Release 4B

This page is part of the FHIR Specification (v4.3.0: R4B - STU). 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

Library-opioidcds-recommendation-05

Clinical Decision Support Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Not linked to any defined compartments

This is the narrative for the resource. See also the XML, JSON or Turtle format. This example conforms to the profile Library.

Participants

AuthorKensaku Kawamoto, MD, PhD, MHS
AuthorBryn Rhodes
AuthorFloyd Eisenberg, MD, MPH
AuthorRobert McClure, MD, MPH

Related Artifacts

DocumentationCDC guideline for prescribing opioids for chronic pain

https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420 ()

Depends Onhttp://example.org/fhir/Library/opioidcds-common
DocumentationMME Conversion Tables

https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf ()

Data Requirements

Type: MedicationRequest
FilterValue
statusOne of these codes: [not stated] active: active
categoryOne of these codes: http://terminology.hl7.org/CodeSystem/medicationrequest-category outpatient: Outpatient

Contents

application/elm+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:healthit-gov:qdm:v4_3" xmlns:qdm53="urn:healthit-gov:qdm:v5_3" xmlns:a="urn:hl7-org:cql-annotations:r1">
   <identifier id="OpioidCDS_STU4" 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="MMECommon" path="OpioidCDS_STU4_Common" version="0.1.0"/>
   </includes>
   <parameters>
      <def name="UserID" accessLevel="Public">
         <parameterTypeSpecifier name="t:String" xsi:type="NamedTypeSpecifier"/>
      </def>
      <def name="ContextPrescriptions" accessLevel="Public">
         <parameterTypeSpecifier xsi:type="ListTypeSpecifier">
            <elementType name="fhir:MedicationRequest" xsi:type="NamedTypeSpecifier"/>
         </parameterTypeSpecifier>
      </def>
   </parameters>
   <statements>
      <def name="Patient" context="Patient">
         <expression xsi:type="SingletonFrom">
            <operand dataType="fhir:Patient" xsi:type="Retrieve"/>
         </expression>
      </def>
      <def name="Get Active Prescriptions" context="Patient" accessLevel="Public">
         <expression xsi:type="Query">
            <source alias="activeRx">
               <expression dataType="fhir:MedicationRequest" xsi:type="Retrieve"/>
            </source>
            <where xsi:type="And">
               <operand xsi:type="Equal">
                  <operand path="value" xsi:type="Property">
                     <source path="status" scope="activeRx" 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="$this">
                                    <expression path="category" scope="activeRx" xsi:type="Property"/>
                                 </source>
                                 <where xsi:type="Not">
                                    <operand xsi:type="IsNull">
                                       <operand path="coding" xsi:type="Property">
                                          <source name="$this" xsi:type="AliasRef"/>
                                       </operand>
                                    </operand>
                                 </where>
                                 <return>
                                    <expression path="coding" xsi:type="Property">
                                       <source name="$this" xsi:type="AliasRef"/>
                                    </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>
         </expression>
      </def>
      <def name="Total MME" context="Patient" accessLevel="Public">
         <expression name="TotalMME" libraryName="MMECommon" xsi:type="FunctionRef">
            <operand xsi:type="Union">
               <operand name="ContextPrescriptions" xsi:type="ParameterRef"/>
               <operand name="Get Active Prescriptions" xsi:type="ExpressionRef"/>
            </operand>
         </expression>
      </def>
      <def name="Is MME 50 Or More?" context="Patient" accessLevel="Public">
         <expression xsi:type="GreaterOrEqual">
            <operand name="Total MME" xsi:type="ExpressionRef"/>
            <operand value="50" unit="mg/d" xsi:type="Quantity"/>
         </expression>
      </def>
      <def name="Get Indicator" context="Patient" accessLevel="Public">
         <expression valueType="t:String" value="warning" xsi:type="Literal"/>
      </def>
      <def name="Get Summary" context="Patient" accessLevel="Public">
         <expression xsi:type="Concatenate">
            <operand valueType="t:String" value="High risk for opioid overdose - " xsi:type="Literal"/>
            <operand xsi:type="Case">
               <caseItem>
                  <when xsi:type="GreaterOrEqual">
                     <operand path="value" xsi:type="Property">
                        <source name="Total MME" xsi:type="ExpressionRef"/>
                     </operand>
                     <operand xsi:type="ToDecimal">
                        <operand valueType="t:Integer" value="90" xsi:type="Literal"/>
                     </operand>
                  </when>
                  <then valueType="t:String" value="taper now" xsi:type="Literal"/>
               </caseItem>
               <else valueType="t:String" value="consider tapering" xsi:type="Literal"/>
            </operand>
         </expression>
      </def>
      <def name="Get Detail" context="Patient" accessLevel="Public">
         <expression xsi:type="Concatenate">
            <operand xsi:type="Concatenate">
               <operand valueType="t:String" value="Total morphine milligram equivalent (MME) is " xsi:type="Literal"/>
               <operand xsi:type="ToString">
                  <operand name="Total MME" xsi:type="ExpressionRef"/>
               </operand>
            </operand>
            <operand valueType="t:String" value=". Taper to less than 50." xsi:type="Literal"/>
         </expression>
      </def>
   </statements>
</library>

 

 

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.