Opioid CDS Recommendation 5 ECA Rule (id = "opioidcds-05")

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

<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="opioidcds-05"/> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="cds"/> 
  </extension> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.11.1"/> 
  </identifier> 
  <identifier> 
    <use value="official"/> 
    <value value="cdc-opioid-guidance"/> 
  </identifier> 
  <version value="0.1.0"/> 
  <name value="Cdcopioid05"/> 
  <title value="CDC Opioid Prescribing Guideline Recommendation #5"/> 
  <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="2017-04-23"/> 
  <publisher value="HL7 International / Clinical Decision Support"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://www.hl7.org/Special/committees/dss"/> 
    </telecom> 
  </contact> 
  <description value="When opioids are started, providers should prescribe the lowest effective dosage."/> 
  <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="Providers should use caution when prescribing opioids at any dosage, should carefully
   reassess evidence of individual benefits and risks when considering increasing
   dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing
   dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to &gt;90
   MME/day"/> 
  <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="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-05"/> 
  <action> 
    <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> 
    <title value="High risk for opioid overdose."/> 
    <description value="Total morphine milligram equivalent (MME) exceeds recommended amount. Taper to
     less than 50."/> 
    <documentation> 
      <type value="documentation"/> 
    </documentation> 
    <trigger> 
      <type value="named-event"/> 
      <name value="medication-prescribe"/> 
    </trigger> 
    <condition> 
      <kind value="applicability"/> 
      <expression> 
        <description value="Is total MME &gt;= 50?"/> 
        <language value="text/cql"/> 
        <expression value="Is MME 50 Or More?"/> 
      </expression> 
    </condition> 
    <groupingBehavior value="visual-group"/> 
    <selectionBehavior value="exactly-one"/> 
    <dynamicValue> 
      <path value="action.title"/> 
      <expression> 
        <language value="text/cql"/> 
        <expression value="getSummary"/> 
      </expression> 
    </dynamicValue> 
    <dynamicValue> 
      <path value="action.description"/> 
      <expression> 
        <language value="text/cql"/> 
        <expression value="getDetail"/> 
      </expression> 
    </dynamicValue> 
    <dynamicValue> 
      <path value="activity.extension"/> 
      <expression> 
        <language value="text/cql"/> 
        <expression value="getIndicator"/> 
      </expression> 
    </dynamicValue> 
    <action> 
      <description value="Will reduce dosage"/> 
    </action> 
    <action> 
      <description value="Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"/> 
    </action> 
    <action> 
      <description value="Acute pain; snooze 1 mo"/> 
    </action> 
    <action> 
      <description value="N/A - see comment (will be reviewed by medical director); snooze 3 mo"/> 
    </action> 
  </action> 
</PlanDefinition>