Examples

CDC Guideline for Prescribing Opioids for Chronic Pain

CDS Service Request

The example illustrates a prescription for Acetaminophen/Hydrocodone Bitartrate for a patient that already has a prescription for Oxycodone Hydrochloride:

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{
  "hookInstance": "d1577c69-dfbe-44ad-ba6d-3e05e953b2ea",
  "fhirServer": "http://fhir.example.com",
  "hook": "medication-prescribe",
  "user": "Practitioner/example",
  "context": [
    {
      "resourceType": "MedicationOrder",
      "id": "medrx001",
      "dateWritten": "2017-05-05",
      "status": "draft",
      "patient": {
        "reference": "Patient/example"
      },
      "medicationCodeableConcept": {
        "coding": [
          {
            "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
            "code": "857001",
            "display": "Acetaminophen 325 MG / Hydrocodone Bitartrate 10 MG Oral Tablet"
          }
        ]
      },
      "dosageInstruction": [
        {
          "text": "Take 1 tablet Oral every 4 hours as needed",
          "timing": {
            "repeat": {
              "frequency": 6,
              "frequencyMax": 6,
              "period": 1,
              "unit": "d"
            }
          },
          "asNeededBoolean": true,
          "doseQuantity": {
            "value": 10,
            "unit": "mg",
            "system": "http://unitsofmeasure.org",
            "code": "mg"
          }
        }
      ]
    }
  ],
  "patient": "Patient/example",
  "prefetch": {
    "medication": {
      "response": {
        "status": "200 OK"
      },
      "resource": {
        "resourceType": "MedicationOrder",
        "id": "medrx002",
        "dateWritten": "2017-04-25",
        "status": "active",
        "patient": {
          "reference": "Patient/example"
        },
        "medicationCodeableConcept": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "1049621",
              "display": "Oxycodone Hydrochloride 5 MG Oral Tablet"
            }
          ]
        },
        "dosageInstruction": [
          {
            "text": "Take 1 tablet by mouth every 4 hours as needed for pain.",
            "timing": {
              "repeat": {
                "frequency": 6,
                "period": 1,
                "periodUnits": "d"
              }
            },
            "asNeededBoolean": true,
            "doseQuantity": {
              "value": 5,
              "unit": "mg",
              "system": "http://unitsofmeasure.org",
              "code": "mg"
            }
          }
        ]
      }
    }
  }
}

This example illustrates the use of the CDS Hooks medication-prescribe hook to implement Recommendation #5 from the CDC guideline for prescribing opioids for chronic pain.

This example is taken from the Opioid Prescribing Support Implementation Guide, developed in partnership with the Centers for Disease Control and Prevention (CDC).

CDS Service Response

The opioid guideline request results in the following response that indicates the patient is at high risk for opioid overdose according to the CDC guidelines, and the dosage should be tapered to less than 50 MME. Links are provided to the guideline, as well as to the MME conversion tables provided by CDC.

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{
  "summary": "High risk for opioid overdose - taper now",
  "indicator": "warning",
  "links": [
    {
      "label": "CDC guideline for prescribing opioids for chronic pain",
      "type": "absolute",
      "url": "https://guidelines.gov/summaries/summary/50153/cdc-guideline-for-prescribing-opioids-for-chronic-pain---united-states-2016#420"
    },
    {
      "label": "MME Conversion Tables",
      "type": "absolute",
      "url": "https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf"
    }
  ],
  "detail": "Total morphine milligram equivalent (MME) is 125mg. Taper to less than 50."
}

Radiology Appropriateness

CDS Service Request

This example illustrates the use of the CDS Hooks order-review hook to implement Radiology Appropriateness scoring.

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{
  "hookInstance": "d1577c69-dfbe-44ad-ba6d-3e05e953b2ea",
  "fhirServer": "http://fhir.example.com",
  "hook": "order-review",
  "user": "Practitioner/example",
  "context": [
    {
      "resourceType": "ProcedureRequest",
      "id": "procedure-request-1",
      "status": "draft",
      "intent": "proposal",
      "priority": "routine",
      "code": {
        "coding": [{
          "system": "http://www.ama-assn.org/go/cpt",
          "code": "70450",
          "display": "CT, head, wo iv contrast"
        }]
      },
      "subject": {
        "reference": "Patient/example"
      },
      "requester": {
        "agent": {
          "reference": "Practitioner/exampmle"
        }
      }
    }
  ],
  "patient": "Patient/example"
}

CDS Service Response

The appropriateness score is communicated via an update of the procedure request that adds an extension element to indicate the appropriateness rating.

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{
  "cards": [
    {
      "summary": "Usually appropriate",
      "indicator": "info",
      "detail": "The requested procedure is usually appropriate for the given indications.",
      "suggestions": [
        {
          "label": "The appropriateness score for this procedure given these indications is 9, usually appropriate.",
          "actions": [{
            "type": "update",
            "description": "Update the order to record the appropriateness score.",
            "resource": {
              "resourceType": "ProcedureRequest",
              "id": "procedure-request-1",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/us/qicore/StructureDefinition/procedurerequest-appropriatenessScore",
                  "valueDecimal": "9"
                }
              ],
              "status": "draft",
              "intent": "proposal",
              "priority": "routine",
              "code": {
                "coding": [{
                  "system": "http://www.ama-assn.org/go/cpt",
                  "code": "70450",
                  "display": "CT, head, wo iv contrast"
                }]
              },
              "subject": {
                "reference": "Patient/example"
              },
              "requester": {
                "agent": {
                  "reference": "Practitioner/exampmle"
                }
              }
            }
          }]
        }
      ]
    }
  ]
}