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{"resourceType":"PlanDefinition","id":"opioidcds-07","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-07\"\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-07\u0026quot; \u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003cb\u003eurl\u003c/b\u003e: \u003ccode\u003ehttp://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-07\u003c/code\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eidentifier\u003c/b\u003e: id: urn:oid:2.16.840.1.113883.4.642.11.6, 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: Cdcopioid07\u003c/p\u003e\u003cp\u003e\u003cb\u003etitle\u003c/b\u003e: CDC Opioid Prescribing Guideline Recommendation #7\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: Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently.\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: If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue 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-07\"\u003ehttp://example.org/fhir/Library/opioidcds-recommendation-07\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: Existing patient should be evaluated for risk of continued opioid therapy.\u003c/p\u003e\u003cp\u003e\u003cb\u003edescription\u003c/b\u003e: Checking if the trigger prescription meets the inclusion criteria for recommendation #7 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 existing patient, without an end of life condition or risk assessment in the past 90 days, has taken an opioid-with-abuse-potential for 7 of the past 10 days or 63 of 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: action.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 schedule assessment of risk for opioid use for the patient\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-07","identifier":[{"system":"urn:ietf:rfc:3986","value":"urn:oid:2.16.840.1.113883.4.642.11.6"},{"use":"official","value":"cdc-opioid-guidance"}],"version":"0.1.0","name":"Cdcopioid07","title":"CDC Opioid Prescribing Guideline Recommendation #7","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":"Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently.","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":"If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue 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-07"],"action":[{"title":"Existing patient should be evaluated for risk of continued opioid therapy.","description":"Checking if the trigger prescription meets the inclusion criteria for recommendation #7 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 existing patient, without an end of life condition or risk assessment in the past 90 days, has taken an opioid-with-abuse-potential for 7 of the past 10 days or 63 of 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":"action.extension","expression":{"language":"text/cql","expression":"Get Indicator"}}],"action":[{"description":"Will schedule assessment of risk for opioid use for the patient"},{"description":"Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"},{"description":"N/A - see comment; snooze 3 mo"}]}]}