Opioid CDS Recommendation 4 Logic (id = "opioidcds-recommendation-04")

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

<Library xmlns="http://hl7.org/fhir">
  <id value="opioidcds-recommendation-04"/> 
  <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> 
            <p> 
              <code> 
                <a href="https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chro
                nic-pain---united-states-2016#420">https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chro
                  nic-pain---united-states-2016#420</a> 
              </code>  (
              <code/>  )
            </p> 
          </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-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">&lt;?xml version=&quot;1.0&quot; encoding=&quot;UTF-8&quot;?&gt;
&lt;library xmlns=&quot;urn:hl7-org:elm:r1&quot; xmlns:t=&quot;urn:hl7-org:elm-types:r1&quot;
           xmlns:xsi=&quot;http://www.w3.org/2001/XMLSchema-instance&quot; xmlns:xsd=&quot;http://www.w3
          .org/2001/XMLSchema&quot; xmlns:fhir=&quot;http://hl7.org/fhir&quot; xmlns:qdm43=&quot;urn:hea
          lthit-gov:qdm:v4_3&quot; xmlns:qdm53=&quot;urn:healthit-gov:qdm:v5_3&quot; xmlns:a=&quot;urn:h
          l7-org:cql-annotations:r1&quot;&gt;
   &lt;annotation startLine=&quot;67&quot; startChar=&quot;5&quot; endLine=&quot;67&quot;
           endChar=&quot;68&quot; message=&quot;Could not resolve code path medicationCodeableConcept
           for the type of the retrieve FHIR.MedicationRequest.&quot; errorType=&quot;semantic&quot;
           errorSeverity=&quot;warning&quot; xsi:type=&quot;a:CqlToElmError&quot;/&gt;
   &lt;annotation startLine=&quot;67&quot; startChar=&quot;5&quot; endLine=&quot;67&quot;
           endChar=&quot;68&quot; message=&quot;Could not resolve membership operator for
           terminology target of the retrieve.&quot; errorType=&quot;semantic&quot; errorSeverity=&quot;
          warning&quot; xsi:type=&quot;a:CqlToElmError&quot;/&gt;
   &lt;annotation startLine=&quot;78&quot; startChar=&quot;83&quot; endLine=&quot;78&quot;
           endChar=&quot;126&quot; message=&quot;List-valued expression was demoted to a singleton.&quot
          ; errorType=&quot;semantic&quot; errorSeverity=&quot;warning&quot; xsi:type=&quot;a:CqlToElmEr
          ror&quot;/&gt;
   &lt;identifier id=&quot;OpioidCDS_STU4_REC_04&quot; version=&quot;0.1.0&quot;/&gt;
   &lt;schemaIdentifier id=&quot;urn:hl7-org:elm&quot; version=&quot;r1&quot;/&gt;
   &lt;usings&gt;
      &lt;def localIdentifier=&quot;System&quot; uri=&quot;urn:hl7-org:elm-types:r1&quot;/&gt
          ;
      &lt;def localIdentifier=&quot;FHIR&quot; uri=&quot;http://hl7.org/fhir&quot;
           version=&quot;3.2.0&quot;/&gt;
   &lt;/usings&gt;
   &lt;includes&gt;
      &lt;def localIdentifier=&quot;Common&quot; path=&quot;OpioidCDS_STU4_Common&quot;
           version=&quot;0.1.0&quot;/&gt;
   &lt;/includes&gt;
   &lt;parameters&gt;
      &lt;def name=&quot;ContextPrescriptions&quot; accessLevel=&quot;Public&quot;&gt;
         &lt;parameterTypeSpecifier xsi:type=&quot;ListTypeSpecifier&quot;&gt;
            &lt;elementType name=&quot;fhir:MedicationRequest&quot; xsi:type=&quot;NamedTypeS
          pecifier&quot;/&gt;
         &lt;/parameterTypeSpecifier&gt;
      &lt;/def&gt;
   &lt;/parameters&gt;
   &lt;statements&gt;
      &lt;def name=&quot;Patient&quot; context=&quot;Patient&quot;&gt;
         &lt;expression xsi:type=&quot;SingletonFrom&quot;&gt;
            &lt;operand dataType=&quot;fhir:Patient&quot; xsi:type=&quot;Retrieve&quot;/&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Inclusion Period&quot; context=&quot;Patient&quot; accessLevel=&quot
          ;Public&quot;&gt;
         &lt;expression lowClosed=&quot;true&quot; highClosed=&quot;true&quot;
           xsi:type=&quot;Interval&quot;&gt;
            &lt;low xsi:type=&quot;Subtract&quot;&gt;
               &lt;operand xsi:type=&quot;Today&quot;/&gt;
               &lt;operand value=&quot;91&quot; unit=&quot;days&quot; xsi:type=&quot;Quantity
          &quot;/&gt;
            &lt;/low&gt;
            &lt;high xsi:type=&quot;Subtract&quot;&gt;
               &lt;operand xsi:type=&quot;Today&quot;/&gt;
               &lt;operand value=&quot;1&quot; unit=&quot;days&quot; xsi:type=&quot;Quantity&
          quot;/&gt;
            &lt;/high&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Encounter Period&quot; context=&quot;Patient&quot; accessLevel=&quot
          ;Public&quot;&gt;
         &lt;expression lowClosed=&quot;true&quot; highClosed=&quot;true&quot;
           xsi:type=&quot;Interval&quot;&gt;
            &lt;low xsi:type=&quot;Subtract&quot;&gt;
               &lt;operand xsi:type=&quot;Subtract&quot;&gt;
                  &lt;operand xsi:type=&quot;Today&quot;/&gt;
                  &lt;operand value=&quot;12&quot; unit=&quot;months&quot; xsi:type=&quot;Qua
          ntity&quot;/&gt;
               &lt;/operand&gt;
               &lt;operand value=&quot;1&quot; unit=&quot;days&quot; xsi:type=&quot;Quantity&
          quot;/&gt;
            &lt;/low&gt;
            &lt;high xsi:type=&quot;Subtract&quot;&gt;
               &lt;operand xsi:type=&quot;Today&quot;/&gt;
               &lt;operand value=&quot;1&quot; unit=&quot;days&quot; xsi:type=&quot;Quantity&
          quot;/&gt;
            &lt;/high&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Get Trigger Event Prescriptions&quot; context=&quot;Patient&quot;
           accessLevel=&quot;Public&quot;&gt;
         &lt;expression xsi:type=&quot;Query&quot;&gt;
            &lt;source alias=&quot;triggerScripts&quot;&gt;
               &lt;expression name=&quot;ContextPrescriptions&quot; xsi:type=&quot;ParameterR
          ef&quot;/&gt;
            &lt;/source&gt;
            &lt;let identifier=&quot;rxNormCode&quot;&gt;
               &lt;expression name=&quot;ToCode&quot; libraryName=&quot;Common&quot;
           xsi:type=&quot;FunctionRef&quot;&gt;
                  &lt;operand xsi:type=&quot;Indexer&quot;&gt;
                     &lt;operand path=&quot;coding&quot; xsi:type=&quot;Property&quot;&gt;
                        &lt;source path=&quot;medication&quot; scope=&quot;triggerScripts&quo
          t; xsi:type=&quot;Property&quot;/&gt;
                     &lt;/operand&gt;
                     &lt;operand valueType=&quot;t:Integer&quot; value=&quot;0&quot;
           xsi:type=&quot;Literal&quot;/&gt;
                  &lt;/operand&gt;
               &lt;/expression&gt;
            &lt;/let&gt;
            &lt;where xsi:type=&quot;And&quot;&gt;
               &lt;operand name=&quot;IsOpioidWithAmbulatoryAbusePotential&quot;
           libraryName=&quot;Common&quot; xsi:type=&quot;FunctionRef&quot;&gt;
                  &lt;operand name=&quot;rxNormCode&quot; xsi:type=&quot;QueryLetRef&quot;/&g
          t;
               &lt;/operand&gt;
               &lt;operand name=&quot;IsLongActingOpioid&quot; libraryName=&quot;Common&quot;
           xsi:type=&quot;FunctionRef&quot;&gt;
                  &lt;operand name=&quot;rxNormCode&quot; xsi:type=&quot;QueryLetRef&quot;/&g
          t;
               &lt;/operand&gt;
            &lt;/where&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Get Trigger Trigger Event Prescription Ids&quot; context=&quot;Patie
          nt&quot; accessLevel=&quot;Public&quot;&gt;
         &lt;expression xsi:type=&quot;Query&quot;&gt;
            &lt;source alias=&quot;triggerScripts&quot;&gt;
               &lt;expression name=&quot;Get Trigger Event Prescriptions&quot;
           xsi:type=&quot;ExpressionRef&quot;/&gt;
            &lt;/source&gt;
            &lt;let identifier=&quot;codeString&quot;&gt;
               &lt;expression valueType=&quot;t:String&quot; value=&quot;&quot;
           xsi:type=&quot;Literal&quot;/&gt;
            &lt;/let&gt;
            &lt;return&gt;
               &lt;expression xsi:type=&quot;Concatenate&quot;&gt;
                  &lt;operand xsi:type=&quot;Concatenate&quot;&gt;
                     &lt;operand name=&quot;codeString&quot; xsi:type=&quot;QueryLetRef&quot;
          /&gt;
                     &lt;operand path=&quot;value&quot; xsi:type=&quot;Property&quot;&gt;
                        &lt;source path=&quot;id&quot; scope=&quot;triggerScripts&quot;
           xsi:type=&quot;Property&quot;/&gt;
                     &lt;/operand&gt;
                  &lt;/operand&gt;
                  &lt;operand valueType=&quot;t:String&quot; value=&quot; &quot;
           xsi:type=&quot;Literal&quot;/&gt;
               &lt;/expression&gt;
            &lt;/return&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Validate Trigger Event&quot; context=&quot;Patient&quot;
           accessLevel=&quot;Public&quot;&gt;
         &lt;expression xsi:type=&quot;Exists&quot;&gt;
            &lt;operand name=&quot;Get Trigger Event Prescriptions&quot; xsi:type=&quot;Expre
          ssionRef&quot;/&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Opioid with Ambulatory Care Abuse Potential in Past 90
           Days&quot; context=&quot;Patient&quot; accessLevel=&quot;Public&quot;&gt;
         &lt;expression xsi:type=&quot;Exists&quot;&gt;
            &lt;operand xsi:type=&quot;Query&quot;&gt;
               &lt;source alias=&quot;orders&quot;&gt;
                  &lt;expression dataType=&quot;fhir:MedicationRequest&quot; codeProperty=&qu
          ot;medicationCodeableConcept&quot; xsi:type=&quot;Retrieve&quot;&gt;
                     &lt;codes name=&quot;Ambulatory Abuse Potential Opioids&quot;
           libraryName=&quot;Common&quot; xsi:type=&quot;ValueSetRef&quot;/&gt;
                  &lt;/expression&gt;
               &lt;/source&gt;
               &lt;where xsi:type=&quot;In&quot;&gt;
                  &lt;operand xsi:type=&quot;DateFrom&quot;&gt;
                     &lt;operand path=&quot;value&quot; xsi:type=&quot;Property&quot;&gt;
                        &lt;source path=&quot;authoredOn&quot; scope=&quot;orders&quot;
           xsi:type=&quot;Property&quot;/&gt;
                     &lt;/operand&gt;
                  &lt;/operand&gt;
                  &lt;operand name=&quot;Inclusion Period&quot; xsi:type=&quot;ExpressionRef&
          quot;/&gt;
               &lt;/where&gt;
            &lt;/operand&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Inclusion Criteria&quot; context=&quot;Patient&quot; accessLevel=&qu
          ot;Public&quot;&gt;
         &lt;expression xsi:type=&quot;And&quot;&gt;
            &lt;operand xsi:type=&quot;And&quot;&gt;
               &lt;operand name=&quot;Validate Trigger Event&quot; xsi:type=&quot;ExpressionR
          ef&quot;/&gt;
               &lt;operand xsi:type=&quot;Not&quot;&gt;
                  &lt;operand name=&quot;Opioid with Ambulatory Care Abuse Potential
           in Past 90 Days&quot; xsi:type=&quot;ExpressionRef&quot;/&gt;
               &lt;/operand&gt;
            &lt;/operand&gt;
            &lt;operand xsi:type=&quot;Exists&quot;&gt;
               &lt;operand xsi:type=&quot;Query&quot;&gt;
                  &lt;source alias=&quot;encounters&quot;&gt;
                     &lt;expression dataType=&quot;fhir:Encounter&quot; xsi:type=&quot;Retrie
          ve&quot;/&gt;
                  &lt;/source&gt;
                  &lt;where xsi:type=&quot;In&quot;&gt;
                     &lt;operand xsi:type=&quot;DateFrom&quot;&gt;
                        &lt;operand path=&quot;value&quot; xsi:type=&quot;Property&quot;&gt;
                           &lt;source path=&quot;start&quot; xsi:type=&quot;Property&quot;&gt
          ;
                              &lt;source path=&quot;period&quot; scope=&quot;encounters&quot;
           xsi:type=&quot;Property&quot;/&gt;
                           &lt;/source&gt;
                        &lt;/operand&gt;
                     &lt;/operand&gt;
                     &lt;operand name=&quot;Encounter Period&quot; xsi:type=&quot;ExpressionR
          ef&quot;/&gt;
                  &lt;/where&gt;
               &lt;/operand&gt;
            &lt;/operand&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Get Indicator&quot; context=&quot;Patient&quot; accessLevel=&quot;Pu
          blic&quot;&gt;
         &lt;expression valueType=&quot;t:String&quot; value=&quot;warning&quot;
           xsi:type=&quot;Literal&quot;/&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Get Summary&quot; context=&quot;Patient&quot; accessLevel=&quot;Publ
          ic&quot;&gt;
         &lt;expression valueType=&quot;t:String&quot; value=&quot;Recommend use
           of immediate-release opioids instead of extended release/long acting opioids when
           starting patient on opioids.&quot; xsi:type=&quot;Literal&quot;/&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Get Detail&quot; context=&quot;Patient&quot; accessLevel=&quot;Publi
          c&quot;&gt;
         &lt;expression xsi:type=&quot;Concatenate&quot;&gt;
            &lt;operand valueType=&quot;t:String&quot; value=&quot;The following
           medication requests(s) release rates should be re-evaluated: &quot; xsi:type=&quot;Literal&qu
          ot;/&gt;
            &lt;operand xsi:type=&quot;SingletonFrom&quot;&gt;
               &lt;operand name=&quot;Get Trigger Trigger Event Prescription Ids&quot;
           xsi:type=&quot;ExpressionRef&quot;/&gt;
            &lt;/operand&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
   &lt;/statements&gt;
&lt;/library&gt;
</code> 
      </pre> 
    </div> 
  </text> 
  <identifier> 
    <use value="official"/> 
    <value value="OpioidCDS_REC_04"/> 
  </identifier> 
  <version value="0.1.0"/> 
  <title value="Opioid CDS Logic for recommendation #4"/> 
  <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 for prescribing extended-release/long-acting (ER/LA)
   opioids when starting a patient on opioids."/> 
  <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 the appropriateness of extended-release
   opioids with ambulatory abuse potential for the patient."/> 
  <usage value="This library is used to notify the prescriber/user that immediate-release opioids
   are recommended when starting a patient on opioids."/> 
  <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"/> 
    <document> 
      <url value="https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chro
      nic-pain---united-states-2016#420"/> 
    </document> 
  </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-abused-in-ambulatory-care"/> 
    </codeFilter> 
  </dataRequirement> 
  <dataRequirement> 
    <type value="Encounter"/> 
  </dataRequirement> 
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