Opioid CDS Recommendation 11 ECA Rule

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

[a fhir:PlanDefinition ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "opioidcds-11"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: PlanDefinition</b><a name=\"opioidcds-11\"> </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-11&quot; </p></div><p><b>url</b>: <code>http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-11</code></p><p><b>identifier</b>: id: urn:oid:2.16.840.1.113883.4.642.11.2, id: cdc-opioid-guidance (use: OFFICIAL)</p><p><b>version</b>: 0.1.0</p><p><b>name</b>: Cdcopioid11</p><p><b>title</b>: CDC Opioid Prescribing Guideline Recommendation #11</p><p><b>type</b>: ECA Rule <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.1.0/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>: Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.</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\"> (<a href=\"http://terminology.hl7.org/5.1.0/CodeSystem-ISO3166Part1.html\">ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code</a>#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>: Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.</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><p><b>document</b></p></blockquote></blockquote><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: documentation</p><p><b>display</b>: MME Conversion Tables</p><blockquote><p><b>document</b></p></blockquote></blockquote><p><b>library</b>: <a href=\"http://example.org/fhir/Library/opioidcds-recommendation-11\">http://example.org/fhir/Library/opioidcds-recommendation-11</a></p><blockquote><p><b>action</b></p><p><b>title</b>: Existing patient has concurrent opioid and benzodiazepine prescriptions.</p><p><b>description</b>: Checking if the trigger prescription meets the inclusion criteria for recommendation #11 workflow.</p><blockquote><p><b>documentation</b></p><p><b>type</b>: documentation</p><blockquote><p><b>document</b></p></blockquote></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 is using opioids concurrently with benzodiazepines.</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.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.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.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 revise</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>"
  ] ; # 
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     fhir:system [ fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ] ;
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  ] [
     fhir:use [ fhir:v "official" ] ;
     fhir:value [ fhir:v "cdc-opioid-guidance" ]
  ] ) ; # 
  fhir:version [ fhir:v "0.1.0"] ; # 
  fhir:name [ fhir:v "Cdcopioid11"] ; # 
  fhir:title [ fhir:v "CDC Opioid Prescribing Guideline Recommendation #11"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/plan-definition-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "eca-rule" ] ;
       fhir:display [ fhir:v "ECA Rule" ]
     ] )
  ] ; # 
  fhir:status [ fhir:v "draft"] ; # 
  fhir:date [ fhir:v "2018-03-19"^^xsd:date] ; # 
  fhir:publisher [ fhir:v "Centers for Disease Control and Prevention (CDC)"] ; # 
  fhir:description [ fhir:v "Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient."] ; # 
  fhir:useContext ( [
     fhir:code [
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       fhir:code [ fhir:v "focus" ] ;
       fhir:display [ fhir:v "Clinical Focus" ]
     ] ;
     fhir:value [
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       fhir:coding ( [
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         fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "182888003" ] ;
         fhir:display [ fhir:v "Medication requested (situation)" ]
       ] )
     ]
  ] [
     fhir:code [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/usage-context-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "focus" ] ;
       fhir:display [ fhir:v "Clinical Focus" ]
     ] ;
     fhir:value [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         a sct:82423001 ;
         fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "82423001" ] ;
         fhir:display [ fhir:v "Chronic pain (finding)" ]
       ] )
     ]
  ] ) ; # 
  fhir:jurisdiction ( [
     fhir:coding ( [
       fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "US" ] ;
       fhir:display [ fhir:v "United States of America" ]
     ] )
  ] ) ; # 
  fhir:purpose [ fhir:v "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."] ; # 
  fhir:usage [ fhir:v "Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible."] ; # 
  fhir:copyright [ fhir:v "© CDC 2016+."] ; # 
  fhir:topic ( [
     fhir:text [ fhir:v "Opioid Prescribing" ]
  ] ) ; # 
  fhir:author ( [
     fhir:name [ fhir:v "Kensaku Kawamoto, MD, PhD, MHS" ]
  ] [
     fhir:name [ fhir:v "Bryn Rhodes" ]
  ] [
     fhir:name [ fhir:v "Floyd Eisenberg, MD, MPH" ]
  ] [
     fhir:name [ fhir:v "Robert McClure, MD, MPH" ]
  ] ) ; # 
  fhir:relatedArtifact ( [
     fhir:type [ fhir:v "documentation" ] ;
     fhir:display [ fhir:v "CDC guideline for prescribing opioids for chronic pain" ] ;
     fhir:document [
       fhir:url [ fhir:v "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420"^^xsd:anyURI ]
     ]
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     fhir:type [ fhir:v "documentation" ] ;
     fhir:display [ fhir:v "MME Conversion Tables" ] ;
     fhir:document [
       fhir:url [ fhir:v "https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"^^xsd:anyURI ]
     ]
  ] ) ; # 
  fhir:library ( [
     fhir:v "http://example.org/fhir/Library/opioidcds-recommendation-11"^^xsd:anyURI ;
     fhir:link <http://example.org/fhir/Library/opioidcds-recommendation-11>
  ] ) ; # 
  fhir:action ( [
     fhir:title [ fhir:v "Existing patient has concurrent opioid and benzodiazepine prescriptions." ] ;
     fhir:description [ fhir:v "Checking if the trigger prescription meets the inclusion criteria for recommendation #11 workflow." ] ;
     fhir:documentation ( [
       fhir:type [ fhir:v "documentation" ] ;
       fhir:document [
         fhir:extension ( [
           fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation"^^xsd:anyURI ] ;
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             a fhir:CodeableConcept ;
             fhir:coding ( [
               fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/recommendation-strength"^^xsd:anyURI ] ;
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           fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence"^^xsd:anyURI ] ;
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               fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/evidence-quality"^^xsd:anyURI ] ;
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               fhir:display [ fhir:v "Low quality" ]
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     fhir:trigger ( [
       fhir:type [ fhir:v "named-event" ] ;
       fhir:name [ fhir:v "medication-prescribe" ]
     ] ) ;
     fhir:condition ( [
       fhir:kind [ fhir:v "applicability" ] ;
       fhir:expression [
         fhir:description [ fhir:v "Check whether the existing patient is using opioids concurrently with benzodiazepines." ] ;
         fhir:language [ fhir:v "text/cql" ] ;
         fhir:expression [ fhir:v "Inclusion Criteria" ]
       ]
     ] ) ;
     fhir:groupingBehavior [ fhir:v "visual-group" ] ;
     fhir:selectionBehavior [ fhir:v "exactly-one" ] ;
     fhir:dynamicValue ( [
       fhir:path [ fhir:v "action.description" ] ;
       fhir:expression [
         fhir:language [ fhir:v "text/cql" ] ;
         fhir:expression [ fhir:v "Get Detail" ]
       ]
     ] [
       fhir:path [ fhir:v "action.title" ] ;
       fhir:expression [
         fhir:language [ fhir:v "text/cql" ] ;
         fhir:expression [ fhir:v "Get Summary" ]
       ]
     ] [
       fhir:path [ fhir:v "action.extension" ] ;
       fhir:expression [
         fhir:language [ fhir:v "text/cql" ] ;
         fhir:expression [ fhir:v "Get Indicator" ]
       ]
     ] ) ;
     fhir:action ( [
       fhir:description [ fhir:v "Will revise" ]
     ] [
       fhir:description [ fhir:v "Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo" ]
     ] [
       fhir:description [ fhir:v "N/A - see comment; snooze 3 mo" ]
     ] )
  ] )] . # 

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