{
  "description": "When opioids are started, providers should prescribe the lowest effective dosage.",
  "_filename": "example/PlanDefinition-opioidcds-r4-recommendation-05.json",
  "package_name": "hl7.fhir.uv.cpg",
  "date": "2017-04-23T00:00:00-04:00",
  "publisher": "Centers for Disease Control and Prevention (CDC)",
  "jurisdiction": [ {
    "coding": [ {
      "code": "001",
      "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
      "display": "World"
    } ]
  } ],
  "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.",
  "name": "OpioidCDS_R4_Recommendation_05",
  "useContext": [ {
    "code": {
      "code": "focus",
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "display": "Clinical Focus"
    },
    "valueCodeableConcept": {
      "coding": [ {
        "code": "182888003",
        "system": "http://snomed.info/sct",
        "display": "Medication requested (situation)"
      } ]
    }
  }, {
    "code": {
      "code": "focus",
      "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
      "display": "Clinical Focus"
    },
    "valueCodeableConcept": {
      "coding": [ {
        "code": "82423001",
        "system": "http://snomed.info/sct",
        "display": "Chronic pain (finding)"
      } ]
    }
  } ],
  "copyright": "© CDC 2016+.",
  "type": "{:coding [{:system \\\"http://terminology.hl7.org/CodeSystem/plan-definition-type\\\", :code \\\"eca-rule\\\", :display \\\"ECA Rule\\\"}]}",
  "experimental": "true",
  "topic": [ {
    "text": "Opioid Prescribing"
  } ],
  "resourceType": "PlanDefinition",
  "title": "CDC Opioid Prescribing Guideline Recommendation #5",
  "library": [ "Library/opioidcds-r4-recommendation-05" ],
  "package_version": "0.1.0",
  "author": [ {
    "name": "Kensaku Kawamoto, MD, PhD, MHS"
  }, {
    "name": "Bryn Rhodes"
  }, {
    "name": "Floyd Eisenberg, MD, MPH"
  }, {
    "name": "Robert McClure, MD, MPH"
  } ],
  "usage": "Providers should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to >90 MME/day",
  "status": "draft",
  "id": "71eeffd3-5515-4fda-b63f-9c4be9f83a05",
  "kind": null,
  "url": "http://fhir.org/guides/cdc/opioid-cds/PlanDefinition/opioidcds-r4-recommendation-05",
  "action": [ {
    "description": "Total morphine milligram equivalent (MME) exceeds recommended amount. Taper to less than 50.",
    "title": "High risk for opioid overdose.",
    "documentation": [ {
      "url": "https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm",
      "type": "documentation",
      "display": "CDC guideline for prescribing opioids for chronic pain"
    }, {
      "type": "documentation",
      "document": {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-strengthOfRecommendation",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "strong",
              "system": "http://terminology.hl7.org/CodeSystem/recommendation-strength",
              "display": "Strong"
            } ]
          }
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence",
          "valueCodeableConcept": {
            "coding": [ {
              "code": "low",
              "system": "http://terminology.hl7.org/CodeSystem/evidence-quality",
              "display": "Low quality"
            } ]
          }
        } ]
      }
    } ],
    "selectionBehavior": "exactly-one",
    "condition": [ {
      "kind": "applicability",
      "expression": {
        "language": "text/cql",
        "expression": "Inclusion Criteria",
        "description": "Is total MME >= 50?"
      }
    } ],
    "groupingBehavior": "visual-group",
    "dynamicValue": [ {
      "path": "action.title",
      "expression": {
        "language": "text/cql",
        "expression": "Get Summary"
      }
    }, {
      "path": "action.description",
      "expression": {
        "language": "text/cql",
        "expression": "Get Detail"
      }
    }, {
      "path": "activity.extension",
      "expression": {
        "language": "text/cql",
        "expression": "Get Indicator"
      }
    } ],
    "action": [ {
      "description": "Will reduce dosage"
    }, {
      "description": "Risk of overdose carefully considered and outweighed by benefit; snooze 3 mo"
    }, {
      "description": "Acute pain; snooze 1 mo"
    }, {
      "description": "N/A - see comment (will be reviewed by medical director); snooze 3 mo"
    } ],
    "trigger": [ {
      "name": "medication-prescribe",
      "type": "named-event"
    } ]
  } ],
  "version": "0.1.0",
  "relatedArtifact": [ {
    "url": "https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf",
    "type": "documentation",
    "display": "MME Conversion Tables"
  } ]
}