#236 added md changelist 2016-2022

docs/Changelist 2016-2022.md

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+# Changelist 2016->2022
+
+General:
+-
+- Reduce active ambulatory calls by forcing cacheing
+- Turning ServiceRequests into an expression so it is cached
+- Add CDCMMEClinicalConversionFactors codesystem using CQL
+- Fix mme calculation dose range
+- Fix mme calculation multiple dose rate
+
+Recommendation1:
+-
+- Maximize nonopioid therapies 
+- Discuss benefits and risks before initiating therapy
+
+Changes:
+- Modified alert
+
+
+Recommendation 2:
+-
+- Maximize nonopioid therapies
+
+Changes:
+- Modified alert
+
+Recommendation 3&4:
+-
+No substantive changes
+
+Recommendation 5:
+-
+- The action triggering this recommendaiton has changed from receiving "higher opioid dosages" to "changing opioid dosages". 
+- Optimize non-opioid therapies when continuing opioid therapy and when tapering
+
+Changes:
+
+- MME level that triggers alert is configurable by site
+- Modified alerts
+- Added disclaimers from MME Calculator page in the MME IG and made them configurable
+- Use of links to reference Guideline content available online
+
+Recommendation 6:
+-
+No substantive changes
+
+Recommendation 7:
+-
+- The timeline for conducting revaluaitons is changed from every 3 months to "regularly" 
+
+Changes:
+- Modified alert
+
+Recommendation 8:
+-
+- Clinicians should offer naloxone when prescribing opioids, particularly to patients at increased risk for overdose, including patients with a history of overdose, patients with a history of substance use disorder, patients with sleep-disordered breathing, patients taking higher dosages of opioids (e.g., ≥50 MME/day), patients taking benzodiazepines with opioids (see Recommendation 11), and patients at risk for returning to a high dose to which they have lost tolerance (e.g., patients undergoing tapering or recently released from prison).
+
+Changes:
+- Added evaluation for sleep disorder breathing  including both central and obstructive sleep apnea
+
+Recommendation 9:
+-
+No substantive changes
+
+Recommendation 10:
+-
+- "Consider toxicology testing" changed to "consider the benefits and risks of toxicology testing" in the finalized recommendation
+
+Changes:
+- Update alert that is triggered when a patient has not had a UDS in the past 12 months to read "Consider the benefits and risks of conducting a urine toxicology screen"
+
+Recommendation 11:
+-
+No substantive changes
+
+Recommendation 12:
+-
+- The finalized version includes a specific recommendation not to discontinue opioid treatment for patients with OUD without also providing pharmacological treatment for OUD
+
+Changes:
+- Added caution to the alert regarding not discontinuing opioids for OUD patients without also providing appropriate pharmacological treatment
+- Added cautions from MME Calculator page of MME IG https://fhir.org/guides/cdc/opioid-mme-r4/mme-calculator.html#cautions 
+- Made all cautions configurable
+