hl7

{"resourceType":"PlanDefinition","id":"opioidcds-08","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-08\"\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-08\u0026quot; \u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003cb\u003eurl\u003c/b\u003e: \u003ccode\u003ehttp://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-08\u003c/code\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eidentifier\u003c/b\u003e: id: urn:oid:2.16.840.1.113883.4.642.11.10, 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: Cdcopioid08\u003c/p\u003e\u003cp\u003e\u003cb\u003etitle\u003c/b\u003e: CDC Opioid Prescribing Guideline Recommendation #8\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 incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present.\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: Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms.\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-08\"\u003ehttp://example.org/fhir/Library/opioidcds-recommendation-08\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 exhibits risk factors for opioid-related harms.\u003c/p\u003e\u003cp\u003e\u003cb\u003edescription\u003c/b\u003e: Checking if the trigger prescription meets the inclusion criteria for recommendation #8 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 exhibits risk factors for opioid-related harms, such as concurrent use with benzodiazepine, a history of substance abuse, and/or an average MME greater than 50 mg/day.\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.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.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.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 offer Naloxone instead\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-08","identifier":[{"system":"urn:ietf:rfc:3986","value":"urn:oid:2.16.840.1.113883.4.642.11.10"},{"use":"official","value":"cdc-opioid-guidance"}],"version":"0.1.0","name":"Cdcopioid08","title":"CDC Opioid Prescribing Guideline Recommendation #8","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 incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present.","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 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The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.","usage":"Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms.","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-08"],"action":[{"title":"Existing patient exhibits risk factors for opioid-related harms.","description":"Checking if the trigger prescription meets the inclusion criteria for recommendation #8 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 exhibits risk factors for opioid-related harms, such as concurrent use with benzodiazepine, a history of substance abuse, and/or an average MME greater than 50 mg/day.","language":"text/cql","expression":"Inclusion Criteria"}}],"groupingBehavior":"visual-group","selectionBehavior":"exactly-one","dynamicValue":[{"path":"action.description","expression":{"language":"text/cql","expression":"Get Detail"}},{"path":"action.title","expression":{"language":"text/cql","expression":"Get Summary"}},{"path":"action.extension","expression":{"language":"text/cql","expression":"Get Indicator"}}],"action":[{"description":"Will offer Naloxone instead"},{"description":"Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"},{"description":"N/A - see comment; snooze 3 mo"}]}]}