Clinical Practice Guidelines
2.0.0-draft - draft International flag

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-draft built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of and changes regularly. See the Directory of published versions

Congestive Heart Failure Example

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:

CHF Case Plan Summary View

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:


Case Features



Example Case

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

Example Case Index

The following index lists all the case-specific resources in this example:

Resource Type Resource
CarePlan chf-scenario1-careplan
CareTeam chf-scenario1-careteam
ClinicalImpression chf-scenario1-clinical-impression
Composition chf-scenario1-caseplanprogressingnote
Composition chf-scenario1-caseplansummary
Composition chf-scenario1-casesummary
Condition chf-scenario1-condition
Encounter chf-scenario1-encounter
EpisodeOfCare chf-scenario1-eoc
Goal chf-scenario1-cardiology-consultation
Goal chf-scenario1-creatinine
Goal chf-scenario1-egfr
Goal chf-scenario1-jvp
Goal chf-scenario1-lasix-iv
Goal chf-scenario1-lasix-po
Goal chf-scenario1-net-io
Goal chf-scenario1-o2-sat
Goal chf-scenario1-potassium
Goal chf-scenario1-urine-out
Goal chf-scenario1-weight-change
Goal chf-scenario1-weight
Group chf-scenario1-group
Location chf-scenario1-location
MeasureReport chf-scenario1-bodyweight-change1
MeasureReport chf-scenario1-bodyweight-change2
MeasureReport chf-scenario1-bodyweight-change3
MeasureReport chf-scenario1-bodyweight1
MeasureReport chf-scenario1-bodyweight2
MeasureReport chf-scenario1-bodyweight3
MeasureReport chf-scenario1-bodyweight4
MeasureReport chf-scenario1-urineout3
MedicationAdministration chf-scenario1-lasix-iv
MedicationAdministration chf-scenario1-lasix-po
MedicationRequest chf-scenario1-lasix-po
MedicationRequest chf-scenario1-stop-lasix-iv
Observation chf-scenario1-bodyweight-change1
Observation chf-scenario1-bodyweight-change2
Observation chf-scenario1-bodyweight-change3
Observation chf-scenario1-bodyweight1
Observation chf-scenario1-bodyweight2
Observation chf-scenario1-bodyweight3
Observation chf-scenario1-bodyweight4
Observation chf-scenario1-creatinine1
Observation chf-scenario1-egfr1
Observation chf-scenario1-jvp1
Observation chf-scenario1-jvp2
Observation chf-scenario1-jvp3
Observation chf-scenario1-jvp4
Observation chf-scenario1-jvp5
Observation chf-scenario1-netio3
Observation chf-scenario1-o2sat1
Observation chf-scenario1-o2sat2
Observation chf-scenario1-potassium1
Observation chf-scenario1-urineout3
Organization chf-scenario1-organization
Patient chf-scenario1-patient
PractitionerRole chf-scenario1-practitionerrole
Practitioner chf-scenario1-practitioner
Procedure chf-scenario1-cardiology-consult
RelatedPerson chf-scenario1-relatedperson
RequestGroup chf-scenario1-daily-management
RequestGroup chf-scenario1-hypervolemia
ServiceRequest chf-scenario1-cardiology-consult-request
ServiceRequest chf-scenario1-jvp
ServiceRequest chf-scenario1-o2-sat

Artifact Index

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