R4 Ballot #1 (Mixed Normative/Trial use)
WorkflowThis page is part of the FHIR Specification (v3.3.0: R4 Ballot 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
. Page versions: R5 R4B R4
| Clinical Decision Support Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Not linked to any defined compartments |
Opioid CDS Recommendation 5 ECA Rule
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/PlanDefinition/opioidcds-05> a fhir:PlanDefinition;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "opioidcds-05"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: opioidcds-05</p><p><b>url</b>: <a>http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-05</a></p><p><b>identifier</b>: cdc-opioid-guidance (OFFICIAL)</p><p><b>version</b>: 0.1.0</p><p><b>name</b>: cdc-opioid-05</p><p><b>title</b>: CDC Opioid Prescribing Guideline Recommendation #5</p><p><b>type</b>: ECA Rule <span>(Details : {http://hl7.org/fhir/plan-definition-type code 'eca-rule' = 'ECA Rule', given as 'ECA Rule'})</span></p><p><b>status</b>: draft</p><p><b>date</b>: 23/04/2017</p><p><b>publisher</b>: Centers for Disease Control and Prevention (CDC)</p><p><b>description</b>: When opioids are started, providers should prescribe the lowest effective dosage.</p><p><b>useContext</b>: , </p><p><b>jurisdiction</b>: United States of America <span>(Details : {urn:iso:std:iso:3166 code 'US' = 'United States of America', given as 'United States of America'})</span></p><p><b>purpose</b>: CDC’s Guideline for Prescribing Opioids for Chronic Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.</p><p><b>usage</b>: Providers should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to >90 MME/day</p><p><b>copyright</b>: © CDC 2016+.</p><p><b>topic</b>: Opioid Prescribing <span>(Details )</span></p><p><b>contributor</b>: , , , </p><p><b>relatedArtifact</b>: , </p><p><b>library</b>: <a>Library/opioidcds-recommendation-05</a></p><blockquote><p><b>action</b></p><p><b>title</b>: High risk for opioid overdose.</p><p><b>description</b>: Total morphine milligram equivalent (MME) exceeds recommended amount. Taper to less than 50.</p><p><b>documentation</b>: </p><p><b>trigger</b>: </p><h3>Conditions</h3><table><tr><td>-</td><td><b>Kind</b></td><td><b>Description</b></td><td><b>Language</b></td><td><b>Expression</b></td></tr><tr><td>*</td><td>applicability</td><td>Is total MME >= 50?</td><td>text/cql</td><td>Is MME 50 Or More?</td></tr></table><p><b>groupingBehavior</b>: visual-group</p><p><b>selectionBehavior</b>: exactly-one</p><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: action.title</p><p><b>expression</b>: getSummary</p></blockquote><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: action.description</p><p><b>expression</b>: getDetail</p></blockquote><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: activity.extension</p><p><b>expression</b>: getIndicator</p></blockquote><h3>Actions</h3><table><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote></div>"
];
fhir:PlanDefinition.url [ fhir:value "http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-05"];
fhir:PlanDefinition.identifier [
fhir:index 0;
fhir:Identifier.use [ fhir:value "official" ];
fhir:Identifier.value [ fhir:value "cdc-opioid-guidance" ]
];
fhir:PlanDefinition.version [ fhir:value "0.1.0"];
fhir:PlanDefinition.name [ fhir:value "cdc-opioid-05"];
fhir:PlanDefinition.title [ fhir:value "CDC Opioid Prescribing Guideline Recommendation #5"];
fhir:PlanDefinition.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/plan-definition-type" ];
fhir:Coding.code [ fhir:value "eca-rule" ];
fhir:Coding.display [ fhir:value "ECA Rule" ]
]
];
fhir:PlanDefinition.status [ fhir:value "draft"];
fhir:PlanDefinition.date [ fhir:value "2017-04-23"^^xsd:date];
fhir:PlanDefinition.publisher [ fhir:value "Centers for Disease Control and Prevention (CDC)"];
fhir:PlanDefinition.description [ fhir:value "When opioids are started, providers should prescribe the lowest effective dosage."];
fhir:PlanDefinition.useContext [
fhir:index 0;
fhir:UsageContext.code [
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/usage-context-type" ];
fhir:Coding.code [ fhir:value "focus" ];
fhir:Coding.display [ fhir:value "Clinical Focus" ]
];
fhir:UsageContext.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
a sct:182888003;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
fhir:Coding.code [ fhir:value "182888003" ];
fhir:Coding.display [ fhir:value "Medication requested (situation)" ]
]
]
], [
fhir:index 1;
fhir:UsageContext.code [
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/usage-context-type" ];
fhir:Coding.code [ fhir:value "focus" ];
fhir:Coding.display [ fhir:value "Clinical Focus" ]
];
fhir:UsageContext.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
a sct:82423001;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
fhir:Coding.code [ fhir:value "82423001" ];
fhir:Coding.display [ fhir:value "Chronic pain (finding)" ]
]
]
];
fhir:PlanDefinition.jurisdiction [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ];
fhir:Coding.code [ fhir:value "US" ];
fhir:Coding.display [ fhir:value "United States of America" ]
]
];
fhir:PlanDefinition.purpose [ fhir:value "CDC’s Guideline for Prescribing Opioids for Chronic Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care."];
fhir:PlanDefinition.usage [ fhir:value "Providers should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to >90 MME/day"];
fhir:PlanDefinition.copyright [ fhir:value "© CDC 2016+."];
fhir:PlanDefinition.topic [
fhir:index 0;
fhir:CodeableConcept.text [ fhir:value "Opioid Prescribing" ]
];
fhir:PlanDefinition.contributor [
fhir:index 0;
fhir:Contributor.type [ fhir:value "author" ];
fhir:Contributor.name [ fhir:value "Kensaku Kawamoto, MD, PhD, MHS" ]
], [
fhir:index 1;
fhir:Contributor.type [ fhir:value "author" ];
fhir:Contributor.name [ fhir:value "Bryn Rhodes" ]
], [
fhir:index 2;
fhir:Contributor.type [ fhir:value "author" ];
fhir:Contributor.name [ fhir:value "Floyd Eisenberg, MD, MPH" ]
], [
fhir:index 3;
fhir:Contributor.type [ fhir:value "author" ];
fhir:Contributor.name [ fhir:value "Robert McClure, MD, MPH" ]
];
fhir:PlanDefinition.relatedArtifact [
fhir:index 0;
fhir:RelatedArtifact.type [ fhir:value "documentation" ];
fhir:RelatedArtifact.display [ fhir:value "CDC guideline for prescribing opioids for chronic pain" ];
fhir:RelatedArtifact.url [ fhir:value "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420" ]
], [
fhir:index 1;
fhir:RelatedArtifact.type [ fhir:value "documentation" ];
fhir:RelatedArtifact.display [ fhir:value "MME Conversion Tables" ];
fhir:RelatedArtifact.url [ fhir:value "https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf" ]
];
fhir:PlanDefinition.library [
fhir:value "Library/opioidcds-recommendation-05";
fhir:index 0;
fhir:link <http://hl7.org/fhir/Library/opioidcds-recommendation-05>
];
fhir:PlanDefinition.action [
fhir:index 0;
fhir:PlanDefinition.action.title [ fhir:value "High risk for opioid overdose." ];
fhir:PlanDefinition.action.description [ fhir:value "Total morphine milligram equivalent (MME) exceeds recommended amount. Taper to less than 50." ];
fhir:PlanDefinition.action.documentation [
fhir:index 0;
fhir:RelatedArtifact.type [ fhir:value "documentation" ];
fhir:RelatedArtifact.document [
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqif-strengthOfRecommendation" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/recommendation-strength" ];
fhir:Coding.code [ fhir:value "strong" ];
fhir:Coding.display [ fhir:value "Strong" ]
]
]
], [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqif-qualityOfEvidence" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/evidence-quality" ];
fhir:Coding.code [ fhir:value "low" ];
fhir:Coding.display [ fhir:value "Low quality" ]
]
]
]
]
];
fhir:PlanDefinition.action.trigger [
fhir:index 0;
fhir:TriggerDefinition.type [ fhir:value "named-event" ];
fhir:TriggerDefinition.name [ fhir:value "medication-prescribe" ]
];
fhir:PlanDefinition.action.condition [
fhir:index 0;
fhir:PlanDefinition.action.condition.kind [ fhir:value "applicability" ];
fhir:PlanDefinition.action.condition.description [ fhir:value "Is total MME >= 50?" ];
fhir:PlanDefinition.action.condition.language [ fhir:value "text/cql" ];
fhir:PlanDefinition.action.condition.expression [ fhir:value "Is MME 50 Or More?" ]
];
fhir:PlanDefinition.action.groupingBehavior [ fhir:value "visual-group" ];
fhir:PlanDefinition.action.selectionBehavior [ fhir:value "exactly-one" ];
fhir:PlanDefinition.action.dynamicValue [
fhir:index 0;
fhir:PlanDefinition.action.dynamicValue.path [ fhir:value "action.title" ];
fhir:PlanDefinition.action.dynamicValue.expression [ fhir:value "getSummary" ]
], [
fhir:index 1;
fhir:PlanDefinition.action.dynamicValue.path [ fhir:value "action.description" ];
fhir:PlanDefinition.action.dynamicValue.expression [ fhir:value "getDetail" ]
], [
fhir:index 2;
fhir:PlanDefinition.action.dynamicValue.path [ fhir:value "activity.extension" ];
fhir:PlanDefinition.action.dynamicValue.expression [ fhir:value "getIndicator" ]
];
fhir:PlanDefinition.action.action [
fhir:index 0;
fhir:PlanDefinition.action.description [ fhir:value "Will reduce dosage" ]
], [
fhir:index 1;
fhir:PlanDefinition.action.description [ fhir:value "Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo" ]
], [
fhir:index 2;
fhir:PlanDefinition.action.description [ fhir:value "Acute pain; snooze 1 mo" ]
], [
fhir:index 3;
fhir:PlanDefinition.action.description [ fhir:value "N/A - see comment (will be reviewed by medical director); snooze 3 mo" ]
]
] .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/PlanDefinition/opioidcds-05.ttl> a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI <http://build.fhir.org/PlanDefinition/opioidcds-05.ttl> .
# -------------------------------------------------------------------------------------
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
®© HL7.org 2011+. FHIR Mixed Nomative/Trial Use Ballot (v3.3.0-13671) generated on Tue, Apr 3, 2018 12:17+1000. QA Page
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