Obesity Assessment Protocol (id = "protocol-example")

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

<PlanDefinition xmlns="http://hl7.org/fhir">
  <id value="protocol-example"/> 
  <text> 

    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
<p> 
    <b> id: </b> example, </p> 

  <p> 
    <b> identifier: </b> , <b> system: </b> http://acme.org, <b> value: </b> example-1, </p> 
  <p> 
    <b> title: </b> Obesity Assessment Protocol, </p> 
  <p> 
    <b> status: </b> draft, </p> 
  <p> 
    <b> type: </b> condition, </p> 
  <p> 
    <b> purpose: </b> Example of A medical algorithm for assessment and treatment of overweight and obesity,
         </p> 
  <p> 
    <b> author: </b> , <b> display: </b> National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/health-pro/guidelines/current/obe
        sity-guidelines/e_textbook/txgd/algorthm/algorthm.htm, </p> 
  <p> 
    <b> step: </b> , <b> name: </b> Measure BMI, <b> description: </b> Measure, Weight, Height, Waist, Circumference; Calculate BMI  Weight must be measured
         so that the BMI can be calculated. Most charts are based on weights obtained with the
         patient wearing undergarments and no shoes. BMI can be manually calculated (kg/[height
         in meters]2), but is more easily obtained from a nomogram. Waist circumference is important
         because evidence suggests that abdominal fat is a particularly strong determinant of cardiovascular
         risk in those with a BMI of 25 to 34.9 kg/m2. Increased waist circumference can also be
         a marker of increased risk even in persons of normal weight. The technique for measuring
         waist circumference is described in the text. A nutrition assessment will also help to
         assess the diet and physical activity habits of overweight patients, <b> precondition: </b> , <b> union: </b> , <b> description: </b> The practitioner must seek to determine whether the patient has ever been overweight.
         While a technical definition is provided, a simple question such as 'Have you ever been
         overweight?' will accomplish the same goal. Questions directed towards weight history,
         dietary habits, physical activities, and medications may provide useful information about
         the origins of obesity in particular patients., <b> condition: </b> , <b> type: </b> , <b> coding: </b> , <b> system: </b> http://acme.org, <b> code: </b> 1234, <b> display: </b> Obesity, <b> valueBoolean: </b> true, <b> union: </b> , <b> description: </b> BMI Measured in Past 2 Years  For those who have not been overweight, a 2 year interval
         is appropriate for the reassessment of BMI. While this time span is not evidence-based,
         it is believed to be a reasonable compromise between the need to identify weight gain
         at an early stage and the need to limit the time, effort, and cost of repeated measurements.,
         <b> condition: </b> , <b> type: </b> , <b> text: </b> BMI in last 2 years, <b> valueBoolean: </b> false, <b> activity: </b> , <b> detail: </b> , <b> category: </b> procedure, <b> code: </b> , <b> coding: </b> , <b> system: </b> http://loinc.org, <b> code: </b> 39156-5, <b> display: </b> Body mass index (BMI) [Ratio], <b> performer: </b> , <b> display: </b> Nurse Ratched, <b> description: </b> Extra information on activity , </p> 
    </div> 
  </text> 
  <contained> 
    <ActivityDefinition> 
      <id value="procedure"/> 
      <status value="draft"/> 
      <!--  Extra information on activity  -->
      <description value="Extra information on activity "/> 
      <kind value="ServiceRequest"/> 
      <code> 
        <coding> 
          <system value="http://loinc.org"/> 
          <code value="39156-5"/> 
          <display value="Body mass index (BMI) [Ratio]"/> 
        </coding> 
      </code> 
      <!--    When should this activity occur
      <timingCodeableConcept></timingCodeableConcept>
        -->

      <!--   Where should it occur
      <location></location>  -->
      <!--  Who should do this  -->
      <participant> 
        <type value="practitioner"/> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/practitioner-role"/> 
            <code value="doctor"/> 
            <display value="Doctor"/> 
          </coding> 
        </role> 
      </participant> 
      <!--   To specify context-specific information, use dynamicValue elements   -->
      <!--  performer>
        <display value="Nurse Ratched"/>
      </performer  -->
      <!--  What supplied or administiered if applicable and how much
      <product></product>
      <quantity></quantity>
        -->
    </ActivityDefinition> 
  </contained> 
  <identifier> 
    <system value="http://acme.org"/> 
    <value value="example-1"/> 
  </identifier> 
  <title value="Obesity Assessment Protocol"/> 
  <!--  A code that classifies the general type of context to which these behavior definitions
   apply. This is used for searching, sorting and display purposes.  -->
  <type> 
    <coding> 
      <code value="clinical-protocol"/> 
    </coding> 
  </type> 
<!--  The status of the protocol.draft | active | retired  -->
  <status value="draft"/> 
  <useContext> 
  <code> 
    <code value="focus"/> 
  </code> 
  <valueCodeableConcept> 
    <coding> 
      <system value="http://snomed.info/sct"/> 
      <code value="414916001"/> 
      <display value="Obesity (disorder)"/> 
    </coding> 
  </valueCodeableConcept> 
  </useContext> 
  <!--  When is the protocol to be used  -->
  <purpose value="Example of A medical algorithm for assessment and treatment of overweight and obesity"/> 
  <!--  Who wrote the Protocol  -->
  <author> 
    <name value="National Heart, Lung, and Blood Institute"/> 
    <telecom> 
    <system value="url"/> 
    <value value="https://www.nhlbi.nih.gov/health-pro/guidelines"/> 
  </telecom> 
  </author> 
  <!--  Where is the Protocol  -->
  <relatedArtifact> 
    <type value="derived-from"/> 
    <display value="Overweight and Obesity Treatment Guidelines"/> 
    <document> 
      <url value="http://www.nhlbi.nih.gov/health-pro/guidelines/current/obesity-guidelines/e_textbook/txgd/algorthm/a
      lgorthm.htm"/> 
    </document> 
  </relatedArtifact> 
  <!--  What does the protocol want to achieve  -->
  <goal id="reduce-bmi-ratio">
    <category> 
      <text value="Treatment"/> 
    </category> 
  <description> 
    <text value="Reduce BMI to below 25"/> 
  </description> 
  <priority> 
    <text value="medium-priority"/> 
  </priority> 
  <start> 
    <text value="When the patient's BMI Ratio is at or above 25"/> 
  </start> 
  <addresses> 
    <coding> 
      <system value="http://snomed.info/sct"/> 
      <code value="414916001"/> 
      <display value="Obesity (disorder)"/> 
    </coding> 
  </addresses> 
  <documentation> 
    <type value="justification"/> 
    <display value="Evaluation and Treatment Strategy"/> 
    <document> 
      <url value="https://www.nhlbi.nih.gov/health-pro/guidelines/current/obesity-guidelines/e_textbook/txgd/42.htm"/> 
    </document> 
  </documentation> 
  <target> 
    <measure> 
        <coding> 
          <system value="http://loinc.org"/> 
          <code value="39156-5"/> 
          <display value="Body mass index (BMI) [Ratio]"/> 
        </coding> 
    </measure> 
    <detailRange> 
      <high> 
        <value value="24.9"/> 
        <unit value="kg/m2"/> 
      </high> 
    </detailRange> 
    <due> 
      <value value="1"/> 
      <unit value="a"/> 
    </due> 
  </target> 
  </goal> 
  <!--    The meat of the protocol - a series of steps  -->
  <action> 
    <!--  step title  -->
    <title value="Measure BMI"/> 
    <description value="Measure, Weight, Height, Waist, Circumference; Calculate BMI"/> 
    <!--  description of activity  -->
    <textEquivalent value="Weight must be measured so that the BMI can be calculated. Most charts are based on weights
     obtained with the patient wearing undergarments and no shoes. BMI can be manually calculated
     (kg/[height in meters]2), but is more easily obtained from a nomogram. Waist circumference
     is important because evidence suggests that abdominal fat is a particularly strong determinant
     of cardiovascular risk in those with a BMI of 25 to 34.9 kg/m2. Increased waist circumference
     can also be a marker of increased risk even in persons of normal weight. The technique
     for measuring waist circumference is described in the text. A nutrition assessment will
     also help to assess the diet and physical activity habits of overweight patients"/> 
    <!--  How long does each step last
<duration></duration>
  -->
    <goalId value="reduce-bmi-ratio"/> 
    <!--  Rules prior to execution  -->
    <condition> 
      <kind value="applicability"/> 
      <expression> 
        <description value="The practitioner must seek to determine whether the patient has ever been overweight.
         While a technical definition is provided, a simple question such as 'Have you ever been
         overweight?' will accomplish the same goal. Questions directed towards weight history,
         dietary habits, physical activities, and medications may provide useful information about
         the origins of obesity in particular patients.  For those who have not been overweight,
         a 2 year interval is appropriate for the reassessment of BMI. While this time span is
         not evidence-based, it is believed to be a reasonable compromise between the need to identify
         weight gain at an early stage and the need to limit the time, effort, and cost of repeated
         measurements."/> 
        <language value="text/cql"/> 
        <expression value="exists ([Condition: Obesity]) or not exists ([Observation: BMI] O where O.effectiveDateTime
         2 years or less before Today())"/> 
      </expression> 
    </condition> 
    <requiredBehavior value="must-unless-documented"/> 
    <cardinalityBehavior value="single"/> 
    <!--    Activities that occur within timepoint  -->
    <definitionCanonical value="#procedure"/> 
  </action> 
</PlanDefinition>