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Resource PlanDefinition/FHIR Server from package fhir.cdc.opioid-cds-r4#current (110 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-09.html
Url http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-09
Version 2022.1.0
Status draft
Date 2025-04-24
Name PlanDefinition_Recommendation_09_Order_Sign
Title Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions
Experimental True
Realm us
Authority hl7
Description When prescribing initial opioid therapy for acute, subacute, or chronic pain, and periodically during opioid therapy for chronic pain, clinicians should review the patient's history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or combinations that put the patient at high risk for overdose.
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-09
Url: Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions
Version: 2022.1.0
Identifier:

value: cdc-opioid-guidance

Name: PlanDefinition_Recommendation_09_Order_Sign
Title: Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions
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 prescribing initial opioid therapy for acute, subacute, or chronic pain, and periodically during opioid therapy for chronic pain, clinicians should review the patient's history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or combinations that put the patient at high risk for overdose.
Logic Definitions:
Library NameNamesequence
OpioidCDSREC09 Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0
define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions":
  ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription
    where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )


Library NameNamesequence
OpioidCDSREC09 Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential 1
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential":
  exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )


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


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


Library NameNamesequence
OpioidCDSRoutines Is Active Cancer Treatment? 4
define "Is Active Cancer Treatment?":
  if (Config."Active Cancer Treatment Encounters Condition Is Enabled") 
    then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period"
      or "Has Active Cancer Diagnosis on Problem List"
  else false


Library NameNamesequence
OpioidCDSRoutines Conditions Likely Terminal for Opioid Prescribing 5
define "Conditions Likely Terminal for Opioid Prescribing":
  if (Config."End-Stage Disease Criteria Enabled") then
    exists (
      Common."US Core-Categorized Conditions" EOLC
        where EOLC.code in Common."Conditions likely terminal for opioid prescribing"
          // and EOLC.clinicalStatus in Common."Active Condition"
    )
  else false


Library NameNamesequence
OpioidCDSRoutines Is Opioid Review Useful? 6
define "Is Opioid Review Useful?":
  not "Patient Age Less Than 18"
    and not "Condition Positive for Sickle Cell"
    and not "Is Active Cancer Treatment?"
    and not "Conditions Likely Terminal for Opioid Prescribing"


Library NameNamesequence
OpioidCDSCommonConfig PDMP Data Not Reviewed in Past 90 Days Criteria Enabled 7
// Recommendation 9
define "PDMP Data Not Reviewed in Past 90 Days Criteria Enabled":
  true


Library NameNamesequence
OpioidCDSREC09 Look Back 90 Days 8
define "Look Back 90 Days":
  Interval[Today() - 90 days, Today()]


Library NameNamesequence
OpioidCDSREC09 PDMP Data Not Reviewed in Past 90 Days 9
define "PDMP Data Not Reviewed in Past 90 Days":
  Config."PDMP Data Not Reviewed in Past 90 Days Criteria Enabled"
    and not (
      exists (
        [Procedure: Common."PDMP review procedure"] P
          where P.status ~ 'completed'
            and P.performed during "Look Back 90 Days"
      )
      or exists (
        [Observation: Common."PDMP data reviewed finding"] O
          where O.status in { 'final', 'amended' }
            and (
              if O.effective is FHIR.Period
                then (O.effective as FHIR.Period) during day of "Look Back 90 Days"
                else if O.effective is FHIR.dateTime
                  then date from O.effective in day of "Look Back 90 Days"
                  else false
          )
      )
    )


Library NameNamesequence
OpioidCDSREC09 Inclusion Criteria 10
define "Inclusion Criteria":
  "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
    and Routines."Is Opioid Review Useful?"
    and "PDMP Data Not Reviewed in Past 90 Days"


Library NameNamesequence
OpioidCDSREC09 Exclusion Criteria 11
define "Exclusion Criteria":
  false


Library NameNamesequence
OpioidCDSREC09 Is Recommendation Applicable? 12
define "Is Recommendation Applicable?":
  "Inclusion Criteria"
    and not "Exclusion Criteria"


Library NameNamesequence
OpioidCDSCommon Is Opioid Analgesic with Ambulatory Misuse Potential? 13
define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>):
  ("Get MedicationRequest Medication as Code"(value)) Rx
    where Rx.medication in "Opioid analgesics with ambulatory misuse potential" 
      and Rx.category in "Community"


Library NameNamesequence
OpioidCDSCommon Get MedicationRequest Medication as Code 14
define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>):
  value Rx
    let Med: 
      if Rx.medication is Reference then singleton from (
        [Medication] M
          where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))
      ) else null
    return 
      MedicationRequest {
        id: Rx.id,
        status: Rx.status,
        intent: Rx.intent,
        category: Rx.category,
        medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,
        subject: Rx.subject,
        authoredOn: Rx.authoredOn,
        recorder: Rx.recorder,
        dosageInstruction: Rx.dosageInstruction,
        dispenseRequest: Rx.dispenseRequest
      }


Library NameNamesequence
FHIRHelpers ToConcept 15
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }


Library NameNamesequence
OpioidCDSRoutines Is Subacute or Chronic Pain Prescription? 16
// End of Active Cancer Treatment Routine

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

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


Library NameNamesequence
OpioidCDSRoutines Is Subacute or Chronic Pain Using Expected Supply Duration 17
define function "Is Subacute or Chronic Pain Using Expected Supply Duration"(prescription FHIR.MedicationRequest):
  (
    prescription.dispenseRequest is not null
      and prescription.dispenseRequest.expectedSupplyDuration is not null
      and (
        Common.GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration) >= 28 days 
      )
  )


Library NameNamesequence
OpioidCDSCommon GetDurationInDays 18
define function GetDurationInDays(value FHIR.Duration):
  if value is null then null
  else
    case
      when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' }
      when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' }
      when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' }
      when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' }
      when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' }
      when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' }
      when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' }
      when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' }
      when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null')
      else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value)
end


Library NameNamesequence
OpioidCDSRoutines Is Subacute or Chronic Pain Using Validity Period 19
define function "Is Subacute or Chronic Pain Using Validity Period"(prescription FHIR.MedicationRequest):
  (
    prescription.dispenseRequest is not null
      and prescription.dispenseRequest.validityPeriod is not null
      and (
        days between prescription.dispenseRequest.validityPeriod.start and prescription.dispenseRequest.validityPeriod.end >= 28 
      )
  )


Library NameNamesequence
FHIRHelpers ToDateTime 20
define function ToDateTime(value dateTime): value.value


Library NameNamesequence
FHIRHelpers ToString 21
define function ToString(value ProcedureStatus): value.value


Library NameNamesequence
FHIRHelpers ToInterval 22
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]


Knowledge Capability: shareable computable executable publishable
Use Context:
codevaluedisplay
focus 182888003 Medication requested (situation)
focus 82423001 Chronic pain (finding)
focus 274663001 Acute pain (finding)
focus
Purpose:

The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.

Usage: At a minimum, during long-term opioid therapy, PDMP data should be reviewed before an initial opioid prescription and then every 3 months or more frequently.
Copyright:

© CDC 2016+.

Related Artifacts:

Documentation

Libraries:
Library - Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions
Actions:
Before Ordering Opioids, Review PDMP Data: Review PDMP data for this patient before completing an opioid order. For guidance about utilizing PDMP information to improve patient safety, see [Recommendation 9 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20take,see%20Recommendation%2010).). [CDC advises not to dismiss patients from your practice on the basis of PDMP information](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20not%20dismiss,Recommendations%208%20and%2012%5D).)
When: Named Event: order-sign
If: Applicability: Check whether the current order is for an opioid with ambulatory misuse potential, if an opioid review is appropriate or there exists evidence of a prescription drug monitoring program (PDMP) review procedure or finding occurred in the past 90 days. (Is Recommendation Applicable?)
Then:
: Access Data - Launch app to review PDMP data
Then:
: Document - PDMP data reviewed, snooze 3 months
Then:
: Snooze* - N/A see comment, snooze 3 months
Then:

Source

{
  "resourceType" : "PlanDefinition",
  "id" : "opioidcds-09",
  "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-09</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-09.html\">Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions</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_09_Order_Sign</td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Title: </b></th>\n <td style=\"padding-left: 4px;\">Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions</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 prescribing initial opioid therapy for acute, subacute, or chronic pain, and periodically during opioid therapy for chronic pain, clinicians should review the patient's history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or combinations that put the patient at high risk for overdose.</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>OpioidCDSREC09</td>\n \n \n <td>Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions</td>\n \n \n <td>0</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot;:\n ( Common.&quot;Is Opioid Analgesic with Ambulatory Misuse Potential?&quot;( ContextPrescriptions ) ) AmbulatoryOpioidPrescription\n where Routines.&quot;Is Subacute or Chronic Pain Prescription?&quot;( AmbulatoryOpioidPrescription )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential</td>\n \n \n <td>1</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential&quot;:\n exists( &quot;Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions&quot; )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Patient Age Less Than 18</td>\n \n \n <td>2</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Patient Age Less Than 18&quot;:\n if (Config.&quot;Age Less than 18 Years Is Enabled&quot;) then\n AgeInYearsAt(Today()) &lt; 18\n else false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Condition Positive for Sickle Cell</td>\n \n \n <td>3</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Condition Positive for Sickle Cell&quot;:\n if (Config.&quot;Sickle Cell Check Enabled&quot;) then\n exists(\n Common.&quot;Positive Sickle Cell Condition&quot;\n ) \n else false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Is Active Cancer Treatment?</td>\n \n \n <td>4</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Is Active Cancer Treatment?&quot;:\n if (Config.&quot;Active Cancer Treatment Encounters Condition Is Enabled&quot;) \n then &quot;Has Two or More Encounters with Cancer Diagnosis During Encounter Period&quot;\n or &quot;Has Active Cancer Diagnosis on Problem List&quot;\n else false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Conditions Likely Terminal for Opioid Prescribing</td>\n \n \n <td>5</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Conditions Likely Terminal for Opioid Prescribing&quot;:\n if (Config.&quot;End-Stage Disease Criteria Enabled&quot;) then\n exists (\n Common.&quot;US Core-Categorized Conditions&quot; EOLC\n where EOLC.code in Common.&quot;Conditions likely terminal for opioid prescribing&quot;\n // and EOLC.clinicalStatus in Common.&quot;Active Condition&quot;\n )\n else false</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Is Opioid Review Useful?</td>\n \n \n <td>6</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Is Opioid Review Useful?&quot;:\n not &quot;Patient Age Less Than 18&quot;\n and not &quot;Condition Positive for Sickle Cell&quot;\n and not &quot;Is Active Cancer Treatment?&quot;\n and not &quot;Conditions Likely Terminal for Opioid Prescribing&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommonConfig</td>\n \n \n <td>PDMP Data Not Reviewed in Past 90 Days Criteria Enabled</td>\n \n \n <td>7</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// Recommendation 9\ndefine &quot;PDMP Data Not Reviewed in Past 90 Days Criteria Enabled&quot;:\n true</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Look Back 90 Days</td>\n \n \n <td>8</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Look Back 90 Days&quot;:\n Interval[Today() - 90 days, Today()]</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>PDMP Data Not Reviewed in Past 90 Days</td>\n \n \n <td>9</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;PDMP Data Not Reviewed in Past 90 Days&quot;:\n Config.&quot;PDMP Data Not Reviewed in Past 90 Days Criteria Enabled&quot;\n and not (\n exists (\n [Procedure: Common.&quot;PDMP review procedure&quot;] P\n where P.status ~ 'completed'\n and P.performed during &quot;Look Back 90 Days&quot;\n )\n or exists (\n [Observation: Common.&quot;PDMP data reviewed finding&quot;] O\n where O.status in { 'final', 'amended' }\n and (\n if O.effective is FHIR.Period\n then (O.effective as FHIR.Period) during day of &quot;Look Back 90 Days&quot;\n else if O.effective is FHIR.dateTime\n then date from O.effective in day of &quot;Look Back 90 Days&quot;\n else false\n )\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>OpioidCDSREC09</td>\n \n \n <td>Inclusion Criteria</td>\n \n \n <td>10</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Inclusion Criteria&quot;:\n &quot;Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential&quot;\n and Routines.&quot;Is Opioid Review Useful?&quot;\n and &quot;PDMP Data Not Reviewed in Past 90 Days&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSREC09</td>\n \n \n <td>Exclusion Criteria</td>\n \n \n <td>11</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Exclusion Criteria&quot;:\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>OpioidCDSREC09</td>\n \n \n <td>Is Recommendation Applicable?</td>\n \n \n <td>12</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define &quot;Is Recommendation Applicable?&quot;:\n &quot;Inclusion Criteria&quot;\n and not &quot;Exclusion Criteria&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Is Opioid Analgesic with Ambulatory Misuse Potential?</td>\n \n \n <td>13</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Is Opioid Analgesic with Ambulatory Misuse Potential?&quot;(value List&lt;MedicationRequest&gt;):\n (&quot;Get MedicationRequest Medication as Code&quot;(value)) Rx\n where Rx.medication in &quot;Opioid analgesics with ambulatory misuse potential&quot; \n and Rx.category in &quot;Community&quot;</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>Get MedicationRequest Medication as Code</td>\n \n \n <td>14</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Get MedicationRequest Medication as Code&quot;(value List&lt;MedicationRequest&gt;):\n value Rx\n let Med: \n if Rx.medication is Reference then singleton from (\n [Medication] M\n where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/')))\n ) else null\n return \n MedicationRequest {\n id: Rx.id,\n status: Rx.status,\n intent: Rx.intent,\n category: Rx.category,\n medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept,\n subject: Rx.subject,\n authoredOn: Rx.authoredOn,\n recorder: Rx.recorder,\n dosageInstruction: Rx.dosageInstruction,\n dispenseRequest: Rx.dispenseRequest\n }</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToConcept</td>\n \n \n <td>15</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>16</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">// End of Active Cancer Treatment Routine\n\n/*\n** Routine #4\n** For Subacute or Chronic Pain Routine\n**\n** Definition | Answer to Proceed | Details | Data (Terminology) Requirement\n** -----------------------------------------------------------------------------------------------------------------------------------\n** Order for opioid analgesic | Yes | Order for opioid analgesics with ambulatory | Opioid analgesics with\n** with expected supply | | misuse potential with a supply duration of &gt;= | ambulatory misuse potential\n** duration &gt;= 28 days | | 28 days |\n** | | |\n** | | - Subacute definition = order for opioid |\n** | | analgesics with ambulatory misuse |\n** | | potential with a supply duration of one to |\n** | | two months. |\n** | | - Chronic pain definition = order for opioid |\n** | | analgesics with ambulatory misuse |\n** | | potential with a supply duration of &gt;= two |\n** | | months. |\n** -----------------------------------------------------------------------------------------------------------------------------------\n**\n*/\n\ndefine function &quot;Is Subacute or Chronic Pain Prescription?&quot;(prescription FHIR.MedicationRequest):\n &quot;Is Subacute or Chronic Pain Using Expected Supply Duration&quot;(prescription)\n or &quot;Is Subacute or Chronic Pain Using Validity Period&quot;(prescription)</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSRoutines</td>\n \n \n <td>Is Subacute or Chronic Pain Using Expected Supply Duration</td>\n \n \n <td>17</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Is Subacute or Chronic Pain Using Expected Supply Duration&quot;(prescription FHIR.MedicationRequest):\n (\n prescription.dispenseRequest is not null\n and prescription.dispenseRequest.expectedSupplyDuration is not null\n and (\n Common.GetDurationInDays(prescription.dispenseRequest.expectedSupplyDuration) &gt;= 28 days \n )\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>OpioidCDSCommon</td>\n \n \n <td>GetDurationInDays</td>\n \n \n <td>18</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>19</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function &quot;Is Subacute or Chronic Pain Using Validity Period&quot;(prescription FHIR.MedicationRequest):\n (\n prescription.dispenseRequest is not null\n and prescription.dispenseRequest.validityPeriod is not null\n and (\n days between prescription.dispenseRequest.validityPeriod.start and prescription.dispenseRequest.validityPeriod.end &gt;= 28 \n )\n )</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToDateTime</td>\n \n \n <td>20</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function ToDateTime(value dateTime): value.value</code></pre>\n \n <br/><br/>\n \n <table class=\"grid-dict\">\n <tr><th><b>Library Name</b></th><th><b>Name</b></th><th><b>sequence</b></th></tr>\n <tr>\n \n <td>FHIRHelpers</td>\n \n \n <td>ToString</td>\n \n \n <td>21</td>\n \n </tr>\n </table>\n \n <pre style=\"max-width: 990px;\"><code class=\"language-cql\">define function ToString(value ProcedureStatus): 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>22</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.&quot;start&quot; is null then\n Interval(period.&quot;start&quot;.value, period.&quot;end&quot;.value]\n else\n Interval[period.&quot;start&quot;.value, period.&quot;end&quot;.value]</code></pre>\n \n <br/><br/>\n \n </td>\n </tr>\n \n \n <tr>\n <th scope=\"row\"><b>Knowledge Capability: </b></th>\n <td style=\"padding-left: 4px;\">\n shareable computable executable publishable \n </td>\n </tr>\n \n \n \n <tr>\n <th scope=\"row\"><b>Use Context: </b></th>\n <td style=\"padding-left: 4px;\">\n <table class=\"grid-dict\">\n <tr><th><b>code</b></th><th><b>value</b></th><th><b>display</b></th></tr>\n \n <tr>\n <td>focus</td>\n <td>182888003</td>\n <td>Medication requested (situation)</td>\n </tr>\n \n <tr>\n <td>focus</td>\n <td>82423001</td>\n <td>Chronic pain (finding)</td>\n </tr>\n \n <tr>\n <td>focus</td>\n <td>274663001</td>\n <td>Acute 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;\">At a minimum, during long-term opioid therapy, PDMP data should be reviewed before an initial opioid prescription and then every 3 months or more frequently.</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-OpioidCDSREC09.html\">Library - Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions</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> Before Ordering Opioids, Review PDMP Data:</b> Review PDMP data for this patient before completing an opioid order.\r\n\r\nFor guidance about utilizing PDMP information to improve patient safety, see [Recommendation 9 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20take,see%20Recommendation%2010).).\r\n\r\n[CDC advises not to dismiss patients from your practice on the basis of PDMP information](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20not%20dismiss,Recommendations%208%20and%2012%5D).)<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, if an opioid review is appropriate or there exists evidence of a prescription drug monitoring program (PDMP) review procedure or finding occurred in the past 90 days. <i>(Is Recommendation Applicable?)</i><br/>\n <b>Then:</b>\n \n <table class=\"grid-dict\">\n \n <tr>\n <td>\n <b> :</b> Access Data - Launch app to review PDMP data<br/>\n \n \n <b>Then:</b>\n \n \n \n \n </td>\n </tr>\n \n <tr>\n <td>\n <b> :</b> Document - PDMP data reviewed, 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" : "Library Config",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommonConfig|2022.1.0"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Opioid analgesics with ambulatory misuse potential",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Community",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community"
        },
        {
          "type" : "depends-on",
          "display" : "Value set PDMP review procedure",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-review-procedure"
        },
        {
          "type" : "depends-on",
          "display" : "Value set PDMP data reviewed finding",
          "resource" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-data-reviewed-finding"
        }
      ],
      "parameter" : [
        {
          "name" : "ContextPrescriptions",
          "use" : "in",
          "min" : 0,
          "max" : "*",
          "type" : "MedicationRequest"
        },
        {
          "name" : "Is Recommendation Applicable?",
          "use" : "out",
          "min" : 0,
          "max" : "1",
          "type" : "boolean"
        }
      ],
      "dataRequirement" : [
        {
          "type" : "Procedure",
          "profile" : [
            "http://hl7.org/fhir/StructureDefinition/Procedure"
          ],
          "mustSupport" : [
            "code",
            "status",
            "performed"
          ],
          "codeFilter" : [
            {
              "path" : "code",
              "valueSet" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-review-procedure"
            }
          ]
        },
        {
          "type" : "Observation",
          "profile" : [
            "http://hl7.org/fhir/StructureDefinition/Observation"
          ],
          "mustSupport" : [
            "code",
            "status"
          ],
          "codeFilter" : [
            {
              "path" : "code",
              "valueSet" : "http://fhir.org/guides/cdc/opioid-cds/ValueSet/pdmp-data-reviewed-finding"
            }
          ]
        }
      ]
    }
  ],
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode" : "shareable"
    },
    {
      "url" : "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode" : "computable"
    },
    {
      "url" : "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode" : "executable"
    },
    {
      "url" : "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability",
      "valueCode" : "publishable"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC09"
        },
        {
          "url" : "name",
          "valueString" : "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\":\n ( Common.\"Is Opioid Analgesic with Ambulatory Misuse Potential?\"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription\n where Routines.\"Is Subacute or Chronic Pain Prescription?\"( AmbulatoryOpioidPrescription )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 0
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC09"
        },
        {
          "url" : "name",
          "valueString" : "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential\":\n exists( \"Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions\" )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 1
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Patient Age Less Than 18"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Patient Age Less Than 18\":\n if (Config.\"Age Less than 18 Years Is Enabled\") then\n AgeInYearsAt(Today()) < 18\n else false"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 2
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Condition Positive for Sickle Cell"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Condition Positive for Sickle Cell\":\n if (Config.\"Sickle Cell Check Enabled\") then\n exists(\n Common.\"Positive Sickle Cell Condition\"\n ) \n else false"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 3
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Is Active Cancer Treatment?"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Is Active Cancer Treatment?\":\n if (Config.\"Active Cancer Treatment Encounters Condition Is Enabled\") \n then \"Has Two or More Encounters with Cancer Diagnosis During Encounter Period\"\n or \"Has Active Cancer Diagnosis on Problem List\"\n else false"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 4
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Conditions Likely Terminal for Opioid Prescribing"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Conditions Likely Terminal for Opioid Prescribing\":\n if (Config.\"End-Stage Disease Criteria Enabled\") then\n exists (\n Common.\"US Core-Categorized Conditions\" EOLC\n where EOLC.code in Common.\"Conditions likely terminal for opioid prescribing\"\n // and EOLC.clinicalStatus in Common.\"Active Condition\"\n )\n else false"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 5
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSRoutines"
        },
        {
          "url" : "name",
          "valueString" : "Is Opioid Review Useful?"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Is Opioid Review Useful?\":\n not \"Patient Age Less Than 18\"\n and not \"Condition Positive for Sickle Cell\"\n and not \"Is Active Cancer Treatment?\"\n and not \"Conditions Likely Terminal for Opioid Prescribing\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 6
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSCommonConfig"
        },
        {
          "url" : "name",
          "valueString" : "PDMP Data Not Reviewed in Past 90 Days Criteria Enabled"
        },
        {
          "url" : "statement",
          "valueString" : "// Recommendation 9\ndefine \"PDMP Data Not Reviewed in Past 90 Days Criteria Enabled\":\n true"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 7
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC09"
        },
        {
          "url" : "name",
          "valueString" : "Look Back 90 Days"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Look Back 90 Days\":\n Interval[Today() - 90 days, Today()]"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 8
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC09"
        },
        {
          "url" : "name",
          "valueString" : "PDMP Data Not Reviewed in Past 90 Days"
        },
        {
          "url" : "statement",
          "valueString" : "define \"PDMP Data Not Reviewed in Past 90 Days\":\n Config.\"PDMP Data Not Reviewed in Past 90 Days Criteria Enabled\"\n and not (\n exists (\n [Procedure: Common.\"PDMP review procedure\"] P\n where P.status ~ 'completed'\n and P.performed during \"Look Back 90 Days\"\n )\n or exists (\n [Observation: Common.\"PDMP data reviewed finding\"] O\n where O.status in { 'final', 'amended' }\n and (\n if O.effective is FHIR.Period\n then (O.effective as FHIR.Period) during day of \"Look Back 90 Days\"\n else if O.effective is FHIR.dateTime\n then date from O.effective in day of \"Look Back 90 Days\"\n else false\n )\n )\n )"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 9
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC09"
        },
        {
          "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 \"PDMP Data Not Reviewed in Past 90 Days\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 10
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC09"
        },
        {
          "url" : "name",
          "valueString" : "Exclusion Criteria"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Exclusion Criteria\":\n false"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 11
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "OpioidCDSREC09"
        },
        {
          "url" : "name",
          "valueString" : "Is Recommendation Applicable?"
        },
        {
          "url" : "statement",
          "valueString" : "define \"Is Recommendation Applicable?\":\n \"Inclusion Criteria\"\n and not \"Exclusion Criteria\""
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 12
        }
      ],
      "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" : 13
        }
      ],
      "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" : 14
        }
      ],
      "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" : 15
        }
      ],
      "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" : 16
        }
      ],
      "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" : 17
        }
      ],
      "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" : 18
        }
      ],
      "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" : 19
        }
      ],
      "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" : 20
        }
      ],
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension" : [
        {
          "url" : "libraryName",
          "valueString" : "FHIRHelpers"
        },
        {
          "url" : "name",
          "valueString" : "ToString"
        },
        {
          "url" : "statement",
          "valueString" : "define function ToString(value ProcedureStatus): value.value"
        },
        {
          "url" : "displaySequence",
          "valueInteger" : 21
        }
      ],
      "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" : 22
        }
      ],
      "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-09",
  "identifier" : [
    {
      "use" : "official",
      "value" : "cdc-opioid-guidance"
    }
  ],
  "version" : "2022.1.0",
  "name" : "PlanDefinition_Recommendation_09_Order_Sign",
  "title" : "Recommendation #9 - Consider Patient's History of Controlled Substance Prescriptions",
  "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 prescribing initial opioid therapy for acute, subacute, or chronic pain, and periodically during opioid therapy for chronic pain, clinicians should review the patient's history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or combinations that put the patient at high risk for overdose.",
  "useContext" : [
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "focus",
        "display" : "Clinical Focus"
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "182888003",
            "display" : "Medication requested (situation)"
          }
        ]
      }
    },
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "focus",
        "display" : "Clinical Focus"
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "82423001",
            "display" : "Chronic pain (finding)"
          }
        ]
      }
    },
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "focus",
        "display" : "Clinical Focus"
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "274663001",
            "display" : "Acute pain (finding)"
          }
        ]
      }
    },
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "focus",
        "display" : "Clinical Focus"
      },
      "valueCodeableConcept" : {
        "text" : "Subacute pain"
      }
    }
  ],
  "purpose" : "The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.",
  "usage" : "At a minimum, during long-term opioid therapy, PDMP data should be reviewed before an initial opioid prescription and then every 3 months or more frequently.",
  "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/OpioidCDSREC09"
  ],
  "action" : [
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/recommendation-strength",
                "code" : "weak",
                "display" : "Weak"
              }
            ]
          }
        },
        {
          "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" : "Before Ordering Opioids, Review PDMP Data",
      "description" : "Review PDMP data for this patient before completing an opioid order.\r\n\r\nFor guidance about utilizing PDMP information to improve patient safety, see [Recommendation 9 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20take,see%20Recommendation%2010).).\r\n\r\n[CDC advises not to dismiss patients from your practice on the basis of PDMP information](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20not%20dismiss,Recommendations%208%20and%2012%5D).)",
      "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, if an opioid review is appropriate or there exists evidence of a prescription drug monitoring program (PDMP) review procedure or finding occurred in the past 90 days.",
            "language" : "text/cql.identifier",
            "expression" : "Is Recommendation Applicable?"
          }
        }
      ],
      "groupingBehavior" : "visual-group",
      "selectionBehavior" : "any",
      "action" : [
        {
          "description" : "Access Data - Launch app to review PDMP data"
        },
        {
          "description" : "Document - PDMP data reviewed, 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.