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

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  <id value="example-cardiology-os"/> 
  <contained> 
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      <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."/> 
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        <text value="Referral to Cardiology" />
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      <dosage> 
        <text value="1 tablet oral 2 time daily"/> 
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        <route> 
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            <display value="Oral route (qualifier value)"/> 
          </coding> 
          <text value="Oral route (qualifier value)"/> 
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      <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> 
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          <doseQuantity> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
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        <maxDosePerAdministration> 
          <value value="3"/> 
          <unit value="{tbl}"/> 
        </maxDosePerAdministration> 
      </dosage> 
      <dynamicValue> 
        <path value="medicationRequest.priority"/> 
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          <expression value="routine"/> 
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  <contained> 
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      <id value="nitroglycerinMedication"/> 
      <code> 
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          <code value="316365"/> 
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        <text value="Nitroglycerin 0.4 MG"/> 
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      <doseForm> 
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          <code value="385055001"/> 
          <display value="Tablet (basic dose form)"/> 
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        <text value="Tablet dose form"/> 
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      <ingredient> 
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          <reference> 
            <reference value="#nitroglycerinSubstance"/> 
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        <strengthRatio> 
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            <unit value="mg"/> 
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            <value value="1"/> 
            <unit value="{tbl}"/> 
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          <text value="Nitroglycerin"/> 
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      </code> 
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  </contained> 
  <contained> 
    <Questionnaire> 
      <id value="CollectReferralReason"/> 
      <status value="draft"/> 
      <item> 
        <linkId value="1"/> 
        <text value="Reason for Cardiology Consult"/> 
        <type value="coding"/> 
        <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> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="cds"/> 
  </extension> 
  <url value="http://va.gov/kas/orderset/B5-Cardiology-ChestPainCAD-OS"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.11.8"/> 
  </identifier> 
  <identifier> 
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    <system value="urn:va.gov:kbs:knart:artifact:r1"/> 
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  <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="HL7 International / Clinical Decision Support"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://www.hl7.org/Special/committees/dss"/> 
    </telecom> 
  </contact> 
  <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="56265001"/> 
        <display value="Heart disease (disorder)"/> 
      </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"/> 
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        <affiliation>
               <name
                 value="Professor, Cardiovascular Medicine, University of Utah
   School of Medicine; Staff
                 Cardiologist, Salt Lake City VA Medical Center (VAMC)"
                        />
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  <author> 
    <name value="Bruce Bray MD"/> 
  </author> 
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     <affiliation>
        <name
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   School of
           Medicine Staff Cardiologist, Electrophysiology, Salt Lake City VAMC"
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    <name value="Scott Wall MD"/> 
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     <affiliation>
        <name
           value="Professor of Medicine, Wayne State University; Section Chief,
   Cardiology, John Dingell VAMC" />
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  <author> 
    <name value="Aiden Abidov MD, PhD"/> 
  </author> 
  <relatedArtifact> 
    <type value="derived-from"/> 
    <display value="Cardiology: Chest Pain (CP) / Coronary Artery Disease (CAD) Clinical Content White
     Paper"/> 
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    </document> 
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  <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/cardiovascul
    ar-disease/10-year-risk.php."/> 
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         <identifier root="D'Agostino RB et al., 2008"
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    <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/cardiovascul
    ar-disease/10-year-risk.php."/> 
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    <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"/> 
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    <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."/> 
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     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."/> 
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    47ac-ae28-ce2dafd6b5c9."/> 
    <document> 
      <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=67bf2a15-b115-47ac-ae28-ce2dafd6b5c9"/> 
    </document> 
  </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."/> 
    <document> 
      <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5c1c694c-4b08-469e-b538-08e69df06146"/> 
    </document> 
  </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."/> 
    <document> 
      <url value="http://heart.bmj.com/content/96/12/974.long"/> 
    </document> 
  </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>
       -->
    <!--   Original order set has sections for Antiplatelet Therapy and Risk Factor Reduction
     not encoded here   -->
    <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> 
    </action> 
  </action> 
</PlanDefinition>