;:\n  exists( &quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot; )</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Patient Age Less Than 18</td>\n                                \n                                \n                                    <td>2</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Patient Age Less Than 18&quot;:\n  if (Config.&quot;Age Less than 18 Years Is Enabled&quot;) then\n    AgeInYearsAt(Today()) &lt; 18\n  else false</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Condition Positive for Sickle Cell</td>\n                                \n                                \n                                    <td>3</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Condition Positive for Sickle Cell&quot;:\n  if (Config.&quot;Sickle Cell Check Enabled&quot;) then\n    exists(\n      Common.&quot;Positive Sickle Cell Condition&quot;\n    ) \n  else false</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Is Active Cancer Treatment?</td>\n                                \n                                \n                                    <td>4</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Is Active Cancer Treatment?&quot;:\n  if (Config.&quot;Active Cancer Treatment Encounters Condition Is Enabled&quot;) \n    then &quot;Has Two or More Encounters with Cancer Diagnosis During Encounter Period&quot;\n      or &quot;Has Active Cancer Diagnosis on Problem List&quot;\n  else false</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Conditions Likely Terminal for Opioid Prescribing</td>\n                                \n                                \n                                    <td>5</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Conditions Likely Terminal for Opioid Prescribing&quot;:\n  if (Config.&quot;End-Stage Disease Criteria Enabled&quot;) then\n    exists (\n      Common.&quot;US Core-Categorized Conditions&quot; EOLC\n        where EOLC.code in Common.&quot;Conditions likely terminal for opioid prescribing&quot;\n          // and EOLC.clinicalStatus in Common.&quot;Active Condition&quot;\n    )\n  else false</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Is Opioid Review Useful?</td>\n                                \n                                \n                                    <td>6</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Is Opioid Review Useful?&quot;:\n  not &quot;Patient Age Less Than 18&quot;\n    and not &quot;Condition Positive for Sickle Cell&quot;\n    and not &quot;Is Active Cancer Treatment?&quot;\n    and not &quot;Conditions Likely Terminal for Opioid Prescribing&quot;</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days</td>\n                                \n                                \n                                    <td>7</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days&quot;:\n    if (Config.&quot;Opioid Naive Prescription Condition Is Enabled&quot;) then\n      exists (&quot;Opioid RX with Ambulatory Abuse Potential In Past 90 Days&quot;)\n    else false</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days</td>\n                                \n                                \n                                    <td>8</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days&quot;:\n  if (Config.&quot;Opioid Naive Prescription Condition Is Enabled&quot;) then\n    exists (&quot;Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days&quot;)\n  else false</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Is Opioid Naive?</td>\n                                \n                                \n                                    <td>9</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// NOTE: MedicationStatement-dependent logic comment out due to bug in Publisher not supporting MedicationStatement in AllTypes.\ndefine &quot;Is Opioid Naive?&quot;:\n    not (&quot;Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days&quot;)\n    /* and not (&quot;Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days&quot;) */\n    and not (&quot;Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days&quot;)</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSCommonConfig</td>\n                                \n                                \n                                    <td>Opioid Treatment Plan Verification Enabled</td>\n                                \n                                \n                                    <td>10</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// Recommendation 2\ndefine &quot;Opioid Treatment Plan Verification Enabled&quot;:\n  true</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSREC02</td>\n                                \n                                \n                                    <td>Treatment Plan Lookback Period</td>\n                                \n                                \n                                    <td>11</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Treatment Plan Lookback Period&quot;:\n  Interval[Today() - 90 days, Today()]</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSREC02</td>\n                                \n                                \n                                    <td>Opioid Treatment Plan Creation or Update in Past 90 Days</td>\n                                \n                                \n                                    <td>12</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Opioid Treatment Plan Creation or Update in Past 90 Days&quot;:\n  [CarePlan: category in Common.&quot;Pain treatment plan&quot;] PainTreatmentPlan\n    where PainTreatmentPlan.status in { 'active', 'completed' }\n      and (\n        FHIRHelpers.ToDateTime( PainTreatmentPlan.created ) during day of &quot;Treatment Plan Lookback Period&quot;\n          or PainTreatmentPlan.meta.lastUpdated during day of &quot;Treatment Plan Lookback Period&quot;\n      )\n      and exists(\n        &quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot;.recorder Recorder\n          where Recorder ~ PainTreatmentPlan.author\n      )</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSREC02</td>\n                                \n                                \n                                    <td>Had Opioid Treatment Plan Reviewed in Past 90 Days</td>\n                                \n                                \n                                    <td>13</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Had Opioid Treatment Plan Reviewed in Past 90 Days&quot;:\n  exists (\n    [Procedure: Common.&quot;Pain management procedure&quot;] PainManagementProcedure\n      where PainManagementProcedure.performed during day of &quot;Treatment Plan Lookback Period&quot;\n        and exists (\n          PainManagementProcedure.performer Performer\n            with &quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot; ChronicPainScript\n            such that Performer.actor ~ ChronicPainScript.recorder\n        )\n  )</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSREC02</td>\n                                \n                                \n                                    <td>No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?</td>\n                                \n                                \n                                    <td>14</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?&quot;:\n  Config.&quot;Opioid Treatment Plan Verification Enabled&quot;\n    and not (\n      exists ( &quot;Opioid Treatment Plan Creation or Update in Past 90 Days&quot; )\n        or &quot;Had Opioid Treatment Plan Reviewed in Past 90 Days&quot;\n    )</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSREC02</td>\n                                \n                                \n                                    <td>Inclusion Criteria</td>\n                                \n                                \n                                    <td>15</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Inclusion Criteria&quot;:\n  &quot;Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential&quot;\n    and Routines.&quot;Is Opioid Review Useful?&quot;\n    and Routines.&quot;Is Opioid Naive?&quot;\n    and &quot;No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?&quot;</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSREC02</td>\n                                \n                                \n                                    <td>Is Recommendation Applicable?</td>\n                                \n                                \n                                    <td>16</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Is Recommendation Applicable?&quot;:\n  &quot;Inclusion Criteria&quot;</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSCommon</td>\n                                \n                                \n                                    <td>Is Opioid Analgesic with Ambulatory Misuse Potential?</td>\n                                \n                                \n                                    <td>17</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Is Opioid Analgesic with Ambulatory Misuse Potential?&quot;(value List&lt;MedicationRequest&gt;):\n  (&quot;Get MedicationRequest Medication as Code&quot;(value)) Rx\n    where Rx.medication in &quot;Opioid analgesics with ambulatory misuse potential&quot; \n      and Rx.category in &quot;Community&quot;</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSCommon</td>\n                                \n                                \n                                    <td>Get MedicationRequest Medication as Code</td>\n                                \n                                \n                                    <td>18</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Get MedicationRequest Medication as Code&quot;(value List&lt;MedicationRequest&gt;):\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      }</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>FHIRHelpers</td>\n                                \n                                \n                                    <td>ToConcept</td>\n                                \n                                \n                                    <td>19</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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        }</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Is Subacute or Chronic Pain Prescription?</td>\n                                \n                                \n                                    <td>20</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// 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 &gt;=  | ambulatory misuse potential\n**  duration &gt;= 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 &gt;= two   |\n**                              |                     |   months.                                      |\n**  -----------------------------------------------------------------------------------------------------------------------------------\n**\n*/\n\ndefine function &quot;Is Subacute or Chronic Pain Prescription?&quot;(prescription FHIR.MedicationRequest):\n  &quot;Is Subacute or Chronic Pain Using Expected Supply Duration&quot;(prescription)\n    or &quot;Is Subacute or Chronic Pain Using Validity Period&quot;(prescription)</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Is Subacute or Chronic Pain Using Expected Supply Duration</td>\n                                \n                                \n                                    <td>21</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Is Subacute or Chronic Pain Using Expected Supply Duration&quot;(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) &gt;= 28 days \n      )\n  )</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSCommon</td>\n                                \n                                \n                                    <td>GetDurationInDays</td>\n                                \n                                \n                                    <td>22</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>OpioidCDSRoutines</td>\n                                \n                                \n                                    <td>Is Subacute or Chronic Pain Using Validity Period</td>\n                                \n                                \n                                    <td>23</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Is Subacute or Chronic Pain Using Validity Period&quot;(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 &gt;= 28 \n      )\n  )</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>FHIRHelpers</td>\n                                \n                                \n                                    <td>ToDateTime</td>\n                                \n                                \n                                    <td>24</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function ToDateTime(value dateTime): value.value</code></pre>\n                        \n                        <br/><br/>\n                    \n                        <table class=\"grid-dict\">\n                            <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n                            <tr>\n                                \n                                    <td>FHIRHelpers</td>\n                                \n                                \n                                    <td>ToString</td>\n                                \n                                \n                                    <td>25</td>\n                                \n                            </tr>\n                        </table>\n                        \n                            <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function ToString(value CarePlanStatus): value.value</code></pre>\n                        \n                        <br/><br/>\n                    \n                </td>\n            </tr>\n        \n        \n        <tr>\n          <th scope=\"row\"><b>Knowledge Capability: </b></th>\n          <td style=\"padding-left: 4px;\">\n            shareable computable executable publishable \n          </td>\n        </tr>\n        \n        \n        \n        <tr>\n            <th scope=\"row\"><b>Use Context: </b></th>\n            <td style=\"padding-left: 4px;\">\n                <table class=\"grid-dict\">\n                    <tr><th><b>code</b></th><th><b>value</b></th><th><b>display</b></th></tr>\n                    \n                      <tr>\n                        <td>focus</td>\n                        <td>182888003</td>\n                        <td>Medication requested (situation)</td>\n                      </tr>\n                    \n                      <tr>\n                        <td>focus</td>\n                        <td>82423001</td>\n                        <td>Chronic pain (finding)</td>\n                      </tr>\n                    \n                      <tr>\n                        <td>focus</td>\n                        <td/>\n                        <td/>\n                      </tr>\n                    \n                </table>\n            </td>\n        </tr>\n        \n        \n        \n        <tr>\n            <th scope=\"row\"><b>Purpose: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>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.</p>\n</div></td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Usage: </b></th>\n            <td style=\"padding-left: 4px;\">Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.</td>\n        </tr>\n        \n        \n        <tr>\n            <th scope=\"row\"><b>Copyright: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>© CDC 2016+.</p>\n</div></td>\n        </tr>\n        \n        \n        \n        \n        \n        \n        <tr>\n          <th scope=\"row\"><b>Related Artifacts: </b></th>\n          <td style=\"padding-left: 4px;\">\n            \n            <p><b>Documentation</b></p>\n            <ul>\n              \n                  <li>\n                    <a href=\"https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm\"> 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain</a>\n                  </li>\n              \n            </ul>\n            \n            \n            \n            \n            \n            \n            \n          </td>\n        </tr>\n        \n\n        \n        <tr>\n          <th scope=\"row\"><b>Libraries: </b></th>\n          <td style=\"padding-left: 4px;\">\n            <table class=\"grid-dict\">\n              \n                <tr><td><a href=\"Library-OpioidCDSREC02.html\">Library - Recommendation #2 - Opioid Therapy Goals Discussion</a></td></tr>\n              \n            </table>\n          </td>\n        </tr>\n        \n\n        \n        <tr>\n          <th scope=\"row\"><b>Actions: </b></th>\n          <td style=\"padding-left: 4px;\">\n            <table class=\"grid-dict\">\n              \n                <tr>\n                  <td>\n                    <b> Maximize Nonopioid Therapies as Appropriate:</b> For many types of subacute and chronic pain, consider maximizing the use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate.\r\n\r\n[Recommendation 2 of the CDC 2022 Clinical Prescribing Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation2) provides nonopioid therapy recommendations for common subacute and acute pain conditions.\r\n\r\n**Nonopioid Pharmacological Therapy**\r\n- [Back pain (chronic, moderate to severe)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20moderate%20to%20severe%20chronic%20back%20pain%20or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74))\r\n- [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=In%20patients%20with%20fibromyalgia%2C%20multiple,effectiveness%20is%20limited%20(8).)\r\n- [Hip or knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74).)\r\n- [Neuropathic pain syndromes](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Tricyclic%20antidepressants%2C%20SNRI%20antidepressants%2C%20selected%20anticonvulsants%2C%20or%20transdermal%20lidocaine%20are%20recommended%20for%20neuropathic%20pain%20syndromes%20(e.g.%2C%20diabetic%20neuropathy%20or%20postherpetic%20neuralgia)%20(156).)\r\n- [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%20that%20is%20not%20sufficiently%20improved%20with%20nonpharmacologic%20interventions%2C%20NSAIDs%20can%20be%20effective%20(179%2C180).)\r\n\r\n**Nonpharmacologic Treatments**\r\n- [Back pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20recommend%20appropriate%20noninvasive%20nonpharmacologic%20approaches%20to%20help%20manage%20chronic%20pain%2C%20such%20as%20exercise%20(e.g.%2C%20aerobic%2C%20aquatic%2C%20or%20resistance%20exercises)%20or%20exercise%20therapy%20(a%20prominent%20modality%20in%20physical%20therapy)%20for%20back%20pain)\r\n- [Back pain (low back, chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=loss%20for%20knee%20osteoarthritis%3B%20manual%20therapies%20for%20hip%20osteoarthritis%3B-,psychological%20therapy%2C%20spinal%20manipulation%2C%20low%2Dlevel%20laser%20therapy%2C%20massage%2C%20mindfulness%2Dbased%20stress%20reduction%2C%20yoga%2C%20acupuncture%2C%20and%20multidisciplinary%20rehabilitation%20for%20low%20back%20pain,-%3B%20mind%2Dbody%20practices%20(e.g.%2C%20yoga%2C%20tai%20chi%2C%20or)\r\n- [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=massage%2C%20and%20acupuncture%20for%20neck%20pain%3B%20cognitive-,behavioral%20therapy%2C%20myofascial%20release%20massage%2C%20mindfulness%20practices%2C%20tai%20chi%2C%20qigong%2C%20acupuncture%2C%20and%20multidisciplinary%20rehabilitation%20for%20fibromyalgia,-%3B%20and%20spinal%20manipulation%20for%20tension%20headache%20()\r\n- [Headache (tension)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=and%20spinal%20manipulation%20for%20tension%20headache.)\r\n- [Knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Many%20noninvasive%20nonpharmacologic,for%20hip%20osteoarthritis%3B)\r\n- [Neck pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=mind%2Dbody%20practices%20(e.g.%2C%20yoga%2C%20tai%20chi%2C%20or%20qigong)%2C%20massage%2C%20and%20acupuncture%20for%20neck%20pain%3B)\r\n- [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%2C%20patient%20education%20and%20self%2Dcare%20can%20be%20effective%2C%20as%20can%20occlusal%20splints%20for%20some%20patients%20and%20biobehavioral%20therapy%20for%20prevention%20of%20disabling%20symptoms%20(172%2C173).)<br/>\n                    <b>When:</b> <i>Named Event:</i> order-sign<br/>\n                    <b>If:</b> <i>Applicability:</i> Check whether the current order is for an opioid with ambulatory misuse potential, a pain treatment plan has been established or edited within the past 90 days, a pain management procedure occurred within the past 90 days, the patient is opioid naive and if an opioid review is appropriate for the patient <i>(Is Recommendation Applicable?)</i><br/>\n                    <b>Then:</b>\n                    \n                      <table class=\"grid-dict\">\n                        \n                          <tr>\n                            <td>\n                              <b> :</b> Document - Collaborated with patient to identify treatment goals<br/>\n                              \n                              \n                              <b>Then:</b>\n                              \n                                \n                                \n                              \n                            </td>\n                          </tr>\n                        \n                          <tr>\n                            <td>\n                              <b> :</b> Snooze* - Attempting alternate therapy, snooze 3 months<br/>\n                              \n                              \n                              <b>Then:</b>\n                              \n                                \n                                \n                              \n                            </td>\n                          </tr>\n                        \n                          <tr>\n                            <td>\n                              <b> :</b> Order - Select alternative therapies from order select<br/>\n                              \n                              \n                              <b>Then:</b>\n                              \n                                \n                                \n                              \n                            </td>\n                          </tr>\n                        \n                          <tr>\n                            <td>\n                              <b> :</b> Snooze* - N/A see comment, snooze 3 months<br/>\n                              \n                              \n                              <b>Then:</b>\n                              \n                                \n                                \n                              \n                            </td>\n                          </tr>\n                        \n                          <tr>\n                            <td>\n                              <b> :</b> Remove - Will remove triggering medication order<br/>\n                              \n                              \n                              <b>Then:</b>\n                              \n                                \n                                \n                              \n                            </td>\n                          </tr>\n                        \n                      </table>\n                    \n                  </td>\n                </tr>\n              \n            </table>\n          </td>\n        </tr>\n        \n    </table>\n</div>"
  },
  "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 Pain treatment plan",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-treatment-plan"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Pain management procedure",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-management-procedure"
        }
      ],
      "parameter" : [
        {
          "name" : "ContextPrescriptions",
          "use" : "in",
          "min" : 0,
          "max" : "*",
          "type" : "MedicationRequest"
        },
        {
          "name" : "Is Recommendation Applicable?",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        }
      ],
      "dataRequirement" : [
        {
          "type" : "CarePlan",
          "profile" : [
            "http://hl7.org/fhir/StructureDefinition/CarePlan"
          ],
          "mustSupport" : [
            "category",
            "status",
            "created",
            "meta",
            "meta.lastUpdated",
            "author"
          ],
          "codeFilter" : [
            {
              "path" : "category",
              "valueSet" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-treatment-plan"
            }
          ]
        },
        {
          "type" : "Procedure",
          "profile" : [
            "http://hl7.org/fhir/StructureDefinition/Procedure"
          ],
          "mustSupport" : [
            "code",
            "performed",
            "performer"
          ],
          "codeFilter" : [
            {
              "path" : "code",
              "valueSet" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pain-management-procedure"
            }
          ]
        }
      ]
    }
  ],
  "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" : "OpioidCDSREC02"
        },
        {
          "url" : "name",
          "valueString" : "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Chronic Pain 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 )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 0
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC02"
        },
        {
          "url" : "name",
          "valueString" : "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential\":\n  exists( \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 1
        }
      ],
      "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" : 2
        }
      ],
      "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" : 3
        }
      ],
      "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" : 4
        }
      ],
      "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" : 5
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Is Opioid Review Useful?"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Is Opioid Review Useful?\":\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" : 6
        }
      ],
      "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" : 7
        }
      ],
      "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" : 8
        }
      ],
      "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" : 9
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommonConfig"
        },
        {
          "url" : "name",
          "valueString" : "Opioid Treatment Plan Verification Enabled"
        },
        {
          "url" : "statement",
          "valueString" : "// Recommendation 2\ndefine \"Opioid Treatment Plan Verification Enabled\":\n  true"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 10
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC02"
        },
        {
          "url" : "name",
          "valueString" : "Treatment Plan Lookback Period"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Treatment Plan Lookback Period\":\n  Interval[Today() - 90 days, Today()]"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 11
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC02"
        },
        {
          "url" : "name",
          "valueString" : "Opioid Treatment Plan Creation or Update in Past 90 Days"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Opioid Treatment Plan Creation or Update in Past 90 Days\":\n  [CarePlan: category in Common.\"Pain treatment plan\"] PainTreatmentPlan\n    where PainTreatmentPlan.status in { 'active', 'completed' }\n      and (\n        FHIRHelpers.ToDateTime( PainTreatmentPlan.created ) during day of \"Treatment Plan Lookback Period\"\n          or PainTreatmentPlan.meta.lastUpdated during day of \"Treatment Plan Lookback Period\"\n      )\n      and exists(\n        \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\".recorder Recorder\n          where Recorder ~ PainTreatmentPlan.author\n      )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 12
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC02"
        },
        {
          "url" : "name",
          "valueString" : "Had Opioid Treatment Plan Reviewed in Past 90 Days"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Had Opioid Treatment Plan Reviewed in Past 90 Days\":\n  exists (\n    [Procedure: Common.\"Pain management procedure\"] PainManagementProcedure\n      where PainManagementProcedure.performed during day of \"Treatment Plan Lookback Period\"\n        and exists (\n          PainManagementProcedure.performer Performer\n            with \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" ChronicPainScript\n            such that Performer.actor ~ ChronicPainScript.recorder\n        )\n  )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 13
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC02"
        },
        {
          "url" : "name",
          "valueString" : "No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?"
        },
        {
          "url" : "statement",
          "valueString" : "define \"No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?\":\n  Config.\"Opioid Treatment Plan Verification Enabled\"\n    and not (\n      exists ( \"Opioid Treatment Plan Creation or Update in Past 90 Days\" )\n        or \"Had Opioid Treatment Plan Reviewed in Past 90 Days\"\n    )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 14
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC02"
        },
        {
          "url" : "name",
          "valueString" : "Inclusion Criteria"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Inclusion Criteria\":\n  \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential\"\n    and Routines.\"Is Opioid Review Useful?\"\n    and Routines.\"Is Opioid Naive?\"\n    and \"No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 15
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC02"
        },
        {
          "url" : "name",
          "valueString" : "Is Recommendation Applicable?"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Is Recommendation Applicable?\":\n  \"Inclusion Criteria\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 16
        }
      ],
      "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" : 17
        }
      ],
      "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" : 18
        }
      ],
      "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" : 19
        }
      ],
      "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" : 20
        }
      ],
      "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" : 21
        }
      ],
      "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" : 22
        }
      ],
      "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" : 23
        }
      ],
      "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" : 24
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "FHIRHelpers"
        },
        {
          "url" : "name",
          "valueString" : "ToString"
        },
        {
          "url" : "statement",
          "valueString" : "define function ToString(value CarePlanStatus): value.value"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 25
        }
      ],
      "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-02",
  "identifier" : [
    {
      "use" : "official",
      "value" : "cdc-opioid-guidance"
    }
  ],
  "version" : "2022.1.0",
  "name" : "PlanDefinition_Recommendation_02_Order_Sign",
  "title" : "Recommendation #2 - Opioid Therapy Goals Discussion",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
        "code" : "eca-rule",
        "display" : "ECA Rule"
      }
    ]
  },
  "status" : "draft",
  "experimental" : true,
  "date" : "2025-04-24",
  "publisher" : "Centers for Disease Control and Prevention (CDC)",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.cdc.gov"
        }
      ]
    }
  ],
  "description" : "Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.",
  "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" : {
        "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" : "Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.",
  "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/OpioidCDSREC02"
  ],
  "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" : "moderate",
                "display" : "Moderate quality"
              }
            ]
          }
        }
      ],
      "title" : "Maximize Nonopioid Therapies as Appropriate",
      "description" : "For many types of subacute and chronic pain, consider maximizing the use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate.\r\n\r\n[Recommendation 2 of the CDC 2022 Clinical Prescribing Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation2) provides nonopioid therapy recommendations for common subacute and acute pain conditions.\r\n\r\n**Nonopioid Pharmacological Therapy**\r\n- [Back pain (chronic, moderate to severe)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20moderate%20to%20severe%20chronic%20back%20pain%20or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74))\r\n- [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=In%20patients%20with%20fibromyalgia%2C%20multiple,effectiveness%20is%20limited%20(8).)\r\n- [Hip or knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74).)\r\n- [Neuropathic pain syndromes](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Tricyclic%20antidepressants%2C%20SNRI%20antidepressants%2C%20selected%20anticonvulsants%2C%20or%20transdermal%20lidocaine%20are%20recommended%20for%20neuropathic%20pain%20syndromes%20(e.g.%2C%20diabetic%20neuropathy%20or%20postherpetic%20neuralgia)%20(156).)\r\n- [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%20that%20is%20not%20sufficiently%20improved%20with%20nonpharmacologic%20interventions%2C%20NSAIDs%20can%20be%20effective%20(179%2C180).)\r\n\r\n**Nonpharmacologic Treatments**\r\n- [Back pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20recommend%20appropriate%20noninvasive%20nonpharmacologic%20approaches%20to%20help%20manage%20chronic%20pain%2C%20such%20as%20exercise%20(e.g.%2C%20aerobic%2C%20aquatic%2C%20or%20resistance%20exercises)%20or%20exercise%20therapy%20(a%20prominent%20modality%20in%20physical%20therapy)%20for%20back%20pain)\r\n- [Back pain (low back, chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=loss%20for%20knee%20osteoarthritis%3B%20manual%20therapies%20for%20hip%20osteoarthritis%3B-,psychological%20therapy%2C%20spinal%20manipulation%2C%20low%2Dlevel%20laser%20therapy%2C%20massage%2C%20mindfulness%2Dbased%20stress%20reduction%2C%20yoga%2C%20acupuncture%2C%20and%20multidisciplinary%20rehabilitation%20for%20low%20back%20pain,-%3B%20mind%2Dbody%20practices%20(e.g.%2C%20yoga%2C%20tai%20chi%2C%20or)\r\n- [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=massage%2C%20and%20acupuncture%20for%20neck%20pain%3B%20cognitive-,behavioral%20therapy%2C%20myofascial%20release%20massage%2C%20mindfulness%20practices%2C%20tai%20chi%2C%20qigong%2C%20acupuncture%2C%20and%20multidisciplinary%20rehabilitation%20for%20fibromyalgia,-%3B%20and%20spinal%20manipulation%20for%20tension%20headache%20()\r\n- [Headache (tension)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=and%20spinal%20manipulation%20for%20tension%20headache.)\r\n- [Knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Many%20noninvasive%20nonpharmacologic,for%20hip%20osteoarthritis%3B)\r\n- [Neck pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=mind%2Dbody%20practices%20(e.g.%2C%20yoga%2C%20tai%20chi%2C%20or%20qigong)%2C%20massage%2C%20and%20acupuncture%20for%20neck%20pain%3B)\r\n- [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%2C%20patient%20education%20and%20self%2Dcare%20can%20be%20effective%2C%20as%20can%20occlusal%20splints%20for%20some%20patients%20and%20biobehavioral%20therapy%20for%20prevention%20of%20disabling%20symptoms%20(172%2C173).)",
      "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, a pain treatment plan has been established or edited within the past 90 days, a pain management procedure occurred within the past 90 days, the patient is opioid naive and if an opioid review is appropriate for the patient",
            "language" : "text/cql.identifier",
            "expression" : "Is Recommendation Applicable?"
          }
        }
      ],
      "groupingBehavior" : "visual-group",
      "selectionBehavior" : "any",
      "action" : [
        {
          "description" : "Document - Collaborated with patient to identify treatment goals"
        },
        {
          "description" : "Snooze* - Attempting alternate therapy, snooze 3 months"
        },
        {
          "description" : "Order - Select alternative therapies from order select"
        },
        {
          "description" : "Snooze* - N/A see comment, snooze 3 months"
        },
        {
          "description" : "Remove - Will remove triggering medication order"
        }
      ]
    }
  ]
}

XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.