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{"resourceType":"PlanDefinition","id":"opioidcds-04","text":{"status":"generated","div":"\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003e\u003cp\u003e\u003cb\u003eGenerated Narrative: PlanDefinition\u003c/b\u003e\u003ca name\u003d\"opioidcds-04\"\u003e \u003c/a\u003e\u003c/p\u003e\u003cdiv style\u003d\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"\u003e\u003cp style\u003d\"margin-bottom: 0px\"\u003eResource PlanDefinition \u0026quot;opioidcds-04\u0026quot; \u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003cb\u003eurl\u003c/b\u003e: \u003ccode\u003ehttp://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-04\u003c/code\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eidentifier\u003c/b\u003e: id: urn:oid:2.16.840.1.113883.4.642.11.4, id: cdc-opioid-guidance (use: OFFICIAL)\u003c/p\u003e\u003cp\u003e\u003cb\u003eversion\u003c/b\u003e: 0.1.0\u003c/p\u003e\u003cp\u003e\u003cb\u003ename\u003c/b\u003e: Cdcopioid04\u003c/p\u003e\u003cp\u003e\u003cb\u003etitle\u003c/b\u003e: CDC Opioid Prescribing Guideline Recommendation #4\u003c/p\u003e\u003cp\u003e\u003cb\u003etype\u003c/b\u003e: ECA Rule \u003cspan style\u003d\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"\u003e (\u003ca href\u003d\"http://terminology.hl7.org/5.1.0/CodeSystem-plan-definition-type.html\"\u003ePlanDefinitionType\u003c/a\u003e#eca-rule)\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003estatus\u003c/b\u003e: draft\u003c/p\u003e\u003cp\u003e\u003cb\u003edate\u003c/b\u003e: 2018-03-19\u003c/p\u003e\u003cp\u003e\u003cb\u003epublisher\u003c/b\u003e: Centers for Disease Control and Prevention (CDC)\u003c/p\u003e\u003cp\u003e\u003cb\u003edescription\u003c/b\u003e: When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.\u003c/p\u003e\u003ch3\u003eUseContexts\u003c/h3\u003e\u003ctable class\u003d\"grid\"\u003e\u003ctr\u003e\u003ctd\u003e-\u003c/td\u003e\u003ctd\u003e\u003cb\u003eCode\u003c/b\u003e\u003c/td\u003e\u003ctd\u003e\u003cb\u003eValue[x]\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003eClinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus \u003d \u0027Clinical Focus\u0027, stated as \u0027Clinical Focus\u0027)\u003c/td\u003e\u003ctd\u003eMedication requested (situation) \u003cspan style\u003d\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"\u003e (\u003ca href\u003d\"https://browser.ihtsdotools.org/\"\u003eSNOMED CT\u003c/a\u003e#182888003)\u003c/span\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003eClinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus \u003d \u0027Clinical Focus\u0027, stated as \u0027Clinical Focus\u0027)\u003c/td\u003e\u003ctd\u003eChronic pain (finding) \u003cspan style\u003d\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"\u003e (\u003ca href\u003d\"https://browser.ihtsdotools.org/\"\u003eSNOMED CT\u003c/a\u003e#82423001)\u003c/span\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cp\u003e\u003cb\u003ejurisdiction\u003c/b\u003e: United States of America \u003cspan style\u003d\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"\u003e (\u003ca href\u003d\"http://terminology.hl7.org/5.1.0/CodeSystem-ISO3166Part1.html\"\u003eISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code\u003c/a\u003e#US)\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003epurpose\u003c/b\u003e: 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.\u003c/p\u003e\u003cp\u003e\u003cb\u003eusage\u003c/b\u003e: 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.\u003c/p\u003e\u003cp\u003e\u003cb\u003ecopyright\u003c/b\u003e: © CDC 2016+.\u003c/p\u003e\u003cp\u003e\u003cb\u003etopic\u003c/b\u003e: Opioid Prescribing \u003cspan style\u003d\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"\u003e ()\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eauthor\u003c/b\u003e: Kensaku Kawamoto, MD, PhD, MHS: , Bryn Rhodes: , Floyd Eisenberg, MD, MPH: , Robert McClure, MD, MPH: \u003c/p\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003erelatedArtifact\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003etype\u003c/b\u003e: documentation\u003c/p\u003e\u003cp\u003e\u003cb\u003edisplay\u003c/b\u003e: CDC guideline for prescribing opioids for chronic pain\u003c/p\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003edocument\u003c/b\u003e\u003c/p\u003e\u003c/blockquote\u003e\u003c/blockquote\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003erelatedArtifact\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003etype\u003c/b\u003e: documentation\u003c/p\u003e\u003cp\u003e\u003cb\u003edisplay\u003c/b\u003e: MME Conversion Tables\u003c/p\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003edocument\u003c/b\u003e\u003c/p\u003e\u003c/blockquote\u003e\u003c/blockquote\u003e\u003cp\u003e\u003cb\u003elibrary\u003c/b\u003e: \u003ca href\u003d\"http://example.org/fhir/Library/opioidcds-recommendation-04\"\u003ehttp://example.org/fhir/Library/opioidcds-recommendation-04\u003c/a\u003e\u003c/p\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003eaction\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003etitle\u003c/b\u003e: Extended-release opioid prescription triggered.\u003c/p\u003e\u003cp\u003e\u003cb\u003edescription\u003c/b\u003e: Checking if the trigger prescription meets the inclusion criteria for recommendation #4 workflow.\u003c/p\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003edocumentation\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003etype\u003c/b\u003e: documentation\u003c/p\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003edocument\u003c/b\u003e\u003c/p\u003e\u003c/blockquote\u003e\u003c/blockquote\u003e\u003ch3\u003eTriggers\u003c/h3\u003e\u003ctable class\u003d\"grid\"\u003e\u003ctr\u003e\u003ctd\u003e-\u003c/td\u003e\u003ctd\u003e\u003cb\u003eType\u003c/b\u003e\u003c/td\u003e\u003ctd\u003e\u003cb\u003eName\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003enamed-event\u003c/td\u003e\u003ctd\u003emedication-prescribe\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003econdition\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ekind\u003c/b\u003e: applicability\u003c/p\u003e\u003ch3\u003eExpressions\u003c/h3\u003e\u003ctable class\u003d\"grid\"\u003e\u003ctr\u003e\u003ctd\u003e-\u003c/td\u003e\u003ctd\u003e\u003cb\u003eDescription\u003c/b\u003e\u003c/td\u003e\u003ctd\u003e\u003cb\u003eLanguage\u003c/b\u003e\u003c/td\u003e\u003ctd\u003e\u003cb\u003eExpression\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003eCheck whether the opioid prescription for the existing patient is extended-release without any opioids-with-abuse-potential prescribed in the past 90 days.\u003c/td\u003e\u003ctd\u003etext/cql\u003c/td\u003e\u003ctd\u003eInclusion Criteria\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003c/blockquote\u003e\u003cp\u003e\u003cb\u003egroupingBehavior\u003c/b\u003e: visual-group\u003c/p\u003e\u003cp\u003e\u003cb\u003eselectionBehavior\u003c/b\u003e: exactly-one\u003c/p\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003edynamicValue\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003epath\u003c/b\u003e: action.title\u003c/p\u003e\u003ch3\u003eExpressions\u003c/h3\u003e\u003ctable class\u003d\"grid\"\u003e\u003ctr\u003e\u003ctd\u003e-\u003c/td\u003e\u003ctd\u003e\u003cb\u003eLanguage\u003c/b\u003e\u003c/td\u003e\u003ctd\u003e\u003cb\u003eExpression\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003etext/cql\u003c/td\u003e\u003ctd\u003eGet Summary\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003c/blockquote\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003edynamicValue\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003epath\u003c/b\u003e: action.description\u003c/p\u003e\u003ch3\u003eExpressions\u003c/h3\u003e\u003ctable class\u003d\"grid\"\u003e\u003ctr\u003e\u003ctd\u003e-\u003c/td\u003e\u003ctd\u003e\u003cb\u003eLanguage\u003c/b\u003e\u003c/td\u003e\u003ctd\u003e\u003cb\u003eExpression\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003etext/cql\u003c/td\u003e\u003ctd\u003eGet Detail\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003c/blockquote\u003e\u003cblockquote\u003e\u003cp\u003e\u003cb\u003edynamicValue\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003epath\u003c/b\u003e: activity.extension\u003c/p\u003e\u003ch3\u003eExpressions\u003c/h3\u003e\u003ctable class\u003d\"grid\"\u003e\u003ctr\u003e\u003ctd\u003e-\u003c/td\u003e\u003ctd\u003e\u003cb\u003eLanguage\u003c/b\u003e\u003c/td\u003e\u003ctd\u003e\u003cb\u003eExpression\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003etext/cql\u003c/td\u003e\u003ctd\u003eGet Indicator\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003c/blockquote\u003e\u003ch3\u003eActions\u003c/h3\u003e\u003ctable class\u003d\"grid\"\u003e\u003ctr\u003e\u003ctd\u003e-\u003c/td\u003e\u003ctd\u003e\u003cb\u003eDescription\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003eWill precribe immediate release\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003eRisk of overdose carefully considered and outweighed by benefit; snooze 3 mo\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003eN/A - see comment; snooze 3 mo\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003c/blockquote\u003e\u003c/div\u003e"},"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"}]}]}