The Agency for Healthcare Research and Quality (AHRQ), in partnership with the MITRE Corporation and OCHIN, developed a SMART on FHIR app that serves as a dashboard or summary for managing chronic pain and pain-related treatment within the electronic health record (EHR). This app was developed as part of an ongoing project called CDS Connect, which provides a platform for authoring and sharing publicly-available clinical decision support (CDS) knowledge resources. This SMART on FHIR app summarizes pain-related information in a single view, such as pain-related diagnoses, medications, lab results, and pain assessment scores. Visual cues point the user to potential concerns, e.g., when current medications include both benzodiazepines and opioids. The app has been piloted through OCHIN, a health information and innovation network serving safety net clinics, where clinicians found it “simple and intuitive.”

This application is inspired by the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain, but is not directly derived from any one recommendation statement. Instead, it is meant to compliment several recommendation statements within the guideline by providing a consolidated view of the patient's pain experience and the management of their pain. Ultimately, the populated pain management summary is intended to promote discussion between the patient and the provider regarding the effectiveness of existing treatments, and the benefits and risks of future interventions while considering the use of non-opioid and/or non-pharmacologic treatment when possible.

The data selection, filtering, and aggregation logic is expressed using Health Level 7 (HL7) Clinical Quality Language (CQL). This logic is embedded within the application and executed using the JavaScript CQL Execution library. This application is deployed as HTML, JavaScript, and CSS, allowing it to be served from any modern HTTP server.

Note that this application requests some data that may not be available over the FHIR interface in some EHRs. Integration with Epic requires a custom build; see the open source code for details. While this application mainly uses standard terminologies (LOINC, SNOMED-CT, ICD-10-CM, ICD-10-PCS, RxNorm), some concepts do not yet have standardized codes. In these cases, local codes were created and used. As standardized codes become available, the application will be updated to use them.

For detailed information about this application and its logic, as well as the pilot implementation, please see its entry on CDS Connect: https://cds.ahrq.gov/cdsconnect/artifact/factors-consider-managing-chronic-pain-pain-management-summary

For the Apache 2.0 licensed open source code, see it on GitHub: https://github.com/AHRQ-CDS/AHRQ-CDS-Connect-PAIN-MANAGEMENT-SUMMARY

Designed for

clinicians

FHIR Compatibility

DSTU 2

Categories

AMIA 2018, Medication

Licensing & Pricing

Free, Open Source

Primary screenshot

OS Support:

Web

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