Release 5 Draft Ballot
Clinical ReasoningThis page is part of the FHIR Specification (v4.6.0: R5 Draft Ballot). 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 | Standards Status: Informative | Compartments: Not linked to any defined compartments |
Raw XML (canonical form + also see XML Format Specification)
Opioid CDS Recommendation 7 Logic (id = "opioidcds-recommendation-07")
<?xml version="1.0" encoding="UTF-8"?> <Library xmlns="http://hl7.org/fhir"> <id value="opioidcds-recommendation-07"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <h2> Participants</h2> <table class="grid"> <tr> <td> Author</td> <td> Kensaku Kawamoto, MD, PhD, MHS</td> </tr> <tr> <td> Author</td> <td> Bryn Rhodes</td> </tr> <tr> <td> Author</td> <td> Floyd Eisenberg, MD, MPH</td> </tr> <tr> <td> Author</td> <td> Robert McClure, MD, MPH</td> </tr> </table> <h2> Related Artifacts</h2> <table class="grid"> <tr> <td> Documentation</td> <td> CDC guideline for prescribing opioids for chronic pain</td> <td> https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pai n---united-states-2016#420</td> </tr> <tr> <td> Depends On</td> <td/> <td> <code> http://example.org/fhir/Library/opioidcds-common</code> </td> </tr> </table> <h2> Data Requirements</h2> <table class="grid"> <tr> <td colspan="2"> <b> Type</b> : <a href="medicationrequest.html">MedicationRequest</a> </td> </tr> <tr style="background-color: #efefef"> <td> Filter</td> <td> Value</td> </tr> <tr> <td> medicationCodeableConcept</td> <td> In ValueSet <a href="http://example.org/fhir/ValueSet/opioids-indicating-end-of-life">http://example.org/fhir/ValueSet/opioids-indicating-end-of-life</a> </td> </tr> </table> <table class="grid"> <tr> <td colspan="2"> <b> Type</b> : <a href="procedure.html">Procedure</a> </td> </tr> <tr style="background-color: #efefef"> <td> Filter</td> <td> Value</td> </tr> <tr> <td> code</td> <td> One of these codes: </td> </tr> </table> <table class="grid"> <tr> <td colspan="2"> <b> Type</b> : <a href="procedure.html">Procedure</a> </td> </tr> <tr style="background-color: #efefef"> <td> Filter</td> <td> Value</td> </tr> <tr> <td> code</td> <td> One of these codes: </td> </tr> </table> <table class="grid"> <tr> <td colspan="2"> <b> Type</b> : <a href="medicationrequest.html">MedicationRequest</a> </td> </tr> <tr style="background-color: #efefef"> <td> Filter</td> <td> Value</td> </tr> <tr> <td> medicationCodeableConcept</td> <td> In ValueSet <a href="http://example.org/fhir/ValueSet/opioids-abused-in-ambulatory-care">http://example.org/fhir/ValueSet/opioids-abused-in-ambulatory-care</a> </td> </tr> </table> <table class="grid"> <tr> <td colspan="2"> <b> Type</b> : <a href="encounter.html">Encounter</a> </td> </tr> </table> <h2> Contents</h2> <p> <code> application/elm+xml</code> </p> <pre> <code class="language-xml"><?xml version="1.0" encoding="UTF-8"?> <library xmlns="urn:hl7-org:elm:r1" xmlns:t="urn:hl7-org:elm-types:r1" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/20 01/XMLSchema" xmlns:fhir="http://hl7.org/fhir" xmlns:qdm43="urn:healthit-gov:qdm: v4_3" xmlns:qdm53="urn:healthit-gov:qdm:v5_3" xmlns:a="urn:hl7-org:cql-annotation s:r1"> <annotation startLine="76" startChar="3" endLine="76" endChar="51" message="Could not resolve code path medicationCodeableConcept for the type of the retrieve FHIR.MedicationRequest." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/> <annotation startLine="76" startChar="3" endLine="76" endChar="51" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/> <annotation startLine="85" startChar="4" endLine="85" endChar="53" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/> <annotation startLine="86" startChar="13" endLine="86" endChar="52" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/> <annotation startLine="95" startChar="3" endLine="95" endChar="66" message="Could not resolve code path medicationCodeableConcept for the type of the retrieve FHIR.MedicationRequest." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/> <annotation startLine="95" startChar="3" endLine="95" endChar="66" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/> <annotation startLine="103" startChar="10" endLine="103" endChar="70" message="List-valued expression was demoted to a singleton." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError" ;/> <annotation startLine="69" startChar="59" endLine="69" endChar="88" message="List-valued expression was demoted to a singleton." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError" ;/> <annotation startLine="115" startChar="6" endLine="115" endChar="35" message="List-valued expression was demoted to a singleton." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError" ;/> <identifier id="OpioidCDS_STU4_REC_07" version="0.1.0"/> <schemaIdentifier id="urn:hl7-org:elm" version="r1"/> <usings> <def localIdentifier="System" uri="urn:hl7-org:elm-types:r1"/> <def localIdentifier="FHIR" uri="http://hl7.org/fhir" version="3.2 .0"/> </usings> <includes> <def localIdentifier="Common" path="OpioidCDS_STU4_Common" version="0.1.0"/> </includes> <parameters> <def name="ContextPrescriptions" accessLevel="Public"> <parameterTypeSpecifier xsi:type="ListTypeSpecifier"> <elementType name="fhir:MedicationRequest" xsi:type="NamedTypeSpecifie r"/> </parameterTypeSpecifier> </def> </parameters> <codeSystems> <def name="SNOMED" id="http://snomed.info/sct" accessLevel="Public "/> </codeSystems> <codes> <def name="Assessment of risk for opioid abuse" id="454281000124100" accessLevel="Public"> <codeSystem name="SNOMED"/> </def> <def name="High risk drug monitoring" id="268525008" accessLevel=" Public"> <codeSystem name="SNOMED"/> </def> </codes> <statements> <def name="Patient" context="Patient"> <expression xsi:type="SingletonFrom"> <operand dataType="fhir:Patient" xsi:type="Retrieve"/> </expression> </def> <def name="Risk Assessment Interval" context="Patient" accessLevel=&quo t;Public"> <expression lowClosed="true" highClosed="true" xsi:type="Interv al"> <low xsi:type="Subtract"> <operand xsi:type="Today"/> <operand value="91" unit="days" xsi:type="Quantity"/ > </low> <high xsi:type="Subtract"> <operand xsi:type="Today"/> <operand value="1" unit="day" xsi:type="Quantity"/&g t; </high> </expression> </def> <def name="Encounter Interval" context="Patient" accessLevel="Publ ic"> <expression lowClosed="true" highClosed="true" xsi:type="Interv al"> <low xsi:type="Subtract"> <operand xsi:type="Subtract"> <operand xsi:type="Today"/> <operand value="12" unit="months" xsi:type="Quantity&q uot;/> </operand> <operand value="1" unit="days" xsi:type="Quantity"/& gt; </low> <high xsi:type="Subtract"> <operand xsi:type="Today"/> <operand value="1" unit="day" xsi:type="Quantity"/&g t; </high> </expression> </def> <def name="Validate Trigger Event" context="Patient" accessLevel=" Public"> <expression xsi:type="Exists"> <operand xsi:type="Query"> <source alias="triggerScript"> <expression name="ContextPrescriptions" xsi:type="ParameterRef&q uot;/> </source> <where name="IsOpioidWithAmbulatoryAbusePotential" libraryName="Com mon" xsi:type="FunctionRef"> <operand name="ToCode" libraryName="Common" xsi:type=" FunctionRef"> <operand xsi:type="Indexer"> <operand path="coding" xsi:type="Property"> <source path="medication" scope="triggerScript" xsi:type="Property"/> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </operand> </operand> </where> </operand> </expression> </def> <def name="Medications Indicating End Of Life" context="Patient" accessLevel="Public"> <expression xsi:type="Query"> <source alias="endOfLifeRx"> <expression dataType="fhir:MedicationRequest" codeProperty="medicat ionCodeableConcept" xsi:type="Retrieve"> <codes name="End Of Life Opioids" libraryName="Common" xsi:type="ValueSetRef"/> </expression> </source> <where xsi:type="Equal"> <operand path="value" xsi:type="Property"> <source path="status" scope="endOfLifeRx" xsi:type="Pr operty"/> </operand> <operand valueType="t:String" value="active" xsi:type="Li teral"/> </where> </expression> </def> <def name="Exclusion Criteria" context="Patient" accessLevel="Publ ic"> <expression xsi:type="Exists"> <operand name="Medications Indicating End Of Life" xsi:type="Expressio nRef"/> </expression> </def> <def name="Opioid Risk Assessment in Past 90 Days" context="Patient" accessLevel="Public"> <expression xsi:type="Query"> <source alias="riskAssessment"> <expression xsi:type="Union"> <operand dataType="fhir:Procedure" codeProperty="code" xsi:type="Retrieve"> <codes name="Assessment of risk for opioid abuse" xsi:type="C odeRef"/> </operand> <operand dataType="fhir:Procedure" codeProperty="code" xsi:type="Retrieve"> <codes name="High risk drug monitoring" xsi:type="CodeRef&quo t;/> </operand> </expression> </source> <where xsi:type="In"> <operand path="value" xsi:type="Property"> <source path="start" xsi:type="Property"> <source path="performed" scope="riskAssessment" xsi:type="Property"/> </source> </operand> <operand name="Risk Assessment Interval" xsi:type="ExpressionRef&qu ot;/> </where> </expression> </def> <def name="Get Active Ambulatory Opioid Rx" context="Patient" accessLevel="Public"> <expression xsi:type="Query"> <source alias="Rx"> <expression dataType="fhir:MedicationRequest" codeProperty="medicat ionCodeableConcept" xsi:type="Retrieve"> <codes name="Ambulatory Abuse Potential Opioids" libraryName="Co mmon" xsi:type="ValueSetRef"/> </expression> </source> <where xsi:type="And"> <operand xsi:type="Equal"> <operand path="value" xsi:type="Property"> <source path="status" scope="Rx" xsi:type="Property "/> </operand> <operand valueType="t:String" value="active" xsi:type="Literal"/> </operand> <operand xsi:type="Equal"> <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand xsi:type="Flatten"> <operand xsi:type="Query"> <source alias="$this"> <expression path="category" scope="Rx" xsi:type="Property"/> </source> <where xsi:type="Not"> <operand xsi:type="IsNull"> <operand path="coding" xsi:type="Property&q uot;> <source name="$this" xsi:type="AliasRef& quot;/> </operand> </operand> </where> <return> <expression path="coding" xsi:type="Property&q uot;> <source name="$this" xsi:type="AliasRef&quo t;/> </expression> </return> </operand> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> <operand valueType="t:String" value="outpatient" xsi:type="Literal"/> </operand> </where> </expression> </def> <def name="Encounter in past 12 months" context="Patient" accessLevel="Public"> <expression xsi:type="Query"> <source alias="E"> <expression dataType="fhir:Encounter" xsi:type="Retrieve"/> </source> <where xsi:type="In"> <operand path="value" xsi:type="Property"> <source path="start" xsi:type="Property"> <source path="period" scope="E" xsi:type="Property& quot;/> </source> </operand> <operand name="Encounter Interval" xsi:type="ExpressionRef"/&g t; </where> </expression> </def> <def name="Rx Active 7 of Past 10 Days With Encounter" context="Patient" ; accessLevel="Public"> <expression xsi:type="And"> <operand xsi:type="SingletonFrom"> <operand name="ProbableDaysInRange" libraryName="Common" xsi:type="FunctionRef"> <operand name="Get Active Ambulatory Opioid Rx" xsi:type="Expres sionRef"/> <operand valueType="t:Integer" value="10" xsi:type="Li teral"/> <operand valueType="t:Integer" value="7" xsi:type="Lit eral"/> </operand> </operand> <operand xsi:type="Exists"> <operand name="Encounter in past 12 months" xsi:type="ExpressionRef "/> </operand> </expression> </def> <def name="Rx Active 63 of Past 90 Days" context="Patient" accessLevel="Public"> <expression name="ProbableDaysInRange" libraryName="Common" xsi:type="FunctionRef"> <operand name="Get Active Ambulatory Opioid Rx" xsi:type="ExpressionRe f"/> <operand valueType="t:Integer" value="90" xsi:type="Literal& quot;/> <operand valueType="t:Integer" value="63" xsi:type="Literal& quot;/> </expression> </def> <def name="Inclusion Criteria" context="Patient" accessLevel="Publ ic"> <expression xsi:type="And"> <operand xsi:type="And"> <operand xsi:type="And"> <operand name="Validate Trigger Event" xsi:type="ExpressionRef&q uot;/> <operand xsi:type="Not"> <operand name="Exclusion Criteria" xsi:type="ExpressionRef&qu ot;/> </operand> </operand> <operand xsi:type="Not"> <operand xsi:type="Exists"> <operand name="Opioid Risk Assessment in Past 90 Days" xsi:type="ExpressionRef"/> </operand> </operand> </operand> <operand xsi:type="Or"> <operand name="Rx Active 7 of Past 10 Days With Encounter" xsi:type="ExpressionRef"/> <operand xsi:type="SingletonFrom"> <operand name="Rx Active 63 of Past 90 Days" xsi:type="Expressio nRef"/> </operand> </operand> </expression> </def> <def name="Get Indicator" context="Patient" accessLevel="Public&qu ot;> <expression valueType="t:String" value="warning" xsi:type="Lite ral"/> </def> <def name="Get Summary" context="Patient" accessLevel="Public" ;> <expression valueType="t:String" value="Patients on opioid therapy should be evaluated for benefits and harms within 1 to 4 weeks of starting opioid therapy and every 3 months or more subsequently." xsi:type="Literal"/> </def> <def name="Get Detail" context="Patient" accessLevel="Public" > <expression xsi:type="If"> <condition xsi:type="SingletonFrom"> <operand name="Rx Active 63 of Past 90 Days" xsi:type="ExpressionRe f"/> </condition> <then valueType="t:String" value="No evaluation for benefits and harms associated with opioid therapy has been performed for the patient in the past 3 months" xsi:type="Literal"/> <else valueType="t:String" value="No evaluation for benefits and harms has been performed for the patient starting opioid therapy" xsi:type="Literal&qu ot;/> </expression> </def> </statements> </library> </code> </pre> </div> </text> <identifier> <use value="official"/> <value value="OpioidCDS_REC_07"/> </identifier> <version value="0.1.0"/> <title value="Opioid CDS Logic for recommendation #7"/> <status value="active"/> <experimental value="false"/> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/library-type"/> <code value="logic-library"/> <display value="Logic Library"/> </coding> </type> <date value="2018-03-25T13:49:09-06:00"/> <publisher value="Centers for Disease Control and Prevention (CDC)"/> <description value="Opioid decision support logic to evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy and harms of continued therapy with patients every 3 months or more frequently."/> <useContext> <code> <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> <code value="focus"/> <display value="Clinical Focus"/> </code> <valueCodeableConcept> <coding> <system value="http://snomed.info/sct"/> <code value="182888003"/> <display value="Medication requested (situation)"/> </coding> </valueCodeableConcept> </useContext> <useContext> <code> <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> <code value="focus"/> <display value="Clinical Focus"/> </code> <valueCodeableConcept> <coding> <system value="http://snomed.info/sct"/> <code value="82423001"/> <display value="Chronic pain (finding)"/> </coding> </valueCodeableConcept> </useContext> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="US"/> <display value="United States of America"/> </coding> </jurisdiction> <purpose value="The purpose of this library is to determine whether the patient has been evaluated for benefits and harms within 1 to 4 weeks of starting opioid therapy and every 3 months or more subsequently."/> <usage value="This library is used to notify the prescriber/user whether an evaluation for benefits and harms associated with opioid therapy is recommended for the patient."/> <copyright value="© CDC 2016+."/> <topic> <text value="Opioid Prescribing"/> </topic> <author> <name value="Kensaku Kawamoto, MD, PhD, MHS"/> </author> <author> <name value="Bryn Rhodes"/> </author> <author> <name value="Floyd Eisenberg, MD, MPH"/> </author> <author> <name value="Robert McClure, MD, MPH"/> </author> <relatedArtifact> <type value="documentation"/> <display value="CDC guideline for prescribing opioids for chronic pain"/> <url value="https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pai n---united-states-2016#420"/> </relatedArtifact> <relatedArtifact> <type value="depends-on"/> <resource value="http://example.org/fhir/Library/opioidcds-common"/> </relatedArtifact> <dataRequirement> <type value="MedicationRequest"/> <codeFilter> <path value="medicationCodeableConcept"/> <valueSet value="http://example.org/fhir/ValueSet/opioids-indicating-end-of-life"/> </codeFilter> </dataRequirement> <dataRequirement> <type value="Procedure"/> <codeFilter> <path value="code"/> </codeFilter> </dataRequirement> <dataRequirement> <type value="Procedure"/> <codeFilter> <path value="code"/> </codeFilter> </dataRequirement> <dataRequirement> <type value="MedicationRequest"/> <codeFilter> <path value="medicationCodeableConcept"/> <valueSet value="http://example.org/fhir/ValueSet/opioids-abused-in-ambulatory-care"/> </codeFilter> </dataRequirement> <dataRequirement> <type value="Encounter"/> </dataRequirement> <content> <contentType value="application/elm+xml"/> <data value="PD94bWwgdmVyc2lvbj0iMS4wIiBlbmNvZGluZz0iVVRGLTgiPz4KPGxpYnJhcnkgeG1sbnM9InVybjpobDctb3JnOmVsbTpyMSIg eG1sbnM6dD0idXJuOmhsNy1vcmc6ZWxtLXR5cGVzOnIxIiB4bWxuczp4c2k9Imh0dHA6Ly93d3cudzMub3JnLzIwMDEvWE1MU2NoZ W1hLWluc3RhbmNlIiB4bWxuczp4c2Q9Imh0dHA6Ly93d3cudzMub3JnLzIwMDEvWE1MU2NoZW1hIiB4bWxuczpmaGlyPSJodHRwOi 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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.
FHIR ®© HL7.org 2011+. FHIR R5 Draft Ballot hl7.fhir.core#4.6.0 generated on Thu, Apr 15, 2021 12:28+1000.
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