contained Generated Narrative: PlanDefinition 0..*

url : http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-07

identifier Σ I 0..* Identifier Business Identifier for observation basedOn : id: urn:oid:2.16.840.1.113883.4.642.11.6, id: cdc-opioid-guidance (use: OFFICIAL)

version : 0.1.0

Σ

I name : Cdcopioid07

0..* title : CDC Opioid Prescribing Guideline Recommendation #7

Reference type : ECA Rule ( CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest ) Fulfills plan, proposal or order partOf PlanDefinitionType Σ I #eca-rule) 0..* Reference ( MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy ) Part of referenced event

status ?! Σ I 1..1 code registered | preliminary | final | amended + Binding: ObservationStatus ( required ) category I : draft

0..* date : 2018-03-19

CodeableConcept publisher : Centers for Disease Control and Prevention (CDC)

Classification of type description : Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of observation Binding: Observation Category Codes ( preferred ) code S Σ I 1..1 CodeableConcept LDL Cholesterol -measured starting opioid therapy for chronic pain or calculated per code Binding: L d l codes ( required ) subject Σ I 0..1 Reference ( Patient | Group | Device | Location ) Who and/or what the observation is about focus Σ I 0..* Reference ( Resource ) What the observation is about, when it is not about the subject of record encounter Σ I 0..1 Reference ( Encounter ) Healthcare event during which this observation is made effective[x] Σ I 0..1 Clinically relevant time/time-period for observation effectiveDateTime dateTime effectivePeriod Period effectiveTiming Timing effectiveInstant instant dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently.

UseContexts

issued Σ I Date/Time this version was made available performer Σ I 0..* Reference interpretation S I 0..1 CodeableConcept + | ++ | +++ | - | -- | --- Binding: Observation Interpretation Codes specimen I 0..1

-	Code 0..1	instant Value[x]
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Medication requested (situation) ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson ) Who is responsible for the observation value[x] Σ I (Slice Definition) Actual result Slice: Unordered, Closed by type:$this value[x]:valueQuantity S Σ I 0..1 Quantity LDL Cholesterol value dataAbsentReason I 0..1 CodeableConcept SNOMED CT Why the result is missing Binding: #182888003) DataAbsentReason ( extensible )
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'Clinical Focus')	Chronic pain (finding) ( extensible ) note S I 0..* Annotation Comments about result bodySite I 0..1 CodeableConcept Observed body part Binding: SNOMED CT Body Structures ( example ) method I 0..1 CodeableConcept How it was done Binding: #82423001) Observation Methods ( example )

Reference jurisdiction : United States of America ( Specimen ) Specimen used ISO 3166-1 Codes for this observation device I 0..1 Reference ( Device | DeviceMetric ) (Measurement) Device referenceRange the representation of names of countries and their subdivisions — Part 1: Country code S I #US) 1..1 BackboneElement Provides guide for interpretation id 0..1 string

Unique id purpose : CDC’s Guideline for inter-element referencing extension I 0..* Extension Additional content defined by implementations modifierExtension ?! Σ I 0..* Extension Extensions that cannot be ignored even if unrecognized high I 1..1 SimpleQuantity A fixed quantity (no comparator) Fixed Value: As shown id 0..0 string Unique id Prescribing Opioids for inter-element referencing extension 0..0 Extension Additional content defined by implementations value 1..1 decimal Numerical value (with implicit precision) Fixed Value: 3.0 comparator 0..0 code < | <= | >= | > - how Chronic Pain is intended to understand improve communication between providers and patients about the value unit 0..0 string Unit representation system 0..0 uri System that defines coded unit form code 0..0 code Coded form risks and benefits of the unit text I 0..1 string Text based reference range in an observation component Σ I 0..* BackboneElement Component results id 0..1 string Unique id opioid therapy for inter-element referencing extension I 0..* Extension Additional content defined by implementations modifierExtension ?! Σ I 0..* Extension Extensions that cannot be ignored even if unrecognized code Σ I 1..1 CodeableConcept Type chronic pain, improve the safety and effectiveness of component observation (code / type) Binding: LOINC Codes ( example ) value[x] Σ I 0..1 Actual component result valueQuantity Quantity valueCodeableConcept CodeableConcept valueString string valueBoolean boolean valueInteger integer valueRange Range valueRatio Ratio valueSampledData SampledData valueTime time valueDateTime dateTime valuePeriod Period dataAbsentReason I 0..1 CodeableConcept Why pain treatment, and reduce the component result risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is missing Binding: DataAbsentReason ( extensible ) interpretation I 0..* CodeableConcept High, low, normal, etc. Binding: Observation Interpretation Codes ( extensible ) referenceRange I 0..* Unknown reference to #Observation.referenceRange Provides guide for interpretation of component result Documentation not intended for this format <!-- Example Lipid Profile --> < xmlns="http://hl7.org/fhir" > <!-- from Element: --> <</id> <</meta> < < < Text summary of the resource, for human interpretation</text> <</contained> <<a href="ldlcholesterol-definitions.html#Observation.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < Business Identifier for observation</identifier> <</basedOn> <</partOf> < <</category> <</code> < Who and/or what the observation is about</subject> < What the observation is about, when it is not about the subject of record</focus> < Healthcare event during which this observation is made</encounter> < Clinically relevant time/time-period for observation</effective[x]> < < Who is responsible for the observation</performer> <</valueQuantity> <</dataAbsentReason> <</interpretation> <</note> <</bodySite> <</method> <</specimen> <</device> < <<a href="ldlcholesterol-definitions.html#Observation.referenceRange.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < Low Range, if relevant</low> < A fixed quantity (no comparator)</high> <</type> <</appliesTo> < Applicable age range, if relevant</age> < </referenceRange> < Related resource that belongs to the Observation group</hasMember> < Related measurements the observation is made from</derivedFrom> < <<a href="ldlcholesterol-definitions.html#Observation.component.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> <</code> <| Actual component result</value[x]> <</dataAbsentReason> <</interpretation> <</referenceRange> </component> </Observation> { // // from Element: " " " " " "<a href="ldlcholesterol-definitions.html#Observation.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"> " " " " " " " " " " " " " " " " { // // from Element: } ], " " " " " " " " " } This structure is derived from Observation . patients who are in active cancer treatment, palliative care, or end-of-life care.

Summary Mandatory: 3 elements Must-Support: 5 elements Fixed Value: 1 element Prohibited: 6 elements 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.

Differential View This structure is derived from Observation . copyright : © CDC 2016+.

Name Flags Card. Type Description & Constraints Observation 1..1 LDL Cholesterol Result code S 1..1 CodeableConcept LDL Cholesterol -measured or calculated per code Binding: L d l codes ( required ) valueQuantity S 0..1 Quantity LDL Cholesterol value interpretation S 0..1 CodeableConcept + | ++ | +++ | - | -- | --- note S 0..* Annotation Comments about result referenceRange S 1..1 BackboneElement low 0 .. 0 high 1..1 SimpleQuantity Fixed Value:

As shown topic : Opioid Prescribing () value 1..1 decimal Numerical value (with implicit precision) Fixed Value:

3.0

author : Kensaku Kawamoto, MD, PhD, MHS: , Bryn Rhodes: , Floyd Eisenberg, MD, MPH: , Robert McClure, MD, MPH:

relatedArtifact

type 0 .. 0 appliesTo 0 .. 0 age 0 .. 0 hasMember 0 .. 0 derivedFrom 0 .. 0 : documentation

Documentation display : CDC guideline for this format prescribing opioids for chronic pain

Snapshot View document

Name Flags Card. Type Description & Constraints Observation I 1..1 LDL Cholesterol Result id Σ 0..1 string Logical id of this artifact meta Σ I 0..1 Meta Metadata about the resource implicitRules ?! Σ I 0..1 uri A set of rules under which this content was created language I 0..1 code Language of the resource content Binding: Common Languages ( preferred ) Max Binding: All Languages text I 0..1 Narrative Text summary of the resource, for human interpretation contained 0..* Resource Contained, inline Resources extension

I relatedArtifact

0..*

type : documentation

Extension

display : MME Conversion Tables

Additional content defined by implementations

document

modifierExtension

library : http://example.org/fhir/Library/opioidcds-recommendation-07 ?! I

0..*

action Extension

Extensions that cannot title : Existing patient should be ignored identifier Σ I 0..* Identifier Business Identifier evaluated for observation basedOn Σ I 0..* Reference ( CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest ) Fulfills plan, proposal or order partOf Σ I 0..* Reference ( MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy ) Part of referenced event status ?! Σ I 1..1 code registered | preliminary | final | amended + Binding: ObservationStatus ( required ) category I 0..* CodeableConcept Classification of type risk of observation Binding: Observation Category Codes ( preferred ) code S Σ I 1..1 CodeableConcept LDL Cholesterol -measured or calculated per code Binding: L d l codes ( required ) subject Σ I 0..1 Reference ( Patient | Group | Device | Location ) Who and/or what the observation is about focus Σ I 0..* continued opioid therapy.

Reference ( Resource )

What description : Checking if the observation is about, when it is not about trigger prescription meets the subject of record encounter Σ I 0..1 Reference ( Encounter ) Healthcare event during which this observation is made effective[x] Σ I 0..1 Clinically relevant time/time-period for observation effectiveDateTime dateTime effectivePeriod Period effectiveTiming Timing effectiveInstant instant issued Σ I 0..1 instant Date/Time this version was made available performer Σ I 0..* Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson ) Who is responsible inclusion criteria for the observation value[x] Σ I (Slice Definition) Actual result Slice: Unordered, Closed by type:$this value[x]:valueQuantity S Σ I 0..1 Quantity LDL Cholesterol value dataAbsentReason I 0..1 CodeableConcept Why the result is missing Binding: DataAbsentReason ( extensible ) recommendation #7 workflow.

documentation

interpretation

type : documentation

S document I

0..1

Triggers

CodeableConcept + | ++ | +++ | method I 0..1 CodeableConcept How it was done Binding: Observation Methods ( example ) specimen I 0..1 Reference ( Specimen ) Specimen used for this observation device I 0..1 Reference ( Device | DeviceMetric ) (Measurement) Device referenceRange S I 1..1 BackboneElement Provides guide for interpretation id 0..1 string Unique id for inter-element referencing extension I 0..* Extension Additional content defined by implementations modifierExtension ?! Σ I 0..* Extension Extensions that cannot be ignored even if unrecognized high I 1..1 SimpleQuantity A fixed quantity (no comparator) Fixed Value: As shown id 0..0 string Unique id for inter-element referencing extension Extension value 1..1 decimal Numerical value (with implicit precision) Fixed Value: 3.0

- | -- | --- Binding: Observation Interpretation Codes ( extensible ) note S I 0..* Annotation Comments about result bodySite I 0..1 CodeableConcept Observed body part Binding: SNOMED CT Body Structures ( example )	Type 0..0	Name Additional content defined by implementations
*	named-event	medication-prescribe

comparator

condition

0..0 kind : applicability

Expressions

code < | <= | >= | > 0..0 string Unit representation uri code 0..0 code Coded form of Unknown reference to #Observation.referenceRange Provides guide for interpretation of component result

- how to understand the value unit	system Description	Language 0..0	Expression System that defines coded unit form
*	Check whether the unit text I 0..1 string Text based reference range existing patient, without an end of life condition or risk assessment in the past 90 days, has taken an observation component Σ I 0..* BackboneElement Component results id 0..1 string Unique id opioid-with-abuse-potential for inter-element referencing extension I 0..* Extension Additional content defined by implementations modifierExtension ?! Σ I 0..* Extension Extensions that cannot be ignored even if unrecognized code Σ I 1..1 CodeableConcept Type 7 of component observation (code / type) Binding: LOINC Codes ( example ) value[x] Σ I 0..1 Actual component result valueQuantity Quantity valueCodeableConcept CodeableConcept valueString string valueBoolean boolean valueInteger integer valueRange Range valueRatio Ratio valueSampledData SampledData valueTime time valueDateTime dateTime valuePeriod Period dataAbsentReason I 0..1 CodeableConcept Why the component result is missing Binding: DataAbsentReason ( extensible ) interpretation I 0..* CodeableConcept High, low, normal, etc. Binding: Observation Interpretation Codes ( extensible ) referenceRange I 0..* past 10 days or 63 of the past 90 days.	text/cql	Inclusion Criteria

Documentation for this format

groupingBehavior : visual-group

XML Template selectionBehavior : exactly-one

<!-- Example Lipid Profile --> < xmlns="http://hl7.org/fhir" > <!-- from Element: --> <</id> <</meta> < < < Text summary of the resource, for human interpretation</text> <</contained> <<a href="ldlcholesterol-definitions.html#Observation.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < Business Identifier for observation</identifier> <</basedOn> <</partOf> < <</category> <</code> < Who and/or what the observation is about</subject> < What the observation is about, when it is not about the subject of record</focus> < Healthcare event during which this observation is made</encounter> < Clinically relevant time/time-period for observation</effective[x]> < < Who is responsible for the observation</performer> <</valueQuantity> <</dataAbsentReason> <</interpretation> <</note> <</bodySite> <</method> <</specimen> <</device> < <<a href="ldlcholesterol-definitions.html#Observation.referenceRange.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> < Low Range, if relevant</low> < A fixed quantity (no comparator)</high> <</type> <</appliesTo> < Applicable age range, if relevant</age> < </referenceRange> < Related resource that belongs to the Observation group</hasMember> < Related measurements the observation is made from</derivedFrom> < <<a href="ldlcholesterol-definitions.html#Observation.component.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"></modifierExtension> <</code> <| Actual component result</value[x]> <</dataAbsentReason> <</interpretation> <</referenceRange> </component> </Observation>

JSON Template dynamicValue

{ // // from Element: " " " " " "<a href="ldlcholesterol-definitions.html#Observation.modifierExtension" title="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself) (this element modifies the meaning of other elements)" class="dict"> " " " " " " " " " " " " " " " " { // // from Element: } ], " " " " " " " " " }  

Alternate definitions: Master Definition ( XML , JSON ), Schematron path : action.title

10.3.12.28.2 Terminology Bindings

Expressions

Common Languages

Path Name -	Conformance Language	ValueSet Expression
Observation.language *	Common Languages text/cql	preferred Get Summary

Observation.status

ObservationStatus

dynamicValue required

path : action.description

ObservationStatus

Expressions

Observation.category L d l codes

Observation Category Codes -	preferred Language	Observation Category Codes Expression
Observation.code *	L d l codes text/cql	required Get Detail

Observation.dataAbsentReason

DataAbsentReason

dynamicValue extensible

path : action.extension

DataAbsentReason

Expressions

Observation.interpretation Observation.bodySite Observation.method Observation Methods example

Observation Interpretation Codes -	extensible Language	Observation Interpretation Codes Expression
SNOMED CT Body Structures *	example text/cql	SNOMED CT Body Structures Get Indicator

Actions

Observation Methods extensible extensible

Observation.component.code LOINC Codes -	example Description LOINC Codes
Observation.component.dataAbsentReason *	DataAbsentReason Will schedule assessment of risk for opioid use for the patient
*	DataAbsentReason Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo
Observation.component.interpretation *	Observation Interpretation Codes N/A - see comment; snooze 3 mo

Observation Interpretation Codes

.