XIG: PlanDefinition/opioidcds-07

FHIR IG Statistics: PlanDefinition/opioidcds-07

Package	fhir.cdc.opioid-cds-r4
Resource Type	PlanDefinition
Id	opioidcds-07
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
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

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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

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

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

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

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?

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

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?

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

define "Risk Assessment Interval":
  Interval[Today() - 91 days, Today() - 1 day]

Library Name

Name

sequence

OpioidCDSREC07

Opioid Risk Assessment in Past 90 Days

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

define "Previous 10 Days Interval":
  Interval[Today() - 10 days, Today()]

Library Name

Name

sequence

OpioidCDSREC07

Encounter Interval

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

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

define "First Month":
Interval[Today() - 3 months, Today() - 2 months]

Library Name

Name

sequence

OpioidCDSCommon

Second Month

define "Second Month":
Interval[Today() - 2 months, Today() - 1 months]

Library Name

Name

sequence

OpioidCDSCommon

Third Month

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

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

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

// 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

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

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

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

define "Exclusion Criteria":
  Common."End of Life Assessment"

Library Name

Name

sequence

OpioidCDSREC07

Is Recommendation Applicable?

define "Is Recommendation Applicable?":
  "Inclusion Criteria"
    and not "Exclusion Criteria"

Library Name

Name

sequence

OpioidCDSCommon

Is Opioid Analgesic with Ambulatory Misuse Potential?

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

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

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?

// 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

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

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

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

define function ToDateTime(value dateTime): value.value

Library Name

Name

sequence

FHIRHelpers

ToInterval

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

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

define function ToString(value string): value.value

Library Name

Name

sequence

OpioidCDSCommon

Prescription Relevant Period

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

2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain

Libraries:

Library - Recommendation #7 - Opioid Therapy Risk Assessment

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": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "name": "EffectiveDataRequirements",
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/library-type",
            "code": "module-definition"
          }
        ]
      },
      "relatedArtifact": [
        {
          "type": "depends-on",
          "display": "Library Common",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommon|2022.1.0"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1"
        },
        {
          "type": "depends-on",
          "display": "Library Routines",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines|2022.1.0"
        },
        {
          "type": "depends-on",
          "display": "Value set Opioid analgesics with ambulatory misuse potential",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential"
        },
        {
          "type": "depends-on",
          "display": "Value set Community",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community"
        },
        {
          "type": "depends-on",
          "display": "Value set Opioid misuse assessment procedure",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-misuse-assessment-procedure"
        },
        {
          "type": "depends-on",
          "display": "Value set Office Visit",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/office-visit"
        },
        {
          "type": "depends-on",
          "display": "Value set Encounter Diagnosis Condition Category",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"
        },
        {
          "type": "depends-on",
          "display": "Value set Problem List Condition Category",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"
        },
        {
          "type": "depends-on",
          "display": "Value set US Core Health Concern Condition Category",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"
        },
        {
          "type": "depends-on",
          "display": "Value set Conditions likely terminal for opioid prescribing",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/conditions-likely-terminal-for-opioid-prescribing"
        },
        {
          "type": "depends-on",
          "display": "Value set Active Condition",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-clinical-status-active"
        },
        {
          "type": "depends-on",
          "display": "Value set Limited life expectancy conditions",
          "resource": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/limited-life-expectancy-conditions"
        }
      ],
      "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",
            "performed"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-misuse-assessment-procedure"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/MedicationRequest"
          ],
          "mustSupport": [
            "medication",
            "id",
            "status",
            "intent",
            "category",
            "subject",
            "authoredOn",
            "recorder",
            "dosageInstruction",
            "dispenseRequest"
          ],
          "codeFilter": [
            {
              "path": "medication",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/opioid-analgesics-with-ambulatory-misuse-potential"
            }
          ]
        },
        {
          "type": "MedicationRequest",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/MedicationRequest"
          ],
          "mustSupport": [
            "medication.reference",
            "id",
            "status",
            "intent",
            "category",
            "subject",
            "authoredOn",
            "recorder",
            "dosageInstruction",
            "dispenseRequest",
            "medication"
          ]
        },
        {
          "type": "Medication",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Medication"
          ],
          "mustSupport": [
            "id",
            "code"
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "type",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/office-visit"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Encounter"
          ],
          "mustSupport": [
            "period",
            "period.start",
            "status",
            "status.value"
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "category",
            "code",
            "clinicalStatus"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-encounter-diagnosis-category"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "category",
            "code",
            "clinicalStatus"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-problem-list-category"
            }
          ]
        },
        {
          "type": "Condition",
          "profile": [
            "http://hl7.org/fhir/StructureDefinition/Condition"
          ],
          "mustSupport": [
            "category",
            "code",
            "clinicalStatus"
          ],
          "codeFilter": [
            {
              "path": "category",
              "valueSet": "http://fhir.org/guides/cdc/opioid-cds/ValueSet/condition-us-core-health-concern-category"
            }
          ]
        }
      ]
    }
  ],
  "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": "OpioidCDSREC07"
        },
        {
          "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": "OpioidCDSREC07"
        },
        {
          "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": "OpioidCDSREC07"
        },
        {
          "url": "name",
          "valueString": "Risk Assessment Interval"
        },
        {
          "url": "statement",
          "valueString": "define \"Risk Assessment Interval\":\n  Interval[Today() - 91 days, Today() - 1 day]"
        },
        {
          "url": "displaySequence",
          "valueInteger": 7
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSREC07"
        },
        {
          "url": "name",
          "valueString": "Opioid Risk Assessment in Past 90 Days"
        },
        {
          "url": "statement",
          "valueString": "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\""
        },
        {
          "url": "displaySequence",
          "valueInteger": 8
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSREC07"
        },
        {
          "url": "name",
          "valueString": "Previous 10 Days Interval"
        },
        {
          "url": "statement",
          "valueString": "define \"Previous 10 Days Interval\":\n  Interval[Today() - 10 days, Today()]"
        },
        {
          "url": "displaySequence",
          "valueInteger": 9
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-logicDefinition"
    },
    {
      "extension": [
        {
          "url": "libraryName",
          "valueString": "OpioidCDSREC07"
        },
        {
          "url": "name",
          "valueString": "Encounter Interval"
        },
        {
          "url": "statement",
          "valueString": "define \"Encounter Interval\":\n  Interval[Today() - 12 months - 1 days, Today() - 1 day]"
        },
        {
          "url": "displaySequence",
          "valueInteger": 10
        }
      ],
      "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"
        }
      ]
    }
  ]
}