Plandefinition-example-cardiology-os.xml

Chest Pain Coronary Artery Disease Order Set KNART (id = "example-cardiology-os")

<?xml version="1.0" encoding="UTF-8"?>

<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="example-cardiology-os"/> 
  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative</b> </p> <div> <p> Resource &quot;example-cardiology-os&quot; </p> </div> <p> <b> url</b> : <code> http://va.gov/kas/orderset/B5-Cardiology-ChestPainCAD-OS</code> </p> <p> <b> identifier</b> : id: bb7ccea6-9744-4743-854a-bcffd87191f6 (OFFICIAL), id: CLIN0004AG, id: KP-914</p> <p> <b> version</b> : 0.1</p> <p> <b> name</b> : ChestPainCoronaryArteryDiseaseOrderSetKNART</p> <p> <b> title</b> : Chest Pain (CP) - Coronary Artery Disease (CAD) Order Set KNART</p> <p> <b> type</b> : Order Set <span>  (<a> PlanDefinitionType</a> #order-set)</span> </p> <p> <b> status</b> : active</p> <p> <b> date</b> : 2017-08-29</p> <p> <b> publisher</b> : Department of Veterans Affairs</p> <p> <b> description</b> : 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.</p> <p> <b> usage</b> : 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.</p> <p> <b> copyright</b> : © Copyright Cognitive Medical Systems, Inc. 9444 Waples Street Suite 300 San Diego,
         CA 92121</p> <p> <b> author</b> : Bruce Bray MD: , Scott Wall MD: , Aiden Abidov MD, PhD: </p> <p> <b> library</b> : <code> #cardiology-chestPain-logic</code> </p> <blockquote> <p> <b> action</b> </p> </blockquote> </div> </text> <contained> 
    <Library> 
      <id value="cardiology-chestPain-logic"/> 
      <status value="active"/> 
      <type> 
         <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/library-type"/> 
            <code value="logic-library"/> 
            <display value="Logic Library"/> 
         </coding> 
      </type> 
      <description value="Placeholder library"/> 
    </Library> 
  </contained> 
  <contained> 
    <ActivityDefinition> 
      <id value="referralToCardiologyConsult"/> 
      <status value="draft"/> 
      <description value="Consider other consult modalities which might be available (e.g., e-consult or other rapidly
       iterative consult method. A simple consult is included here as the overarching clinical
       intent."/> 
      <!--     Kind indicates the type of resource that is defined by this activity, a ServiceRequest
       in this case     -->
      <kind value="ServiceRequest"/> 
      <!--    <code>
        <coding>
          <system value="http://snomed.info/sct" />
          <code value="TSR" />
        </coding>
        <text value="Referral to Cardiology" />
      </code>    -->
      <timingTiming> 
        <event> 
          <!--     The expression here specifies the value for the timing of the resulting resource.
           In this case, referralRequest.fulfillmentTime.start     -->
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression> 
              <language value="text/cql"/> 
              <expression value="Now()"/> 
            </valueExpression> 
          </extension> 
        </event> 
      </timingTiming> 
      <participant> 
        <type value="practitioner"/> 
      </participant> 
    </ActivityDefinition> 
  </contained> 
  <contained> 
    <ActivityDefinition> 
      <id value="metoprololTartrate25Prescription"/> 
      <status value="draft"/> 
      <kind value="MedicationRequest"/> 
      <productReference> 
        <reference value="#metoprololTartrate25Medication"/> 
      </productReference> 
      <dosage> 
        <text value="1 tablet oral 2 time daily"/> 
        <timing> 
          <repeat> 
            <frequency value="2"/> 
            <period value="1"/> 
            <periodUnit value="d"/> 
          </repeat> 
        </timing> 
        <route> 
          <coding> 
            <code value="26643006"/> 
            <display value="Oral route (qualifier value)"/> 
          </coding> 
          <text value="Oral route (qualifier value)"/> 
        </route> 
        <doseAndRate> 
          <type> 
            <coding> 
              <system value="http://terminology.hl7.org/CodeSystem/dose-rate-type"/> 
              <code value="ordered"/> 
              <display value="Ordered"/> 
            </coding> 
          </type> 
          <doseQuantity> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </doseQuantity> 
        </doseAndRate> 
      </dosage> 
      <dynamicValue> 
        <path value="medicationRequest.priority"/> 
        <expression> 
          <language value="text/cql"/> 
          <expression value="routine"/> 
        </expression> 
      </dynamicValue> 
    </ActivityDefinition> 
  </contained> 
  <contained> 
    <Medication> 
      <id value="metoprololTartrate25Medication"/> 
      <code> 
        <coding> 
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
          <code value="866426"/> 
        </coding> 
        <text value="Metoprolol Tartrate 25 MG"/> 
      </code> 
      <form> 
        <coding> 
          <system value="http://snomed.info/sct"/> 
          <code value="385055001"/> 
          <display value="Tablet dose form"/> 
        </coding> 
        <text value="Tablet dose form"/> 
      </form> 
      <ingredient> 
        <itemReference> 
          <reference value="#metoprololTartrate25Substance"/> 
        </itemReference> 
        <strengthRatio> 
          <numerator> 
            <value value="25"/> 
            <unit value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </denominator> 
        </strengthRatio> 
      </ingredient> 
    </Medication> 
  </contained> 
  <contained> 
    <Substance> 
      <id value="metoprololTartrate25Substance"/> 
      <code> 
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
            <code value="6918"/> 
          <text value="Metoprolol"/> 
      </code> 
    </Substance> 
  </contained> 
  <contained> 
    <ActivityDefinition> 
      <id value="metoprololTartrate50Prescription"/> 
      <status value="draft"/> 
      <kind value="MedicationRequest"/> 
      <productReference> 
        <reference value="#metoprololTartrate50Medication"/> 
      </productReference> 
      <dosage> 
        <text value="1 tablet oral 2 time daily"/> 
        <timing> 
          <repeat> 
            <frequency value="2"/> 
            <period value="1"/> 
            <periodUnit value="d"/> 
          </repeat> 
        </timing> 
        <route> 
          <coding> 
            <code value="26643006"/> 
            <display value="Oral route (qualifier value)"/> 
          </coding> 
          <text value="Oral route (qualifier value)"/> 
        </route> 
        <doseAndRate> 
          <type> 
            <coding> 
              <system value="http://terminology.hl7.org/CodeSystem/dose-rate-type"/> 
              <code value="ordered"/> 
              <display value="Ordered"/> 
            </coding> 
          </type> 
          <doseQuantity> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </doseQuantity> 
        </doseAndRate> 
      </dosage> 
      <dynamicValue> 
        <path value="medicationRequest.priority"/> 
        <expression> 
          <language value="text/cql"/> 
          <expression value="routine"/> 
        </expression> 
      </dynamicValue> 
    </ActivityDefinition> 
  </contained> 
  <contained> 
    <Medication> 
      <id value="metoprololTartrate50Medication"/> 
      <code> 
        <coding> 
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
          <code value="866435"/> 
        </coding> 
        <text value="Metoprolol Tartrate 50 MG"/> 
      </code> 
      <form> 
        <coding> 
          <system value="http://snomed.info/sct"/> 
          <code value="385055001"/> 
          <display value="Tablet dose form"/> 
        </coding> 
        <text value="Tablet dose form"/> 
      </form> 
      <ingredient> 
        <itemReference> 
          <reference value="#metoprololTartrate50Substance"/> 
        </itemReference> 
        <strengthRatio> 
          <numerator> 
            <value value="50"/> 
            <unit value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </denominator> 
        </strengthRatio> 
      </ingredient> 
    </Medication> 
  </contained> 
  <contained> 
    <Substance> 
      <id value="metoprololTartrate50Substance"/> 
      <code> 
          <coding> 
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
            <code value="6918"/> 
          </coding> 
          <text value="Metoprolol"/> 
      </code> 
    </Substance> 
  </contained> 
  <!--    <contained>
    <ActivityDefinition>
      <id value="amlodiponePrescription" />
      <status value="draft" />
      <kind value="MedicationRequest" />
      <productReference>
        <reference value="#amlodipineMedication" />
      </productReference>
      <dosage>
        <text value="1 tablet oral 1 time daily" />
        <timing>
          <repeat>
            <frequency value="1" />
            <period value="1" />
            <periodUnit value="d" />
          </repeat>
        </timing>
        <route>
          <coding>
            <code value="26643006" />
            <display value="Oral route (qualifier value)" />
          </coding>
          <text value="Oral route (qualifier value)" />
        </route>
        <doseAndRate>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/dose-rate-type" />
              <code value="ordered" />
              <display value="Ordered" />
            </coding>
          </type>
          <doseQuantity>
            <value value="1" />
            <unit value="{tbl}" />
          </doseQuantity>
        </doseAndRate>
      </dosage>
      <dynamicValue>
        <path value="medicationRequest.priority" />
        <expression value="routine" />
      </dynamicValue>
    </ActivityDefinition>
  </contained>
  <contained>
    <Medication>
      <id value="amlodipineMedication" />
      <code>
        <coding>
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm" />
          <code value="329528" />
        </coding>
        <text value="amLODIPine 5 MG" />
      </code>
      <form>
        <coding>
          <system value="http://snomed.info/sct" />
          <code value="385055001" />
          <display value="Tablet dose form" />
        </coding>
        <text value="Tablet dose form" />
      </form>
      <ingredient>
        <itemReference>
          <reference value="#amlodipineSubstance" />
        </itemReference>
        <amount>
          <numerator>
            <value value="5" />
            <unit value="mg" />
          </numerator>
          <denominator>
            <value value="1" />
            <unit value="{tbl}" />
          </denominator>
        </amount>
      </ingredient>
    </Medication>
  </contained>
  <contained>
    <Substance>
     <instance value="false"/>
     <id value="amlodipineSubstance" />
      <code>
        <coding>
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm" />
          <code value="17767" />
        </coding>
        <text value="amLODIPine" />
      </code>
    </Substance>
  </contained>    -->
  <contained> 
    <ActivityDefinition> 
      <id value="nitroglycerinPrescription"/> 
      <status value="draft"/> 
      <kind value="MedicationRequest"/> 
      <productReference> 
        <reference value="#nitroglycerinMedication"/> 
      </productReference> 
      <dosage> 
        <text value="nitroglycerin 0.4 mg tablet sub-lingual every 5 minutes as needed for chest pain; maximum
         3 tablets"/> 
        <timing> 
          <repeat> 
            <frequency value="1"/> 
            <period value="5"/> 
            <periodUnit value="min"/> 
          </repeat> 
        </timing> 
        <!--    <route>
          <coding>
            <code value="TSR" />
            <display value="sub-lingual route (qualifier value)" />
          </coding>
          <text value="Sub-lingual route (qualifier value)" />
        </route>    -->
        <doseAndRate> 
          <type> 
            <coding> 
              <system value="http://terminology.hl7.org/CodeSystem/dose-rate-type"/> 
              <code value="ordered"/> 
              <display value="Ordered"/> 
            </coding> 
          </type> 
          <doseQuantity> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </doseQuantity> 
        </doseAndRate> 
        <maxDosePerAdministration> 
          <value value="3"/> 
          <unit value="{tbl}"/> 
        </maxDosePerAdministration> 
      </dosage> 
      <dynamicValue> 
        <path value="medicationRequest.priority"/> 
        <expression> 
          <language value="text/cql"/> 
          <expression value="routine"/> 
        </expression> 
      </dynamicValue> 
    </ActivityDefinition> 
  </contained> 
  <contained> 
    <Medication> 
      <id value="nitroglycerinMedication"/> 
      <code> 
        <coding> 
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
          <code value="316365"/> 
        </coding> 
        <text value="Nitroglycerin 0.4 MG"/> 
      </code> 
      <form> 
        <coding> 
          <system value="http://snomed.info/sct"/> 
          <code value="385055001"/> 
          <display value="Tablet dose form"/> 
        </coding> 
        <text value="Tablet dose form"/> 
      </form> 
      <ingredient> 
        <itemReference> 
          <reference value="#nitroglycerinSubstance"/> 
        </itemReference> 
        <strengthRatio> 
          <numerator> 
            <value value="0.4"/> 
            <unit value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </denominator> 
        </strengthRatio> 
      </ingredient> 
    </Medication> 
  </contained> 
  <contained> 
    <Substance> 
      <id value="nitroglycerinSubstance"/> 
      <code> 
          <coding> 
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
            <code value="4917"/> 
          </coding> 
          <text value="Nitroglycerin"/> 
      </code> 
    </Substance> 
  </contained> 
<!--   
  <contained>
    <ValueSet>
      <id value="CardiologyReferralReasonValues" />
      <!-!-  Identifiers: Terminology Service requests still on going for
         value set and code definitions. Hence skeeleton and placeholders here for example-!->
      <name value="Cardiology Referral Reason value set" />
      <status value="draft" />
      <compose>
        <include>
          <system value="http://snomed.info/sct" />
          <concept>
            <code value="429559004" />
            <display value="typical angina" />
          </concept>
        </include>
      </compose>
      <!-!- <compose>
        <include>
          <system value="TSR" />
          <concept>
            <code value="TSR" />
            <display value="typical angina" />
          </concept>
          <concept>
            <code value="TSR" />
            <display value="atypical chest pain" />
          </concept>
          <concept>
            <code value="TSR" />
            <display value="progressive angina symptoms in a stable patient with known
   CAD (if the patient is unstable based upon clinical or test results, direct physician-to-physician
   communication is required)" />
          </concept>
          <concept>
            <code value="TSR" />
            <display value="other" />
          </concept>
        </include>
      </compose> -!->
    </ValueSet>
  </contained>    -->
  
  <contained> 
    <Questionnaire> 
      <id value="CollectReferralReason"/> 
      <status value="draft"/> 
      <item> 
        <linkId value="1"/> 
        <text value="Reason for Cardiology Consult"/> 
        <type value="choice"/> 
        <required value="true"/> 
        <repeats value="true"/> 
        <answerValueSet value="#CardiologyReferralReasonValues"/> 
      </item> 
    </Questionnaire> 
  </contained> 
  <contained> 
    <Questionnaire> 
      <id value="CardiologyConsultationGoal"/> 
      <status value="draft"/> 
      <item> 
        <linkId value="2"/> 
        <text value="Goal of cardiology consultation"/> 
        <type value="string"/> 
      </item> 
    </Questionnaire> 
  </contained> 
  <url value="http://va.gov/kas/orderset/B5-Cardiology-ChestPainCAD-OS"/> 
  <identifier> 
    <!--   identifierName="B5"    -->
    <use value="official"/> 
    <system value="urn:va.gov:kbs:knart:artifact:r1"/> 
    <value value="bb7ccea6-9744-4743-854a-bcffd87191f6"/> 
  </identifier> 
  <!--   identifierName="Contract: VA118-16-D-1008, Task Order (TO): VA-118-16-F-1008-0007, CLIN0004AG"
      -->
  <identifier> 
    <system value="urn:va.gov:kbs:contract:VA118-16-D-1008:to:VA-118-16-F-1008-0007"/> 
    <value value="CLIN0004AG"/> 
  </identifier> 
  <!--   identifierName="Jira KP-914"    -->
  <identifier> 
    <system value="urn:cognitivemedicine.com:lab:jira"/> 
    <value value="KP-914"/> 
  </identifier> 
  <version value="0.1"/> 
  <name value="ChestPainCoronaryArteryDiseaseOrderSetKNART"/> 
  <title value="Chest Pain (CP) - Coronary Artery Disease (CAD) Order Set KNART"/> 
  <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/PCN
    A/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-b8
    3d-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"/> 
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  <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-ae
    28-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-b538-08e
    69df06146."/> 
    <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)"/> 
        <definitionCanonical 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.&quot;NUCC Provider Taxonomy&quot; 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"/> 
        <definitionCanonical value="#CollectReferralReason"/> 
      </action> 
      <action> 
        <title value="Goal of cardiology consultation"/> 
        <definitionCanonical 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"/> 
          <definitionCanonical 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"/> 
          <definitionCanonical 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"/> 
          <definitionCanonical 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"/> 
          <definitionCanonical 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>