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-06.html |
| Url | http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-06 |
| Version | 2022.1.0 |
| Status | draft |
| Date | 2025-04-24 |
| Name | PlanDefinition_Recommendation_06_Order_Sign |
| Title | Recommendation #6 - Prescribe Lowest Effective Dose and Duration |
| Experimental | True |
| Realm | us |
| Authority | hl7 |
| Description | When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. |
| Purpose | The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. |
| Copyright | © CDC 2016+. |
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Narrative
Note: links and images are rebased to the (stated) source
| Id: |
opioidcds-06 |
| Url: |
Recommendation #6 - Prescribe Lowest Effective Dose and Duration |
| Version: |
2022.1.0 |
| Identifier: |
value: cdc-opioid-guidance
|
| Name: |
PlanDefinition_Recommendation_06_Order_Sign |
| Title: |
Recommendation #6 - Prescribe Lowest Effective Dose and Duration |
| Status: |
draft |
| Experimental: |
true |
| Type: |
system: http://terminology.hl7.org/CodeSystem/plan-definition-type
code: eca-rule
display: ECA Rule
|
| Date: |
2025-04-24 |
| Publisher: |
Centers for Disease Control and Prevention (CDC) |
| Description: |
When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. |
| Logic Definitions: |
| Library Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions |
0 |
define "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription )
and Routines."Acute Pain Prescription Greater Than 7 Days?"(AmbulatoryOpioidPrescription)
| Library Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain |
1 |
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain":
exists( "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )
| Library Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| 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 Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Order is for Long-Acting Opioid |
7 |
define "Order is for Long-Acting Opioid":
exists (
"Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" AmbulatoryOpioidPrescription
where AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential"
or Common.GetDurationInDays( AmbulatoryOpioidPrescription.dispenseRequest.expectedSupplyDuration ) > 7 days
)
| Library Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Inclusion Criteria |
8 |
define "Inclusion Criteria":
"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain"
and Routines."Is Opioid Review Useful?"
and "Order is for Long-Acting Opioid"
| Library Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Exclusion Criteria |
9 |
define "Exclusion Criteria":
false
| Library Name | Name | sequence |
|---|
| OpioidCDSREC06 |
Is Recommendation Applicable? |
10 |
define "Is Recommendation Applicable?":
"Inclusion Criteria"
and not "Exclusion Criteria"
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Is Opioid Analgesic with Ambulatory Misuse Potential? |
11 |
define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>):
("Get MedicationRequest Medication as Code"(value)) Rx
where Rx.medication in "Opioid analgesics with ambulatory misuse potential"
and Rx.category in "Community"
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Get MedicationRequest Medication as Code |
12 |
define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>):
value Rx
let Med:
if Rx.medication is Reference then singleton from (
[Medication] M
where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))
) else null
return
MedicationRequest {
id: Rx.id,
status: Rx.status,
intent: Rx.intent,
category: Rx.category,
medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,
subject: Rx.subject,
authoredOn: Rx.authoredOn,
recorder: Rx.recorder,
dosageInstruction: Rx.dosageInstruction,
dispenseRequest: Rx.dispenseRequest
}
| Library Name | Name | sequence |
|---|
| FHIRHelpers |
ToConcept |
13 |
define function ToConcept(concept FHIR.CodeableConcept):
if concept is null then
null
else
System.Concept {
codes: concept.coding C return ToCode(C),
display: concept.text.value
}
| Library Name | Name | sequence |
|---|
| OpioidCDSRoutines |
Is Acute Pain Prescription? |
14 |
// End of For Subacute or Chronic Pain Routine
/*
** Routine #5
** For Acute Pain Routine
**
** Definition | Answer to Proceed | Details | Data (Terminology) Requirement
** -----------------------------------------------------------------------------------------------------------------------------------
** Order for opioid analgesics | Yes | Look for an existing prescription (order) for | Opioid analgesics with
** with ambulatory misuse | | opioid analgesics with ambulatory abuse | ambulatory misuse potential
** potential of duration < 28 | | potential of duration < 28 days |
** days | | |
** -----------------------------------------------------------------------------------------------------------------------------------
**
*/
// should allow DateTime precision, but not working in the Ruler specifically
define function "Is Acute Pain Prescription?"(prescription FHIR.MedicationRequest):
prescription.dispenseRequest is not null
and prescription.dispenseRequest.expectedSupplyDuration is not null
and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
GetDurationInDays |
15 |
define function GetDurationInDays(value FHIR.Duration):
if value is null then null
else
case
when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' }
when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' }
when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' }
when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' }
when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' }
when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' }
when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' }
when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' }
when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null')
else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value)
end
| Library Name | Name | sequence |
|---|
| OpioidCDSRoutines |
Acute Pain Prescription Greater Than 7 Days? |
16 |
// should allow DateTime precision, but not working in the Ruler specifically
define function "Acute Pain Prescription Greater Than 7 Days?"(prescription FHIR.MedicationRequest):
prescription.dispenseRequest is not null
and prescription.dispenseRequest.expectedSupplyDuration is not null
and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) > 7 days
and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days
|
| Knowledge Capability: |
shareable computable executable publishable
|
| Use Context: |
| code | value | display |
|---|
| focus |
182888003 |
Medication requested (situation) |
| focus |
274663001 |
Acute pain (finding) |
|
| Purpose: |
The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.
|
| Usage: |
When the diagnosis and severity of acute pain warrant use of opioids, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. For many common causes of nontraumatic, nonsurgical pain, when opioids are needed, a few days or less are often sufficient, and shorter courses can minimize the need to taper opioids to prevent withdrawal symptoms at the end of a course of opioids. However, durations should be individualized to the patient's clinical circumstances. |
| Copyright: |
|
| Related Artifacts: |
Documentation
|
| Libraries: |
|
| Actions: |
When Treating Acute Pain, Prescribe No More Opioids Than Needed: Please verify that the opioid order quantity and duration are no more than needed for the expected duration of pain severe enough to require opioids.
For guidance regarding prescribing opioids for acute pain, see [Recommendation 6 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation6).
When: Named Event: order-sign
If: Applicability: Check whether the current order is for an opioid with ambulatory misuse potential for acute pain with an intended duration of more than 7 days and if an opioid review is appropriate for the patient (Is Recommendation Applicable?)
Then:
: Document - Will adjust opioid order
Then:
|
: Snooze* - Benefits of opioid therapy duration outweigh risks, snooze 3 months
Then:
|
: Snooze* - N/A see comment, snooze 3 months
Then:
|
|
|
Source
{
"resourceType" : "PlanDefinition",
"id" : "opioidcds-06",
"meta" : {
"profile" : [
"http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-recommendationdefinition",
"http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-publishableplandefinition"
]
},
"text" : {
"status" : "extensions",
"div" : "<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-06</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-06.html\">Recommendation #6 - Prescribe Lowest Effective Dose and Duration</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_06_Order_Sign</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">Recommendation #6 - Prescribe Lowest Effective Dose and Duration</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;\">When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.</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>OpioidCDSREC06</td>\n \n \n <td>Acute 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 "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":\n ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription\n where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription )\n and Routines."Acute Pain Prescription Greater Than 7 Days?"(AmbulatoryOpioidPrescription)</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>OpioidCDSREC06</td>\n \n \n <td>Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain</td>\n \n \n <td>1</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain":\n exists( "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )</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 "Patient Age Less Than 18":\n if (Config."Age Less than 18 Years Is Enabled") then\n AgeInYearsAt(Today()) < 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 "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</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 "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</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 "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</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 "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"</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>OpioidCDSREC06</td>\n \n \n <td>Order is for Long-Acting Opioid</td>\n \n \n <td>7</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Order is for Long-Acting Opioid":\n exists (\n "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" AmbulatoryOpioidPrescription\n where AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential"\n or Common.GetDurationInDays( AmbulatoryOpioidPrescription.dispenseRequest.expectedSupplyDuration ) > 7 days\n )</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>OpioidCDSREC06</td>\n \n \n <td>Inclusion Criteria</td>\n \n \n <td>8</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Inclusion Criteria":\n "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain"\n and Routines."Is Opioid Review Useful?"\n and "Order is for Long-Acting Opioid"</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>OpioidCDSREC06</td>\n \n \n <td>Exclusion Criteria</td>\n \n \n <td>9</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Exclusion Criteria":\n 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>OpioidCDSREC06</td>\n \n \n <td>Is Recommendation Applicable?</td>\n \n \n <td>10</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Is Recommendation Applicable?":\n "Inclusion Criteria"\n and not "Exclusion Criteria"</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>11</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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"</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>12</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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 }</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>13</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 Acute Pain Prescription?</td>\n \n \n <td>14</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// End of For Subacute or Chronic Pain Routine\n\n/*\n** Routine #5\n** For Acute Pain Routine\n**\n** Definition | Answer to Proceed | Details | Data (Terminology) Requirement\n** -----------------------------------------------------------------------------------------------------------------------------------\n** Order for opioid analgesics | Yes | Look for an existing prescription (order) for | Opioid analgesics with\n** with ambulatory misuse | | opioid analgesics with ambulatory abuse | ambulatory misuse potential\n** potential of duration < 28 | | potential of duration < 28 days |\n** days | | |\n** -----------------------------------------------------------------------------------------------------------------------------------\n**\n*/\n\n// should allow DateTime precision, but not working in the Ruler specifically\ndefine function "Is Acute Pain Prescription?"(prescription FHIR.MedicationRequest):\n prescription.dispenseRequest is not null\n and prescription.dispenseRequest.expectedSupplyDuration is not null\n and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days</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>15</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>Acute Pain Prescription Greater Than 7 Days?</td>\n \n \n <td>16</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// should allow DateTime precision, but not working in the Ruler specifically\ndefine function "Acute Pain Prescription Greater Than 7 Days?"(prescription FHIR.MedicationRequest):\n prescription.dispenseRequest is not null\n and prescription.dispenseRequest.expectedSupplyDuration is not null\n and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) > 7 days\n and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days</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>274663001</td>\n <td>Acute pain (finding)</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;\">When the diagnosis and severity of acute pain warrant use of opioids, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. For many common causes of nontraumatic, nonsurgical pain, when opioids are needed, a few days or less are often sufficient, and shorter courses can minimize the need to taper opioids to prevent withdrawal symptoms at the end of a course of opioids. However, durations should be individualized to the patient's clinical circumstances.</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-OpioidCDSREC06.html\">Library - Recommendation #6 - Prescribe Lowest Effective Dose and Duration</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> When Treating Acute Pain, Prescribe No More Opioids Than Needed:</b> Please verify that the opioid order quantity and duration are no more than needed for the expected duration of pain severe enough to require opioids.\r\n\r\nFor guidance regarding prescribing opioids for acute pain, see [Recommendation 6 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation6).<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 for acute pain with an intended duration of more than 7 days 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 - Will adjust opioid order<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> Snooze* - Benefits of opioid therapy duration outweigh risks, 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> 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 </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" : "Value set Opioid analgesics with ambulatory misuse potential",
"resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential"
},
{
"type" : "depends-on",
"display" : "Value set Community",
"resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community"
},
{
"type" : "depends-on",
"display" : "Value set Extended release opioid with ambulatory misuse potential",
"resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/extended-release-opioid-with-ambulatory-misuse-potential"
}
],
"parameter" : [
{
"name" : "ContextPrescriptions",
"use" : "in",
"min" : 0,
"max" : "*",
"type" : "MedicationRequest"
},
{
"name" : "Is Recommendation Applicable?",
"use" : "out",
"min" : 0,
"max" : "1",
"type" : "boolean"
}
]
}
],
"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" : "OpioidCDSREC06"
},
{
"url" : "name",
"valueString" : "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions"
},
{
"url" : "statement",
"valueString" : "define \"Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\":\n ( Common.\"Is Opioid Analgesic with Ambulatory Misuse Potential?\"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription\n where Routines.\"Is Acute Pain Prescription?\"( AmbulatoryOpioidPrescription )\n and Routines.\"Acute Pain Prescription Greater Than 7 Days?\"(AmbulatoryOpioidPrescription)"
},
{
"url" : "displaySequence",
"valueInteger" : 0
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC06"
},
{
"url" : "name",
"valueString" : "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain"
},
{
"url" : "statement",
"valueString" : "define \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain\":\n exists( \"Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" )"
},
{
"url" : "displaySequence",
"valueInteger" : 1
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "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" : "OpioidCDSREC06"
},
{
"url" : "name",
"valueString" : "Order is for Long-Acting Opioid"
},
{
"url" : "statement",
"valueString" : "define \"Order is for Long-Acting Opioid\":\n exists (\n \"Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" AmbulatoryOpioidPrescription\n where AmbulatoryOpioidPrescription.medication in Common.\"Extended release opioid with ambulatory misuse potential\"\n or Common.GetDurationInDays( AmbulatoryOpioidPrescription.dispenseRequest.expectedSupplyDuration ) > 7 days\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 7
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC06"
},
{
"url" : "name",
"valueString" : "Inclusion Criteria"
},
{
"url" : "statement",
"valueString" : "define \"Inclusion Criteria\":\n \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain\"\n and Routines.\"Is Opioid Review Useful?\"\n and \"Order is for Long-Acting Opioid\""
},
{
"url" : "displaySequence",
"valueInteger" : 8
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC06"
},
{
"url" : "name",
"valueString" : "Exclusion Criteria"
},
{
"url" : "statement",
"valueString" : "define \"Exclusion Criteria\":\n false"
},
{
"url" : "displaySequence",
"valueInteger" : 9
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC06"
},
{
"url" : "name",
"valueString" : "Is Recommendation Applicable?"
},
{
"url" : "statement",
"valueString" : "define \"Is Recommendation Applicable?\":\n \"Inclusion Criteria\"\n and not \"Exclusion Criteria\""
},
{
"url" : "displaySequence",
"valueInteger" : 10
}
],
"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" : 11
}
],
"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" : 12
}
],
"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" : 13
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSRoutines"
},
{
"url" : "name",
"valueString" : "Is Acute Pain Prescription?"
},
{
"url" : "statement",
"valueString" : "// End of For Subacute or Chronic Pain Routine\n\n/*\n** Routine #5\n** For Acute Pain Routine\n**\n** Definition | Answer to Proceed | Details | Data (Terminology) Requirement\n** -----------------------------------------------------------------------------------------------------------------------------------\n** Order for opioid analgesics | Yes | Look for an existing prescription (order) for | Opioid analgesics with\n** with ambulatory misuse | | opioid analgesics with ambulatory abuse | ambulatory misuse potential\n** potential of duration < 28 | | potential of duration < 28 days |\n** days | | |\n** -----------------------------------------------------------------------------------------------------------------------------------\n**\n*/\n\n// should allow DateTime precision, but not working in the Ruler specifically\ndefine function \"Is Acute Pain Prescription?\"(prescription FHIR.MedicationRequest):\n prescription.dispenseRequest is not null\n and prescription.dispenseRequest.expectedSupplyDuration is not null\n and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days"
},
{
"url" : "displaySequence",
"valueInteger" : 14
}
],
"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" : 15
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSRoutines"
},
{
"url" : "name",
"valueString" : "Acute Pain Prescription Greater Than 7 Days?"
},
{
"url" : "statement",
"valueString" : "// should allow DateTime precision, but not working in the Ruler specifically\ndefine function \"Acute Pain Prescription Greater Than 7 Days?\"(prescription FHIR.MedicationRequest):\n prescription.dispenseRequest is not null\n and prescription.dispenseRequest.expectedSupplyDuration is not null\n and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) > 7 days\n and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days"
},
{
"url" : "displaySequence",
"valueInteger" : 16
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"id" : "effective-data-requirements",
"url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements",
"valueCanonical" : "#effective-data-requirements"
},
{
"url" : "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-softwaresystem",
"valueReference" : {
"reference" : "Device/cqf-tooling"
}
}
],
"url" : "http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-06",
"identifier" : [
{
"use" : "official",
"value" : "cdc-opioid-guidance"
}
],
"version" : "2022.1.0",
"name" : "PlanDefinition_Recommendation_06_Order_Sign",
"title" : "Recommendation #6 - Prescribe Lowest Effective Dose and Duration",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
"code" : "eca-rule",
"display" : "ECA Rule"
}
]
},
"status" : "draft",
"experimental" : true,
"date" : "2025-04-24",
"publisher" : "Centers for Disease Control and Prevention (CDC)",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "https://www.cdc.gov"
}
]
}
],
"description" : "When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.",
"useContext" : [
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "182888003",
"display" : "Medication requested (situation)"
}
]
}
},
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "274663001",
"display" : "Acute pain (finding)"
}
]
}
}
],
"purpose" : "The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.",
"usage" : "When the diagnosis and severity of acute pain warrant use of opioids, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. For many common causes of nontraumatic, nonsurgical pain, when opioids are needed, a few days or less are often sufficient, and shorter courses can minimize the need to taper opioids to prevent withdrawal symptoms at the end of a course of opioids. However, durations should be individualized to the patient's clinical circumstances.",
"copyright" : "© CDC 2016+.",
"topic" : [
{
"text" : "Opioid Prescribing"
}
],
"author" : [
{
"name" : "Kensaku Kawamoto, MD, PhD, MHS"
},
{
"name" : "Bryn Rhodes"
},
{
"name" : "Floyd Eisenberg, MD, MPH"
},
{
"name" : "Robert McClure, MD, MPH"
}
],
"relatedArtifact" : [
{
"type" : "documentation",
"display" : "2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain",
"url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm",
"document" : {
"url" : "https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm"
}
}
],
"library" : [
"http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC06"
],
"action" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/recommendation-strength",
"code" : "strong",
"display" : "Strong"
}
]
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/evidence-quality",
"code" : "very-low",
"display" : "Very low quality"
}
]
}
}
],
"title" : "When Treating Acute Pain, Prescribe No More Opioids Than Needed",
"description" : "Please verify that the opioid order quantity and duration are no more than needed for the expected duration of pain severe enough to require opioids.\r\n\r\nFor guidance regarding prescribing opioids for acute pain, see [Recommendation 6 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation6).",
"priority" : "urgent",
"trigger" : [
{
"type" : "named-event",
"name" : "order-sign"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "Check whether the current order is for an opioid with ambulatory misuse potential for acute pain with an intended duration of more than 7 days and if an opioid review is appropriate for the patient",
"language" : "text/cql.identifier",
"expression" : "Is Recommendation Applicable?"
}
}
],
"groupingBehavior" : "visual-group",
"selectionBehavior" : "any",
"action" : [
{
"description" : "Document - Will adjust opioid order"
},
{
"description" : "Snooze* - Benefits of opioid therapy duration outweigh risks, snooze 3 months"
},
{
"description" : "Snooze* - N/A see comment, snooze 3 months"
}
]
}
]
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.
FHIR