Opioid CDS Recommendation 4 ECA Rule

{
  "resourceType" : "PlanDefinition",
  "id" : "opioidcds-04",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: PlanDefinition</b><a name=\"opioidcds-04\"> </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-04&quot; </p></div><p><b>url</b>: <code>http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-04</code></p><p><b>identifier</b>: id:\u00a0urn:oid:2.16.840.1.113883.4.642.11.4, id:\u00a0cdc-opioid-guidance\u00a0(use:\u00a0OFFICIAL)</p><p><b>version</b>: 0.1.0</p><p><b>name</b>: Cdcopioid04</p><p><b>title</b>: CDC Opioid Prescribing Guideline Recommendation #4</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>: When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.</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>: Providers should use caution when prescribing extended-release/long-acting (ER/LA) opioids as they carry a higher risk and negligible benefit compared to immediate-release 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><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-04\">http://example.org/fhir/Library/opioidcds-recommendation-04</a></p><blockquote><p><b>action</b></p><p><b>title</b>: Extended-release opioid prescription triggered.</p><p><b>description</b>: Checking if the trigger prescription meets the inclusion criteria for recommendation #4 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 opioid prescription for the existing patient is extended-release without any opioids-with-abuse-potential prescribed in 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>: activity.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 precribe immediate release</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>"
  },
  "url" : "http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-04",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.11.4"
  },
  {
    "use" : "official",
    "value" : "cdc-opioid-guidance"
  }],
  "version" : "0.1.0",
  "name" : "Cdcopioid04",
  "title" : "CDC Opioid Prescribing Guideline Recommendation #4",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
      "code" : "eca-rule",
      "display" : "ECA Rule"
    }]
  },
  "status" : "draft",
  "date" : "2018-03-19",
  "publisher" : "Centers for Disease Control and Prevention (CDC)",
  "description" : "When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.",
  "useContext" : [{
    "code" : {
      "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code" : "focus",
      "display" : "Clinical Focus"
    },
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://snomed.info/sct",
        "code" : "182888003",
        "display" : "Medication requested (situation)"
      }]
    }
  },
  {
    "code" : {
      "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "code" : "focus",
      "display" : "Clinical Focus"
    },
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://snomed.info/sct",
        "code" : "82423001",
        "display" : "Chronic pain (finding)"
      }]
    }
  }],
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    }]
  }],
  "purpose" : "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" : "Providers should use caution when prescribing extended-release/long-acting (ER/LA) opioids as they carry a higher risk and negligible benefit compared to immediate-release opioids.",
  "copyright" : "© CDC 2016+.",
  "topic" : [{
    "text" : "Opioid Prescribing"
  }],
  "author" : [{
    "name" : "Kensaku Kawamoto, MD, PhD, MHS"
  },
  {
    "name" : "Bryn Rhodes"
  },
  {
    "name" : "Floyd Eisenberg, MD, MPH"
  },
  {
    "name" : "Robert McClure, MD, MPH"
  }],
  "relatedArtifact" : [{
    "type" : "documentation",
    "display" : "CDC guideline for prescribing opioids for chronic pain",
    "document" : {
      "url" : "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420"
    }
  },
  {
    "type" : "documentation",
    "display" : "MME Conversion Tables",
    "document" : {
      "url" : "https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"
    }
  }],
  "library" : ["http://example.org/fhir/Library/opioidcds-recommendation-04"],
  "action" : [{
    "title" : "Extended-release opioid prescription triggered.",
    "description" : "Checking if the trigger prescription meets the inclusion criteria for recommendation #4 workflow.",
    "documentation" : [{
      "type" : "documentation",
      "document" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/recommendation-strength",
              "code" : "strong",
              "display" : "Strong"
            }]
          }
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
          "valueCodeableConcept" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/evidence-quality",
              "code" : "low",
              "display" : "Low quality"
            }]
          }
        }]
      }
    }],
    "trigger" : [{
      "type" : "named-event",
      "name" : "medication-prescribe"
    }],
    "condition" : [{
      "kind" : "applicability",
      "expression" : {
        "description" : "Check whether the opioid prescription for the existing patient is extended-release without any opioids-with-abuse-potential prescribed in the past 90 days.",
        "language" : "text/cql",
        "expression" : "Inclusion Criteria"
      }
    }],
    "groupingBehavior" : "visual-group",
    "selectionBehavior" : "exactly-one",
    "dynamicValue" : [{
      "path" : "action.title",
      "expression" : {
        "language" : "text/cql",
        "expression" : "Get Summary"
      }
    },
    {
      "path" : "action.description",
      "expression" : {
        "language" : "text/cql",
        "expression" : "Get Detail"
      }
    },
    {
      "path" : "activity.extension",
      "expression" : {
        "language" : "text/cql",
        "expression" : "Get Indicator"
      }
    }],
    "action" : [{
      "description" : "Will precribe immediate release"
    },
    {
      "description" : "Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"
    },
    {
      "description" : "N/A - see comment; snooze 3 mo"
    }]
  }]
}