Generated Narrative: PlanDefinition

CPG Knowledge Capability Extension : shareable

CPG Knowledge Capability Extension : computable

CPG Knowledge Capability Extension : executable

CPG Knowledge Capability Extension : publishable

CQFM Software System : Device/cqf-tooling

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : Get Summary

url

statement

value : define "Get Summary": if "Is Recommendation Applicable?" then 'Maximize Nonopioid Therapies as Appropriate' else null

url

displaySequence

value : 0

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions

url

statement

value : define "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription where Routines."Is Subacute or Chronic Pain Prescription?"( AmbulatoryOpioidPrescription )

url

displaySequence

value : 1

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential

url

statement

value : define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential": exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )

url

displaySequence

value : 2

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Patient Age Less Than 18

url

statement

value : define "Patient Age Less Than 18": if (Config."Age Less than 18 Years Is Enabled") then AgeInYearsAt(Today()) < 18 else false

url

displaySequence

value : 3

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Condition Positive for Sickle Cell

url

statement

value : define "Condition Positive for Sickle Cell": if (Config."Sickle Cell Check Enabled") then exists( Common."Positive Sickle Cell Condition" ) else false

url

displaySequence

value : 4

CQFM Logic Definition

url

libraryName

value : OpioidCDSCommon

url

name

value : US Core-Categorized Conditions

url

statement

value : // 3. Medications indicating end of life /* or exists ( "Medications Indicating End of Life" ) */ define "US Core-Categorized Conditions": [Condition: category in "Encounter Diagnosis Condition Category"] union [Condition: category in "Problem List Condition Category"] union [Condition: category in "US Core Health Concern Condition Category"]

url

displaySequence

value : 5

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Conditions Indicating End Of Life Present

url

statement

value : define "Conditions Indicating End Of Life Present": exists ( Common."US Core-Categorized Conditions" LLEC where LLEC.code in Common."Limited life expectancy conditions" and LLEC.clinicalStatus in Common."Active Condition" )

url

displaySequence

value : 6

CQFM Logic Definition

url

libraryName

value : OpioidCDSCommon

url

name

value : Service Requests

url

statement

value : define "Service Requests": [ServiceRequest] SR return SR

url

displaySequence

value : 7

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Palliative Care Lookback Period

url

statement

value : /* ** Routine #1 ** Opioid Review Useful Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** ------------------------------------------------------------------------------------------------------------------------------------ ** Age < 18 years? | No | Calculate age from date of birth; exclude | Date of birth ** | | patients with age less than 18 years at the | ** | | time of the prescription | ** ------------------------------------------------------------------------------------------------------------------------------------ ** Evidence of | No | Look for documented findings consistent | Sickle cell disease conditions ** sickle cell disease? | | with those listed in the sickle cell | ** | | value set | ** ------------------------------------------------------------------------------------------------------------------------------------ ** Limited life | No | Look for documented findings consistent | Limited life expectancy conditions ** expectancy conditions | | with those listed in the limited life | ** present? | | expectancy value set (terminal illness, bad | ** | | prognosis, pre-terminal) | ** ------------------------------------------------------------------------------------------------------------------------------------ ** Order for therapies | No | Look for patients with an existing order for | Therapies indicating end of life care ** indicating end of life | | therapies indicating end of life care | ** care in past 90 days? | | written within past 90 days | ** ------------------------------------------------------------------------------------------------------------------------------------ ** Active cancer | No | See sub-routine 3 | See sub-routine 3 ** treatment? | | | ** ------------------------------------------------------------------------------------------------------------------------------------ ** Conditions Likely | No | Look for patients with active conditions in | Conditions likely terminal for opioid ** Terminal for opioid | | the value set end-of-life-conditions | prescribing ** prescribing present? | | | ** ------------------------------------------------------------------------------------------------------------------------------------ ** */ define "Palliative Care Lookback Period": Interval[Today() - 90 days, Today()]

url

displaySequence

value : 8

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Order For Palliative Care In Past 90 Days

url

statement

value : define "Order For Palliative Care In Past 90 Days": exists ( Common."Service Requests" SR where SR.status in { 'active', 'completed'} and SR.intent in {'proposal', 'plan,', 'directive', 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'} and FHIRHelpers.ToDateTime(SR.authoredOn) during day of "Palliative Care Lookback Period" and SR.code in Common."Therapies indicating end of life care" )

url

displaySequence

value : 9

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Is Active Cancer Treatment?

url

statement

value : define "Is Active Cancer Treatment?": if (Config."Active Cancer Treatment Encounters Condition Is Enabled") then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period" else false

url

displaySequence

value : 10

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present

url

statement

value : define "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present": if (Config."End-Stage Disease Criteria Enabled") then exists ( Common."US Core-Categorized Conditions" EOLC where EOLC.code in Common."Conditions likely terminal for opioid prescribing" and EOLC.clinicalStatus in Common."Active Condition" ) else false

url

displaySequence

value : 11

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Is Opioid Review Useful?

url

statement

value : define "Is Opioid Review Useful?": not "Patient Age Less Than 18" and not "Condition Positive for Sickle Cell" and not "Conditions Indicating End Of Life Present" and not "Order For Palliative Care In Past 90 Days" and not "Is Active Cancer Treatment?" and not "Conditions Including Cancer To Exclude Opioid Management Indicating End-Stage Disease Present"

url

displaySequence

value : 12

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days

url

statement

value : define "Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days": if (Config."Opioid Naive Prescription Condition Is Enabled") then exists ("Opioid RX with Ambulatory Abuse Potential In Past 90 Days") else false

url

displaySequence

value : 13

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days

url

statement

value : define "Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days": if (Config."Opioid Naive Prescription Condition Is Enabled") then exists ("Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days") else false

url

displaySequence

value : 14

CQFM Logic Definition

url

libraryName

value : OpioidCDSRoutines

url

name

value : Is Opioid Naive?

url

statement

value : // NOTE: MedicationStatement-dependent logic comment out due to bug in Publisher not supporting MedicationStatement in AllTypes. define "Is Opioid Naive?": not ("Has Opioid RX with Ambulatory Abuse Potential In Past 90 Days") /* and not ("Has Report of Opioid with Ambulatory Care Abuse Potential Reported in Past 90 Days") */ and not ("Has Opioid Dispense with Ambulatory Abuse Potential In Past 90 Days")

url

displaySequence

value : 15

CQFM Logic Definition

url

libraryName

value : OpioidCDSCommonConfig

url

name

value : Opioid Treatment Plan Verification Enabled

url

statement

value : // Recommendation 2 define "Opioid Treatment Plan Verification Enabled": true

url

displaySequence

value : 16

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : Treatment Plan Lookback Period

url

statement

value : define "Treatment Plan Lookback Period": Interval[Today() - 90 days, Today()]

url

displaySequence

value : 17

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : Opioid Treatment Plan Creation or Update in Past 90 Days

url

statement

value : define "Opioid Treatment Plan Creation or Update in Past 90 Days": [CarePlan: category in Common."Pain treatment plan"] PainTreatmentPlan where PainTreatmentPlan.status in { 'active', 'completed' } and ( FHIRHelpers.ToDateTime( PainTreatmentPlan.created ) during day of "Treatment Plan Lookback Period" or PainTreatmentPlan.meta.lastUpdated during day of "Treatment Plan Lookback Period" ) and exists( "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions".recorder Recorder where Recorder ~ PainTreatmentPlan.author )

url

displaySequence

value : 18

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : Had Opioid Treatment Plan Reviewed in Past 90 Days

url

statement

value : define "Had Opioid Treatment Plan Reviewed in Past 90 Days": exists ( [Procedure: Common."Pain management procedure"] PainManagementProcedure where PainManagementProcedure.performed during day of "Treatment Plan Lookback Period" and exists ( PainManagementProcedure.performer Performer with "Chronic Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ChronicPainScript such that Performer.actor ~ ChronicPainScript.recorder ) )

url

displaySequence

value : 19

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?

url

statement

value : define "No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?": Config."Opioid Treatment Plan Verification Enabled" and not ( exists ( "Opioid Treatment Plan Creation or Update in Past 90 Days" ) or "Had Opioid Treatment Plan Reviewed in Past 90 Days" )

url

displaySequence

value : 20

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : Inclusion Criteria

url

statement

value : define "Inclusion Criteria": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential" and Routines."Is Opioid Review Useful?" and Routines."Is Opioid Naive?" and "No Opioid Treatment Plan Created, was Edited or Reviewed in Past 90 Days?"

url

displaySequence

value : 21

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : Is Recommendation Applicable?

url

statement

value : define "Is Recommendation Applicable?": "Inclusion Criteria"

url

displaySequence

value : 22

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : Get Detail

url

statement

value : define "Get Detail": if "Is Recommendation Applicable?" then 'For many types of subacute and chronic pain, consider maximizing the use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate. Consult Recommendation 2 of the 2022 CDC Clinical Practice Guideline for nonopioid therapy recommendations. **Nonopioid Pharmacological Therapy** - [Back pain (chronic, moderate to severe)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20moderate%20to%20severe%20chronic%20back%20pain%20or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74)) - [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=In%20patients%20with%20fibromyalgia%2C%20multiple,effectiveness%20is%20limited%20(8).) - [Hip or knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=or%20hip%20or%20knee%20osteoarthritis%20pain%2C%20a%20nonopioid%20strategy%20starting%20with%20acetaminophen%20or%20NSAIDs%20results%20in%20improved%20pain%20intensity%20with%20fewer%20side%20effects%20compared%20with%20a%20strategy%20starting%20with%20opioids%20(74).) - [Neuropathic pain syndromes](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Tricyclic%20antidepressants%2C%20SNRI%20antidepressants%2C%20selected%20anticonvulsants%2C%20or%20transdermal%20lidocaine%20are%20recommended%20for%20neuropathic%20pain%20syndromes%20(e.g.%2C%20diabetic%20neuropathy%20or%20postherpetic%20neuralgia)%20(156).) - [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%20that%20is%20not%20sufficiently%20improved%20with%20nonpharmacologic%20interventions%2C%20NSAIDs%20can%20be%20effective%20(179%2C180).) **Nonpharmacologic Treatments** - [Back pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Clinicians%20should%20recommend%20appropriate%20noninvasive%20nonpharmacologic%20approaches%20to%20help%20manage%20chronic%20pain%2C%20such%20as%20exercise%20(e.g.%2C%20aerobic%2C%20aquatic%2C%20or%20resistance%20exercises)%20or%20exercise%20therapy%20(a%20prominent%20modality%20in%20physical%20therapy)%20for%20back%20pain) - [Back pain (low back, chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=loss%20for%20knee%20osteoarthritis%3B%20manual%20therapies%20for%20hip%20osteoarthritis%3B-,psychological%20therapy%2C%20spinal%20manipulation%2C%20low%2Dlevel%20laser%20therapy%2C%20massage%2C%20mindfulness%2Dbased%20stress%20reduction%2C%20yoga%2C%20acupuncture%2C%20and%20multidisciplinary%20rehabilitation%20for%20low%20back%20pain,-%3B%20mind%2Dbody%20practices%20(e.g.%2C%20yoga%2C%20tai%20chi%2C%20or) - [Fibromyalgia](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=massage%2C%20and%20acupuncture%20for%20neck%20pain%3B%20cognitive-,behavioral%20therapy%2C%20myofascial%20release%20massage%2C%20mindfulness%20practices%2C%20tai%20chi%2C%20qigong%2C%20acupuncture%2C%20and%20multidisciplinary%20rehabilitation%20for%20fibromyalgia,-%3B%20and%20spinal%20manipulation%20for%20tension%20headache%20() - [Headache (tension)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=and%20spinal%20manipulation%20for%20tension%20headache.) - [Knee osteoarthritis pain (chronic)](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=Many%20noninvasive%20nonpharmacologic,for%20hip%20osteoarthritis%3B) - [Neck pain](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=mind%2Dbody%20practices%20(e.g.%2C%20yoga%2C%20tai%20chi%2C%20or%20qigong)%2C%20massage%2C%20and%20acupuncture%20for%20neck%20pain%3B) - [Temporomandibular disorder](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#:~:text=For%20temporomandibular%20disorder%20pain%2C%20patient%20education%20and%20self%2Dcare%20can%20be%20effective%2C%20as%20can%20occlusal%20splints%20for%20some%20patients%20and%20biobehavioral%20therapy%20for%20prevention%20of%20disabling%20symptoms%20(172%2C173).)' else null

url

displaySequence

value : 23

CQFM Logic Definition

url

libraryName

value : OpioidCDSREC02

url

name

value : Get Indicator

url

statement

value : define "Get Indicator": if "Is Recommendation Applicable?" then 'warning' else null

url

displaySequence

value : 24

CQFM Effective Data Requirements :

Related Artifacts

depends-on	Library Common	http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommon|2022.1.0
depends-on	Library FHIRHelpers	http://fhir.org/guides/cdc/opioid-cds/Library/FHIRHelpers|4.0.1
depends-on	Library Routines	http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSRoutines|2022.1.0
depends-on	Library Config	http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSCommonConfig|2022.1.0
depends-on	Value set Opioid analgesics with ambulatory misuse potential	Opioid analgesics with ambulatory misuse potential
depends-on	Value set Community	http://fhir.org/guides/cdc/opioid-cds/ValueSet/medicationrequest-category-community
depends-on	Value set Encounter Diagnosis Condition Category	ValueSet - Encounter Diagnosis Condition Categories
depends-on	Value set Problem List Condition Category	ValueSet - Problem List Condition Category
depends-on	Value set US Core Health Concern Condition Category	ValueSet - US Core Health Concern Condition Category
depends-on	Value set Limited life expectancy conditions	Limited life expectancy conditions
depends-on	Value set Active Condition	ValueSet - Condition Clinical Status Active
depends-on	Value set Therapies indicating end of life care	Therapies indicating end of life care
depends-on	Value set Pain treatment plan	Pain treatment plan
depends-on	Value set Pain management procedure	Pain management procedure

Parameters

ContextPrescriptions	in	0	*	MedicationRequest
Get Summary	out	0	1	string
Is Recommendation Applicable?	out	0	1	boolean
Get Detail	out	0	1	string
Get Indicator	out	0	1	string

Data Requirements

Type : Medication ( Medication )
Filter	Value
id	One of these codes:

Type : Condition ( Condition )
Filter	Value
category	In ValueSet ValueSet - Encounter Diagnosis Condition Categories

Type : Condition ( Condition )
Filter	Value
category	In ValueSet ValueSet - Problem List Condition Category

Type : Condition ( Condition )
Filter	Value
category	In ValueSet ValueSet - US Core Health Concern Condition Category

Type : ServiceRequest ( ServiceRequest )

Type : ServiceRequest ( ServiceRequest )

Type : CarePlan ( CarePlan )
Filter	Value
category	In ValueSet Pain treatment plan

Type : Procedure ( Procedure )
Filter	Value
code	In ValueSet Pain management procedure

Contents

url : http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-02

identifier : id: cdc-opioid-guidance (use: OFFICIAL)

version : 2022.1.0

name : CDC_opioid_02

title : PlanDefinition - 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain: Recommendation #2

type : ECA Rule (plan-definition-type#eca-rule)

status : DRAFT

experimental : true

date : 2023-05-01

publisher : Centers for Disease Control and Prevention (CDC)

contact : https://www.cdc.gov

description : Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.

UseContexts

-	Code	Value[x]
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'focus', stated as 'Clinical Focus')	Medication requested (situation) (SNOMED CT#182888003)
*	Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'focus', stated as 'Clinical Focus')	Chronic pain (finding) (SNOMED CT#82423001)

jurisdiction : United States of America (ISO Country Codes (ISO-3166)#US)

purpose : The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for 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 continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.

copyright : © CDC 2016+.

topic : Opioid Prescribing ()

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

relatedArtifact

library : http://fhir.org/guides/cdc/opioid-cds/Library/OpioidCDSREC02

action

title : Current Order is for Opioid With Ambulatory Misuse Potential.

description : Checking if the trigger prescription meets the inclusion criteria for recommendation #2 workflow.

documentation

Triggers

-	Type	Name
*	NAMEDEVENT	order-sign

condition

kind : APPLICABILITY

Expressions

-	Description	Language	Expression
*	Check whether the current Order is for Opioid With Ambulatory Misuse Potential.	text/cql.identifier	Is Recommendation Applicable?

groupingBehavior : VISUALGROUP

selectionBehavior : ANY

dynamicValue

path : action.title

Expressions

-	Language	Expression
*	text/cql.identifier	Get Summary

dynamicValue

path : action.description

Expressions

-	Language	Expression
*	text/cql.identifier	Get Detail

dynamicValue

path : activity.extension

Expressions

-	Language	Expression
*	text/cql.identifier	Get Indicator

Actions

-	Description
*	Document - Collaborated with patient to identify treatment goals
*	Snooze* - Attempting alternate therapy, snooze 3 months
*	Order - Select alternative therapies from order select
*	Snooze* - N/A see comment, snooze 3 months
*	Remove - Will remove triggering medication order