Plandefinition-opioidcds-08.xml

Opioid CDS Recommendation 8 ECA Rule (id = "opioidcds-08")

<?xml version="1.0" encoding="UTF-8"?>

<PlanDefinition xmlns="http://hl7.org/fhir">
    <id value="opioidcds-08"/> 
    <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative</b> </p> <p> <b> url</b> : <code> http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-08</code> </p> <p> <b> identifier</b> : id: cdc-opioid-guidance (OFFICIAL)</p> <p> <b> version</b> : 0.1.0</p> <p> <b> name</b> : cdc-opioid-08</p> <p> <b> title</b> : CDC Opioid Prescribing Guideline Recommendation #8</p> <p> <b> type</b> : <span> ECA Rule</span> </p> <p> <b> status</b> : draft</p> <p> <b> date</b> : 2018-03-19</p> <p> <b> publisher</b> : Centers for Disease Control and Prevention (CDC)</p> <p> <b> description</b> : Clinicians should incorporate into the management plan strategies to mitigate risk,
         including considering offering naloxone when factors that increase risk for opioid overdose,
         such as history of overdose, history of substance use disorder, higher opioid dosages
         (≥50 MME/day), or concurrent benzodiazepine use, are present.</p> <h3> UseContexts</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> <tr> <td> *</td> </tr> </table> <p> <b> jurisdiction</b> : <span> 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> : Before starting and periodically during continuation of opioid therapy, clinicians should
         evaluate risk factors for opioid-related harms.</p> <p> <b> copyright</b> : © CDC 2016+.</p> <p> <b> topic</b> : <span> Opioid Prescribing</span> </p> <p> <b> author</b> : Kensaku Kawamoto, MD, PhD, MHS: , Bryn Rhodes: , Floyd Eisenberg, MD, MPH: , Robert
         McClure, MD, MPH: </p> <h3> RelatedArtifacts</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> <tr> <td> *</td> </tr> </table> <p> <b> library</b> : <a> http://example.org/fhir/Library/opioidcds-recommendation-08</a> </p> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Existing patient exhibits risk factors for opioid-related harms.</p> <p> <b> description</b> : Checking if the trigger prescription meets the inclusion criteria for recommendation
           #8 workflow.</p> <h3> Documentations</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> </table> <h3> Triggers</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> </table> <blockquote> <p> <b> condition</b> </p> <p> <b> kind</b> : applicability</p> <h3> Expressions</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> </table> </blockquote> <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.description</p> <h3> Expressions</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> </table> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : action.title</p> <h3> Expressions</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> </table> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : action.extension</p> <h3> Expressions</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> </table> </blockquote> <h3> Actions</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> <tr> <td> *</td> </tr> <tr> <td> *</td> </tr> </table> </blockquote> </div> </text> <url value="http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-08"/> 
    <identifier> 
        <use value="official"/> 
        <value value="cdc-opioid-guidance"/> 
    </identifier> 
    <version value="0.1.0"/> 
    <name value="cdc-opioid-08"/> 
    <title value="CDC Opioid Prescribing Guideline Recommendation #8"/> 
    <type> 
        <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/> 
            <code value="eca-rule"/> 
            <display value="ECA Rule"/> 
        </coding> 
    </type> 
    <status value="draft"/> 
    <date value="2018-03-19"/> 
    <publisher value="Centers for Disease Control and Prevention (CDC)"/> 
    <description value="Clinicians should incorporate into the management plan strategies to mitigate risk, including
   considering offering naloxone when factors that increase risk for opioid overdose, such
   as history of overdose, history of substance use disorder, higher opioid dosages (≥50
   MME/day), or concurrent benzodiazepine use, are present."/> 
    <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="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."/> 
    <usage value="Before starting and periodically during continuation of opioid therapy, clinicians should
   evaluate risk factors for opioid-related harms."/> 
    <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="documentation"/> 
        <display value="MME Conversion Tables"/> 
        <url value="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"/> 
    </relatedArtifact> 
    <library value="http://example.org/fhir/Library/opioidcds-recommendation-08"/> 
    <action> 
        <!--    non-dynamic card summary    -->
        <title value="Existing patient exhibits risk factors for opioid-related harms."/> 
        <description value="Checking if the trigger prescription meets the inclusion criteria for recommendation #8
     workflow."/> 
        <documentation> 
            <type value="documentation"/> 
            <document> 
                <!--    We can use the example code systems from the FHIR CLinical Reasoning Module, or we
         can define GRADE specific code systems and use those here    -->
                <extension url="http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation">
                    <valueCodeableConcept> 
                        <coding> 
                            <system value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/> 
                            <code value="strong"/> 
                            <display value="Strong"/> 
                        </coding> 
                    </valueCodeableConcept> 
                </extension> 
                <extension url="http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence">
                    <valueCodeableConcept> 
                        <coding> 
                            <system value="http://terminology.hl7.org/CodeSystem/evidence-quality"/> 
                            <code value="low"/> 
                            <display value="Low quality"/> 
                        </coding> 
                    </valueCodeableConcept> 
                </extension> 
            </document> 
        </documentation> 
        <trigger> 
            <type value="named-event"/> 
            <name value="medication-prescribe"/> 
        </trigger> 
        <condition> 
            <kind value="applicability"/> 
            <expression> 
              <description value="Check whether the existing patient exhibits risk factors for opioid-related harms, such
         as concurrent use with benzodiazepine, a history of substance abuse, and/or an average
         MME greater than 50 mg/day."/> 
              <language value="text/cql"/> 
              <expression value="Inclusion Criteria"/> 
            </expression> 
        </condition> 
        <groupingBehavior value="visual-group"/> 
        <selectionBehavior value="exactly-one"/> 
        <!--    dynamic card elements    -->
        <dynamicValue> 
            <path value="action.description"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Detail"/> 
            </expression> 
        </dynamicValue> 
        <dynamicValue> 
            <path value="action.title"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Summary"/> 
            </expression> 
        </dynamicValue> 
        <dynamicValue> 
            <path value="action.extension"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Indicator"/> 
            </expression> 
        </dynamicValue> 
        <action> 
            <description value="Will offer Naloxone instead"/> 
            <!--    Open Order Set, where available    -->
        </action> 
        <action> 
            <description value="Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"/> 
        </action> 
        <action> 
            <description value="N/A - see comment; snooze 3 mo"/> 
        </action> 
    </action> 
</PlanDefinition>