Opioid CDS Recommendation 5 Logic (id = "opioidcds-recommendation-05")

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

<Library xmlns="http://hl7.org/fhir">
  <id value="opioidcds-recommendation-05"/> 
  <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> 
        <tr> 
          <td> Documentation</td> 
          <td> MME Conversion Tables</td> 
          <td> 
            <p> 
              <code> 
                <a href="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf">https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf</a> 
              </code>  (
              <code/>  )
            </p> 
          </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> status</td> 
          <td> One of these codes: [not stated] active: active</td> 
        </tr> 
        <tr> 
          <td> category</td> 
          <td> One of these codes: 
            <a href="http://terminology.hl7.org/3.1.0/CodeSystem-medicationrequest-category.html#medicationrequest
            -category-outpatient">MedicationRequest Category Codes</a>  outpatient: Outpatient
          </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;identifier id=&quot;OpioidCDS_STU4&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;MMECommon&quot; path=&quot;OpioidCDS_STU4_Common&quot;
           version=&quot;0.1.0&quot;/&gt;
   &lt;/includes&gt;
   &lt;parameters&gt;
      &lt;def name=&quot;UserID&quot; accessLevel=&quot;Public&quot;&gt;
         &lt;parameterTypeSpecifier name=&quot;t:String&quot; xsi:type=&quot;NamedTypeSpecifi
          er&quot;/&gt;
      &lt;/def&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;Get Active Prescriptions&quot; context=&quot;Patient&quot;
           accessLevel=&quot;Public&quot;&gt;
         &lt;expression xsi:type=&quot;Query&quot;&gt;
            &lt;source alias=&quot;activeRx&quot;&gt;
               &lt;expression dataType=&quot;fhir:MedicationRequest&quot; xsi:type=&quot;Retr
          ieve&quot;/&gt;
            &lt;/source&gt;
            &lt;where xsi:type=&quot;And&quot;&gt;
               &lt;operand xsi:type=&quot;Equal&quot;&gt;
                  &lt;operand path=&quot;value&quot; xsi:type=&quot;Property&quot;&gt;
                     &lt;source path=&quot;status&quot; scope=&quot;activeRx&quot;
           xsi:type=&quot;Property&quot;/&gt;
                  &lt;/operand&gt;
                  &lt;operand valueType=&quot;t:String&quot; value=&quot;active&quot;
           xsi:type=&quot;Literal&quot;/&gt;
               &lt;/operand&gt;
               &lt;operand xsi:type=&quot;Equal&quot;&gt;
                  &lt;operand path=&quot;value&quot; xsi:type=&quot;Property&quot;&gt;
                     &lt;source path=&quot;code&quot; xsi:type=&quot;Property&quot;&gt;
                        &lt;source xsi:type=&quot;Indexer&quot;&gt;
                           &lt;operand xsi:type=&quot;Flatten&quot;&gt;
                              &lt;operand xsi:type=&quot;Query&quot;&gt;
                                 &lt;source alias=&quot;$this&quot;&gt;
                                    &lt;expression path=&quot;category&quot; scope=&quot;acti
          veRx&quot; xsi:type=&quot;Property&quot;/&gt;
                                 &lt;/source&gt;
                                 &lt;where xsi:type=&quot;Not&quot;&gt;
                                    &lt;operand xsi:type=&quot;IsNull&quot;&gt;
                                       &lt;operand path=&quot;coding&quot; xsi:type=&quot;Pro
          perty&quot;&gt;
                                          &lt;source name=&quot;$this&quot; xsi:type=&quot;Al
          iasRef&quot;/&gt;
                                       &lt;/operand&gt;
                                    &lt;/operand&gt;
                                 &lt;/where&gt;
                                 &lt;return&gt;
                                    &lt;expression path=&quot;coding&quot; xsi:type=&quot;Pro
          perty&quot;&gt;
                                       &lt;source name=&quot;$this&quot; xsi:type=&quot;Alias
          Ref&quot;/&gt;
                                    &lt;/expression&gt;
                                 &lt;/return&gt;
                              &lt;/operand&gt;
                           &lt;/operand&gt;
                           &lt;operand valueType=&quot;t:Integer&quot; value=&quot;0&quot;
           xsi:type=&quot;Literal&quot;/&gt;
                        &lt;/source&gt;
                     &lt;/source&gt;
                  &lt;/operand&gt;
                  &lt;operand valueType=&quot;t:String&quot; value=&quot;outpatient&quot;
           xsi:type=&quot;Literal&quot;/&gt;
               &lt;/operand&gt;
            &lt;/where&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Total MME&quot; context=&quot;Patient&quot; accessLevel=&quot;Public
          &quot;&gt;
         &lt;expression name=&quot;TotalMME&quot; libraryName=&quot;MMECommon&quot;
           xsi:type=&quot;FunctionRef&quot;&gt;
            &lt;operand xsi:type=&quot;Union&quot;&gt;
               &lt;operand name=&quot;ContextPrescriptions&quot; xsi:type=&quot;ParameterRef&
          quot;/&gt;
               &lt;operand name=&quot;Get Active Prescriptions&quot; xsi:type=&quot;Expressio
          nRef&quot;/&gt;
            &lt;/operand&gt;
         &lt;/expression&gt;
      &lt;/def&gt;
      &lt;def name=&quot;Is MME 50 Or More?&quot; context=&quot;Patient&quot; accessLevel=&qu
          ot;Public&quot;&gt;
         &lt;expression xsi:type=&quot;GreaterOrEqual&quot;&gt;
            &lt;operand name=&quot;Total MME&quot; xsi:type=&quot;ExpressionRef&quot;/&gt;
            &lt;operand value=&quot;50&quot; unit=&quot;mg/d&quot; xsi:type=&quot;Quantity&qu
          ot;/&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 xsi:type=&quot;Concatenate&quot;&gt;
            &lt;operand valueType=&quot;t:String&quot; value=&quot;High risk for
           opioid overdose - &quot; xsi:type=&quot;Literal&quot;/&gt;
            &lt;operand xsi:type=&quot;Case&quot;&gt;
               &lt;caseItem&gt;
                  &lt;when xsi:type=&quot;GreaterOrEqual&quot;&gt;
                     &lt;operand path=&quot;value&quot; xsi:type=&quot;Property&quot;&gt;
                        &lt;source name=&quot;Total MME&quot; xsi:type=&quot;ExpressionRef&qu
          ot;/&gt;
                     &lt;/operand&gt;
                     &lt;operand xsi:type=&quot;ToDecimal&quot;&gt;
                        &lt;operand valueType=&quot;t:Integer&quot; value=&quot;90&quot;
           xsi:type=&quot;Literal&quot;/&gt;
                     &lt;/operand&gt;
                  &lt;/when&gt;
                  &lt;then valueType=&quot;t:String&quot; value=&quot;taper now&quot;
           xsi:type=&quot;Literal&quot;/&gt;
               &lt;/caseItem&gt;
               &lt;else valueType=&quot;t:String&quot; value=&quot;consider tapering&quot;
           xsi:type=&quot;Literal&quot;/&gt;
            &lt;/operand&gt;
         &lt;/expression&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 xsi:type=&quot;Concatenate&quot;&gt;
               &lt;operand valueType=&quot;t:String&quot; value=&quot;Total morphine
           milligram equivalent (MME) is &quot; xsi:type=&quot;Literal&quot;/&gt;
               &lt;operand xsi:type=&quot;ToString&quot;&gt;
                  &lt;operand name=&quot;Total MME&quot; xsi:type=&quot;ExpressionRef&quot;/&
          gt;
               &lt;/operand&gt;
            &lt;/operand&gt;
            &lt;operand valueType=&quot;t:String&quot; value=&quot;. Taper to less
           than 50.&quot; xsi:type=&quot;Literal&quot;/&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_05"/> 
  </identifier> 
  <version value="0.1.0"/> 
  <title value="Opioid CDS Logic for recommendation #5"/> 
  <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 use in implementing CDC Opioid Prescribing Guidelines."/> 
  <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="This library works in concert with the OMTK logic library to provide decision support
   for Morphine Milligram Equivalence calculations and dynamic value resolution."/> 
  <usage value="This library is to notify the prescriber/user whether the current prescription
   exceeds the recommended MME."/> 
  <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> 
  <relatedArtifact> 
    <type value="documentation"/> 
    <display value="MME Conversion Tables"/> 
    <document> 
      <url value="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"/> 
    </document> 
  </relatedArtifact> 
  <dataRequirement id="medications">
    <type value="MedicationRequest"/> 
    <codeFilter> 
      <path value="status"/> 
      <code> 
        <code value="active"/> 
      </code> 
    </codeFilter> 
    <codeFilter> 
      <path value="category"/> 
      <code> 
        <system value="http://terminology.hl7.org/CodeSystem/medicationrequest-category"/> 
        <code value="outpatient"/> 
      </code> 
    </codeFilter> 
  </dataRequirement> 
  <content> 
    <contentType value="application/elm+xml"/> 
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