Generated Narrative with Details

id: example-cardiology-os

contained: , , , , , , , , , , , ,

url: http://va.gov/kas/orderset/B5-Cardiology-ChestPainCAD-OS

identifier: bb7ccea6-9744-4743-854a-bcffd87191f6 (OFFICIAL), CLIN0004AG, KP-914

version: 0.1

name: ChestPainCoronaryArteryDiseaseOrderSetKNART

title: Chest Pain (CP) - Coronary Artery Disease (CAD) Order Set KNART

type: Order Set (Details : {http://terminology.hl7.org/CodeSystem/plan-definition-type code 'order-set' = 'Order Set', given as 'Order Set'})

status: active

date: 29/08/2017

publisher: Department of Veterans Affairs

description: The Cardiology chest pain (CP) and coronary artery disease (CAD) group of KNARTs are intended to assist primary care providers in the management of adult patients with stable chest pain (with or without known CAD); aid in determining when a cardiology consultation is appropriate; provide guidance for initial noninvasive diagnostic orders (stress testing) and provide a structured documentation template for the process. Stable patients with cardiac chest pain require risk stratification, office-based workup, initiation of disease-specific medications, and subspecialty referral to a cardiologist.

useContext:

usage: The Cardiology chest pain (CP) and coronary artery disease (CAD) group of KNARTs are intended to assist primary care providers in the management of adult patients with stable chest pain (with or without known CAD); aid in determining when a cardiology consultation is appropriate; provide guidance for initial noninvasive diagnostic orders (stress testing) and provide a structured documentation template for the process. Stable patients with cardiac chest pain require risk stratification, office-based workup, initiation of disease-specific medications, and subspecialty referral to a cardiologist. This context excludes emergent patients (new/ongoing/unstable pattern CP). Included are those patients with stable CP with or without known CAD, to be considered for evaluation by cardiology.

copyright: © Copyright Cognitive Medical Systems, Inc. 9444 Waples Street Suite 300 San Diego, CA 92121

author: , ,

relatedArtifact: , , , , , , , , , , ,

library: #cardiology-chestPain-logic

action

Actions

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<type> <coding> <system value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/> <code value="order-set"/> <display value="Order Set"/> </coding> </type> <status value="active"/> <date value="2017-08-29"/> <publisher value="Department of Veterans Affairs"/> <description value="The Cardiology chest pain (CP) and coronary artery disease (CAD) group of KNARTs are intended to assist primary care providers in the management of adult patients with stable chest pain (with or without known CAD); aid in determining when a cardiology consultation is appropriate; provide guidance for initial noninvasive diagnostic orders (stress testing) and provide a structured documentation template for the process. Stable patients with cardiac chest pain require risk stratification, office-based workup, initiation of disease-specific medications, and subspecialty referral to a cardiologist."/> <useContext> <code> <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> <code value="focus"/> </code> <valueCodeableConcept> <coding> <system value="http://snomed.info/sct"/> <code value="look up value"/> <display value="appropriate snomed condition"/> </coding> </valueCodeableConcept> </useContext> <usage value="The Cardiology chest pain (CP) and coronary artery disease (CAD) group of KNARTs are intended to assist primary care providers in the management of adult patients with stable chest pain (with or without known CAD); aid in determining when a cardiology consultation is appropriate; provide guidance for initial noninvasive diagnostic orders (stress testing) and provide a structured documentation template for the process. Stable patients with cardiac chest pain require risk stratification, office-based workup, initiation of disease-specific medications, and subspecialty referral to a cardiologist. This context excludes emergent patients (new/ongoing/unstable pattern CP). Included are those patients with stable CP with or without known CAD, to be considered for evaluation by cardiology."/> <copyright value="© Copyright Cognitive Medical Systems, Inc. 9444 Waples Street Suite 300 San Diego, CA 92121"/> <author> <name value="Bruce Bray MD"/> <!-- No place for affiliation in the contributor, left here as comments <affiliation> <name value="Professor, Cardiovascular Medicine, University of Utah School of Medicine; Staff Cardiologist, Salt Lake City VA Medical Center (VAMC)" /> </affiliation> --> </author> <author> <name value="Scott Wall MD"/> <!-- No place for affiliation in the contributor, left here as comments <affiliation> <name value="Assistant Professor, Cardiovascular Medicine, University of Utah; School of Medicine Staff Cardiologist, Electrophysiology, Salt Lake City VAMC" /> </affiliation> --> </author> <author> <name value="Aiden Abidov MD, PhD"/> <!-- No place for affiliation in the contributor, left here as comments <affiliation> <name value="Professor of Medicine, Wayne State University; Section Chief, Cardiology, John Dingell VAMC" /> </affiliation> --> </author> <relatedArtifact> <type value="derived-from"/> <display value="Cardiology: Chest Pain (CP) / Coronary Artery Disease (CAD) Clinical Content White Paper"/> <url value="NEED-A-URL-HERE"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- used the description from HeD example for display here --> <display value="Outcome CVD (coronary death, myocardial infarction, coronary insufficiency, angina, ischemic stroke, hemorrhagic stroke, transient ischemic attack, peripheral artery disease, heart failure)"/> <citation value="Cardiovascular disease (10-year risk) [Internet].: Framingham Heart Study; cited 2017]. Available from: https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php."/> <url value="https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="https://doi.org/10.1161/CIRCULATIONAHA.107.699579" identifierName="DOI"/> <identifier root="D'Agostino RB et al., 2008" identifierName="LocalDocBook"/> </identifiers> --> <!-- used the title from HeD example for display here --> <display value="General cardiovascular risk profile for use in primary care: the Framingham Heart Study"/> <citation value="Cardiovascular disease (10-year risk) [Internet].: Framingham Heart Study; cited 2017]. Available from: https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php."/> <url value="https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="10.1016/j.jtcvs.2014.11.002" identifierName="DOI"/> <identifier root="Fihn et al., 2015" identifierName="LocalDocBook"/> </identifiers> --> <!-- used the title from HeD example for display here --> <display value="2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons"/> <!-- here is the description from the source OS, no spot for it <description value="A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons"/> --> <citation value="Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the american college of cardiology/american heart association task force on practice guidelines, and the american association for thoracic surgery, preventive cardiovascular nurses association, society for cardiovascular angiography and interventions, and society of thoracic surgeons. J Thorac Cardiovasc Surg. 2015 March 01;149(3):5."/> <url value="NEED-A-URL-HERE"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="https://doi.org/10.1016/S0735-1097(02)02164-2" identifierName="DOI"/> <identifier root="Gibbons et al., 2002" identifierName="LocalDocBook"/> </identifiers> --> <!-- used the title from HeD example for display here --> <display value="ACC/AHA 2002 guideline update for exercise testing: summary article: A report of the American college of cardiology/American heart association task force on practice guidelines (committee to update the 1997 exercise testing guidelines)"/> <!-- there was no description in this specific entry --> <citation value="Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: Summary article: A report of the american college of cardiology/american heart association task force on practice guidelines (committee to update the 1997 exercise testing guidelines). Circulation. 2002 October 01;106(14):1883-92."/> <url value="NEED-A-URL-HERE"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="b4064039-2345-4227-b83d-54dc13a838d3"/> <identifier root="NLM 2017a" identifierName="LocalDocBook"/> </identifiers> --> <!-- used the title from HeD example for display here --> <display value="LABEL: ASPIRIN 81 MG- aspirin tablet, coated"/> <!-- there was no description in this specific entry --> <citation value="Label: ASPIRIN 81 MG- aspirin tablet, coated [Internet].: National Library of Medicine; 2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b4064039-2345-4227-b83d-54dc13a838d3."/> <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b4064039-2345-4227-b83d-54dc13a838d3"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="edae8df1-caf9-ff72-1304-5ae8b355f8e7"/> <identifier root="NLM 2017b" identifierName="LocalDocBook"/> </identifiers> --> <!-- used the title from HeD example for display here --> <display value="LABEL: CLOPIDOGREL- clopidogrel bisulfate tablet, film coated"/> <!-- there was no description in this specific entry --> <citation value="LABEL: CLOPIDOGREL- clopidogrel bisulfate tablet, film coated [Internet].: National Library of Medicine; 2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=edae8df1-caf9-ff72-1304-5ae8b355f8e7."/> <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155-bc00-406b-b097-e8aece187a8a"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="7fe85155-bc00-406b-b097-e8aece187a8a"/> <identifier root="NLM 2017c" identifierName="LocalDocBook"/> </identifiers> --> <!-- used the title from HeD example for display here --> <display value="LABEL: LIPITOR- atorvastatin calcium tablet, film coated"/> <!-- there was no description in this specific entry --> <citation value="LABEL: LIPITOR- atorvastatin calcium tablet, film coated [Internet].: National Library of Medicine; 2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155-bc00-406b-b097-e8aece187a8a."/> <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155-bc00-406b-b097-e8aece187a8a"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="2d948600-35d8-4490-983b-918bdce488c8"/> <identifier root="NLM 2017d" identifierName="LocalDocBook"/> </identifiers> --> <!-- used the title from HeD example for display here --> <display value="LABEL: METOPROLOL SUCCINATE EXTENDED-RELEASE - metoprolol succinate tablet, film coated, extended release"/> <!-- there was no description in this specific entry --> <citation value="LABEL: LIPITOR- atorvastatin calcium tablet, film coated [Internet].: National Library of Medicine; 2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155-bc00-406b-b097-e8aece187a8a."/> <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2d948600-35d8-4490-983b-918bdce488c8"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="67bf2a15-b115-47ac-ae28-ce2dafd6b5c9"/> <identifier root="NLM 2017e" identifierName="LocalDocBook"/> </identifiers> --> <!-- used the title from HeD example for display here --> <display value="LABEL: NITROGLYCERIN- nitroglycerin tablet"/> <!-- there was no description in this specific entry --> <citation value="LABEL: NITROGLYCERIN- nitroglycerin tablet [Internet].: National Library of Medicine; 2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=67bf2a15-b115-47ac-ae28-ce2dafd6b5c9."/> <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=67bf2a15-b115-47ac-ae28-ce2dafd6b5c9"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="5c1c694c-4b08-469e-b538-08e69df06146"/> <identifier root="NLM 2017g" identifierName="LocalDocBook"/> </identifiers> --> <!-- used the title from HeD example for display here --> <display value="LABEL: SIMVASTATIN - simvastatin tablet"/> <!-- there was no description in this specific entry --> <citation value="LABEL: SIMVASTATIN - simvastatin tablet [Internet].: National Library of Medicine; 2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5c1c694c-4b08-469e-b538-08e69df06146."/> <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5c1c694c-4b08-469e-b538-08e69df06146"/> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="10.1136/hrt.2009.190066" identifierName="DOI"/> <identifier root="Skinner et al., 2010" identifierName="LocalDocBook"/> </identifiers> --> <!-- used the title from HeD example for display here --> <display value="Chest Pain Guideline Development Group. NICE guidance. Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin."/> <!-- there was no description in this specific entry --> <citation value="Skinner JS, Smeeth L, Kendall JM, Adams PC, Timmis A, Chest Pain Guideline Development Group. NICE guidance. chest pain of recent onset: Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. Heart. 2010 June 01;96(12):974-8."/> <url value="http://heart.bmj.com/content/96/12/974.long"/> </relatedArtifact> <library value="#cardiology-chestPain-logic"/> <!-- Actions --> <action> <!-- <action> Patient disposition and triage group </action> --> <action> <title value="Consults and Referrals"/> <groupingBehavior value="logical-group"/> <selectionBehavior value="any"/> <action> <textEquivalent value="Referral to cardiology to evaluate chest pain (routine)"/> <definition value="#referralToCardiologyConsult"/> <!-- These expressions will be evaluated with the library referenced above as an include --> <dynamicValue> <path value="timing.event"/> <expression> <language value="text/cql"/> <expression value="Now()"/> </expression> </dynamicValue> <dynamicValue> <path value="specialty"/> <!-- This expression is code selector syntax in CQL, returning the code from the NPI provider taxonomy --> <expression> <language value="text/cql"/> <expression value="Code '261QM0850X' from CardiologyChestPainLogic."NUCC Provider Taxonomy" display 'Adult Mental Health'"/> </expression> </dynamicValue> <dynamicValue> <!-- The fulfillmentTime element of the resulting ServiceRequest will be set to the result of the ServiceRequestFulfillmentTime expression defined in the SuicideRiskLogic library --> <path value="occurrenceDateTime"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.ServiceRequestFulfillmentTime"/> </expression> </dynamicValue> <dynamicValue> <path value="subject"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.Patient"/> </expression> </dynamicValue> <dynamicValue> <path value="requester.agent"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.Practitioner"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.CardiologyReferralReason"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonReference"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.RiskAssessment"/> </expression> </dynamicValue> </action> <action> <title value="Reason for cardiology consultation"/> <definition value="#CollectReferralReason"/> </action> <action> <title value="Goal of cardiology consultation"/> <definition value="#CardiologyConsultationGoal"/> </action> </action> <!-- <action> Imaging and ECG group </action> --> <!-- <action> Laboratory Tests </action> --> <!-- <action> Cardiac Risk Stratification </action> --> <action> <title value="Medications"/> <description value="Consider the following medications for stable patients to be initiated prior to the cardiology consultation."/> <action> <groupingBehavior value="logical-group"/> <selectionBehavior value="at-most-one"/> </action> <action> <title value="Antianginal Therapy"/> <groupingBehavior value="logical-group"/> <selectionBehavior value="at-most-one"/> <action> <textEquivalent value="metoprolol tartrate 25 mg tablet 1 tablet oral 2 time daily"/> <definition value="#metoprololTartrate25Prescription"/> <dynamicValue> <path value="status"/> <expression> <language value="text/cql"/> <expression value="'draft'"/> </expression> </dynamicValue> <dynamicValue> <path value="patient"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.Patient"/> </expression> </dynamicValue> <dynamicValue> <path value="prescriber"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.Practitioner"/> </expression> </dynamicValue> </action> <action> <textEquivalent value="metoprolol tartrate 50 mg tablet 1 tablet oral 2 time daily"/> <definition value="#metoprololTartrate50Prescription"/> <dynamicValue> <path value="status"/> <expression> <language value="text/cql"/> <expression value="'draft'"/> </expression> </dynamicValue> <dynamicValue> <path value="patient"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.Patient"/> </expression> </dynamicValue> <dynamicValue> <path value="prescriber"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.Practitioner"/> </expression> </dynamicValue> </action> <action> <textEquivalent value="amlodipine 5 tablet 1 tablet oral daily"/> <definition value="#amlodipinePrescription"/> <dynamicValue> <path value="status"/> <expression> <language value="text/cql"/> <expression value="'draft'"/> </expression> </dynamicValue> <dynamicValue> <path value="patient"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.Patient"/> </expression> </dynamicValue> <dynamicValue> <path value="prescriber"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.Practitioner"/> </expression> </dynamicValue> </action> </action> <action> <title value="Nitroglycerin"/> <groupingBehavior value="logical-group"/> <selectionBehavior value="at-most-one"/> <!-- This is a subgroup with one element --> <action> <textEquivalent value="nitroglycerin 0.4 mg tablet sub-lingual every 5 minutes as needed for chest pain; maximum 3 tablets"/> <definition value="#nitroglycerinPrescription"/> <dynamicValue> <path value="status"/> <expression> <language value="text/cql"/> <expression value="'draft'"/> </expression> </dynamicValue> <dynamicValue> <path value="patient"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.Patient"/> </expression> </dynamicValue> <dynamicValue> <path value="prescriber"/> <expression> <language value="text/cql"/> <expression value="CardiologyChestPainLogic.Practitioner"/> </expression> </dynamicValue> </action> </action> <!-- Original order set has sections for Antiplatelet Therapy and Risk Factor Reduction not encoded here --> </action> </action> </PlanDefinition>