Release 4 4B

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Library-opioidcds-recommendation-08

Clinical Decision Support Work Group Maturity Level : N/A Standards Status : Informative Compartments : Not linked to any defined compartments

This is the narrative for the resource. See also the XML , JSON or Turtle format. This example conforms to the profile Library .

Generated Narrative with Details id : opioidcds-recommendation-08 identifier : OpioidCDS_REC_04 (OFFICIAL) version : 0.1.0 title : Opioid CDS Logic for recommendation #4 status : active experimental : false type : Logic Library (Details : {http://terminology.hl7.org/CodeSystem/library-type code 'logic-library' = 'Logic Library', given as 'Logic Library'}) date : 25/03/2018 1:49:09 PM publisher : Centers for Disease Control and Prevention (CDC) description : Opioid decision support logic to consider offering Naloxone when factors that increase risk for opioid overdose are present. useContext : , jurisdiction : United States of America (Details : {urn:iso:std:iso:3166 code 'US' = 'United States of America', given as 'United States of America'}) purpose : The purpose of this library is to determine whether increased risks for opioid overdose are present. usage : This library is used to recommend the prescriber/user to consider offering Naloxone when increased risks for opioid overdose are present. copyright : © CDC 2016+. topic : Opioid Prescribing (Details ) author : , , , relatedArtifact : , , dataRequirement : , , ,

Participants

AuthorKensaku Kawamoto, MD, PhD, MHS
AuthorBryn Rhodes
AuthorFloyd Eisenberg, MD, MPH
AuthorRobert McClure, MD, MPH

Related Artifacts

DocumentationCDC guideline for prescribing opioids for chronic pain

https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420 ()

Depends Onhttp://example.org/fhir/Library/opioidcds-common
DocumentationMME Conversion Tables

https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf ()

Data Requirements

Type: MedicationRequest
FilterValue
medicationCodeableConceptIn ValueSet http://example.org/fhir/ValueSet/naloxone
Type: MedicationRequest
FilterValue
medicationCodeableConceptIn ValueSet http://example.org/fhir/ValueSet/opioids-abused-in-ambulatory-care
Type: MedicationRequest
FilterValue
medicationCodeableConceptIn ValueSet http://example.org/fhir/ValueSet/benzodiazepines
Type: Condition
FilterValue
codeIn ValueSet http://example.org/fhir/ValueSet/substance-abuse

Contents

application/elm+xml

<?xml version="1.0" encoding="UTF-8"?>
<library xmlns="urn:hl7-org:elm:r1" xmlns:t="urn:hl7-org:elm-types:r1" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:fhir="http://hl7.org/fhir" xmlns:qdm43="urn:healthit-gov:qdm:v4_3" xmlns:qdm53="urn:healthit-gov:qdm:v5_3" xmlns:a="urn:hl7-org:cql-annotations:r1">
   <annotation startLine="63" startChar="11" endLine="63" endChar="48" message="Could not resolve code path medicationCodeableConcept for the type of the retrieve FHIR.MedicationRequest." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation startLine="63" startChar="11" endLine="63" endChar="48" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation startLine="81" startChar="5" endLine="81" endChar="68" message="Could not resolve code path medicationCodeableConcept for the type of the retrieve FHIR.MedicationRequest." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation startLine="81" startChar="5" endLine="81" endChar="68" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation startLine="74" startChar="11" endLine="74" endChar="55" message="Could not resolve code path medicationCodeableConcept for the type of the retrieve FHIR.MedicationRequest." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation startLine="74" startChar="11" endLine="74" endChar="55" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <annotation startLine="77" startChar="12" endLine="77" endChar="41" message="Could not resolve membership operator for terminology target of the retrieve." errorType="semantic" errorSeverity="warning" xsi:type="a:CqlToElmError"/>
   <identifier id="OpioidCDS_STU4_REC_08" version="0.1.0"/>
   <schemaIdentifier id="urn:hl7-org:elm" version="r1"/>
   <usings>
      <def localIdentifier="System" uri="urn:hl7-org:elm-types:r1"/>
      <def localIdentifier="FHIR" uri="http://hl7.org/fhir" version="3.2.0"/>
   </usings>
   <includes>
      <def localIdentifier="Common" path="OpioidCDS_STU4_Common" version="0.1.0"/>
   </includes>
   <parameters>
      <def name="ContextPrescriptions" accessLevel="Public">
         <parameterTypeSpecifier xsi:type="ListTypeSpecifier">
            <elementType name="fhir:MedicationRequest" xsi:type="NamedTypeSpecifier"/>
         </parameterTypeSpecifier>
      </def>
   </parameters>
   <valueSets>
      <def name="Substance Abuse" id="TODO" accessLevel="Public"/>
   </valueSets>
   <statements>
      <def name="Patient" context="Patient">
         <expression xsi:type="SingletonFrom">
            <operand dataType="fhir:Patient" xsi:type="Retrieve"/>
         </expression>
      </def>
      <def name="Validate Trigger Event" context="Patient" accessLevel="Public">
         <expression xsi:type="Exists">
            <operand xsi:type="Query">
               <source alias="triggerScript">
                  <expression name="ContextPrescriptions" xsi:type="ParameterRef"/>
               </source>
               <where name="IsOpioidWithAmbulatoryAbusePotential" libraryName="Common" xsi:type="FunctionRef">
                  <operand name="ToCode" libraryName="Common" xsi:type="FunctionRef">
                     <operand xsi:type="Indexer">
                        <operand path="coding" xsi:type="Property">
                           <source path="medication" scope="triggerScript" xsi:type="Property"/>
                        </operand>
                        <operand valueType="t:Integer" value="0" xsi:type="Literal"/>
                     </operand>
                  </operand>
               </where>
            </operand>
         </expression>
      </def>
      <def name="Exclusion Criteria" context="Patient" accessLevel="Public">
         <expression xsi:type="Exists">
            <operand dataType="fhir:MedicationRequest" codeProperty="medicationCodeableConcept" xsi:type="Retrieve">
               <codes name="Naloxone" libraryName="Common" xsi:type="ValueSetRef"/>
            </operand>
         </expression>
      </def>
      <def name="Get Active Ambulatory Opioid Rx" context="Patient" accessLevel="Public">
         <expression xsi:type="Union">
            <operand xsi:type="Query">
               <source alias="Rx">
                  <expression dataType="fhir:MedicationRequest" codeProperty="medicationCodeableConcept" xsi:type="Retrieve">
                     <codes name="Ambulatory Abuse Potential Opioids" libraryName="Common" xsi:type="ValueSetRef"/>
                  </expression>
               </source>
               <where xsi:type="And">
                  <operand xsi:type="Equal">
                     <operand path="value" xsi:type="Property">
                        <source path="status" scope="Rx" xsi:type="Property"/>
                     </operand>
                     <operand valueType="t:String" value="active" xsi:type="Literal"/>
                  </operand>
                  <operand xsi:type="Equal">
                     <operand path="value" xsi:type="Property">
                        <source path="code" xsi:type="Property">
                           <source xsi:type="Indexer">
                              <operand xsi:type="Flatten">
                                 <operand xsi:type="Query">
                                    <source alias="$this">
                                       <expression path="category" scope="Rx" xsi:type="Property"/>
                                    </source>
                                    <where xsi:type="Not">
                                       <operand xsi:type="IsNull">
                                          <operand path="coding" xsi:type="Property">
                                             <source name="$this" xsi:type="AliasRef"/>
                                          </operand>
                                       </operand>
                                    </where>
                                    <return>
                                       <expression path="coding" xsi:type="Property">
                                          <source name="$this" xsi:type="AliasRef"/>
                                       </expression>
                                    </return>
                                 </operand>
                              </operand>
                              <operand valueType="t:Integer" value="0" xsi:type="Literal"/>
                           </source>
                        </source>
                     </operand>
                     <operand valueType="t:String" value="outpatient" xsi:type="Literal"/>
                  </operand>
               </where>
            </operand>
            <operand name="ContextPrescriptions" xsi:type="ParameterRef"/>
         </expression>
      </def>
      <def name="Average MME" context="Patient" accessLevel="Public">
         <expression name="TotalMME" libraryName="Common" xsi:type="FunctionRef">
            <operand name="Get Active Ambulatory Opioid Rx" xsi:type="ExpressionRef"/>
         </expression>
      </def>
      <def name="MME >= 50 mg/d?" context="Patient" accessLevel="Public">
         <expression xsi:type="If">
            <condition asType="t:Boolean" xsi:type="As">
               <operand xsi:type="IsNull">
                  <operand name="Average MME" xsi:type="ExpressionRef"/>
               </operand>
            </condition>
            <then valueType="t:Boolean" value="false" xsi:type="Literal"/>
            <else xsi:type="GreaterOrEqual">
               <operand name="Average MME" xsi:type="ExpressionRef"/>
               <operand value="50" unit="mg/d" xsi:type="Quantity"/>
            </else>
         </expression>
      </def>
      <def name="On Benzodiazepine" context="Patient" accessLevel="Public">
         <expression xsi:type="Exists">
            <operand dataType="fhir:MedicationRequest" codeProperty="medicationCodeableConcept" xsi:type="Retrieve">
               <codes name="Benzodiazepines" libraryName="Common" xsi:type="ValueSetRef"/>
            </operand>
         </expression>
      </def>
      <def name="Inclusion Criteria" context="Patient" accessLevel="Public">
         <expression xsi:type="And">
            <operand xsi:type="And">
               <operand name="Validate Trigger Event" xsi:type="ExpressionRef"/>
               <operand xsi:type="Not">
                  <operand name="Exclusion Criteria" xsi:type="ExpressionRef"/>
               </operand>
            </operand>
            <operand xsi:type="Or">
               <operand name="MME >= 50 mg/d?" xsi:type="ExpressionRef"/>
               <operand name="On Benzodiazepine" xsi:type="ExpressionRef"/>
            </operand>
         </expression>
      </def>
      <def name="Has Substance Abuse History" context="Patient" accessLevel="Public">
         <expression xsi:type="Exists">
            <operand dataType="fhir:Condition" codeProperty="code" xsi:type="Retrieve">
               <codes name="Substance Abuse" xsi:type="ValueSetRef"/>
            </operand>
         </expression>
      </def>
      <def name="Get Indicator" context="Patient" accessLevel="Public">
         <expression valueType="t:String" value="warning" xsi:type="Literal"/>
      </def>
      <def name="Get Summary" context="Patient" accessLevel="Public">
         <expression valueType="t:String" value="Incorporate into the management plan strategies to mitigate risk; including considering offering naloxone when factors that increase risk for opioid overdose are present" xsi:type="Literal"/>
      </def>
      <def name="Get Notification" context="Patient" accessLevel="Public">
         <expression xsi:type="Concatenate">
            <operand valueType="t:String" value="Consider offering naloxone given following risk factor(s) for opioid overdose: " xsi:type="Literal"/>
            <operand xsi:type="If">
               <condition asType="t:Boolean" xsi:type="As">
                  <operand name="MME >= 50 mg/d?" xsi:type="ExpressionRef"/>
               </condition>
               <then xsi:type="Concatenate">
                  <operand xsi:type="Concatenate">
                     <operand valueType="t:String" value="Average MME (" xsi:type="Literal"/>
                     <operand xsi:type="ToString">
                        <operand name="Average MME" xsi:type="ExpressionRef"/>
                     </operand>
                  </operand>
                  <operand valueType="t:String" value=") >= 50 mg/day, " xsi:type="Literal"/>
               </then>
               <else xsi:type="Concatenate">
                  <operand valueType="t:String" value="" xsi:type="Literal"/>
                  <operand xsi:type="If">
                     <condition asType="t:Boolean" xsi:type="As">
                        <operand name="On Benzodiazepine" xsi:type="ExpressionRef"/>
                     </condition>
                     <then valueType="t:String" value="concurrent use of benzodiazepine, " xsi:type="Literal"/>
                     <else valueType="t:String" value="" xsi:type="Literal"/>
                  </operand>
               </else>
            </operand>
         </expression>
      </def>
   </statements>
</library>

content
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Other examples that reference this example: PlanDefinition/OpioidCDSRecommendation8  

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.