FHIR Clincal Guidelines (v1.0.0) (STU 1)
This page is part of the Clinical Guidelines (v1.0.0: STU 1) based on FHIR R4. 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 
This is an example computable clinical practice guideline (CPG) illustrating a congestive heart failure (CHF) care pathway.
The following diagram illustrates a Case/Plan Summary View for the guideline, showing the major components and how they fit together:
Overall, this is a patient-centric view, from the perspective of the congestive heart failure pathway, showing how the patient is progressing along the pathway, and providing the most relevant information and indicators.
The pathway has two strategies, CHF Daily Management, and CHF Hypervolemia. These strategies are then made up of recommendations. The Daily Management strategy is made up of the Weight, Weight Change, Urine Out, and Net IO’s recommendations, and the Hypervolemia strategy is made up of the JVP, O2 Sat, Potassium, Creatinine, eGFR, LASIX, and Cardiology Consultation recommendations.
The timeline view in the center depicts patient events, proposals, and planned items as determined by the overall care pathway. Along the left-side of the timeline, the pathway event (or case feature) is named, and along the right-side of the timeline, a goal is provided for that case feature. The goal is defined by the pathway as part of the recommendation associated with that case feature.
Within the timeline view, events in green indicate metrics that are on-pathway, while events in grey indicate case features that aren’t reported as metrics. Items in yellow are cautions that indicate actions should be considered, (such as measuring Jugular Venous Pressure), while events in red indicate values that are off-pathway or indicate immediate attention is needed.
The example CPG artifacts are organized as follows:
For the example case, a Patient is defined with
a Case, an Encounter,
and a Condition, establishing the patient
as having an admitting diagnosis of Congestive Heart Failure. This meets the Inclusion Criteria
defined by the group, and results in the patient being added to the pathway, and
included as a member of the CHF Group. This
results in the creation of a CarePlan, with
Daily Management and
Hypervolemia strategies. Each of these
strategies establish actions and goals for each of the recommendations.
The diagram above is a snapshot of the Case/Plan Summary View at 9:41 AM on February 3rd, 2019, the 4th day of the encounter.
Weight CaseFeatureDefinition: Weight in kg Observation: 96.9kg @2019-02-02T07:00 Observation: 95.7kg @2019-02-03T07:00 Goal: 92kg Metric: 95.7kg
Weight Change CaseFeatureDefinition: Weight change per day Observation: -1.2kg @2019-02-03T07:00 Goal: 0.5..1.5 kg/d (absolute value) Metric: -1.2kg @2019-02-03T07:00
Urine Out CaseFeatureDefinition: Urine Out Observation Daily Observation: 3.8L/24hr (1.9L/8hr) @2019-02-02T07:00..2019-02-03T07:00 Goal: 3..5 L/day
Net IO’s CaseFeatureDefinition: Net IO’s Observation Daily Observation: -2.1L/24hr (-1.2L/8hr) @2019-02-02T07:00..2019-02-03T07:00
JVP ServiceRequest: Record Jugular Venous Pressure (in cmH2O) Sometime between @2019-02-03 Pertinents: JVP 4-day: 9.1 8.5 8.4 8.2 WT 4-day: 96 95.4 96.9 95.7 24hr UOP: 2.1L 3.1L 2.9L 4.1L LASIX: 40 mg IV x10 @2019-01-31..2019-02-03
O2 Sat: CaseFeatureDefinition: Observation: 87% @2019-02-03T05:00 (Critical Low) Observation: 93% @2019-02-03T09:41 Goal: < 8.0cmH2O Proposed: @2019-02-03T13:00
Potassium: CaseFeatureDefinition: Observation: 3.9 mEq/L Goal: 3.5..5.0
Creatinine: CaseFeatureDefinition: Observation: 0.9 mg/dL @2019-02-03T09:41 Goal: < 1.2 mg/dL
eGFR: CaseFeatureDefinition: Observation: 65 mL/mm/m2 @2019-02-03T09:41 Goal: > 60 mL/mm/m2
LASIX IV: CaseFeatureDefinition MedicationAdministration: 40 mg ServiceRequest: Stop LASIX IV @2019-02-03T13:00
LASIX PO: CaseFeatureDefinition MedicationRequest: Transition to LASIX PO @2019-02-03T13:00
HCTZX: CaseFeatureDefinition PO QD @2019-02-03T07:00
Cardiology Consultation: Case Feature Definition: Service Request: Within @2019-02-03T11:00..2019-02-04T11:00
History: Condition: Congestive Heart Failure @2015-08-20T12:11 Procedure: Electrocardiogram @2018-08-24T09:17 Encounter: History & Physical @2018-11-09T16:03 Composition: Cardiology Consult @2018-11-10T11:31 Composition: Discharge Summary @2018-11-11T13:52 CarePlan: Heart Failure Care Pathway (discharged) @2018-11-11T17:43
The following index lists all the case-specific resources in this example:
The following index lists all the artifacts (case-independent) in this example:
| Resource Type | Resource |
|---|---|
| ActivityDefinition | chf-bodyweight-change |
| ActivityDefinition | chf-bodyweight |
| ActivityDefinition | chf-cardiology-consultation |
| ActivityDefinition | chf-creatinine |
| ActivityDefinition | chf-egfr |
| ActivityDefinition | chf-jvp |
| ActivityDefinition | chf-lasix-iv |
| ActivityDefinition | chf-lasix-po |
| ActivityDefinition | chf-net-io |
| ActivityDefinition | chf-o2-sat |
| ActivityDefinition | chf-potassium |
| ActivityDefinition | chf-report-bodyweight-change |
| ActivityDefinition | chf-report-bodyweight |
| ActivityDefinition | chf-report-urine-out |
| ActivityDefinition | chf-urine-out |
| CareTeam | chf-careteamdefinition |
| CodeSystem | chf-codes |
| GraphDefinition | chf-caseplansummarydefinition |
| GraphDefinition | chf-casesummarydefinition |
| Group | chf-groupdefinition |
| ImplementationGuide | chf |
| Library | CHF |
| Location | chf-locationdefinition |
| Measure | chf-bodyweight-change |
| Measure | chf-bodyweight |
| Measure | chf-urine-out |
| PlanDefinition | chf-bodyweight-change |
| PlanDefinition | chf-bodyweight |
| PlanDefinition | chf-cardiology-consultation |
| PlanDefinition | chf-creatinine |
| PlanDefinition | chf-daily-management |
| PlanDefinition | chf-egfr |
| PlanDefinition | chf-hypervolemia |
| PlanDefinition | chf-jvp |
| PlanDefinition | chf-lasix |
| PlanDefinition | chf-net-io |
| PlanDefinition | chf-o2-sat |
| PlanDefinition | chf-pathway |
| PlanDefinition | chf-potassium |
| PlanDefinition | chf-urine-out |
| PractitionerRole | chf-practitionerroledefinition |
| StructureDefinition | chf-bodyweight-change |
| StructureDefinition | chf-bodyweight |
| StructureDefinition | chf-cardiology-consult-request |
| StructureDefinition | chf-cardiology-consult |
| StructureDefinition | chf-creatinine |
| StructureDefinition | chf-egfr |
| StructureDefinition | chf-jvp-request |
| StructureDefinition | chf-jvp |
| StructureDefinition | chf-lasix-iv-administration |
| StructureDefinition | chf-lasix-iv-request |
| StructureDefinition | chf-lasix-po-administration |
| StructureDefinition | chf-lasix-po-request |
| StructureDefinition | chf-net-io |
| StructureDefinition | chf-o2-sat-request |
| StructureDefinition | chf-o2-sat |
| StructureDefinition | chf-potassium |
| StructureDefinition | chf-urine-out |
© HL7.org (Clinical Decision Support WG). hl7.fhir.uv.cpg#1.0.0 based on FHIR v4.0.1. Generated 2021-02-11.
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