A Computable Guideline in FHIR Opioid Prescribing Product
summary
CDC represents its opioid-prescribing recommendation as FHIR Clinical Reasoning resources so a system can compute total morphine milligram equivalents and trigger actions at 50 and 90 MME thresholds. The implementation uses RxNorm/RxNav for ingredient/conversion data, a refreshable CQL library of 1,700 lines to map drug+ingredient strengths, PlanDefinition/ActivityDefinition to encode actions, and returns advice as CDS Hooks cards. Prototype artifacts cover six of 12 recommendations, interoperate with quality measures, and run via a FHIR-enabled CQL engine exposing a CDS service.
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chapters (23)
- 0:00Intro
- 0:21A Computable Guideline in FHIR: Opioid Prescribing Support
- 14:39The Running Example
- 15:29Implementation w/in a Health IT system
- 16:58Morphine milligram equivalents (MME/day)
- 17:53What is the implementation effort involved?
- 19:29Can't someone else do it?
- 20:47Clinical Reasoning Module
- 21:15Key Resources in Sharing Decision Support
- 23:08Knowledge-based Implementation
- 23:40An aside about Opioid ValueSets
- 25:00An aside about process decisions
- 26:41Portable Opioid Management Terminology Knowledge
- 28:01Portable MME Calculation
- 29:31And a PlanDefinition to describe the rule
- 29:57Shareable definition, but is it executable?
- 30:31COL Evaluation Architecture
- 31:31Native CQL (ELM) Engine
- 32:16Java-Based COL Engine
- 34:41Generalizing the implementation
- 37:51Requirements - Running Code
- 42:14Methods of Implementation
- 44:04Recommendations in FHIR (CPG-on-FHIR)
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