Release 4

Plandefinition-opioidcds-10.xml

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

Raw XML (canonical form + also see XML Format Specification)

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Opioid CDS Recommendation 10 ECA Rule (id = "opioidcds-10")

<?xml version="1.0" encoding="UTF-8"?>

<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="opioidcds-10"/> 
  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative with Details</b> </p> <p> <b> id</b> : opioidcds-10</p> <p> <b> url</b> : <b> http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-10</b> </p> <p> <b> identifier</b> : cdc-opioid-guidance (OFFICIAL)</p> <p> <b> version</b> : 0.1.0</p> <p> <b> name</b> : cdc-opioid-10</p> <p> <b> title</b> : CDC Opioid Prescribing Guideline Recommendation #10</p> <p> <b> type</b> : ECA Rule <span> (Details : {http://terminology.hl7.org/CodeSystem/plan-definition-type code 'eca-rule'
           = 'ECA Rule', given as 'ECA Rule'})</span> </p> <p> <b> status</b> : draft</p> <p> <b> date</b> : Apr 23, 2017</p> <p> <b> publisher</b> : Centers for Disease Control and Prevention (CDC)</p> <p> <b> description</b> : When prescribing opioids for chronic pain, providers should use urine drug testing before
         starting opioid therapy and consider urine drug testing at least annually to assess for
         prescribed medications as well as other controlled prescription drugs and illicit drugs.</p> <p> <b> useContext</b> : , </p> <p> <b> jurisdiction</b> : United States of America <span> (Details : {urn:iso:std:iso:3166 code 'US' = 'United States of America', given as 'United
           States of America'})</span> </p> <p> <b> purpose</b> : 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.</p> <p> <b> usage</b> : Providers should be aware if patients are taking other prescription drugs or illicit
         drugs that might increase their risk of an overdose.</p> <p> <b> copyright</b> : © CDC 2016+.</p> <p> <b> topic</b> : Opioid Prescribing <span> (Details )</span> </p> <p> <b> author</b> : , , , </p> <p> <b> relatedArtifact</b> : </p> <p> <b> library</b> : <a> Library/opioidcds-recommendation-10</a> </p> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Annual Urine Screening Check</p> <p> <b> description</b> : Patient has not had a urine screening in the past 12 months</p> <p> <b> documentation</b> : </p> <p> <b> trigger</b> : </p> <h3> Conditions</h3> <table> <tr> <td> -</td> <td> <b> Kind</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> applicability</td> <td/>  </tr> </table> <h3> DynamicValues</h3> <table> <tr> <td> -</td> <td> <b> Path</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> activity.extension</td> <td/>  </tr> </table> <h3> Actions</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> <tr> <td> *</td> </tr> </table> </blockquote> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Positive Urine Screening Check</p> <p> <b> description</b> : Patient has a urine screening testing positive for either unprescribed opioids or illicit
           drugs in the past 12 months</p> <p> <b> documentation</b> : </p> <h3> Conditions</h3> <table> <tr> <td> -</td> <td> <b> Kind</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> applicability</td> <td/>  </tr> </table> <h3> Actions</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> <tr> <td> *</td> </tr> <tr> <td> *</td> </tr> </table> </blockquote> </div> </text> <url value="http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-10"/> 
  <identifier> 
    <use value="official"/> 
    <value value="cdc-opioid-guidance"/> 
  </identifier> 
  <version value="0.1.0"/> 
  <name value="cdc-opioid-10"/> 
  <title value="CDC Opioid Prescribing Guideline Recommendation #10"/> 
  <type> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/> 
      <code value="eca-rule"/> 
      <display value="ECA Rule"/> 
    </coding> 
  </type> 
  <status value="draft"/> 
  <date value="2017-04-23"/> 
  <publisher value="Centers for Disease Control and Prevention (CDC)"/> 
  <description value="When prescribing opioids for chronic pain, providers should use urine drug testing before
   starting opioid therapy and consider urine drug testing at least annually to assess for
   prescribed medications as well as other controlled prescription drugs and illicit drugs."/> 
  <useContext> 
    <code> 
      <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> 
      <code value="focus"/> 
      <display value="Clinical Focus"/> 
    </code> 
    <valueCodeableConcept> 
      <coding> 
        <system value="http://snomed.info/sct"/> 
        <code value="182888003"/> 
        <display value="Medication requested (situation)"/> 
      </coding> 
    </valueCodeableConcept> 
  </useContext> 
  <useContext> 
    <code> 
      <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> 
      <code value="focus"/> 
      <display value="Clinical Focus"/> 
    </code> 
    <valueCodeableConcept> 
      <coding> 
        <system value="http://snomed.info/sct"/> 
        <code value="82423001"/> 
        <display value="Chronic pain (finding)"/> 
      </coding> 
    </valueCodeableConcept> 
  </useContext> 
  <jurisdiction> 
    <coding> 
      <system value="urn:iso:std:iso:3166"/> 
      <code value="US"/> 
      <display value="United States of America"/> 
    </coding> 
  </jurisdiction> 
  <purpose value="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 value="Providers should be aware if patients are taking other prescription drugs or illicit drugs
   that might increase their risk of an overdose."/> 
  <copyright value="© CDC 2016+."/> 
  <topic> 
    <text value="Opioid Prescribing"/> 
  </topic> 
    <author> 
        <name value="Kensaku Kawamoto, MD, PhD, MHS"/> 
    </author> 
    <author> 
        <name value="Bryn Rhodes"/> 
    </author> 
    <author> 
        <name value="Floyd Eisenberg, MD, MPH"/> 
    </author> 
    <author> 
        <name value="Robert McClure, MD, MPH"/> 
    </author> 
  <relatedArtifact> 
    <type value="documentation"/> 
    <display value="CDC guideline for prescribing opioids for chronic pain"/> 
    <url value="https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pai
    n---united-states-2016#420"/> 
  </relatedArtifact> 
  <library value="Library/opioidcds-recommendation-10"/> 
  <action> 
    <title value="Annual Urine Screening Check"/> 
    <description value="Patient has not had a urine screening in the past 12 months"/> 
    <documentation> 
      <type value="documentation"/> 
      <document> 
        <!--    We can use the example code systems from the FHIR CLinical Reasoning Module, or we
         can define GRADE specific code systems and use those here    -->
        <extension url="http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation">
          <valueCodeableConcept> 
            <coding> 
              <system value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/> 
              <code value="strong"/> 
              <display value="Strong"/> 
            </coding> 
          </valueCodeableConcept> 
        </extension> 
        <extension url="http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence">
          <valueCodeableConcept> 
            <coding> 
              <system value="http://terminology.hl7.org/CodeSystem/evidence-quality"/> 
              <code value="low"/> 
              <display value="Low quality"/> 
            </coding> 
          </valueCodeableConcept> 
        </extension> 
      </document> 
    </documentation> 
    <trigger> 
      <type value="named-event"/> 
      <name value="medication-prescribe"/> 
    </trigger> 
    <condition> 
      <kind value="applicability"/> 
            <expression> 
            <description value="Patient has not had a urine screening in the past 12 months"/> 
          <language value="text/cql"/> 
              <expression value="No Screenings in Past Year"/> 
            </expression> 
    </condition> 
    <dynamicValue> 
      <path value="activity.extension"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="Get Indicator"/> 
            </expression> 
    </dynamicValue> 
    <action> 
      <description value="Will perform urine screening"/> 
      <!--    Open Order Set, where available    -->
    </action> 
    <action> 
      <description value="Not for chronic pain management. Snooze 3 months"/> 
    </action> 
  </action> 
  <action> 
    <title value="Positive Urine Screening Check"/> 
    <description value="Patient has a urine screening testing positive for either unprescribed opioids or illicit
     drugs in the past 12 months"/> 
    <documentation> 
      <type value="documentation"/> 
      <document> 
        <!--    We can use the example code systems from the FHIR CLinical Reasoning Module, or we
         can define GRADE specific code systems and use those here    -->
        <extension url="http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation">
          <valueCodeableConcept> 
            <coding> 
              <system value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/> 
              <code value="strong"/> 
              <display value="Strong"/> 
            </coding> 
          </valueCodeableConcept> 
        </extension> 
        <extension url="http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence">
          <valueCodeableConcept> 
            <coding> 
              <system value="http://terminology.hl7.org/CodeSystem/evidence-quality"/> 
              <code value="low"/> 
              <display value="Low quality"/> 
            </coding> 
          </valueCodeableConcept> 
        </extension> 
      </document> 
    </documentation> 
    <condition> 
      <kind value="applicability"/> 
            <expression> 
              <description value="Patient has a positive urine screening in the past 12 months"/> 
        <language value="text/cql"/> 
        <expression value="Has Positive Screening?"/> 
      </expression> 
    </condition> 
    <action> 
      <title value="Unprescribed Opioids Found In Urine Screening"/> 
      <description value="Patient has a positive urine screening in the past 12 months for opioid(s), which is not
       prescribed"/> 
      <documentation> 
        <type value="documentation"/> 
        <document> 
          <!--    We can use the example code systems from the FHIR CLinical Reasoning Module, or we
           can define GRADE specific code systems and use those here    -->
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation">
            <valueCodeableConcept> 
              <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/> 
                <code value="strong"/> 
                <display value="Strong"/> 
              </coding> 
            </valueCodeableConcept> 
          </extension> 
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence">
            <valueCodeableConcept> 
              <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/evidence-quality"/> 
                <code value="low"/> 
                <display value="Low quality"/> 
              </coding> 
            </valueCodeableConcept> 
          </extension> 
        </document> 
      </documentation> 
      <condition> 
        <kind value="applicability"/> 
                <expression> 
                  <description value="Patient has a positive urine screening in the past 12 months for opioid(s), which is not
           prescribed"/> 
          <language value="text/cql"/> 
          <expression value="Has Unprescribed Opioids?"/> 
        </expression> 
      </condition> 
      <dynamicValue> 
        <path value="activity.extension"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Get Indicator"/> 
          </expression> 
      </dynamicValue> 
      <dynamicValue> 
        <path value="action.description"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Inconsistent Unprescribed Opioids"/> 
          </expression> 
      </dynamicValue> 
      <action> 
        <description value="Not for chronic pain management. Snooze 3 months"/> 
      </action> 
    </action> 
    <action> 
      <title value="Prescribed Opioids Not Found In Urine Screening"/> 
      <description value="Patient has a positive urine screening in the past 12 months, which does not include prescribed
       opioids"/> 
      <documentation> 
        <type value="documentation"/> 
        <document> 
          <!--    We can use the example code systems from the FHIR CLinical Reasoning Module, or we
           can define GRADE specific code systems and use those here    -->
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation">
            <valueCodeableConcept> 
              <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/> 
                <code value="strong"/> 
                <display value="Strong"/> 
              </coding> 
            </valueCodeableConcept> 
          </extension> 
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence">
            <valueCodeableConcept> 
              <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/evidence-quality"/> 
                <code value="low"/> 
                <display value="Low quality"/> 
              </coding> 
            </valueCodeableConcept> 
          </extension> 
        </document> 
      </documentation> 
      <condition> 
        <kind value="applicability"/> 
                <expression> 
              <description value="Patient has a positive urine screening in the past 12 months, which does not include prescribed
           opioids"/> 
          <language value="text/cql"/> 
          <expression value="Has Missing Opioids?"/> 
        </expression> 
      </condition> 
      <dynamicValue> 
        <path value="activity.extension"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Get Indicator"/> 
          </expression> 
      </dynamicValue> 
      <dynamicValue> 
        <path value="action.description"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Inconsistent Missing Opioids"/> 
          </expression> 
      </dynamicValue> 
    </action> 
    <action> 
      <title value="Illicit Drugs Found In Urine Screening"/> 
      <description value="Patient has a positive urine screening in the past 12 months for illicit drugs"/> 
      <documentation> 
        <type value="documentation"/> 
        <document> 
          <!--    We can use the example code systems from the FHIR CLinical Reasoning Module, or we
           can define GRADE specific code systems and use those here    -->
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation">
            <valueCodeableConcept> 
              <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/recommendation-strength"/> 
                <code value="strong"/> 
                <display value="Strong"/> 
              </coding> 
            </valueCodeableConcept> 
          </extension> 
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence">
            <valueCodeableConcept> 
              <coding> 
                <system value="http://terminology.hl7.org/CodeSystem/evidence-quality"/> 
                <code value="low"/> 
                <display value="Low quality"/> 
              </coding> 
            </valueCodeableConcept> 
          </extension> 
        </document> 
      </documentation> 
      <condition> 
        <kind value="applicability"/> 
                <expression> 
                  <description value="Patient has a positive urine screening in the past 12 months for illicit drugs"/> 
          <language value="text/cql"/> 
          <expression value="Has Illicit Drugs in Screening?"/> 
        </expression> 
      </condition> 
      <dynamicValue> 
        <path value="activity.extension"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Get Indicator"/> 
          </expression> 
      </dynamicValue> 
      <dynamicValue> 
        <path value="action.description"/> 
                <expression> 
                  <language value="text/cql"/> 
            <expression value="Inconsistent Illicit Drugs"/> 
          </expression> 
      </dynamicValue> 
      <action> 
        <description value="Not for chronic pain management. Snooze 3 months"/> 
      </action> 
    </action> 
  </action> 
</PlanDefinition>

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.