Opioid CDS Recommendation 7 ECA Rule (id = "opioidcds-07")

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

<PlanDefinition xmlns="http://hl7.org/fhir">
    <id value="opioidcds-07"/> 
    <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: PlanDefinition</b> <a name="opioidcds-07"> </a> </p> <div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px
       solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PlanDefinition &quot;opioidcds-07&quot; </p> </div> <p> <b> url</b> : <code> http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-07</code> </p> <p> <b> identifier</b> : id: urn:oid:2.16.840.1.113883.4.642.11.6, id: cdc-opioid-guidance (OFFICIAL)</p> <p> <b> version</b> : 0.1.0</p> <p> <b> name</b> : cdc-opioid-07</p> <p> <b> title</b> : CDC Opioid Prescribing Guideline Recommendation #7</p> <p> <b> type</b> : ECA Rule <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="codesystem-plan-definition-type.html">PlanDefinitionType</a> #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 evaluate benefits and harms with patients within 1 to 4 weeks of starting
         opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits
         and harms of continued therapy with patients every 3 months or more frequently.</p> <h3> UseContexts</h3> <table class="grid"><tr> <td> -</td> <td> <b> Code</b> </td> <td> <b> Value[x]</b> </td> </tr> <tr> <td> *</td> <td> Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code
             focus = 'Clinical Focus', stated as 'Clinical Focus')</td> <td> Medication requested (situation) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #182888003)</span> </td> </tr> <tr> <td> *</td> <td> Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code
             focus = 'Clinical Focus', stated as 'Clinical Focus')</td> <td> Chronic pain (finding) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #82423001)</span> </td> </tr> </table> <p> <b> jurisdiction</b> : United States of America <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (unknown#US)</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> : If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize
         other therapies and work with patients to taper opioids to lower dosages or to taper and
         discontinue opioids.</p> <p> <b> copyright</b> : © CDC 2016+.</p> <p> <b> topic</b> : Opioid Prescribing <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span> </p> <p> <b> author</b> : Kensaku Kawamoto, MD, PhD, MHS: , Bryn Rhodes: , Floyd Eisenberg, MD, MPH: , Robert
         McClure, MD, MPH: </p> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : documentation</p> <p> <b> display</b> : CDC guideline for prescribing opioids for chronic pain</p> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : documentation</p> <p> <b> display</b> : MME Conversion Tables</p> </blockquote> <p> <b> library</b> : <a href="http://example.org/fhir/Library/opioidcds-recommendation-07">http://example.org/fhir/Library/opioidcds-recommendation-07</a> </p> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : <span title="  non-dynamic card summary  ">Existing patient should be evaluated for risk of continued opioid therapy.</span> </p> <p> <b> description</b> : Checking if the trigger prescription meets the inclusion criteria for recommendation
           #7 workflow.</p> <blockquote> <p> <b> documentation</b> </p> <p> <b> type</b> : documentation</p> </blockquote> <h3> Triggers</h3> <table class="grid"><tr> <td> -</td> <td> <b> Type</b> </td> <td> <b> Name</b> </td> </tr> <tr> <td> *</td> <td> named-event</td> <td> medication-prescribe</td> </tr> </table> <blockquote> <p> <b> condition</b> </p> <p> <b> kind</b> : applicability</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Description</b> </td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> Check whether the existing patient, without an end of life condition or risk assessment
                 in the past 90 days, has taken an opioid-with-abuse-potential for 7 of the past 10 days
                 or 63 of the past 90 days.</td> <td> text/cql</td> <td> Inclusion Criteria</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.title</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> text/cql</td> <td> Get Summary</td> </tr> </table> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : action.description</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> text/cql</td> <td> Get Detail</td> </tr> </table> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : action.extension</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> text/cql</td> <td> Get Indicator</td> </tr> </table> </blockquote> <h3> Actions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Description</b> </td> </tr> <tr> <td> *</td> <td> Will schedule assessment of risk for opioid use for the patient</td> </tr> <tr> <td> *</td> <td> Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo</td> </tr> <tr> <td> *</td> <td> N/A - see comment; snooze 3 mo</td> </tr> </table> </blockquote> </div> </text> <url value="http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-07"/> 
    <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.11.6"/> 
  </identifier> 
  <identifier> 
        <use value="official"/> 
        <value value="cdc-opioid-guidance"/> 
    </identifier> 
    <version value="0.1.0"/> 
    <name value="cdc-opioid-07"/> 
    <title value="CDC Opioid Prescribing Guideline Recommendation #7"/> 
    <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 evaluate benefits and harms with patients within 1 to 4 weeks of starting
   opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits
   and harms of continued therapy with patients every 3 months or more frequently."/> 
    <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="If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize
   other therapies and work with patients to taper opioids to lower dosages or to taper and
   discontinue 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-chronic-pai
      n---united-states-2016#420"/> 
        </document> 
    </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> 
    <library value="http://example.org/fhir/Library/opioidcds-recommendation-07"/> 
    <action> 
        <!--    non-dynamic card summary    -->
        <title value="Existing patient should be evaluated for risk of continued opioid therapy."/> 
        <description value="Checking if the trigger prescription meets the inclusion criteria for recommendation #7
     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, without an end of life condition or risk assessment
         in the past 90 days, has taken an opioid-with-abuse-potential for 7 of the past 10 days
         or 63 of the past 90 days."/> 
              <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.title"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Summary"/> 
            </expression> 
        </dynamicValue> 
        <dynamicValue> 
            <path value="action.description"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Detail"/> 
            </expression> 
        </dynamicValue> 
        <dynamicValue> 
            <path value="action.extension"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Indicator"/> 
            </expression> 
        </dynamicValue> 
        <action> 
            <description value="Will schedule assessment of risk for opioid use for the patient"/> 
            <!--    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>