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Opioid CDS Recommendation 11 ECA Rule
{
"resourceType": "PlanDefinition",
"id": "opioidcds-11",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: opioidcds-11</p><p><b>url</b>: <b>http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-11</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-11</p><p><b>title</b>: CDC Opioid Prescribing Guideline Recommendation #11</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>: 19/03/2018</p><p><b>publisher</b>: Centers for Disease Control and Prevention (CDC)</p><p><b>description</b>: Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.</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>: Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.</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-11</a></p><blockquote><p><b>action</b></p><p><b>title</b>: Existing patient has concurrent opioid and benzodiazepine prescriptions.</p><p><b>description</b>: Checking if the trigger prescription meets the inclusion criteria for recommendation #11 workflow.</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><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.description</p><p><b>expression</b>: </p></blockquote><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: action.title</p><p><b>expression</b>: </p></blockquote><blockquote><p><b>dynamicValue</b></p><p><b>path</b>: action.extension</p><p><b>expression</b>: </p></blockquote><h3>Actions</h3><table><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote></div>"
"resourceType" : "PlanDefinition",
"id" : "opioidcds-11",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: PlanDefinition</b><a name=\"opioidcds-11\"> </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 "opioidcds-11" </p></div><p><b>url</b>: <code>http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-11</code></p><p><b>identifier</b>: id:\u00a0urn:oid:2.16.840.1.113883.4.642.11.2, id:\u00a0cdc-opioid-guidance\u00a0(use:\u00a0OFFICIAL)</p><p><b>version</b>: 0.1.0</p><p><b>name</b>: Cdcopioid11</p><p><b>title</b>: CDC Opioid Prescribing Guideline Recommendation #11</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>: Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.</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 code focus = 'Clinical Focus', stated as 'Clinical Focus')</td><td>Medication requested (situation) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#182888003)</span></td></tr><tr><td>*</td><td>Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type 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>: Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.</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-11\">http://example.org/fhir/Library/opioidcds-recommendation-11</a></p><blockquote><p><b>action</b></p><p><b>title</b>: Existing patient has concurrent opioid and benzodiazepine prescriptions.</p><p><b>description</b>: Checking if the trigger prescription meets the inclusion criteria for recommendation #11 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 existing patient is using opioids concurrently with benzodiazepines.</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.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>: 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.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 revise</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>"
},
"url": "http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-11",
"identifier": [
{
"use": "official",
"value": "cdc-opioid-guidance"
"url" : "http://hl7.org/fhir/ig/opioid-cds/PlanDefinition/opioidcds-11",
"identifier" : [{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:oid:2.16.840.1.113883.4.642.11.2"
},
{
"use" : "official",
"value" : "cdc-opioid-guidance"
}],
"version" : "0.1.0",
"name" : "Cdcopioid11",
"title" : "CDC Opioid Prescribing Guideline Recommendation #11",
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
"code" : "eca-rule",
"display" : "ECA Rule"
}]
},
"status" : "draft",
"date" : "2018-03-19",
"publisher" : "Centers for Disease Control and Prevention (CDC)",
"description" : "Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.",
"useContext" : [{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://snomed.info/sct",
"code" : "182888003",
"display" : "Medication requested (situation)"
}]
}
],
"version": "0.1.0",
"name": "cdc-opioid-11",
"title": "CDC Opioid Prescribing Guideline Recommendation #11",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/plan-definition-type",
"code": "eca-rule",
"display": "ECA Rule"
}
]
},
"status": "draft",
"date": "2018-03-19",
"publisher": "Centers for Disease Control and Prevention (CDC)",
"description": "Concurrently prescribing opioid medications with benzodiazepines increases the risk of harm for the patient.",
"useContext": [
{
"code": {
"system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code": "focus",
"display": "Clinical Focus"
},
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "182888003",
"display": "Medication requested (situation)"
}
]
}
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "focus",
"display" : "Clinical Focus"
},
{
"code": {
"system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code": "focus",
"display": "Clinical Focus"
},
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "82423001",
"display": "Chronic pain (finding)"
}
]
}
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://snomed.info/sct",
"code" : "82423001",
"display" : "Chronic pain (finding)"
}]
}
],
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "US",
"display": "United States of America"
}
]
}],
"jurisdiction" : [{
"coding" : [{
"system" : "urn:iso:std:iso:3166",
"code" : "US",
"display" : "United States of America"
}]
}],
"purpose" : "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" : "Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.",
"copyright" : "© CDC 2016+.",
"topic" : [{
"text" : "Opioid Prescribing"
}],
"author" : [{
"name" : "Kensaku Kawamoto, MD, PhD, MHS"
},
{
"name" : "Bryn Rhodes"
},
{
"name" : "Floyd Eisenberg, MD, MPH"
},
{
"name" : "Robert McClure, MD, MPH"
}],
"relatedArtifact" : [{
"type" : "documentation",
"display" : "CDC guideline for prescribing opioids for chronic pain",
"document" : {
"url" : "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420"
}
],
"purpose": "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": "Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.",
"copyright": "© CDC 2016+.",
"topic": [
{
"text": "Opioid Prescribing"
},
{
"type" : "documentation",
"display" : "MME Conversion Tables",
"document" : {
"url" : "https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"
}
],
"author": [
{
"name": "Kensaku Kawamoto, MD, PhD, MHS"
}],
"library" : ["http://example.org/fhir/Library/opioidcds-recommendation-11"],
"action" : [{
"title" : "Existing patient has concurrent opioid and benzodiazepine prescriptions.",
"description" : "Checking if the trigger prescription meets the inclusion criteria for recommendation #11 workflow.",
"documentation" : [{
"type" : "documentation",
"document" : {
"extension" : [{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/recommendation-strength",
"code" : "strong",
"display" : "Strong"
}]
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
"valueCodeableConcept" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/evidence-quality",
"code" : "low",
"display" : "Low quality"
}]
}
}]
}
}],
"trigger" : [{
"type" : "named-event",
"name" : "medication-prescribe"
}],
"condition" : [{
"kind" : "applicability",
"expression" : {
"description" : "Check whether the existing patient is using opioids concurrently with benzodiazepines.",
"language" : "text/cql",
"expression" : "Inclusion Criteria"
}
}],
"groupingBehavior" : "visual-group",
"selectionBehavior" : "exactly-one",
"dynamicValue" : [{
"path" : "action.description",
"expression" : {
"language" : "text/cql",
"expression" : "Get Detail"
}
},
{
"name": "Bryn Rhodes"
"path" : "action.title",
"expression" : {
"language" : "text/cql",
"expression" : "Get Summary"
}
},
{
"name": "Floyd Eisenberg, MD, MPH"
"path" : "action.extension",
"expression" : {
"language" : "text/cql",
"expression" : "Get Indicator"
}
}],
"action" : [{
"description" : "Will revise"
},
{
"name": "Robert McClure, MD, MPH"
}
],
"relatedArtifact": [
{
"type": "documentation",
"display": "CDC guideline for prescribing opioids for chronic pain",
"url": "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420"
"description" : "Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"
},
{
"type": "documentation",
"display": "MME Conversion Tables",
"url": "https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"
}
],
"library": [
"Library/opioidcds-recommendation-11"
],
"action": [
{
"title": "Existing patient has concurrent opioid and benzodiazepine prescriptions.",
"description": "Checking if the trigger prescription meets the inclusion criteria for recommendation #11 workflow.",
"documentation": [
{
"type": "documentation",
"document": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/recommendation-strength",
"code": "strong",
"display": "Strong"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/evidence-quality",
"code": "low",
"display": "Low quality"
}
]
}
}
]
}
}
],
"trigger": [
{
"type": "named-event",
"name": "medication-prescribe"
}
],
"condition": [
{
"kind": "applicability",
"expression": {
"description": "Check whether the existing patient is using opioids concurrently with benzodiazepines.",
"language": "text/cql",
"expression": "Inclusion Criteria"
}
}
],
"groupingBehavior": "visual-group",
"selectionBehavior": "exactly-one",
"dynamicValue": [
{
"path": "action.description",
"expression": {
"language": "text/cql",
"expression": "Get Detail"
}
},
{
"path": "action.title",
"expression": {
"language": "text/cql",
"expression": "Get Summary"
}
},
{
"path": "action.extension",
"expression": {
"language": "text/cql",
"expression": "Get Indicator"
}
}
],
"action": [
{
"description": "Will revise"
},
{
"description": "Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"
},
{
"description": "N/A - see comment; snooze 3 mo"
}
]
}
]
"description" : "N/A - see comment; snooze 3 mo"
}]
}]
}
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.
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