Opioid CDS Recommendation 4 ECA Rule (id = "opioidcds-04")

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        : 
        
      
      
        : id: cdc-opioid-guidance (OFFICIAL)
      
      
        : 0.1.0
      
      
        : cdc-opioid-04
      
      
        : CDC Opioid Prescribing Guideline Recommendation #4
      
      
        : ECA Rule 
         (
          #eca-rule)
        
      
      
        : draft
      
      
        : 2018-03-19
      
      
        : Centers for Disease Control and Prevention (CDC)
      
      
        : When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release
         opioids instead of extended-release/long-acting (ER/LA) opioids.
      
      
        : 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 use caution when prescribing extended-release/long-acting (ER/LA) opioids
         as they carry a higher risk and negligible benefit compared to immediate-release opioids.
      
      
        : © CDC 2016+.
      
      
        : Opioid Prescribing 
        
      
      
        : Kensaku Kawamoto, MD, PhD, MHS: , Bryn Rhodes: , Floyd Eisenberg, MD, MPH: , Robert
         McClure, MD, MPH: 
      
      
        : 
        
      
      
        
          
        
        
          : Extended-release opioid prescription triggered.
        
        
          : Checking if the trigger prescription meets the inclusion criteria for recommendation
           #4 workflow.
        
        
          
            
          
          
            : applicability
          
        
        
          : visual-group
        
        
          : exactly-one
        
        
          
            
          
          
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<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="opioidcds-04"/> 
  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: PlanDefinition</b> <a name="opioidcds-04"> </a> </p> <div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border:
       1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PlanDefinition &quot;opioidcds-04&quot; </p> </div> <p> <b> url</b> : <code> http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-04</code> </p> <p> <b> identifier</b> : id: urn:oid:2.16.840.1.113883.4.642.11.4, id: cdc-opioid-guidance (use: OFFICIAL)</p> <p> <b> version</b> : 0.1.0</p> <p> <b> name</b> : Cdcopioid04</p> <p> <b> title</b> : CDC Opioid Prescribing Guideline Recommendation #4</p> <p> <b> type</b> : ECA Rule <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.1.0/CodeSystem-plan-definition-type.html">PlanDefinitionType</a> #eca-rule)</span> </p> <p> <b> status</b> : draft</p> <p> <b> date</b> : 2018-03-19</p> <p> <b> publisher</b> : Centers for Disease Control and Prevention (CDC)</p> <p> <b> description</b> : When starting opioid therapy for chronic pain, clinicians should prescribe immediate-releas
        e opioids instead of extended-release/long-acting (ER/LA) opioids.</p> <h3> UseContexts</h3> <table class="grid"><tr> <td> -</td> <td> <b> Code</b> </td> <td> <b> Value[x]</b> </td> </tr> <tr> <td> *</td> <td> Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type
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             code focus = 'Clinical Focus', stated as 'Clinical Focus')</td> <td> Chronic pain (finding) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #82423001)</span> </td> </tr> </table> <p> <b> jurisdiction</b> : United States of America <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.1.0/CodeSystem-ISO3166Part1.html">ISO 3166-1 Codes for the representation of names of countries and their subdivisions
             — Part 1: Country code</a> #US)</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 use caution when prescribing extended-release/long-acting (ER/LA)
         opioids as they carry a higher risk and negligible benefit compared to immediate-release
         opioids.</p> <p> <b> copyright</b> : © CDC 2016+.</p> <p> <b> topic</b> : Opioid Prescribing <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span> </p> <p> <b> author</b> : Kensaku Kawamoto, MD, PhD, MHS: , Bryn Rhodes: , Floyd Eisenberg, MD, MPH: ,
         Robert McClure, MD, MPH: </p> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : documentation</p> <p> <b> display</b> : CDC guideline for prescribing opioids for chronic pain</p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : documentation</p> <p> <b> display</b> : MME Conversion Tables</p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <p> <b> library</b> : <a href="http://example.org/fhir/Library/opioidcds-recommendation-04">http://example.org/fhir/Library/opioidcds-recommendation-04</a> </p> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Extended-release opioid prescription triggered.</p> <p> <b> description</b> : Checking if the trigger prescription meets the inclusion criteria for recommendation
           #4 workflow.</p> <blockquote> <p> <b> documentation</b> </p> <p> <b> type</b> : documentation</p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <h3> Triggers</h3> <table class="grid"><tr> <td> -</td> <td> <b> Type</b> </td> <td> <b> Name</b> </td> </tr> <tr> <td> *</td> <td> named-event</td> <td> medication-prescribe</td> </tr> </table> <blockquote> <p> <b> condition</b> </p> <p> <b> kind</b> : applicability</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Description</b> </td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> Check whether the opioid prescription for the existing patient is extended-release
                 without any opioids-with-abuse-potential prescribed in the past 90 days.</td> <td> text/cql</td> <td> Inclusion Criteria</td> </tr> </table> </blockquote> <p> <b> groupingBehavior</b> : visual-group</p> <p> <b> selectionBehavior</b> : exactly-one</p> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : action.title</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> text/cql</td> <td> Get Summary</td> </tr> </table> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : action.description</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> text/cql</td> <td> Get Detail</td> </tr> </table> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : activity.extension</p> <h3> Expressions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td> *</td> <td> text/cql</td> <td> Get Indicator</td> </tr> </table> </blockquote> <h3> Actions</h3> <table class="grid"><tr> <td> -</td> <td> <b> Description</b> </td> </tr> <tr> <td> *</td> <td> Will precribe immediate release</td> </tr> <tr> <td> *</td> <td> Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo</td> </tr> <tr> <td> *</td> <td> N/A - see comment; snooze 3 mo</td> </tr> </table> </blockquote> </div> </text> <url value="http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-04"/> 
  <identifier>     <system value="urn:ietf:rfc:3986"/>     <value value="urn:oid:2.16.840.1.113883.4.642.11.4"/>   </identifier>   <identifier>     <use value="official"/>     <value value="cdc-opioid-guidance"/>   </identifier>   <version value="0.1.0"/>   <name value="Cdcopioid04"/>   <title value="CDC Opioid Prescribing Guideline Recommendation #4"/>   <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="2018-03-19"/>   <publisher value="Centers for Disease Control and Prevention (CDC)"/> 
  <description value="When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release
   opioids instead of extended-release/long-acting (ER/LA) opioids.
  
    
      
      
      
    
    
      
        
        
        
      
    
  
  
    
      
      
      
    
    
      
        
        
        
      
    
  
  
    
      
      
      
    
  
  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 use caution when prescribing extended-release/long-acting (ER/LA) opioids
   as they carry a higher risk and negligible benefit compared to immediate-release opioids.
  
  
    
  
  
    
  
  
    
  
  
    
  
  
    
  
  
    
    
    https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pai
    n---united-states-2016#420
    
      https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pai
      n---united-states-2016#420
    
  
  
    
    
    
    
      
    
  
  
  
    
    Checking if the trigger prescription meets the inclusion criteria for recommendation #4
     workflow.
    
      
      
        
          
            
              
              
              
            
          
        
        
          
            
              
              
              
            
          
        
      
    
    
      
      
    
    
      
      
        Check whether the opioid prescription for the existing patient is extended-release without
         any opioids-with-abuse-potential prescribed in the past 90 days.
        
        
      
    
    
    
    
      
      
        
        
      
    
    
      
      
        
        
      
    
    
      
      
        
        
      
    
    
      
    
    
      
    
    
      
    
  

   opioids instead of extended-release/long-acting (ER/LA) opioids."/> 
  <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 use caution when prescribing extended-release/long-acting (ER/LA)

   opioids as they carry a higher risk and negligible benefit compared to immediate-release
   opioids."/> 
  <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>   <relatedArtifact>     <type value="documentation"/>     <display value="MME Conversion Tables"/>     <document>       <url value="https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"/>     </document>   </relatedArtifact>   <library value="http://example.org/fhir/Library/opioidcds-recommendation-04"/>   <action>     <title value="Extended-release opioid prescription triggered."/>     <description value="Checking if the trigger prescription meets the inclusion criteria for recommendation

     #4 workflow."/> 
    <documentation>       <type value="documentation"/>       <document>         <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="Check whether the opioid prescription for the existing patient is extended-release

         without any opioids-with-abuse-potential prescribed in the past 90 days."/> 
        <language value="text/cql"/>         <expression value="Inclusion Criteria"/>       </expression>     </condition>     <groupingBehavior value="visual-group"/>     <selectionBehavior value="exactly-one"/>     <dynamicValue>       <path value="action.title"/>       <expression>         <language value="text/cql"/>         <expression value="Get Summary"/>       </expression>     </dynamicValue>     <dynamicValue>       <path value="action.description"/>       <expression>         <language value="text/cql"/>         <expression value="Get Detail"/>       </expression>     </dynamicValue>     <dynamicValue>       <path value="activity.extension"/>       <expression>         <language value="text/cql"/>         <expression value="Get Indicator"/>       </expression>     </dynamicValue>     <action>       <description value="Will precribe immediate release"/>     </action>     <action>       <description value="Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"/>     </action>     <action>       <description value="N/A - see comment; snooze 3 mo"/>     </action>   </action> 


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