Release 5
WorkflowThis page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions 
. Page versions: R5 R4B R4
| Clinical Decision Support Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: No defined compartments |
Raw XML (canonical form + also see XML Format Specification)
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: PlanDefinition</b> <a name="example-cardiology-os"> </a> </p> <div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PlanDefinition "example-cardiology-os" </p> </div> <p> <b> url</b> : <code> http://va.gov/kas/orderset/B5-Cardiology-ChestPainCAD-OS</code> </p> <p> <b> identifier</b> : id: urn:oid:2.16.840.1.113883.4.642.11.8, id: bb7ccea6-9744-4743-854a-bcffd87191f6 (use: OF FICIAL), <span title=" identifierName="Contract: VA118-16-D-1008, Task Order (TO): VA-118-16-F-1008-0007, CLIN0004AG" ">id: CLIN0004AG</span> , <span title=" identifierName="Jira KP-914" ">id: KP-914</span> </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 style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.1.0/CodeSystem-plan-definition-type.html">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> <h3> UseContexts</h3> <table class="grid"><tr> <td> -</td> <td> <b> Code</b> </td> <td> <b> Value[x]</b> </td> </tr> <tr> <td> *</td> <td> Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code focus = 'Clinical Focus', stated as 'null')</td> <td> appropriate snomed condition <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #look up value)</span> </td> </tr> </table> <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> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : derived-from</p> <p> <b> display</b> : Cardiology: Chest Pain (CP) / Coronary Artery Disease (CAD) Clinical Content White Paper</p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" used the description from HeD example for display here ">Outcome CVD (coronary death, myocardial infarction, coronary insufficiency, angina, ischemic stroke, hemorrhagic stroke, transient ischemic attack, peripheral artery disease, heart failure)</span> </p> <p> <b> citation</b> : Cardiovascular disease (10-year risk) [Internet].: Framingham Heart Study; cited 2017]. Available from: https://www.framinghamheartstudy.org/risk-functions/cardi ovascular-disease/10-year-risk.php.</p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" 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> &#10; used the title from HeD example for display here ">General cardiovascular risk profile for use in primary care: the Framingham Heart Study</span> </p> <p> <b> citation</b> : Cardiovascular disease (10-year risk) [Internet].: Framingham Heart Study; cited 2017]. Available from: https://www.framinghamheartstudy.org/risk-functions/cardi ovascular-disease/10-year-risk.php.</p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" 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& quot;/> </identifiers> &#10; used the title from HeD example for display here ">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</span> </p> <p> <b> citation</b> : <span title=" 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"/> ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" 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="LocalDocBo ok"/> </identifiers> &#10; used the title from HeD example for display here ">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)</span> </p> <p> <b> citation</b> : <span title=" there was no description in this specific entry ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" 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> &#10; used the title from HeD example for display here ">LABEL: ASPIRIN 81 MG- aspirin tablet, coated</span> </p> <p> <b> citation</b> : <span title=" there was no description in this specific entry ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" 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"/&g t; </identifiers> &#10; used the title from HeD example for display here ">LABEL: CLOPIDOGREL- clopidogrel bisulfate tablet, film coated</span> </p> <p> <b> citation</b> : <span title=" there was no description in this specific entry ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" 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> &#10; used the title from HeD example for display here ">LABEL: LIPITOR- atorvastatin calcium tablet, film coated</span> </p> <p> <b> citation</b> : <span title=" there was no description in this specific entry ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" 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> &#10; used the title from HeD example for display here ">LABEL: METOPROLOL SUCCINATE EXTENDED-RELEASE - metoprolol succinate tablet, film coated, extended release</span> </p> <p> <b> citation</b> : <span title=" there was no description in this specific entry ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" 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> &#10; used the title from HeD example for display here ">LABEL: NITROGLYCERIN- nitroglycerin tablet</span> </p> <p> <b> citation</b> : <span title=" there was no description in this specific entry ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" 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> &#10; used the title from HeD example for display here ">LABEL: SIMVASTATIN - simvastatin tablet</span> </p> <p> <b> citation</b> : <span title=" there was no description in this specific entry ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title=" 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&qu ot;/> <identifier root="Skinner et al., 2010" identifierName="LocalDocB ook"/> </identifiers> &#10; used the title from HeD example for display here ">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.</span> </p> <p> <b> citation</b> : <span title=" there was no description in this specific entry ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <p> <b> library</b> : <code> #cardiology-chestPain-logic</code> </p> <blockquote> <p> <b> action</b> </p> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Consults and Referrals</p> <p> <b> groupingBehavior</b> : logical-group</p> <p> <b> selectionBehavior</b> : any</p> <blockquote> <p> <b> action</b> </p> </blockquote> <blockquote> <p> <b> action</b> </p> </blockquote> <blockquote> <p> <b> action</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> action</b> </p> <p> <b> title</b> : Medications</p> <p> <b> description</b> : Consider the following medications for stable patients to be initiated prior to the cardiology consultation.</p> <blockquote> <p> <b> action</b> </p> </blockquote> <blockquote> <p> <b> action</b> </p> </blockquote> <blockquote> <p> <b> action</b> </p> </blockquote> </blockquote> </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> <doseForm> <coding> <system value="http://snomed.info/sct"/> <code value="385055001"/> <display value="Tablet dose form"/> </coding> <text value="Tablet dose form"/> </doseForm> <ingredient> <item> <reference> <reference value="#metoprololTartrate25Substance"/> </reference> </item> <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"/> <instance value="false"/> <code> <concept> <coding> <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> <code value="6918"/> </coding> <text value="Metoprolol"/> </concept> </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> <doseForm> <coding> <system value="http://snomed.info/sct"/> <code value="385055001"/> <display value="Tablet dose form"/> </coding> <text value="Tablet dose form"/> </doseForm> <ingredient> <item> <reference> <reference value="#metoprololTartrate50Substance"/> </reference> </item> <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"/> <instance value="false"/> <code> <concept> <coding> <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> <code value="6918"/> </coding> <text value="Metoprolol"/> </concept> </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> <doseForm> <coding> <system value="http://snomed.info/sct"/> <code value="385055001"/> <display value="Tablet dose form"/> </coding> <text value="Tablet dose form"/> </doseForm> <ingredient> <item> <reference> <reference value="#nitroglycerinSubstance"/> </reference> </item> <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"/> <instance value="false"/> <code> <concept> <coding> <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> <code value="4917"/> </coding> <text value="Nitroglycerin"/> </concept> </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="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> <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> <!-- 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"/> <document> <url value="NEED-A-URL-HERE"/> </document> </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/cardiovascul ar-disease/10-year-risk.php."/> <document> <url value="https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php"/> </document> </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/cardiovascul ar-disease/10-year-risk.php."/> <document> <url value="https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php"/> </document> </relatedArtifact> <relatedArtifact> <type value="justification"/> <!-- no identifier field available, this is an example of what is in the source OS <identifiers> <identifier root="10.1016/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."/> <document> <url value="NEED-A-URL-HERE"/> </document> </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."/> <document> <url value="NEED-A-URL-HERE"/> </document> </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."/> <document> <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b4064039-2345-4227-b83d-54dc13a838d3"/> </document> </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."/> <document> <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155-bc00-406b-b097-e8aece187a8a"/> </document> </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."/> <document> <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155-bc00-406b-b097-e8aece187a8a"/> </document> </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."/> <document> <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2d948600-35d8-4490-983b-918bdce488c8"/> </document> </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."/> <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."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"/> <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>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
FHIR ®© HL7.org 2011+. FHIR R5 hl7.fhir.core#5.0.0 generated on Sun, Mar 26, 2023 15:25+1100.
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