Release 4B

This page is part of the FHIR Specification (v4.3.0: R4B - STU). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4

Plandefinition-example-cardiology-os.json

Clinical Decision Support Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Not linked to any defined compartments

Raw JSON (canonical form + also see JSON Format Specification)

Chest Pain Coronary Artery Disease Order Set KNART

{
  "resourceType" : "PlanDefinition",
  "id" : "example-cardiology-os",
  "text" : {
    "status" : "generated",
    "div" : "<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>"
  },
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    "id" : "cardiology-chestPain-logic",
    "status" : "active",
    "type" : {
      "coding" : [{
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        "code" : "logic-library",
        "display" : "Logic Library"
      }]
    },
    "description" : "Placeholder library"
  },
  {
    "resourceType" : "ActivityDefinition",
    "id" : "referralToCardiologyConsult",
    "status" : "draft",
    "description" : "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" : "ServiceRequest",
    "timingTiming" : {
      "event" : [null],
      "_event" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
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    "participant" : [{
      "type" : "practitioner"
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    "resourceType" : "ActivityDefinition",
    "id" : "metoprololTartrate25Prescription",
    "status" : "draft",
    "kind" : "MedicationRequest",
    "productReference" : {
      "reference" : "#metoprololTartrate25Medication"
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    "dosage" : [{
      "text" : "1 tablet oral 2 time daily",
      "timing" : {
        "repeat" : {
          "frequency" : 2,
          "period" : 1,
          "periodUnit" : "d"
        }
      },
      "route" : {
        "coding" : [{
          "code" : "26643006",
          "display" : "Oral route (qualifier value)"
        }],
        "text" : "Oral route (qualifier value)"
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      "doseAndRate" : [{
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/dose-rate-type",
            "code" : "ordered",
            "display" : "Ordered"
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    "code" : {
      "coding" : [{
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "866426"
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      "text" : "Metoprolol Tartrate 25 MG"
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    "form" : {
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        "code" : "385055001",
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      "strength" : {
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          "unit" : "mg"
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      "timing" : {
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          "period" : 1,
          "periodUnit" : "d"
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          "display" : "Oral route (qualifier value)"
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        "text" : "Oral route (qualifier value)"
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      "doseAndRate" : [{
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    "resourceType" : "Medication",
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    "code" : {
      "coding" : [{
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "866435"
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      "text" : "Metoprolol Tartrate 50 MG"
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      "coding" : [{
        "system" : "http://snomed.info/sct",
        "code" : "385055001",
        "display" : "Tablet dose form"
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      "text" : "Tablet dose form"
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      "itemReference" : {
        "reference" : "#metoprololTartrate50Substance"
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      "strength" : {
        "numerator" : {
          "value" : 50,
          "unit" : "mg"
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          "value" : 1,
          "unit" : "{tbl}"
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  {
    "resourceType" : "Substance",
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    "code" : {
      "coding" : [{
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
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      "text" : "Metoprolol"
    }
  },
  {
    "resourceType" : "ActivityDefinition",
    "id" : "nitroglycerinPrescription",
    "status" : "draft",
    "kind" : "MedicationRequest",
    "productReference" : {
      "reference" : "#nitroglycerinMedication"
    },
    "dosage" : [{
      "text" : "nitroglycerin 0.4 mg tablet sub-lingual every 5 minutes as needed for chest pain; maximum 3 tablets",
      "timing" : {
        "repeat" : {
          "frequency" : 1,
          "period" : 5,
          "periodUnit" : "min"
        }
      },
      "doseAndRate" : [{
        "type" : {
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          "unit" : "{tbl}"
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      "maxDosePerAdministration" : {
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        "unit" : "{tbl}"
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    "resourceType" : "Medication",
    "id" : "nitroglycerinMedication",
    "code" : {
      "coding" : [{
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "316365"
      }],
      "text" : "Nitroglycerin 0.4 MG"
    },
    "form" : {
      "coding" : [{
        "system" : "http://snomed.info/sct",
        "code" : "385055001",
        "display" : "Tablet dose form"
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      "text" : "Tablet dose form"
    },
    "ingredient" : [{
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        "reference" : "#nitroglycerinSubstance"
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      "strength" : {
        "numerator" : {
          "value" : 0.4,
          "unit" : "mg"
        },
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          "value" : 1,
          "unit" : "{tbl}"
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        "code" : "4917"
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      "text" : "Nitroglycerin"
    }
  },
  {
    "resourceType" : "Questionnaire",
    "id" : "CollectReferralReason",
    "status" : "draft",
    "item" : [{
      "linkId" : "1",
      "text" : "Reason for Cardiology Consult",
      "type" : "choice",
      "required" : true,
      "repeats" : true,
      "answerValueSet" : "#CardiologyReferralReasonValues"
    }]
  },
  {
    "resourceType" : "Questionnaire",
    "id" : "CardiologyConsultationGoal",
    "status" : "draft",
    "item" : [{
      "linkId" : "2",
      "text" : "Goal of cardiology consultation",
      "type" : "string"
    }]
  }],
  "url" : "http://va.gov/kas/orderset/B5-Cardiology-ChestPainCAD-OS",
  "identifier" : [{
    "use" : "official",
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  {
    "system" : "urn:va.gov:kbs:contract:VA118-16-D-1008:to:VA-118-16-F-1008-0007",
    "value" : "CLIN0004AG"
  },
  {
    "system" : "urn:cognitivemedicine.com:lab:jira",
    "value" : "KP-914"
  }],
  "version" : "0.1",
  "name" : "ChestPainCoronaryArteryDiseaseOrderSetKNART",
  "title" : "Chest Pain (CP) - Coronary Artery Disease (CAD) Order Set KNART",
  "type" : {
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      "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
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  },
  "status" : "active",
  "experimental" : true,
  "date" : "2017-08-29",
  "publisher" : "Department of Veterans Affairs",
  "description" : "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.",
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    "valueCodeableConcept" : {
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        "code" : "look up value",
        "display" : "appropriate snomed condition"
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  "usage" : "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" : "© Copyright Cognitive Medical Systems, Inc. 9444 Waples Street Suite 300 San Diego, CA 92121",
  "author" : [{
    "name" : "Bruce Bray MD"
  },
  {
    "name" : "Scott Wall MD"
  },
  {
    "name" : "Aiden Abidov MD, PhD"
  }],
  "relatedArtifact" : [{
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    "display" : "Cardiology: Chest Pain (CP) / Coronary Artery Disease (CAD) Clinical Content White Paper",
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      "url" : "NEED-A-URL-HERE"
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    "citation" : "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.",
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    "citation" : "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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  "library" : ["#cardiology-chestPain-logic"],
  "action" : [{
    "action" : [{
      "title" : "Consults and Referrals",
      "groupingBehavior" : "logical-group",
      "selectionBehavior" : "any",
      "action" : [{
        "textEquivalent" : "Referral to cardiology to evaluate chest pain (routine)",
        "definitionCanonical" : "#referralToCardiologyConsult",
        "dynamicValue" : [{
          "path" : "timing.event",
          "expression" : {
            "language" : "text/cql",
            "expression" : "Now()"
          }
        },
        {
          "path" : "specialty",
          "expression" : {
            "language" : "text/cql",
            "expression" : "Code '261QM0850X' from CardiologyChestPainLogic.\"NUCC Provider Taxonomy\" display 'Adult Mental Health'"
          }
        },
        {
          "path" : "occurrenceDateTime",
          "expression" : {
            "language" : "text/cql",
            "expression" : "CardiologyChestPainLogic.ServiceRequestFulfillmentTime"
          }
        },
        {
          "path" : "subject",
          "expression" : {
            "language" : "text/cql",
            "expression" : "CardiologyChestPainLogic.Patient"
          }
        },
        {
          "path" : "requester.agent",
          "expression" : {
            "language" : "text/cql",
            "expression" : "CardiologyChestPainLogic.Practitioner"
          }
        },
        {
          "path" : "reasonCode",
          "expression" : {
            "language" : "text/cql",
            "expression" : "CardiologyChestPainLogic.CardiologyReferralReason"
          }
        },
        {
          "path" : "reasonReference",
          "expression" : {
            "language" : "text/cql",
            "expression" : "CardiologyChestPainLogic.RiskAssessment"
          }
        }]
      },
      {
        "title" : "Reason for cardiology consultation",
        "definitionCanonical" : "#CollectReferralReason"
      },
      {
        "title" : "Goal of cardiology consultation",
        "definitionCanonical" : "#CardiologyConsultationGoal"
      }]
    },
    {
      "title" : "Medications",
      "description" : "Consider the following medications for stable patients to be initiated prior to the cardiology consultation.",
      "action" : [{
        "groupingBehavior" : "logical-group",
        "selectionBehavior" : "at-most-one"
      },
      {
        "title" : "Antianginal Therapy",
        "groupingBehavior" : "logical-group",
        "selectionBehavior" : "at-most-one",
        "action" : [{
          "textEquivalent" : "metoprolol tartrate 25 mg tablet 1 tablet oral 2 time daily",
          "definitionCanonical" : "#metoprololTartrate25Prescription",
          "dynamicValue" : [{
            "path" : "status",
            "expression" : {
              "language" : "text/cql",
              "expression" : "'draft'"
            }
          },
          {
            "path" : "patient",
            "expression" : {
              "language" : "text/cql",
              "expression" : "CardiologyChestPainLogic.Patient"
            }
          },
          {
            "path" : "prescriber",
            "expression" : {
              "language" : "text/cql",
              "expression" : "CardiologyChestPainLogic.Practitioner"
            }
          }]
        },
        {
          "textEquivalent" : "metoprolol tartrate 50 mg tablet 1 tablet oral 2 time daily",
          "definitionCanonical" : "#metoprololTartrate50Prescription",
          "dynamicValue" : [{
            "path" : "status",
            "expression" : {
              "language" : "text/cql",
              "expression" : "'draft'"
            }
          },
          {
            "path" : "patient",
            "expression" : {
              "language" : "text/cql",
              "expression" : "CardiologyChestPainLogic.Patient"
            }
          },
          {
            "path" : "prescriber",
            "expression" : {
              "language" : "text/cql",
              "expression" : "CardiologyChestPainLogic.Practitioner"
            }
          }]
        },
        {
          "textEquivalent" : "amlodipine 5  tablet 1 tablet oral  daily",
          "definitionCanonical" : "#amlodipinePrescription",
          "dynamicValue" : [{
            "path" : "status",
            "expression" : {
              "language" : "text/cql",
              "expression" : "'draft'"
            }
          },
          {
            "path" : "patient",
            "expression" : {
              "language" : "text/cql",
              "expression" : "CardiologyChestPainLogic.Patient"
            }
          },
          {
            "path" : "prescriber",
            "expression" : {
              "language" : "text/cql",
              "expression" : "CardiologyChestPainLogic.Practitioner"
            }
          }]
        }]
      },
      {
        "title" : "Nitroglycerin",
        "groupingBehavior" : "logical-group",
        "selectionBehavior" : "at-most-one",
        "action" : [{
          "textEquivalent" : "nitroglycerin 0.4 mg tablet sub-lingual every 5 minutes as needed for chest pain; maximum 3 tablets",
          "definitionCanonical" : "#nitroglycerinPrescription",
          "dynamicValue" : [{
            "path" : "status",
            "expression" : {
              "language" : "text/cql",
              "expression" : "'draft'"
            }
          },
          {
            "path" : "patient",
            "expression" : {
              "language" : "text/cql",
              "expression" : "CardiologyChestPainLogic.Patient"
            }
          },
          {
            "path" : "prescriber",
            "expression" : {
              "language" : "text/cql",
              "expression" : "CardiologyChestPainLogic.Practitioner"
            }
          }]
        }]
      }]
    }]
  }]
}

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.