=============================================================================== FactorsToConsiderInManagingChronicPain Change Log =============================================================================== The following CQL downloads are currently available on CDS Connect. Older versions may be available by request. - FactorsToConsiderInManagingChronicPainFHIRv102_v4.0.0_CQL.zip - FactorsToConsiderInManagingChronicPainFHIRv401_v4.0.0_CQL.zip =============================================================================== Factors_to_Consider_in_Managing_Chronic_Pain (FHIR DSTU2) =============================================================================== ------------------------------------------------------------------------------- VERSION 1.0.0 ------------------------------------------------------------------------------- Initial FHIR DSTU2 version piloted in Summer 2018. ------------------------------------------------------------------------------- VERSION 1.1.0 ------------------------------------------------------------------------------- The Factors_to_Consider_in_Managing_Chronic_Pain library version 1.1.0 introduces the following changes from the initially piloted version of the artifact: - Added the following value sets for identifying Risk Factors for Opioid-Related Harms (in addition to existing ones): - Depression Diagnosis ICD9 (2.16.840.1.113883.3.600.143) - Anxiety Disorders ICD9 (2.16.840.1.113883.3.1240.2017.3.2.1015) - Substance Abuse (2.16.840.1.113883.3.464.1003.106.11.1010) - Pregnancy (New ICD10 codes published in 2018 and 2019) (2.16.840.1.113762.1.4.1032.80) - Changed the Suicide Attempt value set to 2.16.840.1.113762.1.4.1032.102 - Removed specific inclusion of SNOMED-CT 86849004 since it is now in the Suicide Attempt value set - Added LOINC codes for the Pain intensity, Enjoyment of life, General activity scale [PEG] - Previous local codes are still supported (but discouraged) - Added logic to normalize long LOINC display text for PEG codes to shorter names - Added LOINC code for the STarT Back Screening Tool - Previous local code is still supported (but discouraged) - Added logic to display the range for Opioid Risk Tool (ORT) - Updated QuantityText logic to not include '{score}' units (since the scalar number is enough in those cases) - Updated the CDS Connect Commons library to 1.3.1 in order to resolve an implicit conversion from FHIR.Date to System.DateTime that is no longer allowed by the CQL-to-ELM translator. Factors_to_Consider_in_Managing_Chronic_Pain version 1.1.0 has not been piloted in a clinical setting, but has undergone logic testing and review. =============================================================================== FactorsToConsiderInManagingChronicPainFHIRv102 (FHIR DSTU2) =============================================================================== ------------------------------------------------------------------------------- VERSION 2.0.0 ------------------------------------------------------------------------------- The FactorsToConsiderInManagingChronicPainFHIRv102 library version 2.0.0 implements several best practices prescribed by FHIR Clinical Guidelines, including: - Rename library from Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv102 to FactorsToConsiderInManagingChronicPainFHIRv102 - Update CDS Connect Commons library to CDSConnectCommonsForFHIRv102 version 2.0.0 - Surround all library-level identifiers and datatypes in quotes - Use descriptive names (no abbreviations) for query aliases and function arguments - Replace C3F.NullSafeToConcept with FHIRHelpers.ToConcept (which is now null-safe) - Remove use of coalesce where only one argument was provided - Fix non-standard use of Exists(...) as a function Version 2.0.0 also introduces the following changes from the previous version: - Replace "Conditions associated with chronic pain" 2.16.840.1.113762.1.4.1032.37 value set with 2.16.840.1.113762.1.4.1021.95 - Replace "Pregnancy" 2.16.840.1.113883.3.526.3.378 and "Pregnancy (New ICD10 codes published in 2018 and 2019)" 2.16.840.1.113762.1.4.1032.80 value sets with grouping value set "CDS Pregnancy" 2.16.840.1.113762.1.4.1032.264 NOTE: This version has not been piloted in a clinical setting, but has undergone logic testing and review. ------------------------------------------------------------------------------- VERSION 3.0.0 ------------------------------------------------------------------------------- Version 3.0.0 makes significant changes to the inclusion criteria as well as other meaningful changes, including: - Remove adjuvant analgesics from inclusions and add non-Opioid pain medications instead - Add note (in comments) about excluding patients with sickle cell disease - Add opioid tapering to risk factors for opioid-related harms - Add adjuvant pain medications to treatment history section - Rename "Opioid Pain Medications" value set to "Opioid pain medications" - Rename "Adjuvant Analgesic Medications" value set to "Adjuvant pain medications" - Rename "Non opioid pain medications" value set to "Nonopioid pain medications" - Add "Management of opioid dosage tapering (procedure)" code (SNOMED-CT 874903005) - Convert "ReportOlderThan65" and "ReportMostRecentPositivePregnancyObservation" to lists before unioning them - Remove CQL concept definitions in favor of using CQL code definitions directly NOTE: This version has not been piloted in a clinical setting, but has undergone logic testing and review. ------------------------------------------------------------------------------- VERSION 4.0.0 ------------------------------------------------------------------------------- Version 4.0.0 is considered a major (breaking) release because property names in the summary have changed. Version 4.0.0 includes the following changes: - Renamed "NaloxoneMedications" to "NaloxoneAndNalmefeneMedications" in the Summary.RiskConsiderations tuple - Renamed "Naloxone medications" value set to "Naloxone and Nalmefene medications" - Renamed "NaloxoneMedicationRequests" expression to "NaloxoneAndNalmefeneMedicationRequests" - Renamed "ReportNaloxoneMedicationRequests" expression to "ReportNaloxoneAndNalmefeneMedicationRequests" - Renamed "NaloxoneMedicationStatements" expression to "NaloxoneAndNalmefeneMedicationStatements" - Renamed "ReportNaloxoneMedicationStatements" expression to "ReportNaloxoneAndNalmefeneMedicationStatements" - Renamed "ReportNaloxoneMedications" expression to "ReportNaloxoneAndNalmefeneMedications" - Updated CDSConnectCommonsForFHIRv102 to version 2.1.1 NOTE: This version has not been piloted in a clinical setting, but has undergone logic testing and review. =============================================================================== Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400 (FHIR R4 - 4.0.0) =============================================================================== ------------------------------------------------------------------------------- VERSION 1.0.0 ------------------------------------------------------------------------------- The Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400 version 1.0.0 library is a FHIR R4 port of Factors_to_Consider_in_Managing_Chronic_Pain version 1.1.0. While the intent of the logic remains the same as the FHIR DSTU2-based version, changes in the FHIR specification (from DSTU2 to R4) require additional changes in the CQL logic. This R4 representation contains the following changes related to the movement from FHIR DSTU2 to FHIR R4: - FHIR data model is now version 4.0.10 - FHIRHelpers is now version 4.0.0 - CDS_Connect_Commons_for_FHIRv102 has been replaced by CDS_Connect_Commons_for_FHIRv400 version 1.0.0 - MedicationOrder is replaced by MedicationRequest, and as a result, the reported type has changed from "Order" to "Request" - MedicationOrder dateWritten is replaced by MedicationRequest authoredOn - MedicationRequest no longer supports the dateEnded property, so end dates will always be blank for MedicationRequests - MedicationStatement no longer supports the wasNotTaken property - Observation adds an "instant" variant of the effective time - Observation's interpretation changed from single-value to multi-value, so the FHIR R4-based CQL only looks at the first interpretation value - Observations now check for verificationStatus "corrected", in addition to "final" and "amended" - Condition no longer supports the abatementBoolean property - Condition's clinicalStatus was changed from a code to a CodeableConcept - Condition's dateRecorded (Date) is replaced by recordedDate (DateTime) - ActiveOrRecurring Conditions now check for clinicalStatus "recurrence" in addition to "active" and "relapse" - ProcedureRequest is replaced by ServiceRequest - ProcedureRequest's orderedOn is replaced by ServiceRequest's authoredOn - ReferralRequest is replaced by ServiceRequest - ProcedureRequest's dateSent is replaced by ServiceRequest's authoredOn - NonPharmacologicTreatmentServiceRequests now queries for active or completed ServiceRequests rather than accepted, in-progress, or completed ProcedureRequests and accepted, active, or completed ReferralRequests - Procedure no longer supports the notDone property - ProcedurePerformance now excludes statuses: preparation, not-done, entered-in-error, and unknown - Due to changes in the CQL model representation of FHIR, choices are now accessed via CQL casts rather than explicit properties Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv400 version 1.0.0 has not been piloted in a clinical setting, but has undergone logic testing and review. =============================================================================== Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv401 (FHIR R4 - 4.0.1) =============================================================================== ------------------------------------------------------------------------------- VERSION 1.0.0 ------------------------------------------------------------------------------- The Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv401 version 1.0.0 library updates the FHIR model from version 4.0.0 to version 4.0.1 and leverages new capabilities in the CQL specification and tooling. This artifact has not been piloted in a clinical setting. This library differs from the previous FHIR 4.0.0 library in the following ways: - FHIR data model is now version 4.0.1 - FHIRHelpers is now version 4.0.1 - CDS_Connect_Commons_for_FHIRv400 has been replaced by CDS_Connect_Commons_for_FHIRv401 version 1.0.0 - Updated value set declarations to use URL-based value set identifiers rather than OID-based value set identifiers - Removed unnecessary concept declarations, preferring simpler code declarations instead (made possible by improvements to CQL-to-ELM) - Translated to ELM using the CQL-to-ELM version 1.5 translator Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv401 version 1.0.0 has not been piloted in a clinical setting, but has undergone logic testing and review. =============================================================================== FactorsToConsiderInManagingChronicPainFHIRv401 (FHIR R4 - 4.0.1) =============================================================================== ------------------------------------------------------------------------------- VERSION 2.0.0 ------------------------------------------------------------------------------- The FactorsToConsiderInManagingChronicPainFHIRv401 library version 2.0.0 implements several best practices prescribed by FHIR Clinical Guidelines, including: - Rename library from Factors_to_Consider_in_Managing_Chronic_Pain_FHIRv401 to FactorsToConsiderInManagingChronicPainFHIRv401 - Update CDS Connect Commons library to CDSConnectCommonsForFHIRv401 version 2.0.0 - Surround all library-level identifiers and datatypes in quotes - Use descriptive names (no abbreviations) for query aliases and function arguments - Fix non-standard use of Exists(...) as a function Version 2.0.0 also introduces the following changes from the previous version: - Replace "Conditions associated with chronic pain" 2.16.840.1.113762.1.4.1032.37 value set with 2.16.840.1.113762.1.4.1021.95 - Replace "Pregnancy" 2.16.840.1.113883.3.526.3.378 and "Pregnancy (New ICD10 codes published in 2018 and 2019)" 2.16.840.1.113762.1.4.1032.80 value sets with grouping value set "CDS Pregnancy" 2.16.840.1.113762.1.4.1032.264 NOTE: This version has not been piloted in a clinical setting, but has undergone logic testing and review. ------------------------------------------------------------------------------- VERSION 3.0.0 ------------------------------------------------------------------------------- Version 3.0.0 makes significant changes to the inclusion criteria as well as other meaningful changes, including: - Remove adjuvant analgesics from inclusions and add non-Opioid pain medications instead - Add note (in comments) about excluding patients with sickle cell disease - Add opioid tapering to risk factors for opioid-related harms - Add adjuvant pain medications to treatment history section - Rename "Opioid Pain Medications" value set to "Opioid pain medications" - Rename "Adjuvant Analgesic Medications" value set to "Adjuvant pain medications" - Rename "Non opioid pain medications" value set to "Nonopioid pain medications" - Add "Management of opioid dosage tapering (procedure)" code (SNOMED-CT 874903005) - Convert "ReportOlderThan65" and "ReportMostRecentPositivePregnancyObservation" to lists before unioning them NOTE: This version has not been piloted in a clinical setting, but has undergone logic testing and review. ------------------------------------------------------------------------------- VERSION 4.0.0 ------------------------------------------------------------------------------- Version 4.0.0 is considered a major (breaking) release because property names in the summary have changed. Version 4.0.0 includes the following changes: - Renamed "NaloxoneMedications" to "NaloxoneAndNalmefeneMedications" in the Summary.RiskConsiderations tuple - Renamed "Naloxone medications" value set to "Naloxone and Nalmefene medications" - Renamed "NaloxoneMedicationRequests" expression to "NaloxoneAndNalmefeneMedicationRequests" - Renamed "ReportNaloxoneMedicationRequests" expression to "ReportNaloxoneAndNalmefeneMedicationRequests" - Renamed "NaloxoneMedicationStatements" expression to "NaloxoneAndNalmefeneMedicationStatements" - Renamed "ReportNaloxoneMedicationStatements" expression to "ReportNaloxoneAndNalmefeneMedicationStatements" - Renamed "ReportNaloxoneMedications" expression to "ReportNaloxoneAndNalmefeneMedications" - Updated CDSConnectCommonsForFHIRv401 to version 2.1.1