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{"resourceType":"PlanDefinition","id":"opioidcds-05","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-05\"\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-05\u0026quot; \u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003cb\u003eurl\u003c/b\u003e: \u003ccode\u003ehttp://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-05\u003c/code\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eidentifier\u003c/b\u003e: id: urn:oid:2.16.840.1.113883.4.642.11.1, 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: Cdcopioid05\u003c/p\u003e\u003cp\u003e\u003cb\u003etitle\u003c/b\u003e: CDC Opioid Prescribing Guideline Recommendation #5\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: 2017-04-23\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 opioids are started, providers should prescribe the lowest effective dosage.\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 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 \u0026gt;90 MME/day\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-05\"\u003ehttp://example.org/fhir/Library/opioidcds-recommendation-05\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: High risk for opioid overdose.\u003c/p\u003e\u003cp\u003e\u003cb\u003edescription\u003c/b\u003e: Total morphine milligram equivalent (MME) exceeds recommended amount. Taper to less than 50.\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\u003eIs total MME \u0026gt;\u003d 50?\u003c/td\u003e\u003ctd\u003etext/cql\u003c/td\u003e\u003ctd\u003eIs MME 50 Or More?\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\u003egetSummary\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\u003egetDetail\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\u003egetIndicator\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 reduce dosage\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\u003eAcute pain; snooze 1 mo\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd\u003e*\u003c/td\u003e\u003ctd\u003eN/A - see comment (will be reviewed by medical director); 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-05","identifier":[{"system":"urn:ietf:rfc:3986","value":"urn:oid:2.16.840.1.113883.4.642.11.1"},{"use":"official","value":"cdc-opioid-guidance"}],"version":"0.1.0","name":"Cdcopioid05","title":"CDC Opioid Prescribing Guideline Recommendation #5","type":{"coding":[{"system":"http://terminology.hl7.org/CodeSystem/plan-definition-type","code":"eca-rule","display":"ECA Rule"}]},"status":"draft","date":"2017-04-23","publisher":"Centers for Disease Control and Prevention (CDC)","description":"When opioids are started, providers should prescribe the lowest effective dosage.","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 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 \u003e90 MME/day","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-05"],"action":[{"title":"High risk for opioid overdose.","description":"Total morphine milligram equivalent (MME) exceeds recommended amount. Taper to less than 50.","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":"Is total MME \u003e\u003d 50?","language":"text/cql","expression":"Is MME 50 Or More?"}}],"groupingBehavior":"visual-group","selectionBehavior":"exactly-one","dynamicValue":[{"path":"action.title","expression":{"language":"text/cql","expression":"getSummary"}},{"path":"action.description","expression":{"language":"text/cql","expression":"getDetail"}},{"path":"activity.extension","expression":{"language":"text/cql","expression":"getIndicator"}}],"action":[{"description":"Will reduce dosage"},{"description":"Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"},{"description":"Acute pain; snooze 1 mo"},{"description":"N/A - see comment (will be reviewed by medical director); snooze 3 mo"}]}]}