Release 4B Snapshot #1
Clinical ReasoningThis page is part of the FHIR Specification (v4.3.0-snapshot1: Release 4B Snapshot #1). 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 |
This is the narrative for the resource. See also the XML, JSON or Turtle format. This example conforms to the profile Library.
| Author | Kensaku Kawamoto, MD, PhD, MHS |
| Author | Bryn Rhodes |
| Author | Floyd Eisenberg, MD, MPH |
| Author | Robert McClure, MD, MPH |
| Documentation | CDC guideline for prescribing opioids for chronic pain | https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420 |
| Depends On | http://example.org/fhir/Library/opioidcds-common | |
| Documentation | MME Conversion Tables | https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf |
| Type: MedicationRequest | |
| Filter | Value |
| medicationCodeableConcept | In ValueSet http://example.org/fhir/ValueSet/naloxone |
| Type: MedicationRequest | |
| Filter | Value |
| medicationCodeableConcept | In ValueSet http://example.org/fhir/ValueSet/opioids-abused-in-ambulatory-care |
| Type: MedicationRequest | |
| Filter | Value |
| medicationCodeableConcept | In ValueSet http://example.org/fhir/ValueSet/benzodiazepines |
| Type: Condition | |
| Filter | Value |
| code | In ValueSet http://example.org/fhir/ValueSet/substance-abuse |
application/elm+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/2001/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-annotations:r1">
<annotation startLine="63" startChar="11" endLine="63" endChar="48" 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="63" startChar="11" endLine="63" endChar="48" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
<annotation startLine="81" startChar="5" endLine="81" endChar="68" 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="81" startChar="5" endLine="81" endChar="68" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
<annotation startLine="74" startChar="11" endLine="74" endChar="55" 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="74" startChar="11" endLine="74" endChar="55" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
<annotation startLine="77" startChar="12" endLine="77" endChar="41" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
<identifier id="OpioidCDS_STU4_REC_08" 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="NamedTypeSpecifier"/>
</parameterTypeSpecifier>
</def>
</parameters>
<valueSets>
<def name="Substance Abuse" id="TODO" accessLevel="Public"/>
</valueSets>
<statements>
<def name="Patient" context="Patient">
<expression xsi:type="SingletonFrom">
<operand dataType="fhir:Patient" xsi:type="Retrieve"/>
</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"/>
</source>
<where name="IsOpioidWithAmbulatoryAbusePotential" 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="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="Public">
<expression xsi:type="Exists">
<operand dataType="fhir:MedicationRequest" codeProperty="medicationCodeableConcept" xsi:type="Retrieve">
<codes name="Naloxone" libraryName="Common" xsi:type="ValueSetRef"/>
</operand>
</expression>
</def>
<def name="Get Active Ambulatory Opioid Rx" context="Patient" accessLevel="Public">
<expression xsi:type="Union">
<operand xsi:type="Query">
<source alias="Rx">
<expression dataType="fhir:MedicationRequest" codeProperty="medicationCodeableConcept" xsi:type="Retrieve">
<codes name="Ambulatory Abuse Potential Opioids" libraryName="Common" 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="$this">
<expression path="category" scope="Rx" xsi:type="Property"/>
</source>
<where xsi:type="Not">
<operand xsi:type="IsNull">
<operand path="coding" xsi:type="Property">
<source name="$this" xsi:type="AliasRef"/>
</operand>
</operand>
</where>
<return>
<expression path="coding" xsi:type="Property">
<source name="$this" xsi:type="AliasRef"/>
</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>
</operand>
<operand name="ContextPrescriptions" xsi:type="ParameterRef"/>
</expression>
</def>
<def name="Average MME" context="Patient" accessLevel="Public">
<expression name="TotalMME" libraryName="Common" xsi:type="FunctionRef">
<operand name="Get Active Ambulatory Opioid Rx" xsi:type="ExpressionRef"/>
</expression>
</def>
<def name="MME >= 50 mg/d?" context="Patient" accessLevel="Public">
<expression xsi:type="If">
<condition asType="t:Boolean" xsi:type="As">
<operand xsi:type="IsNull">
<operand name="Average MME" xsi:type="ExpressionRef"/>
</operand>
</condition>
<then valueType="t:Boolean" value="false" xsi:type="Literal"/>
<else xsi:type="GreaterOrEqual">
<operand name="Average MME" xsi:type="ExpressionRef"/>
<operand value="50" unit="mg/d" xsi:type="Quantity"/>
</else>
</expression>
</def>
<def name="On Benzodiazepine" context="Patient" accessLevel="Public">
<expression xsi:type="Exists">
<operand dataType="fhir:MedicationRequest" codeProperty="medicationCodeableConcept" xsi:type="Retrieve">
<codes name="Benzodiazepines" libraryName="Common" xsi:type="ValueSetRef"/>
</operand>
</expression>
</def>
<def name="Inclusion Criteria" context="Patient" accessLevel="Public">
<expression xsi:type="And">
<operand xsi:type="And">
<operand name="Validate Trigger Event" xsi:type="ExpressionRef"/>
<operand xsi:type="Not">
<operand name="Exclusion Criteria" xsi:type="ExpressionRef"/>
</operand>
</operand>
<operand xsi:type="Or">
<operand name="MME >= 50 mg/d?" xsi:type="ExpressionRef"/>
<operand name="On Benzodiazepine" xsi:type="ExpressionRef"/>
</operand>
</expression>
</def>
<def name="Has Substance Abuse History" context="Patient" accessLevel="Public">
<expression xsi:type="Exists">
<operand dataType="fhir:Condition" codeProperty="code" xsi:type="Retrieve">
<codes name="Substance Abuse" xsi:type="ValueSetRef"/>
</operand>
</expression>
</def>
<def name="Get Indicator" context="Patient" accessLevel="Public">
<expression valueType="t:String" value="warning" xsi:type="Literal"/>
</def>
<def name="Get Summary" context="Patient" accessLevel="Public">
<expression valueType="t:String" value="Incorporate into the management plan strategies to mitigate risk; including considering offering naloxone when factors that increase risk for opioid overdose are present" xsi:type="Literal"/>
</def>
<def name="Get Notification" context="Patient" accessLevel="Public">
<expression xsi:type="Concatenate">
<operand valueType="t:String" value="Consider offering naloxone given following risk factor(s) for opioid overdose: " xsi:type="Literal"/>
<operand xsi:type="If">
<condition asType="t:Boolean" xsi:type="As">
<operand name="MME >= 50 mg/d?" xsi:type="ExpressionRef"/>
</condition>
<then xsi:type="Concatenate">
<operand xsi:type="Concatenate">
<operand valueType="t:String" value="Average MME (" xsi:type="Literal"/>
<operand xsi:type="ToString">
<operand name="Average MME" xsi:type="ExpressionRef"/>
</operand>
</operand>
<operand valueType="t:String" value=") >= 50 mg/day, " xsi:type="Literal"/>
</then>
<else xsi:type="Concatenate">
<operand valueType="t:String" value="" xsi:type="Literal"/>
<operand xsi:type="If">
<condition asType="t:Boolean" xsi:type="As">
<operand name="On Benzodiazepine" xsi:type="ExpressionRef"/>
</condition>
<then valueType="t:String" value="concurrent use of benzodiazepine, " xsi:type="Literal"/>
<else valueType="t:String" value="" xsi:type="Literal"/>
</operand>
</else>
</operand>
</expression>
</def>
</statements>
</library>
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 R4B Ballot #1 hl7.fhir.core#4.3.0-snapshot1 generated on Mon, Dec 20, 2021 14:14+1100.
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