Resource PlanDefinition/FHIR Server from package fhir.cdc.opioid-cds-r4#current (172 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-07.html |
| Url | http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-07 |
| Version | 2022.1.0 |
| Status | draft |
| Date | 2025-04-24 |
| Name | PlanDefinition_Recommendation_07_Order_Sign |
| Title | Recommendation #7 - Opioid Therapy Risk Assessment |
| Experimental | True |
| Realm | us |
| Authority | hl7 |
| Description | Clinicians should evaluate benefits and risks with patients within 1-4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should regularly reevaluate benefits and risks of continued opioid therapy with patients. |
| 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-07 |
| Url: |
Recommendation #7 - Opioid Therapy Risk Assessment |
| Version: |
2022.1.0 |
| Identifier: |
value: cdc-opioid-guidance
|
| Name: |
PlanDefinition_Recommendation_07_Order_Sign |
| Title: |
Recommendation #7 - Opioid Therapy Risk Assessment |
| 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: |
Clinicians should evaluate benefits and risks with patients within 1-4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should regularly reevaluate benefits and risks of continued opioid therapy with patients. |
| Logic Definitions: |
| Library Name | Name | sequence |
|---|
| OpioidCDSREC07 |
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 Name | Name | sequence |
|---|
| OpioidCDSREC07 |
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 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 |
|---|
| OpioidCDSREC07 |
Risk Assessment Interval |
7 |
define "Risk Assessment Interval":
Interval[Today() - 91 days, Today() - 1 day]
| Library Name | Name | sequence |
|---|
| OpioidCDSREC07 |
Opioid Risk Assessment in Past 90 Days |
8 |
define "Opioid Risk Assessment in Past 90 Days":
[Procedure: Common."Opioid misuse assessment procedure"] riskAssessment
where start of (riskAssessment.performed as FHIR.Period) in day of "Risk Assessment Interval"
| Library Name | Name | sequence |
|---|
| OpioidCDSREC07 |
Previous 10 Days Interval |
9 |
define "Previous 10 Days Interval":
Interval[Today() - 10 days, Today()]
| Library Name | Name | sequence |
|---|
| OpioidCDSREC07 |
Encounter Interval |
10 |
define "Encounter Interval":
Interval[Today() - 12 months - 1 days, Today() - 1 day]
| Library Name | Name | sequence |
|---|
| OpioidCDSREC07 |
Prescribed Opioids for 7 of Past 10 Days with an Encounter |
11 |
define "Prescribed Opioids for 7 of Past 10 Days with an Encounter":
Common."Days on Opioids during Period"( "Previous 10 Days Interval" ) >= 7
and exists (
[Encounter: Common."Office Visit"] AmbulatoryEncounter
where AmbulatoryEncounter.period during "Encounter Interval"
)
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
First Month |
12 |
define "First Month":
Interval[Today() - 3 months, Today() - 2 months]
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Second Month |
13 |
define "Second Month":
Interval[Today() - 2 months, Today() - 1 months]
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Third Month |
14 |
define "Third Month":
Interval[Today() - 1 months, Today()]
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months |
15 |
define "Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months":
"Days on Opioids during Period"("First Month") >= 21
and "Days on Opioids during Period"("Second Month") >= 21
and "Days on Opioids during Period"("Third Month") >= 21
| Library Name | Name | sequence |
|---|
| OpioidCDSREC07 |
Inclusion Criteria |
16 |
define "Inclusion Criteria":
"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
and Routines."Is Opioid Review Useful?"
and not exists ( "Opioid Risk Assessment in Past 90 Days" )
and (
"Prescribed Opioids for 7 of Past 10 Days with an Encounter"
or Common."Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months"
)
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
US Core-Categorized Conditions |
17 |
// 3. Medications indicating end of life
/* or exists (
"Medications Indicating End of Life"
) */
define "US Core-Categorized Conditions":
[Condition: category in "Encounter Diagnosis Condition Category"]
union [Condition: category in "Problem List Condition Category"]
union [Condition: category in "US Core Health Concern Condition Category"]
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Conditions Indicating End of Life or With Limited Life Expectancy |
18 |
define "Conditions Indicating End of Life or With Limited Life Expectancy":
(
"US Core-Categorized Conditions" C
where C.code in "Conditions likely terminal for opioid prescribing"
and C.clinicalStatus in "Active Condition"
)
union
(
"US Core-Categorized Conditions" C
where C.code in "Limited life expectancy conditions"
and C.clinicalStatus in "Active Condition"
)
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Admitted/Referred/Discharged to Hospice Care |
19 |
define "Admitted/Referred/Discharged to Hospice Care":
(
if (Config."Hospice Findings Exclusion Enabled") then
[Observation: code in "Hospice Finding Codes"] O
where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })
else
{}
)
union
(
[Encounter] E
where date from E.period.start 1 year or less on or before Today()
and (
if E.hospitalization.dischargeDisposition.coding is null
or not exists (E.hospitalization.dischargeDisposition.coding)
then false
else E.hospitalization.dischargeDisposition in "Hospice Disposition"
)
and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }
)
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
End of Life Assessment |
20 |
define "End of Life Assessment":
// 1. Conditions indicating end of life or with limited life expectancy
exists (
"Conditions Indicating End of Life or With Limited Life Expectancy"
)
// 2. Admitted/referred/discharged to hospice care
or exists (
"Admitted/Referred/Discharged to Hospice Care"
)
| Library Name | Name | sequence |
|---|
| OpioidCDSREC07 |
Exclusion Criteria |
21 |
define "Exclusion Criteria":
Common."End of Life Assessment"
| Library Name | Name | sequence |
|---|
| OpioidCDSREC07 |
Is Recommendation Applicable? |
22 |
define "Is Recommendation Applicable?":
"Inclusion Criteria"
and not "Exclusion Criteria"
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Is Opioid Analgesic with Ambulatory Misuse Potential? |
23 |
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 |
24 |
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 |
25 |
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 Subacute or Chronic Pain Prescription? |
26 |
// 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 Name | Name | sequence |
|---|
| OpioidCDSRoutines |
Is Subacute or Chronic Pain Using Expected Supply Duration |
27 |
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 Name | Name | sequence |
|---|
| OpioidCDSCommon |
GetDurationInDays |
28 |
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 |
Is Subacute or Chronic Pain Using Validity Period |
29 |
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 Name | Name | sequence |
|---|
| FHIRHelpers |
ToDateTime |
30 |
define function ToDateTime(value dateTime): value.value
| Library Name | Name | sequence |
|---|
| FHIRHelpers |
ToInterval |
31 |
define function ToInterval(period FHIR.Period):
if period is null then
null
else
if period."start" is null then
Interval(period."start".value, period."end".value]
else
Interval[period."start".value, period."end".value]
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Days on Opioids during Period |
32 |
define function "Days on Opioids during Period"(period Interval<Date>):
Sum(
(
collapse (
[MedicationRequest: "Opioid analgesics with ambulatory misuse potential"] OpioidPrescription
return "Prescription Relevant Period"( OpioidPrescription ) intersect period
)
) OpioidUseInterval
return days between start of OpioidUseInterval and end of OpioidUseInterval
)
| Library Name | Name | sequence |
|---|
| FHIRHelpers |
ToString |
33 |
define function ToString(value string): value.value
| Library Name | Name | sequence |
|---|
| OpioidCDSCommon |
Prescription Relevant Period |
34 |
define function "Prescription Relevant Period"(prescription FHIR.MedicationRequest):
if (
prescription.authoredOn is not null and prescription.dispenseRequest is not null
and prescription.dispenseRequest.expectedSupplyDuration is not null
)
then Interval[
date from prescription.authoredOn,
date from prescription.authoredOn + GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration)
]
else null
|
| Knowledge Capability: |
shareable computable executable publishable
|
| Use Context: |
| code | value | display |
|---|
| 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: |
In addition to evaluating benefits and risks of opioids before starting opioid therapy (see Recommendation 2), clinicians should evaluate patients to assess benefits and risks of opioids within 1-4 weeks of starting long-term opioid therapy or of dosage escalation. |
| Copyright: |
|
| Related Artifacts: |
Documentation
|
| Libraries: |
|
| Actions: |
Regularly Evaluate the Benefits and Risks of Opioid Therapy: Recommend that clinicians evaluate benefits and risks with patients within 1-4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should also regularly reevaluate the benefits and risks of continued opioid therapy with patients.
For additional guidance regarding opioid therapy patient consultations, see [Recommendation 7 of the 2022 CDC Clinical Practice Guideline for additional guidance](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation7)
When: Named Event: order-sign
If: Applicability: Check whether the patient has a current order is for an opioid with ambulatory misuse potential for subacute or chronic pain, a risk assessment has been performed in the past 90 days, has taken an opioid with abuse potential for 7 of the past 10 days or 63 of the past 90 days and if an opioid review is appropriate. (Is Recommendation Applicable?)
Then:
: Document - Conducted benefit and risk assessment
Then:
|
: Snooze* - Conducted assessment, snooze 3 months
Then:
|
: Snooze* - N/A see comment, snooze 3 months
Then:
|
|
|
Source
{
"resourceType" : "PlanDefinition",
"id" : "opioidcds-07",
"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-07</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-07.html\">Recommendation #7 - Opioid Therapy Risk Assessment</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_07_Order_Sign</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">Recommendation #7 - Opioid Therapy Risk Assessment</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;\">Clinicians should evaluate benefits and risks with patients within 1-4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should regularly reevaluate benefits and risks of continued opioid therapy with patients.</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>OpioidCDSREC07</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 "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 )</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>OpioidCDSREC07</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 "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":\n exists( "Chronic 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>OpioidCDSREC07</td>\n \n \n <td>Risk Assessment Interval</td>\n \n \n <td>7</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Risk Assessment Interval":\n Interval[Today() - 91 days, Today() - 1 day]</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>OpioidCDSREC07</td>\n \n \n <td>Opioid Risk Assessment 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 "Opioid Risk Assessment in Past 90 Days":\n [Procedure: Common."Opioid misuse assessment procedure"] riskAssessment\n where start of (riskAssessment.performed as FHIR.Period) in day of "Risk Assessment Interval"</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>OpioidCDSREC07</td>\n \n \n <td>Previous 10 Days Interval</td>\n \n \n <td>9</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Previous 10 Days Interval":\n Interval[Today() - 10 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>OpioidCDSREC07</td>\n \n \n <td>Encounter Interval</td>\n \n \n <td>10</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Encounter Interval":\n Interval[Today() - 12 months - 1 days, Today() - 1 day]</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>OpioidCDSREC07</td>\n \n \n <td>Prescribed Opioids for 7 of Past 10 Days with an Encounter</td>\n \n \n <td>11</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Prescribed Opioids for 7 of Past 10 Days with an Encounter":\n Common."Days on Opioids during Period"( "Previous 10 Days Interval" ) >= 7\n and exists (\n [Encounter: Common."Office Visit"] AmbulatoryEncounter\n where AmbulatoryEncounter.period during "Encounter Interval"\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>First Month</td>\n \n \n <td>12</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "First Month":\nInterval[Today() - 3 months, Today() - 2 months]</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>Second Month</td>\n \n \n <td>13</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Second Month":\nInterval[Today() - 2 months, Today() - 1 months]</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>Third Month</td>\n \n \n <td>14</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Third Month":\nInterval[Today() - 1 months, 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>OpioidCDSCommon</td>\n \n \n <td>Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months</td>\n \n \n <td>15</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months":\n "Days on Opioids during Period"("First Month") >= 21\n and "Days on Opioids during Period"("Second Month") >= 21\n and "Days on Opioids during Period"("Third Month") >= 21</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>OpioidCDSREC07</td>\n \n \n <td>Inclusion Criteria</td>\n \n \n <td>16</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"\n and Routines."Is Opioid Review Useful?"\n and not exists ( "Opioid Risk Assessment in Past 90 Days" )\n and (\n "Prescribed Opioids for 7 of Past 10 Days with an Encounter"\n or Common."Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months"\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>US Core-Categorized Conditions</td>\n \n \n <td>17</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// 3. Medications indicating end of life\n /* or exists (\n "Medications Indicating End of Life"\n ) */\n\ndefine "US Core-Categorized Conditions":\n [Condition: category in "Encounter Diagnosis Condition Category"]\n union [Condition: category in "Problem List Condition Category"]\n union [Condition: category in "US Core Health Concern Condition Category"]</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>Conditions Indicating End of Life or With Limited Life Expectancy</td>\n \n \n <td>18</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Conditions Indicating End of Life or With Limited Life Expectancy":\n (\n "US Core-Categorized Conditions" C\n where C.code in "Conditions likely terminal for opioid prescribing"\n and C.clinicalStatus in "Active Condition"\n )\n union\n (\n "US Core-Categorized Conditions" C\n where C.code in "Limited life expectancy conditions"\n and C.clinicalStatus in "Active Condition"\n )</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>Admitted/Referred/Discharged to Hospice Care</td>\n \n \n <td>19</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Admitted/Referred/Discharged to Hospice Care":\n (\n if (Config."Hospice Findings Exclusion Enabled") then\n [Observation: code in "Hospice Finding Codes"] O\n where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })\n else\n {}\n )\n union\n (\n [Encounter] E\n where date from E.period.start 1 year or less on or before Today()\n and (\n if E.hospitalization.dischargeDisposition.coding is null\n or not exists (E.hospitalization.dischargeDisposition.coding)\n then false\n else E.hospitalization.dischargeDisposition in "Hospice Disposition"\n )\n and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }\n )</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>End of Life Assessment</td>\n \n \n <td>20</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "End of Life Assessment":\n // 1. Conditions indicating end of life or with limited life expectancy\n exists (\n "Conditions Indicating End of Life or With Limited Life Expectancy"\n )\n // 2. Admitted/referred/discharged to hospice care\n or exists (\n "Admitted/Referred/Discharged to Hospice Care"\n )</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>OpioidCDSREC07</td>\n \n \n <td>Exclusion Criteria</td>\n \n \n <td>21</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define "Exclusion Criteria":\n Common."End of Life Assessment"</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>OpioidCDSREC07</td>\n \n \n <td>Is Recommendation Applicable?</td>\n \n \n <td>22</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>23</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>24</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>25</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>26</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 >= | 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)</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>27</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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 )</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>28</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>29</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">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 )</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>30</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>ToInterval</td>\n \n \n <td>31</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function ToInterval(period FHIR.Period):\n if period is null then\n null\n else\n if period."start" is null then\n Interval(period."start".value, period."end".value]\n else\n Interval[period."start".value, period."end".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>OpioidCDSCommon</td>\n \n \n <td>Days on Opioids during Period</td>\n \n \n <td>32</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function "Days on Opioids during Period"(period Interval<Date>):\n Sum(\n (\n collapse (\n [MedicationRequest: "Opioid analgesics with ambulatory misuse potential"] OpioidPrescription\n return "Prescription Relevant Period"( OpioidPrescription ) intersect period\n )\n ) OpioidUseInterval\n return days between start of OpioidUseInterval and end of OpioidUseInterval\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>ToString</td>\n \n \n <td>33</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function ToString(value string): 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>OpioidCDSCommon</td>\n \n \n <td>Prescription Relevant Period</td>\n \n \n <td>34</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function "Prescription Relevant Period"(prescription FHIR.MedicationRequest):\n if (\n prescription.authoredOn is not null and prescription.dispenseRequest is not null\n and prescription.dispenseRequest.expectedSupplyDuration is not null\n )\n then Interval[\n date from prescription.authoredOn,\n date from prescription.authoredOn + GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration)\n ]\n else null</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;\">In addition to evaluating benefits and risks of opioids before starting opioid therapy (see Recommendation 2), clinicians should evaluate patients to assess benefits and risks of opioids within 1-4 weeks of starting long-term opioid therapy or of dosage escalation.</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-OpioidCDSREC07.html\">Library - Recommendation #7 - Opioid Therapy Risk Assessment</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> Regularly Evaluate the Benefits and Risks of Opioid Therapy:</b> Recommend that clinicians evaluate benefits and risks with patients within 1-4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should also regularly reevaluate the benefits and risks of continued opioid therapy with patients.\r\n\r\nFor additional guidance regarding opioid therapy patient consultations, see [Recommendation 7 of the 2022 CDC Clinical Practice Guideline for additional guidance](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation7)<br/>\n <b>When:</b> <i>Named Event:</i> order-sign<br/>\n <b>If:</b> <i>Applicability:</i> Check whether the patient has a current order is for an opioid with ambulatory misuse potential for subacute or chronic pain, a risk assessment has been performed in the past 90 days, has taken an opioid with abuse potential for 7 of the past 10 days or 63 of the past 90 days and if an opioid review is appropriate. <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 - Conducted benefit and risk assessment<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> Snooze* - Conducted assessment, 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>"
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}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC07"
},
{
"url" : "name",
"valueString" : "Prescribed Opioids for 7 of Past 10 Days with an Encounter"
},
{
"url" : "statement",
"valueString" : "define \"Prescribed Opioids for 7 of Past 10 Days with an Encounter\":\n Common.\"Days on Opioids during Period\"( \"Previous 10 Days Interval\" ) >= 7\n and exists (\n [Encounter: Common.\"Office Visit\"] AmbulatoryEncounter\n where AmbulatoryEncounter.period during \"Encounter Interval\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 11
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "First Month"
},
{
"url" : "statement",
"valueString" : "define \"First Month\":\nInterval[Today() - 3 months, Today() - 2 months]"
},
{
"url" : "displaySequence",
"valueInteger" : 12
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "Second Month"
},
{
"url" : "statement",
"valueString" : "define \"Second Month\":\nInterval[Today() - 2 months, Today() - 1 months]"
},
{
"url" : "displaySequence",
"valueInteger" : 13
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "Third Month"
},
{
"url" : "statement",
"valueString" : "define \"Third Month\":\nInterval[Today() - 1 months, Today()]"
},
{
"url" : "displaySequence",
"valueInteger" : 14
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months"
},
{
"url" : "statement",
"valueString" : "define \"Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months\":\n \"Days on Opioids during Period\"(\"First Month\") >= 21\n and \"Days on Opioids during Period\"(\"Second Month\") >= 21\n and \"Days on Opioids during Period\"(\"Third Month\") >= 21"
},
{
"url" : "displaySequence",
"valueInteger" : 15
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC07"
},
{
"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 not exists ( \"Opioid Risk Assessment in Past 90 Days\" )\n and (\n \"Prescribed Opioids for 7 of Past 10 Days with an Encounter\"\n or Common.\"Prescribed Opioids for 21 or more of 30 Days for each of the past 3 Months\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 16
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "US Core-Categorized Conditions"
},
{
"url" : "statement",
"valueString" : "// 3. Medications indicating end of life\n /* or exists (\n \"Medications Indicating End of Life\"\n ) */\n\ndefine \"US Core-Categorized Conditions\":\n [Condition: category in \"Encounter Diagnosis Condition Category\"]\n union [Condition: category in \"Problem List Condition Category\"]\n union [Condition: category in \"US Core Health Concern Condition Category\"]"
},
{
"url" : "displaySequence",
"valueInteger" : 17
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "Conditions Indicating End of Life or With Limited Life Expectancy"
},
{
"url" : "statement",
"valueString" : "define \"Conditions Indicating End of Life or With Limited Life Expectancy\":\n (\n \"US Core-Categorized Conditions\" C\n where C.code in \"Conditions likely terminal for opioid prescribing\"\n and C.clinicalStatus in \"Active Condition\"\n )\n union\n (\n \"US Core-Categorized Conditions\" C\n where C.code in \"Limited life expectancy conditions\"\n and C.clinicalStatus in \"Active Condition\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 18
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "Admitted/Referred/Discharged to Hospice Care"
},
{
"url" : "statement",
"valueString" : "define \"Admitted/Referred/Discharged to Hospice Care\":\n (\n if (Config.\"Hospice Findings Exclusion Enabled\") then\n [Observation: code in \"Hospice Finding Codes\"] O\n where not (O.status.value in { 'unknown', 'entered-in-error', 'cancelled' })\n else\n {}\n )\n union\n (\n [Encounter] E\n where date from E.period.start 1 year or less on or before Today()\n and (\n if E.hospitalization.dischargeDisposition.coding is null\n or not exists (E.hospitalization.dischargeDisposition.coding)\n then false\n else E.hospitalization.dischargeDisposition in \"Hospice Disposition\"\n )\n and E.status.value in { 'planned', 'arrived', 'in-progress', 'finished', 'onleave' }\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 19
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "End of Life Assessment"
},
{
"url" : "statement",
"valueString" : "define \"End of Life Assessment\":\n // 1. Conditions indicating end of life or with limited life expectancy\n exists (\n \"Conditions Indicating End of Life or With Limited Life Expectancy\"\n )\n // 2. Admitted/referred/discharged to hospice care\n or exists (\n \"Admitted/Referred/Discharged to Hospice Care\"\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 20
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC07"
},
{
"url" : "name",
"valueString" : "Exclusion Criteria"
},
{
"url" : "statement",
"valueString" : "define \"Exclusion Criteria\":\n Common.\"End of Life Assessment\""
},
{
"url" : "displaySequence",
"valueInteger" : 21
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSREC07"
},
{
"url" : "name",
"valueString" : "Is Recommendation Applicable?"
},
{
"url" : "statement",
"valueString" : "define \"Is Recommendation Applicable?\":\n \"Inclusion Criteria\"\n and not \"Exclusion Criteria\""
},
{
"url" : "displaySequence",
"valueInteger" : 22
}
],
"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" : 23
}
],
"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" : 24
}
],
"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" : 25
}
],
"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" : 26
}
],
"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" : 27
}
],
"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" : 28
}
],
"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" : 29
}
],
"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" : 30
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "FHIRHelpers"
},
{
"url" : "name",
"valueString" : "ToInterval"
},
{
"url" : "statement",
"valueString" : "define function ToInterval(period FHIR.Period):\n if period is null then\n null\n else\n if period.\"start\" is null then\n Interval(period.\"start\".value, period.\"end\".value]\n else\n Interval[period.\"start\".value, period.\"end\".value]"
},
{
"url" : "displaySequence",
"valueInteger" : 31
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "Days on Opioids during Period"
},
{
"url" : "statement",
"valueString" : "define function \"Days on Opioids during Period\"(period Interval<Date>):\n Sum(\n (\n collapse (\n [MedicationRequest: \"Opioid analgesics with ambulatory misuse potential\"] OpioidPrescription\n return \"Prescription Relevant Period\"( OpioidPrescription ) intersect period\n )\n ) OpioidUseInterval\n return days between start of OpioidUseInterval and end of OpioidUseInterval\n )"
},
{
"url" : "displaySequence",
"valueInteger" : 32
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "FHIRHelpers"
},
{
"url" : "name",
"valueString" : "ToString"
},
{
"url" : "statement",
"valueString" : "define function ToString(value string): value.value"
},
{
"url" : "displaySequence",
"valueInteger" : 33
}
],
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
},
{
"extension" : [
{
"url" : "libraryName",
"valueString" : "OpioidCDSCommon"
},
{
"url" : "name",
"valueString" : "Prescription Relevant Period"
},
{
"url" : "statement",
"valueString" : "define function \"Prescription Relevant Period\"(prescription FHIR.MedicationRequest):\n if (\n prescription.authoredOn is not null and prescription.dispenseRequest is not null\n and prescription.dispenseRequest.expectedSupplyDuration is not null\n )\n then Interval[\n date from prescription.authoredOn,\n date from prescription.authoredOn + GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration)\n ]\n else null"
},
{
"url" : "displaySequence",
"valueInteger" : 34
}
],
"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-07",
"identifier" : [
{
"use" : "official",
"value" : "cdc-opioid-guidance"
}
],
"version" : "2022.1.0",
"name" : "PlanDefinition_Recommendation_07_Order_Sign",
"title" : "Recommendation #7 - Opioid Therapy Risk Assessment",
"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" : "Clinicians should evaluate benefits and risks with patients within 1-4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should regularly reevaluate benefits and risks of continued opioid therapy with patients.",
"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" : "In addition to evaluating benefits and risks of opioids before starting opioid therapy (see Recommendation 2), clinicians should evaluate patients to assess benefits and risks of opioids within 1-4 weeks of starting long-term opioid therapy or of dosage escalation.",
"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/OpioidCDSREC07"
],
"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" : "Regularly Evaluate the Benefits and Risks of Opioid Therapy",
"description" : "Recommend that clinicians evaluate benefits and risks with patients within 1-4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should also regularly reevaluate the benefits and risks of continued opioid therapy with patients.\r\n\r\nFor additional guidance regarding opioid therapy patient consultations, see [Recommendation 7 of the 2022 CDC Clinical Practice Guideline for additional guidance](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation7)",
"priority" : "urgent",
"trigger" : [
{
"type" : "named-event",
"name" : "order-sign"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"description" : "Check whether the patient has a current order is for an opioid with ambulatory misuse potential for subacute or chronic pain, a risk assessment has been performed in the past 90 days, has taken an opioid with abuse potential for 7 of the past 10 days or 63 of the past 90 days and if an opioid review is appropriate.",
"language" : "text/cql.identifier",
"expression" : "Is Recommendation Applicable?"
}
}
],
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/action-type",
"code" : "create",
"display" : "Create"
}
]
},
"groupingBehavior" : "visual-group",
"selectionBehavior" : "any",
"definitionCanonical" : "http://fhir.org/guides/cdc/opioid-cds/ActivityDefinition/opioidcds-risk-assessment-request",
"action" : [
{
"description" : "Document - Conducted benefit and risk assessment"
},
{
"description" : "Snooze* - Conducted assessment, 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