OpioidCDS_R4_Recommendation_05

<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="opioidcds-r4-recommendation-05"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: opioidcds-r4-recommendation-05</p><p><b>url</b>: <a href="http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-r4-recommendation-05">http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-r4-recommendation-05</a></p><p><b>version</b>: 0.1.0</p><p><b>name</b>: OpioidCDS_R4_Recommendation_05</p><p><b>title</b>: CDC Opioid Prescribing Guideline Recommendation #5</p><p><b>type</b>: ECA Rule <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/plan-definition-type code 'eca-rule' = 'ECA Rule', given as 'ECA Rule'})</span></p><p><b>status</b>: draft</p><p><b>experimental</b>: true</p><p><b>date</b>: Apr 23, 2017 12:00:00 AM</p><p><b>publisher</b>: Centers for Disease Control and Prevention (CDC)</p><p><b>description</b>: When opioids are started, providers should prescribe the lowest effective dosage.</p><p><b>useContext</b>: , </p><p><b>jurisdiction</b>: World <span style="background: LightGoldenRodYellow">(Details : {http://unstats.un.org/unsd/methods/m49/m49.htm code '001' = 'World', given as 'World'})</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>: 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</p><p><b>copyright</b>: © CDC 2016+.</p><p><b>topic</b>: Opioid Prescribing <span style="background: LightGoldenRodYellow">(Details )</span></p><p><b>author</b>: , , , </p><p><b>relatedArtifact</b>: </p><p><b>library</b>: <a href="Library/opioidcds-r4-recommendation-05">Library/opioidcds-r4-recommendation-05</a></p><blockquote><p><b>action</b></p><p><b>title</b>: High risk for opioid overdose.</p><p><b>description</b>: Total morphine milligram equivalent (MME) exceeds recommended amount. Taper to less than 50.</p><p><b>documentation</b>: , </p><p><b>trigger</b>: </p><h3>Conditions</h3><table class="grid"><tr><td>-</td><td><b>Kind</b></td><td><b>Expression</b></td></tr><tr><td>*</td><td>applicability</td><td/></tr></table><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><p><b>expression</b>: </p></blockquote><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: action.description</p><p><b>expression</b>: </p></blockquote><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: activity.extension</p><p><b>expression</b>: </p></blockquote><h3>Actions</h3><table class="grid"><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote></div>
  </text>
  <url
       value="http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-r4-recommendation-05"/>
  <version value="0.1.0"/>
  <name value="OpioidCDS_R4_Recommendation_05"/>
  <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"/>
  <experimental value="true"/>
  <date value="2017-04-23T00:00:00-04:00"/>
  <publisher value="Centers for Disease Control and Prevention (CDC)"/>
  <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="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </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="MME Conversion Tables"/>
    <url
         value="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"/>
  </relatedArtifact>
  <library value="Library/opioidcds-r4-recommendation-05"/>
  <action>
    <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"/>
      <display value="CDC guideline for prescribing opioids for chronic pain"/>
      <url
           value="https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm"/>
    </documentation>
    <documentation>
      <type value="documentation"/>
      <document>
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                   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="Is total MME &gt;= 50?"/>
        <language value="text/cql"/>
        <expression value="Inclusion Criteria"/>
      </expression>
    </condition>
    <groupingBehavior value="visual-group"/>
    <selectionBehavior value="exactly-one"/>
    <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="activity.extension"/>
      <expression>
        <language value="text/cql"/>
        <expression value="Get Indicator"/>
      </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>