Clinical Practice Guidelines
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Clinical Practice Guidelines, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cqf-recommendations/ and changes regularly. See the Directory of published versions

: CKD Ambulatory Plan Definition - JSON Representation

Active as of 2024-11-26

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{
  "resourceType" : "PlanDefinition",
  "id" : "cc-cpg-plan-ckd",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-ordersetdefinition"🔗 ,
      "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-computableplandefinition"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: PlanDefinition cc-cpg-plan-ckd</b></p><a name=\"cc-cpg-plan-ckd\"> </a><a name=\"hccc-cpg-plan-ckd\"> </a><a name=\"cc-cpg-plan-ckd-en-US\"> </a><p><b>CQF Knowledge capability</b>: shareable</p><p><b>CQF Knowledge capability</b>: computable</p><p><b>CQF Knowledge capability</b>: publishable</p><p><b>url</b>: <a href=\"PlanDefinition-cc-cpg-plan-ckd.html\">PlanDefinition ChronicKidneyDiseaseAmbulatory</a></p><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.1.0/NamingSystem-uri.html\" title=\"As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase) and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.txt \r\n\r\nThis oid is used as an identifier II.root to indicate the the extension is an absolute URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid or urn:uuid: \r\n\r\nNote that this OID is created to aid with interconversion between CDA and FHIR - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear more commonly in FHIR.\r\n\r\nThis OID may also be used in CD.codeSystem.\">Uniform Resource Identifier (URI)</a>/urn:oid:2.16.840.1.113883.4.642.40.48.34.21</p><p><b>version</b>: 2.0.0</p><p><b>name</b>: ChronicKidneyDiseaseAmbulatory</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/plan-definition-type order-set}\">Order Set</span></p><p><b>status</b>: Active</p><p><b>experimental</b>: true</p><p><b>date</b>: 2024-11-26 06:42:34+0000</p><p><b>publisher</b>: HL7 International / Clinical Decision Support</p><p><b>contact</b>: HL7 International / Clinical Decision Support: <a href=\"http://www.hl7.org/Special/committees/dss\">http://www.hl7.org/Special/committees/dss</a></p><p><b>description</b>: </p><div><p>Chronic Kidney Disease - Ambulatory</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.1.0/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 709044004}\">Chronic kidney disease (disorder)</span></td></tr></table><p><b>jurisdiction</b>: <span title=\"Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}\">World</span></p><p><b>copyright</b>: </p><div><p>Copyright © Elsevier, and others.</p>\n</div><p><b>topic</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/definition-topic treatment}\">Treatment</span></p><blockquote><p><b>relatedArtifact</b></p><p><b>type</b>: Justification</p><p><b>display</b>: SYNOPSIS - Chronic Kidney Disease\n\n\n\t\n\tKEY POINTS\n\n\t\n\t\tDecline in function of the kidney characterized by at least 3 months of reduced GFR (less than 60 mL/minute/ 1.73 m&amp;sup2;) or at least 3 months of structural or functional kidney damage\n\t\tAssessment of both GFR and albuminuria is necessary to diagnose chronic kidney disease and monitor disease progression\n\t\tGFR is most commonly estimated through measuring serum creatinine and the use of GFR estimating equations, either the Modification of Diet in Renal Disease Study equation or the Chronic Kidney Disease Epidemiology Collaboration equation\n\t\tAlbuminuria is measured by urine albumin/creatinine ratio; greater than 30 mg/g indicates albuminuria\n\t\tChronic kidney disease is commonly associated with hypertension, diabetes, and cardiovascular disease\n\t\tFirst line therapy includes ACE inhibitors and/or angiotensin II receptor blockers to reduce albuminuria and hypertension\n\t\tIf left untreated, chronic kidney disease can progress to end-stage renal disease requiring dialysis or renal transplant\n\t\t\n\t\t\tSymptoms of end-stage renal disease (eg, pruritus, refractory electrolyte imbalances, metabolic acidosis, severe nausea, neurologic impairments) typically occur when GFR is 5 to 10 mL/minute/1.73 m&amp;sup2;\n\t\t\n\t\t\n\t\tCarefully monitor electrolyte levels, hemoglobin, parathyroid hormone levels, and sodium bicarbonate levels to detect complications of chronic kidney disease, including cardiovascular disease, anemia, bone mineral disease, and metabolic acidosis\n\t\n\t\n\n\n\n\t\n\tURGENT ACTION\n\n\t\n\t\tHyperkalemia may require urgent treatment in patients being treated for chronic kidney disease\n\t\t\n\t\t\tUrgent treatment consists of calcium chloride or calcium gluconate and regimens of sodium bicarbonate, glucose and insulin, or nebulized albuterol\n\t\t\n\t\t\n\t\n\t\n\n\n\n\t\n\tPITFALLS\n\n\t\n\t\tEarly stages are often asymptomatic, causing chronic kidney disease to be untreated, leading to further progression of kidney damage and worse prognosis</p><p><b>citation</b>: </p><div><p>Chronic Kidney Disease Clinical Overview. ClinicalKey. Source</p>\n</div><p><b>url</b>: <a href=\"http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325\">http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325</a></p><h3>Documents</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325\">http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325</a></td></tr></table></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>cc-cpg-activity-referral-nephrology</blockquote><p><b>title</b>: Referrals</p><p><b>groupingBehavior</b>: Visual Group</p><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>34387224</blockquote><p><b>title</b>: Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]</p><p><b>description</b>: Referrals</p><p><b>requiredBehavior</b>: Could</p><p><b>precheckBehavior</b>: No</p><p><b>definition</b>: <a href=\"ActivityDefinition-cc-cpg-activity-referral-nephrology.html\">ReferralNephrology</a></p></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>cc-cpg-activity-referral-dietition</blockquote><p><b>title</b>: Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]</p><p><b>description</b>: Referrals</p><p><b>requiredBehavior</b>: Could</p><p><b>precheckBehavior</b>: No</p><p><b>definition</b>: <a href=\"ActivityDefinition-cc-cpg-activity-referral-dietitian.html\">ReferralDietitian</a></p></blockquote></blockquote></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability",
      "valueCode" : "shareable"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability",
      "valueCode" : "computable"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability",
      "valueCode" : "publishable"
    }
  ],
  "url" : "http://hl7.org/fhir/uv/cpg/PlanDefinition/cc-cpg-plan-ckd",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.4.642.40.48.34.21"
    }
  ],
  "version" : "2.0.0",
  "name" : "ChronicKidneyDiseaseAmbulatory",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
        "code" : "order-set",
        "display" : "Order Set"
      }
    ]
  },
  "status" : "active",
  "experimental" : true,
  "date" : "2024-11-26T06:42:34+00:00",
  "publisher" : "HL7 International / Clinical Decision Support",
  "contact" : [
    {
      "name" : "HL7 International / Clinical Decision Support",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/dss"
        }
      ]
    }
  ],
  "description" : "Chronic Kidney Disease - Ambulatory",
  "useContext" : [
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "focus",
        "display" : "Clinical Focus"
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "709044004",
            "display" : "Chronic kidney disease (disorder)"
          }
        ]
      }
    }
  ],
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code" : "001",
          "display" : "World"
        }
      ]
    }
  ],
  "copyright" : "Copyright © Elsevier, and others.",
  "topic" : [
    {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/definition-topic",
          "code" : "treatment",
          "display" : "Treatment"
        }
      ],
      "text" : "Treatment"
    }
  ],
  "relatedArtifact" : [
    {
      "type" : "justification",
      "display" : "SYNOPSIS - Chronic Kidney Disease\n\n\n\t\n\tKEY POINTS\n\n\t\n\t\tDecline in function of the kidney characterized by at least 3 months of reduced GFR (less than 60 mL/minute/ 1.73 m&sup2;) or at least 3 months of structural or functional kidney damage\n\t\tAssessment of both GFR and albuminuria is necessary to diagnose chronic kidney disease and monitor disease progression\n\t\tGFR is most commonly estimated through measuring serum creatinine and the use of GFR estimating equations, either the Modification of Diet in Renal Disease Study equation or the Chronic Kidney Disease Epidemiology Collaboration equation\n\t\tAlbuminuria is measured by urine albumin/creatinine ratio; greater than 30 mg/g indicates albuminuria\n\t\tChronic kidney disease is commonly associated with hypertension, diabetes, and cardiovascular disease\n\t\tFirst line therapy includes ACE inhibitors and/or angiotensin II receptor blockers to reduce albuminuria and hypertension\n\t\tIf left untreated, chronic kidney disease can progress to end-stage renal disease requiring dialysis or renal transplant\n\t\t\n\t\t\tSymptoms of end-stage renal disease (eg, pruritus, refractory electrolyte imbalances, metabolic acidosis, severe nausea, neurologic impairments) typically occur when GFR is 5 to 10 mL/minute/1.73 m&sup2;\n\t\t\n\t\t\n\t\tCarefully monitor electrolyte levels, hemoglobin, parathyroid hormone levels, and sodium bicarbonate levels to detect complications of chronic kidney disease, including cardiovascular disease, anemia, bone mineral disease, and metabolic acidosis\n\t\n\t\n\n\n\n\t\n\tURGENT ACTION\n\n\t\n\t\tHyperkalemia may require urgent treatment in patients being treated for chronic kidney disease\n\t\t\n\t\t\tUrgent treatment consists of calcium chloride or calcium gluconate and regimens of sodium bicarbonate, glucose and insulin, or nebulized albuterol\n\t\t\n\t\t\n\t\n\t\n\n\n\n\t\n\tPITFALLS\n\n\t\n\t\tEarly stages are often asymptomatic, causing chronic kidney disease to be untreated, leading to further progression of kidney damage and worse prognosis",
      "citation" : "Chronic Kidney Disease Clinical Overview. ClinicalKey. Source",
      "url" : "http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325",
      "document" : {
        "url" : "http://himss19.ordersetsmanager.com/evidenceviewer/#/7CBBBE9B75E10232E05352E3610A5325/7CBBBE9B75E10232E05352E3610A5325"
      }
    }
  ],
  "action" : [
    {
      "id" : "cc-cpg-activity-referral-nephrology",
      "title" : "Referrals",
      "groupingBehavior" : "visual-group",
      "action" : [
        {
          "id" : "34387224",
          "title" : "Referral: Nephrology; History: [add diagnosis, symptom(s)]; Question: [add reason for referral]",
          "description" : "Referrals",
          "requiredBehavior" : "could",
          "precheckBehavior" : "no",
          "definitionCanonical" : "http://hl7.org/fhir/uv/cpg/ActivityDefinition/cc-cpg-activity-referral-nephrology"
        },
        {
          "id" : "cc-cpg-activity-referral-dietition",
          "title" : "Referral: Dietitian; History: chronic kidney disease; Question: [add reason for referral]",
          "description" : "Referrals",
          "requiredBehavior" : "could",
          "precheckBehavior" : "no",
          "definitionCanonical" : "http://hl7.org/fhir/uv/cpg/ActivityDefinition/cc-cpg-activity-referral-dietitian"
        }
      ]
    }
  ]
}