R5 Final QA
Clinical ReasoningThis page is part of the FHIR Specification (v5.0.0-draft-final: Final QA Preview for R5 - see ballot notes). 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 |
Raw XML (canonical form + also see XML Format Specification)
Opioid CDS Recommendation 8 Logic (id = "opioidcds-recommendation-08")
<?xml version="1.0" encoding="UTF-8"?> <Library xmlns="http://hl7.org/fhir"> <id value="opioidcds-recommendation-08"/> <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> medicationCodeableConcept</td> <td> In ValueSet <a href="http://example.org/fhir/ValueSet/naloxone">http://example.org/fhir/ValueSet/naloxone</a> </td> </tr> </table> <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="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/benzodiazepines">http://example.org/fhir/ValueSet/benzodiazepines</a> </td> </tr> </table> <table class="grid"> <tr> <td colspan="2"> <b> Type</b> : <a href="condition.html">Condition</a> </td> </tr> <tr style="background-color: #efefef"> <td> Filter</td> <td> Value</td> </tr> <tr> <td> code</td> <td> In ValueSet <a href="http://example.org/fhir/ValueSet/substance-abuse">http://example.org/fhir/ValueSet/substance-abuse</a> </td> </tr> </table> <h2> Contents</h2> <p> <code> application/elm+xml</code> </p> <pre> <code class="language-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:hea lthit-gov:qdm:v4_3" xmlns:qdm53="urn:healthit-gov:qdm:v5_3" xmlns:a="urn:h l7-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="NamedTypeS pecifier"/> </parameterTypeSpecifier> </def> </parameters> <valueSets> <def name="Substance Abuse" id="TODO" accessLevel="Public&q uot;/> </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="Paramet erRef"/> </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&q uot; 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=&qu ot;Public"> <expression xsi:type="Exists"> <operand dataType="fhir:MedicationRequest" codeProperty="medica tionCodeableConcept" 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=&qu ot;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="Al iasRef"/> </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&quo t;/> </expression> </def> <def name="Average MME" context="Patient" accessLevel="Publ ic"> <expression name="TotalMME" libraryName="Common" xsi:type="FunctionRef"> <operand name="Get Active Ambulatory Opioid Rx" xsi:type="Expre ssionRef"/> </expression> </def> <def name="MME >= 50 mg/d?" context="Patient" accessLevel=&qu ot;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="L iteral"/> <else xsi:type="GreaterOrEqual"> <operand name="Average MME" xsi:type="ExpressionRef"/&g t; <operand value="50" unit="mg/d" xsi:type="Quantity "/> </else> </expression> </def> <def name="On Benzodiazepine" context="Patient" accessLevel=&quo t;Public"> <expression xsi:type="Exists"> <operand dataType="fhir:MedicationRequest" codeProperty="medica tionCodeableConcept" xsi:type="Retrieve"> <codes name="Benzodiazepines" libraryName="Common" xsi:type="ValueSetRef"/> </operand> </expression> </def> <def name="Inclusion Criteria" context="Patient" accessLevel=&qu ot;Public"> <expression xsi:type="And"> <operand xsi:type="And"> <operand name="Validate Trigger Event" xsi:type="ExpressionR ef"/> <operand xsi:type="Not"> <operand name="Exclusion Criteria" xsi:type="ExpressionRe f"/> </operand> </operand> <operand xsi:type="Or"> <operand name="MME >= 50 mg/d?" xsi:type="ExpressionRef&q uot;/> <operand name="On Benzodiazepine" xsi:type="ExpressionRef&qu ot;/> </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"/&g t; </operand> </expression> </def> <def name="Get Indicator" context="Patient" accessLevel="Pu blic"> <expression valueType="t:String" value="warning" xsi:type="Literal"/> </def> <def name="Get Summary" context="Patient" accessLevel="Publ ic"> <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&qu ot;/> <operand xsi:type="If"> <condition asType="t:Boolean" xsi:type="As"> <operand name="MME >= 50 mg/d?" xsi:type="ExpressionRe f"/> </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="Express ionRef"/> </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> </code> </pre> </div> </text> <identifier> <use value="official"/> <value value="OpioidCDS_REC_04"/> </identifier> <version value="0.1.0"/> <name value="OpioidCDSLogicForRecommendation4"/> <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 to consider offering Naloxone when factors that increase risk for opioid overdose 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="The purpose of this library is to determine whether increased risks for opioid overdose are present."/> <usage value="This library is used to recommend the prescriber/user to consider offering Naloxone when increased risks for opioid overdose are present."/> <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> <type value="MedicationRequest"/> <codeFilter> <path value="medicationCodeableConcept"/> <valueSet value="http://example.org/fhir/ValueSet/naloxone"/> </codeFilter> </dataRequirement> <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="MedicationRequest"/> <codeFilter> <path value="medicationCodeableConcept"/> <valueSet value="http://example.org/fhir/ValueSet/benzodiazepines"/> </codeFilter> </dataRequirement> <dataRequirement> <type value="Condition"/> <codeFilter> <path value="code"/> <valueSet value="http://example.org/fhir/ValueSet/substance-abuse"/> </codeFilter> </dataRequirement> <content> <contentType value="application/elm+xml"/> <data value="PD94bWwgdmVyc2lvbj0iMS4wIiBlbmNvZGluZz0iVVRGLTgiPz4KPGxpYnJhcnkgeG1sbnM9InVybjpobDctb3JnOmVsb 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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 R5 hl7.fhir.core#5.0.0-draft-final generated on Wed, Mar 1, 2023 23:06+1100.
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