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

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


  
  (Details : {http://terminology.hl7.org/CodeSystem/plan-definition-type code 'eca-rule'
           = 'ECA Rule', given as 'ECA Rule'}): 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.(Details : {urn:iso:std:iso:3166 code 'US' = 'United States of America', given as 'United
           States of America'}): 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.: Providers should be aware if patients are taking other prescription drugs or illicit
         drugs that might increase their risk of an overdose.: Patient has a urine screening testing positive for either unprescribed opioids or illicit
           drugs in the past 12 months
  
    
    
  
  
  
  
  
    
      
      
      
    
  
  
  
  
  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.
  
    
      
      
      
    
    
      
        
        
        
      
    
  
  
    
      
      
      
    
    
      
        
        
        
      
    
  
  
    
      
      
      
    
  
  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.
  Providers should be aware if patients are taking other prescription drugs or illicit drugs
   that might increase their risk of an overdose.
  
  
    
  
    
        
    
    
        
    
    
        
    
    
        
    
  
    
    
    https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pai
    n---united-states-2016#420
  
  
  
    
    
    
      
      
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         can define GRADE specific code systems and use those here    -->
        
          
            
              
              
              
            
          
        
        
          
            
              
              
              
            
          
        
      
    
    
      
      
    
    
      
            
            
          
              
            
    
    
      
            
              
              
            
    
    
      
      
    
    
      
    
  
  
    
    Patient has a urine screening testing positive for either unprescribed opioids or illicit
     drugs in the past 12 months
    
      
      
        <!--    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    -->
        
          
            
              
              
              
            
          
        
        
          
            
              
              
              
            
          
        
      
    
    
      
            
              
        
        
      
    
    
      
      Patient has a positive urine screening in the past 12 months for opioid(s), which is not
       prescribed
      
        
        
          <!--    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    -->
          
            
              
                
                
                
              
            
          
          
            
              
                
                
                
              
            
          
        
      
      
        
                
                  Patient has a positive urine screening in the past 12 months for opioid(s), which is not
           prescribed
          
          
        
      
      
        
                
                  
            
          
      
      
        
                
                  
            
          
      
      
        
      
    
    
      
      Patient has a positive urine screening in the past 12 months, which does not include prescribed
       opioids
      
        
        
          <!--    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    -->
          
            
              
                
                
                
              
            
          
          
            
              
                
                
                
              
            
          
        
      
      
        
                
              Patient has a positive urine screening in the past 12 months, which does not include prescribed
           opioids
          
          
        
      
      
        
                
                  
            
          
      
      
        
                
                  
            
          
      
    
    
      
      
      
        
        
          <!--    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    -->
          
            
              
                
                
                
              
            
          
          
            
              
                
                
                
              
            
          
        
      
      
        
                
                  
          
          
        
      
      
        
                
                  
            
          
      
      
        
                
                  
            
          
      
      
        
      
    
  

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  <id value="opioidcds-10"/> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="cds"/> 
  </extension> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.11.3"/> 
  </identifier> 
  <identifier> 
    <use value="official"/> 
    <value value="cdc-opioid-guidance"/> 
  </identifier> 
  <version value="0.1.0"/> 
  <name value="Cdcopioid10"/> 
  <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="HL7 International / Clinical Decision Support"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://www.hl7.org/Special/committees/dss"/> 
    </telecom> 
  </contact> 
  <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"/>     <document>       <url value="https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chro

      nic-pain---united-states-2016#420"/> 
    </document>   </relatedArtifact>   <library value="http://example.org/fhir/Library/opioidcds-recommendation-10"/>   <action>     <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>     <title value="Annual Urine Screening Check"/>     <description value="Patient has not had a urine screening in the past 12 months"/>     <documentation>       <type value="documentation"/>     </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-identifier"/>         <expression value="No Screenings in Past Year"/>       </expression>     </condition>     <dynamicValue>       <path value="activity.extension"/>       <expression>         <language value="text/cql-identifier"/>         <expression value="Get Indicator"/>       </expression>     </dynamicValue>     <action>       <description value="Will perform urine screening"/>     </action>     <action>       <description value="Not for chronic pain management. Snooze 3 months"/>     </action>   </action>   <action>     <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>     <title value="Positive Urine Screening Check"/>     <description value="Patient has a urine screening testing positive for either unprescribed opioids

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    <documentation>       <type value="documentation"/>     </documentation>     <condition>       <kind value="applicability"/>       <expression>         <description value="Patient has a positive urine screening in the past 12 months"/>         <language value="text/cql-identifier"/>         <expression value="Has Positive Screening?"/>       </expression>     </condition>     <action>       <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>       <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"/> 
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          <language value="text/cql-identifier"/>           <expression value="Has Unprescribed Opioids?"/>         </expression>       </condition>       <dynamicValue>         <path value="activity.extension"/>         <expression>           <language value="text/cql-identifier"/>           <expression value="Get Indicator"/>         </expression>       </dynamicValue>       <dynamicValue>         <path value="action.description"/>         <expression>           <language value="text/cql-identifier"/>           <expression value="Inconsistent Unprescribed Opioids"/>         </expression>       </dynamicValue>       <action>         <description value="Not for chronic pain management. Snooze 3 months"/>       </action>     </action>     <action>       <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>       <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

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</

PlanDefinition

>