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 10 Logic (id = "opioidcds-recommendation-10")
<?xml version="1.0" encoding="UTF-8"?> <Library xmlns="http://hl7.org/fhir"> <id value="opioidcds-recommendation-10"/> <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="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="observation.html">Observation</a> </td> </tr> <tr style="background-color: #efefef"> <td> Filter</td> <td> Value</td> </tr> <tr> <td> combo-code</td> <td> In ValueSet <a href="http://example.org/fhir/ValueSet/illicit-drug-urine-screening">http://example.org/fhir/ValueSet/illicit-drug-urine-screening</a> </td> </tr> </table> <table class="grid"> <tr> <td colspan="2"> <b> Type</b> : <a href="observation.html">Observation</a> </td> </tr> <tr style="background-color: #efefef"> <td> Filter</td> <td> Value</td> </tr> <tr> <td> combo-code</td> <td> In ValueSet <a href="http://example.org/fhir/ValueSet/opioid-urine-screening">http://example.org/fhir/ValueSet/opioid-urine-screening</a> </td> </tr> </table> <h2> Contents</h2> <p> <code> application/elm+xml</code> </p> <pre> <code> <?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="62" startChar="12" endLine="62" endChar="60" 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="62" startChar="12" endLine="62" endChar="60" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/> <annotation startLine="66" startChar="3" endLine="66" 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="66" startChar="3" endLine="66" endChar="66" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/> <annotation startLine="74" startChar="3" endLine="74" endChar="64" message="Could not resolve code path combo-code for the type of the retrieve FHIR.Observation." errorType="semantic" errorSeverity="warning&q uot; xsi:type="a:CqlToElmError"/> <annotation startLine="74" startChar="3" endLine="74" endChar="64" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/> <annotation startLine="79" startChar="3" endLine="79" endChar="63" message="Could not resolve code path combo-code for the type of the retrieve FHIR.Observation." errorType="semantic" errorSeverity="warning&q uot; xsi:type="a:CqlToElmError"/> <annotation startLine="79" startChar="3" endLine="79" endChar="63" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/> <annotation startLine="134" startChar="20" endLine="134" endChar="76" message="List-valued expression was demoted to a singleton." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError" ;/> <annotation startLine="143" startChar="16" endLine="143" endChar="17" message="List-valued expression was demoted to a singleton." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError" ;/> <annotation startLine="157" startChar="52" endLine="157" endChar="73" message="List-valued expression was demoted to a singleton." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError" ;/> <annotation startLine="171" startChar="62" endLine="171" endChar="78" message="List-valued expression was demoted to a singleton." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError" ;/> <identifier id="OpioidCDS_STU4_REC_10" 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> <statements> <def name="Patient" context="Patient"> <expression xsi:type="SingletonFrom"> <operand dataType="fhir:Patient" xsi:type="Retrieve"/> </expression> </def> <def name="Lookback Year" context="Patient" accessLevel="Public&qu ot;> <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="Exclusion Criteria" context="Patient" accessLevel="Publ ic"> <expression xsi:type="Or"> <operand xsi:type="Exists"> <operand dataType="fhir:MedicationRequest" codeProperty="medication CodeableConcept" xsi:type="Retrieve"> <codes name="End Of Life Opioids" libraryName="Common" xsi:type="ValueSetRef"/> </operand> </operand> <operand name="HasMetastaticCancer" libraryName="Common" xsi:type="ExpressionRef"/> </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="Get Illicit Drug Urine Screenings in Last 12 Months" context="Pat ient" accessLevel="Public"> <expression xsi:type="Query"> <source alias="observation"> <expression dataType="fhir:Observation" codeProperty="combo-code&qu ot; xsi:type="Retrieve"> <codes name="Illicit Drug Screening" libraryName="Common" xsi:type="ValueSetRef"/> </expression> </source> <where xsi:type="In"> <operand path="value" xsi:type="Property"> <source path="effective" scope="observation" xsi:type="Property"/> </operand> <operand name="Lookback Year" xsi:type="ExpressionRef"/> </where> <sort> <by direction="asc" xsi:type="ByExpression"> <expression path="value" xsi:type="Property"> <source name="effective" xsi:type="IdentifierRef"/> </expression> </by> </sort> </expression> </def> <def name="Most Recent Illicit Drug Urine Screenings in Last 12 Months" context="Patient" accessLevel="Public"> <expression xsi:type="Last"> <source name="Get Illicit Drug Urine Screenings in Last 12 Months" xsi:type="ExpressionRef"/> </expression> </def> <def name="Get Opioid Drug Urine Screenings in Last 12 Months" context="Pati ent" accessLevel="Public"> <expression xsi:type="Query"> <source alias="observation"> <expression dataType="fhir:Observation" codeProperty="combo-code&qu ot; xsi:type="Retrieve"> <codes name="Opioid Drug Screening" libraryName="Common" xsi:type="ValueSetRef"/> </expression> </source> <where xsi:type="In"> <operand path="value" xsi:type="Property"> <source path="effective" scope="observation" xsi:type="Property"/> </operand> <operand name="Lookback Year" xsi:type="ExpressionRef"/> </where> <sort> <by direction="asc" xsi:type="ByExpression"> <expression path="value" xsi:type="Property"> <source name="effective" xsi:type="IdentifierRef"/> </expression> </by> </sort> </expression> </def> <def name="Most Recent Opioid Drug Urine Screenings in Last 12 Months" context="Patient" accessLevel="Public"> <expression xsi:type="Last"> <source name="Get Opioid Drug Urine Screenings in Last 12 Months" xsi:type="ExpressionRef"/> </expression> </def> <def name="No Urine Screening In Last 12 Months" context="Patient" accessLevel="Public"> <expression xsi:type="And"> <operand xsi:type="IsNull"> <operand name="Most Recent Illicit Drug Urine Screenings in Last 12 Months" xsi:type="ExpressionRef"/> </operand> <operand xsi:type="IsNull"> <operand name="Most Recent Opioid Drug Urine Screenings in Last 12 Months" xsi:type="ExpressionRef"/> </operand> </expression> </def> <def name="Positive Opioid Drug Screening" context="Patient" accessLevel="Public"> <expression xsi:type="Query"> <source alias="mostRecentScreening"> <expression name="Most Recent Opioid Drug Urine Screenings in Last 12 Months" xsi:type="ExpressionRef"/> </source> <where xsi:type="Or"> <operand xsi:type="Equal"> <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand path="coding" xsi:type="Property"> <source path="interpretation" scope="mostRecentScree ning" xsi:type="Property"/> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> <operand valueType="t:String" value="POS" xsi:type="Li teral"/> </operand> <operand xsi:type="If"> <condition asType="t:Boolean" xsi:type="As"> <operand xsi:type="Not"> <operand xsi:type="IsNull"> <operand xsi:type="Indexer"> <operand path="component" scope="mostRecentScreening " xsi:type="Property"/> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </operand> </operand> </operand> </condition> <then xsi:type="Equal"> <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand path="coding" xsi:type="Property"> <source path="interpretation" xsi:type="Property& quot;> <source xsi:type="Indexer"> <operand path="component" scope="mostRecent Screening" xsi:type="Property"/> <operand valueType="t:Integer" value="0&quo t; xsi:type="Literal"/> </source> </source> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> <operand valueType="t:String" value="POS" xsi:type="Literal"/> </then> <else valueType="t:Boolean" value="false" xsi:type="Li teral"/> </operand> </where> </expression> </def> <def name="Orders Before Most Recent Opioid Screening" context="Patient" ; accessLevel="Public"> <expression xsi:type="Query"> <source alias="orders"> <expression name="Get Active Ambulatory Opioid Rx" xsi:type="Expres sionRef"/> </source> <relationship alias="mostRecentScreening" xsi:type="With"> <expression name="Positive Opioid Drug Screening" xsi:type="Express ionRef"/> <suchThat xsi:type="Less"> <operand path="value" xsi:type="Property"> <source path="authoredOn" scope="orders" xsi:type=" Property"/> </operand> <operand path="value" xsi:type="Property"> <source path="effective" scope="mostRecentScreening" xsi:type="Property"/> </operand> </suchThat> </relationship> <return> <expression name="orders" xsi:type="AliasRef"/> </return> </expression> </def> <def name="Prescribed Opioids" context="Patient" accessLevel="Publ ic"> <expression xsi:type="Query"> <source alias="orders"> <expression name="Orders Before Most Recent Opioid Screening" xsi:type="ExpressionRef"/> </source> <return> <expression xsi:type="Lower"> <operand xsi:type="SingletonFrom"> <operand name="GetIngredient" libraryName="Common" 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="orders" xsi:type="Property"/> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </operand> </operand> </operand> </operand> </expression> </return> </expression> </def> <def name="GetOpioid" context="Patient" accessLevel="Public" xsi:type="FunctionDef"> <expression xsi:type="Case"> <comparand name="value" xsi:type="OperandRef"/> <caseItem> <when valueType="t:String" value="3299-5" xsi:type="Liter al"/> <then valueType="t:String" value="Acetaminophen" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="14184-6" xsi:type="Lite ral"/> <then valueType="t:String" value="Atropine" xsi:type="Lit eral"/> </caseItem> <caseItem> <when valueType="t:String" value="16485-5" xsi:type="Lite ral"/> <then valueType="t:String" value="Bromodiphenhydramine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3408-2" xsi:type="Liter al"/> <then valueType="t:String" value="Brompheniramine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3414-0" xsi:type="Liter al"/> <then valueType="t:String" value="Buprenorphine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3421-5" xsi:type="Liter al"/> <then valueType="t:String" value="Butalbital" xsi:type="L iteral"/> </caseItem> <caseItem> <when valueType="t:String" value="12333-1" xsi:type="Lite ral"/> <then valueType="t:String" value="Butorphanol" xsi:type=" Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3423-1" xsi:type="Liter al"/> <then valueType="t:String" value="Caffeine" xsi:type="Lit eral"/> </caseItem> <caseItem> <when valueType="t:String" value="21142-5" xsi:type="Lite ral"/> <then valueType="t:String" value="Carisoprodol" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="16605-8" xsi:type="Lite ral"/> <then valueType="t:String" value="Chlorcyclizine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3467-8" xsi:type="Liter al"/> <then valueType="t:String" value="Chlorpheniramine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3507-1" xsi:type="Liter al"/> <then valueType="t:String" value="Codeine" xsi:type="Lite ral"/> </caseItem> <caseItem> <when valueType="t:String" value="14066-5" xsi:type="Lite ral"/> <then valueType="t:String" value="Dihydrocodeine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3571-7" xsi:type="Liter al"/> <then valueType="t:String" value="Diphenhydramine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="11235-9" xsi:type="Lite ral"/> <then valueType="t:String" value="Fentanyl" xsi:type="Lit eral"/> </caseItem> <caseItem> <when valueType="t:String" value="12308-3" xsi:type="Lite ral"/> <then valueType="t:String" value="Hydrocodone" xsi:type=" Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="9834-3" xsi:type="Liter al"/> <then valueType="t:String" value="Hydromorphone" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="14071" xsi:type="Litera l"/> <then valueType="t:String" value="Ibuprofen" xsi:type="Li teral"/> </caseItem> <caseItem> <when valueType="t:String" value="3711-9" xsi:type="Liter al"/> <then valueType="t:String" value="Levorphanol" xsi:type=" Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3746-5" xsi:type="Liter al"/> <then valueType="t:String" value="Meperidine" xsi:type="L iteral"/> </caseItem> <caseItem> <when valueType="t:String" value="3773-9" xsi:type="Liter al"/> <then valueType="t:String" value="Methadone" xsi:type="Li teral"/> </caseItem> <caseItem> <when valueType="t:String" value="3830-7" xsi:type="Liter al"/> <then valueType="t:String" value="Morphine" xsi:type="Lit eral"/> </caseItem> <caseItem> <when valueType="t:String" value="42618-9" xsi:type="Lite ral"/> <then valueType="t:String" value="Naloxone" xsi:type="Lit eral"/> </caseItem> <caseItem> <when valueType="t:String" value="12309-1" xsi:type="Lite ral"/> <then valueType="t:String" value="Naltrexone" xsi:type="L iteral"/> </caseItem> <caseItem> <when valueType="t:String" value="10998-3" xsi:type="Lite ral"/> <then valueType="t:String" value="Oxycodone" xsi:type="Li teral"/> </caseItem> <caseItem> <when valueType="t:String" value="11247-4" xsi:type="Lite ral"/> <then valueType="t:String" value="Oxymorphone" xsi:type=" Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3917-2" xsi:type="Liter al"/> <then valueType="t:String" value="Pentazocine" xsi:type=" Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3962-8" xsi:type="Liter al"/> <then valueType="t:String" value="Phenylephrine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3965-1" xsi:type="Liter al"/> <then valueType="t:String" value="Phenylpropanolamine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="11000-7" xsi:type="Lite ral"/> <then valueType="t:String" value="Promethazine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="4003-0" xsi:type="Liter al"/> <then valueType="t:String" value="Pseudoephedrine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="4009-7" xsi:type="Liter al"/> <then valueType="t:String" value="Pyrilamine" xsi:type="L iteral"/> </caseItem> <caseItem> <when valueType="t:String" value="65807-0" xsi:type="Lite ral"/> <then valueType="t:String" value="Tapentadol" xsi:type="L iteral"/> </caseItem> <caseItem> <when valueType="t:String" value="43219-5" xsi:type="Lite ral"/> <then valueType="t:String" value="Tramadol" xsi:type="Lit eral"/> </caseItem> <else xsi:type="Concatenate"> <operand valueType="t:String" value="Unknown code: " xsi:type="Literal"/> <operand name="value" xsi:type="OperandRef"/> </else> </expression> <operand name="value"> <operandTypeSpecifier name="t:String" xsi:type="NamedTypeSpecifier&quo t;/> </operand> </def> <def name="Missing Opioids" context="Patient" accessLevel="Public& quot;> <expression xsi:type="If"> <condition asType="t:Boolean" xsi:type="As"> <operand xsi:type="Not"> <operand xsi:type="IsNull"> <operand name="Positive Opioid Drug Screening" xsi:type="Expr essionRef"/> </operand> </operand> </condition> <then xsi:type="Except"> <operand xsi:type="Query"> <source alias="Prescriptions"> <expression name="Prescribed Opioids" xsi:type="ExpressionRef "/> </source> </operand> <operand xsi:type="ToList"> <operand xsi:type="Lower"> <operand name="GetOpioid" xsi:type="FunctionRef"> <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand path="coding" xsi:type="Property"&g t; <source path="code" xsi:type="Property"&g t; <source name="Positive Opioid Drug Screening" xsi:type="ExpressionRef"/> </source> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> </operand> </operand> </operand> </then> <else xsi:type="As"> <operand xsi:type="Null"/> <asTypeSpecifier xsi:type="ListTypeSpecifier"> <elementType name="t:String" xsi:type="NamedTypeSpecifier"/ > </asTypeSpecifier> </else> </expression> </def> <def name="Has Missing Opioids?" context="Patient" accessLevel="Pu blic"> <expression xsi:type="Exists"> <operand name="Missing Opioids" xsi:type="ExpressionRef"/> </expression> </def> <def name="Get Opioids From Most Recent Screening" context="Patient" accessLevel="Public"> <expression xsi:type="Query"> <source alias="mostRecentScreening"> <expression name="Positive Opioid Drug Screening" xsi:type="Express ionRef"/> </source> <return> <expression xsi:type="Union"> <operand xsi:type="ToList"> <operand xsi:type="Lower"> <operand name="GetOpioid" xsi:type="FunctionRef"> <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand path="coding" xsi:type="Property" ;> <source path="code" scope="mostRecentScreen ing" xsi:type="Property"/> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> </operand> </operand> </operand> <operand xsi:type="ToList"> <operand xsi:type="If"> <condition asType="t:Boolean" xsi:type="As"> <operand xsi:type="Not"> <operand xsi:type="IsNull"> <operand xsi:type="Indexer"> <operand path="component" scope="mostRecentScr eening" xsi:type="Property"/> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </operand> </operand> </operand> </condition> <then xsi:type="Lower"> <operand name="GetOpioid" xsi:type="FunctionRef"&g t; <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand path="coding" xsi:type="Property&q uot;> <source path="code" xsi:type="Property&q uot;> <source xsi:type="Indexer"> <operand path="component" scope="mostRecentScreening" xsi:type="Property"/> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> <operand valueType="t:Integer" value="0&quo t; xsi:type="Literal"/> </source> </source> </operand> </operand> </then> <else asType="t:String" xsi:type="As"> <operand xsi:type="SingletonFrom"> <operand xsi:type="List"/> </operand> </else> </operand> </operand> </expression> </return> </expression> </def> <def name="Unprescribed Opioids" context="Patient" accessLevel="Pu blic"> <expression xsi:type="Query"> <source alias="mostRecentScreeningOpioids"> <expression name="Get Opioids From Most Recent Screening" xsi:type="ExpressionRef"/> </source> <relationship alias="ingredients" xsi:type="With"> <expression name="Prescribed Opioids" xsi:type="ExpressionRef" /> <suchThat xsi:type="Not"> <operand xsi:type="In"> <operand name="mostRecentScreeningOpioids" xsi:type="AliasRef "/> <operand xsi:type="ToList"> <operand name="ingredients" xsi:type="AliasRef"/> </operand> </operand> </suchThat> </relationship> <return> <expression name="mostRecentScreeningOpioids" xsi:type="AliasRef&qu ot;/> </return> </expression> </def> <def name="Has Unprescribed Opioids?" context="Patient" accessLevel=&qu ot;Public"> <expression xsi:type="Exists"> <operand name="Unprescribed Opioids" xsi:type="ExpressionRef"/> ; </expression> </def> <def name="Positive Illicit Drug Screening" context="Patient" accessLevel="Public"> <expression xsi:type="Query"> <source alias="mostRecentScreening"> <expression name="Most Recent Illicit Drug Urine Screenings in Last 12 Months" xsi:type="ExpressionRef"/> </source> <where xsi:type="Or"> <operand xsi:type="Equal"> <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand path="coding" xsi:type="Property"> <source path="interpretation" scope="mostRecentScree ning" xsi:type="Property"/> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> <operand valueType="t:String" value="POS" xsi:type="Li teral"/> </operand> <operand xsi:type="If"> <condition asType="t:Boolean" xsi:type="As"> <operand xsi:type="Not"> <operand xsi:type="IsNull"> <operand xsi:type="Indexer"> <operand path="component" scope="mostRecentScreening " xsi:type="Property"/> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </operand> </operand> </operand> </condition> <then xsi:type="Equal"> <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand path="coding" xsi:type="Property"> <source path="interpretation" xsi:type="Property& quot;> <source xsi:type="Indexer"> <operand path="component" scope="mostRecent Screening" xsi:type="Property"/> <operand valueType="t:Integer" value="0&quo t; xsi:type="Literal"/> </source> </source> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> <operand valueType="t:String" value="POS" xsi:type="Literal"/> </then> <else valueType="t:Boolean" value="false" xsi:type="Li teral"/> </operand> </where> </expression> </def> <def name="Has Illicit Drugs in Screening?" context="Patient" accessLevel="Public"> <expression xsi:type="Exists"> <operand xsi:type="ToList"> <operand name="Positive Illicit Drug Screening" xsi:type="Expressio nRef"/> </operand> </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="AnyTrue"> <source name="ProbableDaysInRange" libraryName="Common" xsi:type="FunctionRef"> <operand name="Get Active Ambulatory Opioid Rx" xsi:type="Exp ressionRef"/> <operand valueType="t:Integer" value="90" xsi:type="Literal"/> <operand valueType="t:Integer" value="80" xsi:type="Literal"/> </source> </operand> </operand> <operand xsi:type="Or"> <operand xsi:type="Or"> <operand xsi:type="Or"> <operand name="No Urine Screening In Last 12 Months" xsi:type="ExpressionRef"/> <operand name="Has Missing Opioids?" xsi:type="ExpressionRef& quot;/> </operand> <operand name="Has Unprescribed Opioids?" xsi:type="ExpressionRe f"/> </operand> <operand name="Has Illicit Drugs in Screening?" xsi:type="Expressio nRef"/> </operand> </expression> </def> <def name="GetIllicitDrug" context="Patient" accessLevel="Public&q uot; xsi:type="FunctionDef"> <expression xsi:type="Case"> <comparand name="value" xsi:type="OperandRef"/> <caseItem> <when valueType="t:String" value="3397-7" xsi:type="Liter al"/> <then valueType="t:String" value="Cocaine" xsi:type="Lite ral"/> </caseItem> <caseItem> <when valueType="t:String" value="14267-9" xsi:type="Lite ral"/> <then valueType="t:String" value="Methylenedioxymethamphetamine (MDMA)" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="29868-7" xsi:type="Lite ral"/> <then valueType="t:String" value="Gamma Hydroxybutyric Acid (GHB)" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="12327-3" xsi:type="Lite ral"/> <then valueType="t:String" value="Ketamine" xsi:type="Lit eral"/> </caseItem> <caseItem> <when valueType="t:String" value="3732-5" xsi:type="Liter al"/> <then valueType="t:String" value="Lysergic Acid Diethylamide (LSD)" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3779-6" xsi:type="Liter al"/> <then valueType="t:String" value="Methamphetamine" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="17504-2" xsi:type="Lite ral"/> <then valueType="t:String" value="Psilocybin" xsi:type="L iteral"/> </caseItem> <caseItem> <when valueType="t:String" value="41020-9" xsi:type="Lite ral"/> <then valueType="t:String" value="Flunitrazepam (Rohypnol)" xsi:type="Literal"/> </caseItem> <caseItem> <when valueType="t:String" value="3426-4" xsi:type="Liter al"/> <then valueType="t:String" value="Tetrahydrocannabinol (THC)" xsi:type="Literal"/> </caseItem> <else xsi:type="Concatenate"> <operand valueType="t:String" value="Unknown code: " xsi:type="Literal"/> <operand name="value" xsi:type="OperandRef"/> </else> </expression> <operand name="value"> <operandTypeSpecifier name="t:String" xsi:type="NamedTypeSpecifier&quo t;/> </operand> </def> <def name="Inconsistent Illicit Drugs" context="Patient" accessLevel="Public"> <expression xsi:type="Concatenate"> <operand valueType="t:String" value="Found the following illicit drug(s) in urine drug screen: " xsi:type="Literal"/> <operand xsi:type="If"> <condition asType="t:Boolean" xsi:type="As"> <operand xsi:type="IsNull"> <operand name="GetIllicitDrug" xsi:type="FunctionRef"> ; <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand path="coding" xsi:type="Property"&g t; <source path="code" xsi:type="Property"&g t; <source name="Positive Illicit Drug Screening" xsi:type="ExpressionRef"/> </source> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> </operand> </operand> </condition> <then name="GetIllicitDrug" xsi:type="FunctionRef"> <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand path="coding" xsi:type="Property"> <source path="interpretation" xsi:type="Property&quo t;> <source name="Positive Illicit Drug Screening" xsi:type="ExpressionRef"/> </source> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> </then> <else name="GetIllicitDrug" xsi:type="FunctionRef"> <operand path="value" xsi:type="Property"> <source path="code" xsi:type="Property"> <source xsi:type="Indexer"> <operand path="coding" xsi:type="Property"> <source path="code" xsi:type="Property"> <source name="Positive Illicit Drug Screening" xsi:type="ExpressionRef"/> </source> </operand> <operand valueType="t:Integer" value="0" xsi:type="Literal"/> </source> </source> </operand> </else> </operand> </expression> </def> <def name="Has Opioids in Screening?" context="Patient" accessLevel=&qu ot;Public"> <expression xsi:type="Exists"> <operand xsi:type="ToList"> <operand name="Positive Opioid Drug Screening" xsi:type="Expression Ref"/> </operand> </expression> </def> <def name="Inconsistent Unprescribed Opioids" context="Patient" accessLevel="Public"> <expression xsi:type="Concatenate"> <operand valueType="t:String" value="Found the following unprescribed opioid(s): " xsi:type="Literal"/> <operand xsi:type="SingletonFrom"> <operand name="Unprescribed Opioids" xsi:type="ExpressionRef"/ > </operand> </expression> </def> <def name="Inconsistent Missing Opioids" context="Patient" accessLevel="Public"> <expression xsi:type="Concatenate"> <operand valueType="t:String" value="The following opioids are missing from the screening: " xsi:type="Literal"/> <operand xsi:type="SingletonFrom"> <operand name="Missing Opioids" xsi:type="ExpressionRef"/> </operand> </expression> </def> <def name="Get Indicator" context="Patient" accessLevel="Public&qu ot;> <expression valueType="t:String" value="warning" xsi:type="Lite ral"/> </def> </statements> </library> </code> </pre> </div> </text> <identifier> <use value="official"/> <value value="OpioidCDS_REC_10"/> </identifier> <version value="0.1.0"/> <title value="Opioid CDS Logic for recommendation #10"/> <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 whether the patient has had a urine screening in the past 12 months and provide analysis."/> <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 had a urine screening in the past 12 months. Is so, then check the results for missing opioids that are prescribed, present opioids that aren't prescribed or present illicit drugs."/> <usage value="This library is used to notify the prescriber/user whether the patient has had a urine screening in the past 12 months and to provide analysis if true."/> <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="MedicationRequest"/> <codeFilter> <path value="medicationCodeableConcept"/> <valueSet value="http://example.org/fhir/ValueSet/opioids-abused-in-ambulatory-care"/> </codeFilter> </dataRequirement> <dataRequirement> <type value="Observation"/> <codeFilter> <path value="combo-code"/> <valueSet value="http://example.org/fhir/ValueSet/illicit-drug-urine-screening"/> </codeFilter> </dataRequirement> <dataRequirement> <type value="Observation"/> <codeFilter> <path value="combo-code"/> <valueSet value="http://example.org/fhir/ValueSet/opioid-urine-screening"/> </codeFilter> </dataRequirement> <content> <contentType value="application/elm+xml"/> <data 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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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