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 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 &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 style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (
          <a href="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> 
      <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> 
          <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> 
        <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> 
      </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 value="ServiceRequest"/> 
      <timingTiming> 
        <event> 
          <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> 
        <strength> 
          <numerator> 
            <value value="25"/> 
            <unit value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </denominator> 
        </strength> 
      </ingredient> 
    </Medication> 
  </contained> 
  <contained> 
    <Substance> 
      <id value="metoprololTartrate25Substance"/> 
      <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="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> 
        <strength> 
          <numerator> 
            <value value="50"/> 
            <unit value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </denominator> 
        </strength> 
      </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="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> 
        <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> 
        <strength> 
          <numerator> 
            <value value="0.4"/> 
            <unit value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </denominator> 
        </strength> 
      </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> 
    <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> 
    <use value="official"/> 
    <system value="urn:va.gov:kbs:knart:artifact:r1"/> 
    <value value="bb7ccea6-9744-4743-854a-bcffd87191f6"/> 
  </identifier> 
  <identifier> 
    <system value="urn:va.gov:kbs:contract:VA118-16-D-1008:to:VA-118-16-F-1008-0007"/> 
    <value value="CLIN0004AG"/> 
  </identifier> 
  <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"/> 
  <experimental value="true"/> 
  <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"/> 
  </author> 
  <author> 
    <name value="Scott Wall MD"/> 
  </author> 
  <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"/> 
    <url value="NEED-A-URL-HERE"/> 
    <document> 
      <url value="NEED-A-URL-HERE"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
    <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"/> 
    <document> 
      <url value="https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
    <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"/> 
    <document> 
      <url value="https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
    <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"/> 
    <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"/> 
    <document> 
      <url value="NEED-A-URL-HERE"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
    <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)"/> 
    <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"/> 
    <document> 
      <url value="NEED-A-URL-HERE"/> 
    </document> 
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    <type value="justification"/> 
    <display value="LABEL: ASPIRIN 81 MG- aspirin tablet, coated"/> 
    <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"/> 
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     of Medicine; 2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=edae8df1
    -caf9-ff72-1304-5ae8b355f8e7."/> 
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     of Medicine; 2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155
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  <relatedArtifact> 
    <type value="justification"/> 
    <display value="LABEL: METOPROLOL SUCCINATE EXTENDED-RELEASE - metoprolol succinate tablet, film coated,
     extended release"/> 
    <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."/> 
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  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
    <display value="LABEL: NITROGLYCERIN- nitroglycerin tablet"/> 
    <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."/> 
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    <display value="LABEL: SIMVASTATIN - simvastatin tablet"/> 
    <citation value="LABEL: SIMVASTATIN - simvastatin tablet [Internet].: National Library of Medicine; 2017.
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    69df06146."/> 
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