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Example PlanDefinition/example-cardiology-os (XML)

Clinical Decision Support Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: No defined compartments

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

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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="extensions"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: PlanDefinition</b> <a name="example-cardiology-os"> </a> <a name="hcexample-cardiology-os"> </a> </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 PlanDefinition &quot;example-cardiology-os&quot; </p> </div> <p> <b> StructureDefinition Work Group</b> : cds</p> <p> <b> url</b> : <code> http://va.gov/kas/orderset/B5-Cardiology-ChestPainCAD-OS</code> </p> <p> <b> identifier</b> : <a href="http://terminology.hl7.org/5.5.0/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.t
        xt 

This 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: 

Note 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.

This OID may also be used in CD.codeSystem.">URI</a> /urn:oid:2.16.840.1.113883.4.642.11.8, <code> urn:va.gov:kbs:knart:artifact:r1</code> /bb7ccea6-9744-4743-854a-bcffd87191f6 (use: OFFICIAL), <span title=" identifierName=&quot;Contract: VA118-16-D-1008, Task Order (TO): VA-118-16-F-1008-0007,
         CLIN0004AG&quot;  "><code> urn:va.gov:kbs:contract:VA118-16-D-1008:to:VA-118-16-F-1008-0007</code> /CLIN0004AG</span> , <span title=" identifierName=&quot;Jira KP-914&quot;  "><code> urn:cognitivemedicine.com:lab:jira</code> /KP-914</span> </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="http://terminology.hl7.org/5.5.0/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> : HL7 International / Clinical Decision Support</p> <p> <b> contact</b> : </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> <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> Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type
             code focus = 'Clinical Focus', stated as 'null')</td> <td> Heart disease (disorder) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #56265001)</span> </td> </tr> </table> <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> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : derived-from</p> <p> <b> display</b> : Cardiology: Chest Pain (CP) / Coronary Artery Disease (CAD) Clinical Content
           White Paper</p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="  used the description from HeD example for display here ">Outcome CVD (coronary death, myocardial infarction, coronary insufficiency, angina,
             ischemic stroke, hemorrhagic stroke, transient ischemic attack, peripheral artery
             disease, heart failure)</span> </p> <p> <b> citation</b> : Cardiovascular disease          (10-year risk) [Internet].: Framingham Heart
           Study; cited 2017]. Available from: https://www.framinghamheartstudy.org/risk-functions/cardi
          ovascular-disease/10-year-risk.php.</p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="   no identifier field available, this is an example of what is in the source OS
     &lt;identifiers&gt;
         &lt;identifier root=&quot;https://doi.org/10.1161/CIRCULATIONAHA.107.699579&quot;
            identifierName=&quot;DOI&quot;/&gt;
         &lt;identifier root=&quot;D'Agostino RB et al., 2008&quot;
            identifierName=&quot;LocalDocBook&quot;/&gt;
      &lt;/identifiers&gt;  &amp;#10;  used the title from HeD example for display
           here ">General cardiovascular risk profile for use in primary care: the Framingham Heart
             Study</span> </p> <p> <b> citation</b> : Cardiovascular disease          (10-year risk) [Internet].: Framingham Heart
           Study; cited 2017]. Available from: https://www.framinghamheartstudy.org/risk-functions/cardi
          ovascular-disease/10-year-risk.php.</p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="   no identifier field available, this is an example of what is in the source OS
     &lt;identifiers&gt;
         &lt;identifier root=&quot;10.1016/j.jtcvs.2014.11.002&quot; identifierName=&quot;DOI
          &quot;/&gt;
         &lt;identifier root=&quot;Fihn et al., 2015&quot; identifierName=&quot;LocalDocBook&
          quot;/&gt;
      &lt;/identifiers&gt;  &amp;#10;  used the title from HeD example for display
           here ">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</span> </p> <p> <b> citation</b> : <span title="  here is the description from the source OS, no spot for it
        &lt;description
            value=&quot;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&quot;/&gt;
       ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="   no identifier field available, this is an example of what is in the source OS
     &lt;identifiers&gt;
        &lt;identifier root=&quot;https://doi.org/10.1016/S0735-1097(02)02164-2&quot;
                   identifierName=&quot;DOI&quot;/&gt;
         &lt;identifier root=&quot;Gibbons et al., 2002&quot; identifierName=&quot;LocalDocBo
          ok&quot;/&gt;
     &lt;/identifiers&gt;  &amp;#10;  used the title from HeD example for display
           here ">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)</span> </p> <p> <b> citation</b> : <span title="  there was no description in this specific entry  ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="   no identifier field available, this is an example of what is in the source OS
     &lt;identifiers&gt;
       &lt;identifier root=&quot;b4064039-2345-4227-b83d-54dc13a838d3&quot;/&gt;
       &lt;identifier root=&quot;NLM 2017a&quot; identifierName=&quot;LocalDocBook&quot;/&gt;
      &lt;/identifiers&gt;  &amp;#10;  used the title from HeD example for display
           here ">LABEL: ASPIRIN 81 MG- aspirin tablet, coated</span> </p> <p> <b> citation</b> : <span title="  there was no description in this specific entry  ">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-b83d-54dc13a838d3.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="   no identifier field available, this is an example of what is in the source OS
     &lt;identifiers&gt;
         &lt;identifier root=&quot;edae8df1-caf9-ff72-1304-5ae8b355f8e7&quot;/&gt;
         &lt;identifier root=&quot;NLM 2017b&quot; identifierName=&quot;LocalDocBook&quot;/&g
          t;
     &lt;/identifiers&gt;  &amp;#10;  used the title from HeD example for display
           here ">LABEL: CLOPIDOGREL- clopidogrel bisulfate tablet, film coated</span> </p> <p> <b> citation</b> : <span title="  there was no description in this specific entry  ">LABEL: CLOPIDOGREL- clopidogrel bisulfate tablet, film coated [Internet].: National
             Library of Medicine; 2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
            ?setid=edae8df1-caf9-ff72-1304-5ae8b355f8e7.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="   no identifier field available, this is an example of what is in the source OS
     &lt;identifiers&gt;
        &lt;identifier root=&quot;7fe85155-bc00-406b-b097-e8aece187a8a&quot;/&gt;
        &lt;identifier root=&quot;NLM 2017c&quot; identifierName=&quot;LocalDocBook&quot;/&gt
          ;
      &lt;/identifiers&gt;  &amp;#10;  used the title from HeD example for display
           here ">LABEL: LIPITOR- atorvastatin calcium tablet, film coated</span> </p> <p> <b> citation</b> : <span title="  there was no description in this specific entry  ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="   no identifier field available, this is an example of what is in the source OS
     &lt;identifiers&gt;
       &lt;identifier root=&quot;2d948600-35d8-4490-983b-918bdce488c8&quot;/&gt;
       &lt;identifier root=&quot;NLM 2017d&quot; identifierName=&quot;LocalDocBook&quot;/&gt;
      &lt;/identifiers&gt;  &amp;#10;  used the title from HeD example for display
           here ">LABEL: METOPROLOL SUCCINATE EXTENDED-RELEASE - metoprolol succinate tablet, film
             coated, extended release</span> </p> <p> <b> citation</b> : <span title="  there was no description in this specific entry  ">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.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="   no identifier field available, this is an example of what is in the source OS
     &lt;identifiers&gt;
       &lt;identifier root=&quot;67bf2a15-b115-47ac-ae28-ce2dafd6b5c9&quot;/&gt;
       &lt;identifier root=&quot;NLM 2017e&quot; identifierName=&quot;LocalDocBook&quot;/&gt;
     &lt;/identifiers&gt;  &amp;#10;  used the title from HeD example for display
           here ">LABEL: NITROGLYCERIN- nitroglycerin tablet</span> </p> <p> <b> citation</b> : <span title="  there was no description in this specific entry  ">LABEL: NITROGLYCERIN- nitroglycerin tablet [Internet].: National Library of Medicine;
             2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=67bf2a15-b115-
            47ac-ae28-ce2dafd6b5c9.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="   no identifier field available, this is an example of what is in the source OS
      &lt;identifiers&gt;
        &lt;identifier root=&quot;5c1c694c-4b08-469e-b538-08e69df06146&quot;/&gt;
        &lt;identifier root=&quot;NLM 2017g&quot; identifierName=&quot;LocalDocBook&quot;/&gt
          ;
      &lt;/identifiers&gt;  &amp;#10;  used the title from HeD example for display
           here ">LABEL: SIMVASTATIN - simvastatin tablet</span> </p> <p> <b> citation</b> : <span title="  there was no description in this specific entry  ">LABEL: SIMVASTATIN - simvastatin tablet [Internet].: National Library of Medicine;
             2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5c1c694c-4b08-
            469e-b538-08e69df06146.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> relatedArtifact</b> </p> <p> <b> type</b> : justification</p> <p> <b> display</b> : <span title="   no identifier field available, this is an example of what is in the source OS
       &lt;identifiers&gt;
          &lt;identifier root=&quot;10.1136/hrt.2009.190066&quot; identifierName=&quot;DOI&qu
          ot;/&gt;
          &lt;identifier root=&quot;Skinner et al., 2010&quot; identifierName=&quot;LocalDocB
          ook&quot;/&gt;
        &lt;/identifiers&gt;  &amp;#10;  used the title from HeD example for display
           here ">Chest Pain Guideline Development Group. NICE guidance. Chest          pain of recent
             onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected
             cardiac origin.</span> </p> <p> <b> citation</b> : <span title="  there was no description in this specific entry  ">Skinner JS, Smeeth L, Kendall JM, Adams PC, Timmis A, Chest Pain Guideline Development
             Group. NICE guidance. chest pain of recent onset: Assessment and diagnosis of recent
             onset chest pain or discomfort of suspected cardiac origin. Heart. 2010 June 01;96(12):974-8.</span> </p> <blockquote> <p> <b> document</b> </p> </blockquote> </blockquote> <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> <p> <b> action</b> </p> </blockquote> <blockquote> <p> <b> action</b> </p> </blockquote> <blockquote> <p> <b> action</b> </p> </blockquote> </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> <p> <b> action</b> </p> </blockquote> <blockquote> <p> <b> action</b> </p> </blockquote> <blockquote> <p> <b> action</b> </p> </blockquote> </blockquote> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: Library #cardiology-chestPain-logic</b> <a name="cardiology-chestPain-logic"> </a> <a name="hccardiology-chestPain-logic"> </a> </p> <p> <b> status</b> : active</p> <p> <b> type</b> : Logic Library <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-library-type.html">LibraryType</a> #logic-library)</span> </p> <p> <b> description</b> : Placeholder library</p> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: ActivityDefinition #referralToCardiologyConsult</b> <a name="referralToCardiologyConsult"> </a> <a name="hcreferralToCardiologyConsult"> </a> </p> <p> <b> status</b> : draft</p> <p> <b> description</b> : 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.</p> <p> <b> kind</b> : <span title="   Kind indicates the type of resource that is defined by this activity, a ServiceRequest
           in this case   ">ServiceRequest</span> </p> <p> <b> timing</b> : <span title="  &lt;code&gt;
        &lt;coding&gt;
          &lt;system value=&quot;http://snomed.info/sct&quot; /&gt;
          &lt;code value=&quot;TSR&quot; /&gt;
        &lt;/coding&gt;
        &lt;text value=&quot;Referral to Cardiology&quot; /&gt;
      &lt;/code&gt;  ">Events: Now()</span> </p> <h3> Participants</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Type</b> </td> </tr> <tr> <td style="display: none">*</td> <td> practitioner</td> </tr> </table> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: ActivityDefinition #metoprololTartrate25Prescription</b> <a name="metoprololTartrate25Prescription"> </a> <a name="hcmetoprololTartrate25Prescription"> </a> </p> <p> <b> status</b> : draft</p> <p> <b> kind</b> : MedicationRequest</p> <p> <b> product</b> : <a href="#hcmetoprololTartrate25Medication">#metoprololTartrate25Medication</a> </p> <blockquote> <p> <b> dosage</b> </p> <p> <b> text</b> : 1 tablet oral 2 time daily</p> <p> <b> timing</b> : 2 per 1 days</p> <p> <b> route</b> : Oral route (qualifier value) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ([not stated]#26643006)</span> </p> <blockquote> <p> <b> doseAndRate</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : medicationRequest.priority</p> <h3> Expressions</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td style="display: none">*</td> <td> text/cql</td> <td> routine</td> </tr> </table> </blockquote> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: Medication #metoprololTartrate25Medication</b> <a name="metoprololTartrate25Medication"> </a> <a name="hcmetoprololTartrate25Medication"> </a> </p> <p> <b> code</b> : Metoprolol Tartrate 25 MG <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html">RxNorm</a> #866426)</span> </p> <p> <b> doseForm</b> : Tablet dose form <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #385055001 &quot;Tablet (basic dose form)&quot;)</span> </p> <blockquote> <p> <b> ingredient</b> </p> <h3> Items</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Reference</b> </td> </tr> <tr> <td style="display: none">*</td> <td> <a href="#hcmetoprololTartrate25Substance">#metoprololTartrate25Substance</a> </td> </tr> </table> <p> <b> strength</b> : 25 mg/1 {tbl}</p> </blockquote> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: Substance #metoprololTartrate25Substance</b> <a name="metoprololTartrate25Substance"> </a> <a name="hcmetoprololTartrate25Substance"> </a> </p> <p> <b> instance</b> : false</p> <h3> Codes</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Concept</b> </td> </tr> <tr> <td style="display: none">*</td> <td> Metoprolol <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html">RxNorm</a> #6918)</span> </td> </tr> </table> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: ActivityDefinition #metoprololTartrate50Prescription</b> <a name="metoprololTartrate50Prescription"> </a> <a name="hcmetoprololTartrate50Prescription"> </a> </p> <p> <b> status</b> : draft</p> <p> <b> kind</b> : MedicationRequest</p> <p> <b> product</b> : <a href="#hcmetoprololTartrate50Medication">#metoprololTartrate50Medication</a> </p> <blockquote> <p> <b> dosage</b> </p> <p> <b> text</b> : 1 tablet oral 2 time daily</p> <p> <b> timing</b> : 2 per 1 days</p> <p> <b> route</b> : Oral route (qualifier value) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ([not stated]#26643006)</span> </p> <blockquote> <p> <b> doseAndRate</b> </p> </blockquote> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : medicationRequest.priority</p> <h3> Expressions</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td style="display: none">*</td> <td> text/cql</td> <td> routine</td> </tr> </table> </blockquote> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: Medication #metoprololTartrate50Medication</b> <a name="metoprololTartrate50Medication"> </a> <a name="hcmetoprololTartrate50Medication"> </a> </p> <p> <b> code</b> : Metoprolol Tartrate 50 MG <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html">RxNorm</a> #866435)</span> </p> <p> <b> doseForm</b> : Tablet dose form <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #385055001 &quot;Tablet (basic dose form)&quot;)</span> </p> <blockquote> <p> <b> ingredient</b> </p> <h3> Items</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Reference</b> </td> </tr> <tr> <td style="display: none">*</td> <td> <a href="#hcmetoprololTartrate50Substance">#metoprololTartrate50Substance</a> </td> </tr> </table> <p> <b> strength</b> : 50 mg/1 {tbl}</p> </blockquote> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: Substance #metoprololTartrate50Substance</b> <a name="metoprololTartrate50Substance"> </a> <a name="hcmetoprololTartrate50Substance"> </a> </p> <p> <b> instance</b> : false</p> <h3> Codes</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Concept</b> </td> </tr> <tr> <td style="display: none">*</td> <td> Metoprolol <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html">RxNorm</a> #6918)</span> </td> </tr> </table> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: ActivityDefinition #nitroglycerinPrescription</b> <a name="nitroglycerinPrescription"> </a> <a name="hcnitroglycerinPrescription"> </a> </p> <p> <b> status</b> : draft</p> <p> <b> kind</b> : MedicationRequest</p> <p> <b> product</b> : <a href="#hcnitroglycerinMedication">#nitroglycerinMedication</a> </p> <blockquote> <p> <b> dosage</b> </p> <p> <b> text</b> : nitroglycerin 0.4 mg tablet sub-lingual every 5 minutes as needed for chest pain;
             maximum 3 tablets</p> <p> <b> timing</b> : Once per 5 minutes</p> <blockquote> <p> <b> doseAndRate</b> </p> </blockquote> <p> <b> maxDosePerAdministration</b> : 3 {tbl}</p> </blockquote> <blockquote> <p> <b> dynamicValue</b> </p> <p> <b> path</b> : medicationRequest.priority</p> <h3> Expressions</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Language</b> </td> <td> <b> Expression</b> </td> </tr> <tr> <td style="display: none">*</td> <td> text/cql</td> <td> routine</td> </tr> </table> </blockquote> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: Medication #nitroglycerinMedication</b> <a name="nitroglycerinMedication"> </a> <a name="hcnitroglycerinMedication"> </a> </p> <p> <b> code</b> : Nitroglycerin 0.4 MG <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html">RxNorm</a> #316365)</span> </p> <p> <b> doseForm</b> : Tablet dose form <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #385055001 &quot;Tablet (basic dose form)&quot;)</span> </p> <blockquote> <p> <b> ingredient</b> </p> <h3> Items</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Reference</b> </td> </tr> <tr> <td style="display: none">*</td> <td> <a href="#hcnitroglycerinSubstance">#nitroglycerinSubstance</a> </td> </tr> </table> <p> <b> strength</b> : 0.4 mg/1 {tbl}</p> </blockquote> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: Substance #nitroglycerinSubstance</b> <a name="nitroglycerinSubstance"> </a> <a name="hcnitroglycerinSubstance"> </a> </p> <p> <b> instance</b> : false</p> <h3> Codes</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Concept</b> </td> </tr> <tr> <td style="display: none">*</td> <td> Nitroglycerin <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-rxNorm.html">RxNorm</a> #4917)</span> </td> </tr> </table> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: Questionnaire #CollectReferralReason</b> <a name="CollectReferralReason"> </a> <a name="hcCollectReferralReason"> </a> </p> <p> <b> status</b> : draft</p> <h3> Items</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> LinkId</b> </td> <td> <b> Text</b> </td> <td> <b> Type</b> </td> <td> <b> Required</b> </td> <td> <b> Repeats</b> </td> <td> <b> AnswerValueSet</b> </td> </tr> <tr> <td style="display: none">*</td> <td> 1</td> <td> Reason for Cardiology Consult</td> <td> coding</td> <td> true</td> <td> true</td> <td> <code> #CardiologyReferralReasonValues</code> </td> </tr> </table> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: Questionnaire #CardiologyConsultationGoal</b> <a name="CardiologyConsultationGoal"> </a> <a name="hcCardiologyConsultationGoal"> </a> </p> <p> <b> status</b> : draft</p> <h3> Items</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> LinkId</b> </td> <td> <b> Text</b> </td> <td> <b> Type</b> </td> </tr> <tr> <td style="display: none">*</td> <td> 2</td> <td> Goal of cardiology consultation</td> <td> string</td> </tr> </table> </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 indicates the type of resource that is defined by this activity, a ServiceRequest
       in this case     -->
      <kind value="ServiceRequest"/> 
          <!--    <code>
        <coding>
          <system value="http://snomed.info/sct" />
          <code value="TSR" />
        </coding>
        <text value="Referral to Cardiology" />
      </code>    -->
      <timingTiming> 
        <event> 
              <!--     The expression here specifies the value for the timing of the resulting resource.
           In this case, referralRequest.fulfillmentTime.start     -->
          <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> 
      <doseForm> 
        <coding> 
          <system value="http://snomed.info/sct"/> 
          <code value="385055001"/> 
          <display value="Tablet (basic dose form)"/> 
        </coding> 
        <text value="Tablet dose form"/> 
      </doseForm> 
      <ingredient> 
        <item> 
          <reference> 
          <reference value="#metoprololTartrate25Substance"/> 
          </reference> 
        </item> 
        <strengthRatio> 
          <numerator> 
            <value value="25"/> 
            <unit value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </denominator> 
        </strengthRatio> 
      </ingredient> 
    </Medication> 
  </contained> 
  <contained> 
    <Substance> 
      <id value="metoprololTartrate25Substance"/> 
      <instance value="false"/> 
      <code> 
        <concept> 
          <coding> 
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
            <code value="6918"/> 
          </coding> 
          <text value="Metoprolol"/> 
        </concept> 
      </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> 
      <doseForm> 
        <coding> 
          <system value="http://snomed.info/sct"/> 
          <code value="385055001"/> 
          <display value="Tablet (basic dose form)"/> 
        </coding> 
        <text value="Tablet dose form"/> 
      </doseForm> 
      <ingredient> 
        <item> 
        <reference> 
          <reference value="#metoprololTartrate50Substance"/> 
        </reference> 
        </item> 
        <strengthRatio> 
          <numerator> 
            <value value="50"/> 
            <unit value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </denominator> 
        </strengthRatio> 
      </ingredient> 
    </Medication> 
  </contained> 
  <contained> 
    <Substance> 
      <id value="metoprololTartrate50Substance"/> 
      <instance value="false"/> 
      <code> 
        <concept> 
          <coding> 
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
            <code value="6918"/> 
          </coding> 
          <text value="Metoprolol"/> 
        </concept> 
      </code> 
    </Substance> 
  </contained> 
      <!--    <contained>
    <ActivityDefinition>
      <id value="amlodiponePrescription" />
      <status value="draft" />
      <kind value="MedicationRequest" />
      <productReference>
        <reference value="#amlodipineMedication" />
      </productReference>
      <dosage>
        <text value="1 tablet oral 1 time daily" />
        <timing>
          <repeat>
            <frequency value="1" />
            <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 value="routine" />
      </dynamicValue>
    </ActivityDefinition>
  </contained>
  <contained>
    <Medication>
      <id value="amlodipineMedication" />
      <code>
        <coding>
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm" />
          <code value="329528" />
        </coding>
        <text value="amLODIPine 5 MG" />
      </code>
      <form>
        <coding>
          <system value="http://snomed.info/sct" />
          <code value="385055001" />
          <display value="Tablet (basic dose form)" />
        </coding>
        <text value="Tablet dose form" />
      </form>
      <ingredient>
        <itemReference>
          <reference value="#amlodipineSubstance" />
        </itemReference>
        <amount>
          <numerator>
            <value value="5" />
            <unit value="mg" />
          </numerator>
          <denominator>
            <value value="1" />
            <unit value="{tbl}" />
          </denominator>
        </amount>
      </ingredient>
    </Medication>
  </contained>
  <contained>
    <Substance>
     <instance value="false"/>
     <id value="amlodipineSubstance" />
      <code>
        <coding>
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm" />
          <code value="17767" />
        </coding>
        <text value="amLODIPine" />
      </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> 
            <!--    <route>
          <coding>
            <code value="TSR" />
            <display value="sub-lingual route (qualifier value)" />
          </coding>
          <text value="Sub-lingual 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> 
        <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> 
      <doseForm> 
        <coding> 
          <system value="http://snomed.info/sct"/> 
          <code value="385055001"/> 
          <display value="Tablet (basic dose form)"/> 
        </coding> 
        <text value="Tablet dose form"/> 
      </doseForm> 
      <ingredient> 
        <item> 
        <reference> 
          <reference value="#nitroglycerinSubstance"/> 
        </reference> 
        </item> 
        <strengthRatio> 
          <numerator> 
            <value value="0.4"/> 
            <unit value="mg"/> 
          </numerator> 
          <denominator> 
            <value value="1"/> 
            <unit value="{tbl}"/> 
          </denominator> 
        </strengthRatio> 
      </ingredient> 
    </Medication> 
  </contained> 
  <contained> 
    <Substance> 
      <id value="nitroglycerinSubstance"/> 
      <instance value="false"/> 
      <code> 
        <concept> 
          <coding> 
            <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> 
            <code value="4917"/> 
          </coding> 
          <text value="Nitroglycerin"/> 
        </concept> 
      </code> 
    </Substance> 
  </contained> 
    <!--   
  <contained>
    <ValueSet>
      <id value="CardiologyReferralReasonValues" />
      <!-!-  Identifiers: Terminology Service requests still on going for
         value set and code definitions. Hence skeeleton and placeholders here
   for example-!->
      <name value="Cardiology Referral Reason value set" />
      <status value="draft" />
      <compose>
        <include>
          <system value="http://snomed.info/sct" />
          <concept>
            <code value="429559004" />
            <display value="typical angina" />
          </concept>
        </include>
      </compose>
      <!-!- <compose>
        <include>
          <system value="TSR" />
          <concept>
            <code value="TSR" />
            <display value="typical angina" />
          </concept>
          <concept>
            <code value="TSR" />
            <display value="atypical chest pain" />
          </concept>
          <concept>
            <code value="TSR" />
            <display value="progressive angina symptoms in a stable patient with
   known CAD (if the patient is unstable based upon clinical or test results, direct
   physician-to-physician communication is required)" />
          </concept>
          <concept>
            <code value="TSR" />
            <display value="other" />
          </concept>
        </include>
      </compose> -!->
    </ValueSet>
  </contained>    -->

  <contained> 
    <Questionnaire> 
      <id value="CollectReferralReason"/> 
      <status value="draft"/> 
      <item> 
        <linkId value="1"/> 
        <text value="Reason for Cardiology Consult"/> 
        <type value="coding"/> 
        <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> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"><valueCode value="cds"/> </extension> 
  <url value="http://va.gov/kas/orderset/B5-Cardiology-ChestPainCAD-OS"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.11.8"/> 
  </identifier> 
  <identifier> 
        <!--   identifierName="B5"    -->
    <use value="official"/> 
    <system value="urn:va.gov:kbs:knart:artifact:r1"/> 
    <value value="bb7ccea6-9744-4743-854a-bcffd87191f6"/> 
  </identifier> 
      <!--   identifierName="Contract: VA118-16-D-1008, Task Order (TO): VA-118-16-F-1008-0007,
   CLIN0004AG"    -->
  <identifier> 
    <system value="urn:va.gov:kbs:contract:VA118-16-D-1008:to:VA-118-16-F-1008-0007"/> 
    <value value="CLIN0004AG"/> 
  </identifier> 
      <!--   identifierName="Jira KP-914"    -->
  <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"/> 
  <date value="2017-08-29"/> 
  <publisher value="HL7 International / Clinical Decision Support"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      </telecom> 
  </contact> 
  <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="56265001"/> 
        <display value="Heart disease (disorder)"/> 
      </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"/> 
        <!--    No place for affiliation in the contributor, left here as comments
        <affiliation>
               <name
                 value="Professor, Cardiovascular Medicine, University of Utah
     School of Medicine; Staff
                 Cardiologist, Salt Lake City VA Medical Center (VAMC)"
                        />
           </affiliation>    -->
  </author> 
  <author> 
    <name value="Scott Wall MD"/> 
        <!--    No place for affiliation in the contributor, left here as comments
     <affiliation>
        <name
           value="Assistant Professor, Cardiovascular Medicine, University of Utah;
     School of
           Medicine Staff Cardiologist, Electrophysiology, Salt Lake City VAMC"
        />
     </affiliation>    -->
  </author> 
  <author> 
    <name value="Aiden Abidov MD, PhD"/> 
        <!--    No place for affiliation in the contributor, left here as comments
     <affiliation>
        <name
           value="Professor of Medicine, Wayne State University; Section Chief,
     Cardiology, John Dingell VAMC" />
     </affiliation>    -->
  </author> 
  <relatedArtifact> 
    <type value="derived-from"/> 
    <display value="Cardiology: Chest Pain (CP) / Coronary Artery Disease (CAD) Clinical Content White
     Paper"/> 
    <document> 
      <url value="NEED-A-URL-HERE"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
        <!--    used the description from HeD example for display here   -->
    <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/cardiovascul
    ar-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"/> 
        <!--     no identifier field available, this is an example of what is in the source
     OS
     <identifiers>
         <identifier root="https://doi.org/10.1161/CIRCULATIONAHA.107.699579"
            identifierName="DOI"/>
         <identifier root="D'Agostino RB et al., 2008"
            identifierName="LocalDocBook"/>
      </identifiers>    -->
        <!--    used the title from HeD example for display here   -->
    <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/cardiovascul
    ar-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"/> 
        <!--     no identifier field available, this is an example of what is in the source
     OS
     <identifiers>
         <identifier root="10.1016/j.jtcvs.2014.11.002" identifierName="DOI"/>
         <identifier root="Fihn et al., 2015" identifierName="LocalDocBook"/>
      </identifiers>    -->
        <!--    used the title from HeD example for display here   -->
    <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"/> 
        <!--    here is the description from the source OS, no spot for it
        <description
            value="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/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."/> 
    <document> 
      <url value="NEED-A-URL-HERE"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
        <!--     no identifier field available, this is an example of what is in the source
     OS
     <identifiers>
        <identifier root="https://doi.org/10.1016/S0735-1097(02)02164-2"
                   identifierName="DOI"/>
         <identifier root="Gibbons et al., 2002" identifierName="LocalDocBook"/>
     </identifiers>    -->
        <!--    used the title from HeD example for display here   -->
    <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)"/> 
        <!--    there was no description in this specific entry    -->
    <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."/> 
    <document> 
      <url value="NEED-A-URL-HERE"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
        <!--     no identifier field available, this is an example of what is in the source
     OS
     <identifiers>
       <identifier root="b4064039-2345-4227-b83d-54dc13a838d3"/>
       <identifier root="NLM 2017a" identifierName="LocalDocBook"/>
      </identifiers>    -->
        <!--    used the title from HeD example for display here   -->
    <display value="LABEL: ASPIRIN 81 MG- aspirin tablet, coated"/> 
        <!--    there was no description in this specific entry    -->
    <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-b83d-54dc13a838d3."/> 
    <document> 
      <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b4064039-2345-4227-b83d-54dc13a838d3"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
        <!--     no identifier field available, this is an example of what is in the source
     OS
     <identifiers>
         <identifier root="edae8df1-caf9-ff72-1304-5ae8b355f8e7"/>
         <identifier root="NLM 2017b" identifierName="LocalDocBook"/>
     </identifiers>    -->
        <!--    used the title from HeD example for display here   -->
    <display value="LABEL: CLOPIDOGREL- clopidogrel bisulfate tablet, film coated"/> 
        <!--    there was no description in this specific entry    -->
    <citation value="LABEL: CLOPIDOGREL- clopidogrel bisulfate tablet, film coated [Internet].: National
     Library of Medicine; 2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
    ?setid=edae8df1-caf9-ff72-1304-5ae8b355f8e7."/> 
    <document> 
      <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155-bc00-406b-b097-e8aece187a8a"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
        <!--     no identifier field available, this is an example of what is in the source
     OS
     <identifiers>
        <identifier root="7fe85155-bc00-406b-b097-e8aece187a8a"/>
        <identifier root="NLM 2017c" identifierName="LocalDocBook"/>
      </identifiers>    -->
        <!--    used the title from HeD example for display here   -->
    <display value="LABEL: LIPITOR- atorvastatin calcium tablet, film coated"/> 
        <!--    there was no description in this specific entry    -->
    <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."/> 
    <document> 
      <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155-bc00-406b-b097-e8aece187a8a"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
        <!--     no identifier field available, this is an example of what is in the source
     OS
     <identifiers>
       <identifier root="2d948600-35d8-4490-983b-918bdce488c8"/>
       <identifier root="NLM 2017d" identifierName="LocalDocBook"/>
      </identifiers>    -->
        <!--    used the title from HeD example for display here   -->
    <display value="LABEL: METOPROLOL SUCCINATE EXTENDED-RELEASE - metoprolol succinate tablet, film
     coated, extended release"/> 
        <!--    there was no description in this specific entry    -->
    <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."/> 
    <document> 
      <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2d948600-35d8-4490-983b-918bdce488c8"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
        <!--     no identifier field available, this is an example of what is in the source
     OS
     <identifiers>
       <identifier root="67bf2a15-b115-47ac-ae28-ce2dafd6b5c9"/>
       <identifier root="NLM 2017e" identifierName="LocalDocBook"/>
     </identifiers>    -->
        <!--    used the title from HeD example for display here   -->
    <display value="LABEL: NITROGLYCERIN- nitroglycerin tablet"/> 
        <!--    there was no description in this specific entry    -->
    <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-ae28-ce2dafd6b5c9."/> 
    <document> 
      <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=67bf2a15-b115-47ac-ae28-ce2dafd6b5c9"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
        <!--     no identifier field available, this is an example of what is in the source
     OS
      <identifiers>
        <identifier root="5c1c694c-4b08-469e-b538-08e69df06146"/>
        <identifier root="NLM 2017g" identifierName="LocalDocBook"/>
      </identifiers>    -->
        <!--    used the title from HeD example for display here   -->
    <display value="LABEL: SIMVASTATIN - simvastatin tablet"/> 
        <!--    there was no description in this specific entry    -->
    <citation value="LABEL: SIMVASTATIN - simvastatin tablet [Internet].: National Library of Medicine;
     2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5c1c694c-4b08-
    469e-b538-08e69df06146."/> 
    <document> 
      <url value="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5c1c694c-4b08-469e-b538-08e69df06146"/> 
    </document> 
  </relatedArtifact> 
  <relatedArtifact> 
    <type value="justification"/> 
        <!--     no identifier field available, this is an example of what is in the source
     OS
       <identifiers>
          <identifier root="10.1136/hrt.2009.190066" identifierName="DOI"/>
          <identifier root="Skinner et al., 2010" identifierName="LocalDocBook"/>
        </identifiers>    -->
        <!--    used the title from HeD example for display here   -->
    <display value="Chest Pain Guideline Development Group. NICE guidance. Chest          pain of recent
     onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected
     cardiac origin."/> 
        <!--    there was no description in this specific entry    -->
    <citation value="Skinner JS, Smeeth L, Kendall JM, Adams PC, Timmis A, Chest Pain Guideline Development
     Group. NICE guidance. chest pain of recent onset: Assessment and diagnosis of recent
     onset chest pain or discomfort of suspected cardiac origin. Heart. 2010 June 01;96(12):974-8."/> 
    <document> 
      <url value="http://heart.bmj.com/content/96/12/974.long"/> 
    </document> 
  </relatedArtifact> 
  <library value="#cardiology-chestPain-logic"/> 
      <!--     Actions     -->
  <action> 
        <!--   
    <action>
      Patient disposition and triage group
    </action>
         -->
    <action> 
      <title value="Consults and Referrals"/> 
      <groupingBehavior value="logical-group"/> 
      <selectionBehavior value="any"/> 
      <action> 
        <textEquivalent value="Referral to cardiology to evaluate chest pain (routine)"/> 
        <definitionCanonical value="#referralToCardiologyConsult"/> 
            <!--     These expressions will be evaluated with the library referenced above as an
         include     -->
        <dynamicValue> 
          <path value="timing.event"/> 
          <expression> 
            <language value="text/cql"/> 
            <expression value="Now()"/> 
          </expression> 
        </dynamicValue> 
        <dynamicValue> 
          <path value="specialty"/> 
              <!--     This expression is code selector syntax in CQL, returning the code from the
           NPI provider taxonomy     -->
          <expression> 
            <language value="text/cql"/> 
            <expression value="Code '261QM0850X' from CardiologyChestPainLogic.&quot;NUCC Provider Taxonomy&quot;
             display 'Adult Mental Health'"/> 
          </expression> 
        </dynamicValue> 
        <dynamicValue> 
              <!--     The fulfillmentTime element of the resulting ServiceRequest will be set to
           the result of the ServiceRequestFulfillmentTime expression defined in the SuicideRiskLogic
           library     -->
          <path value="occurrenceDateTime"/> 
          <expression> 
            <language value="text/cql"/> 
            <expression value="CardiologyChestPainLogic.ServiceRequestFulfillmentTime"/> 
          </expression> 
        </dynamicValue> 
        <dynamicValue> 
          <path value="subject"/> 
          <expression> 
            <language value="text/cql"/> 
            <expression value="CardiologyChestPainLogic.Patient"/> 
          </expression> 
        </dynamicValue> 
        <dynamicValue> 
          <path value="requester.agent"/> 
          <expression> 
            <language value="text/cql"/> 
            <expression value="CardiologyChestPainLogic.Practitioner"/> 
          </expression> 
        </dynamicValue> 
        <dynamicValue> 
          <path value="reasonCode"/> 
          <expression> 
            <language value="text/cql"/> 
            <expression value="CardiologyChestPainLogic.CardiologyReferralReason"/> 
          </expression> 
        </dynamicValue> 
        <dynamicValue> 
          <path value="reasonReference"/> 
          <expression> 
            <language value="text/cql"/> 
            <expression value="CardiologyChestPainLogic.RiskAssessment"/> 
          </expression> 
        </dynamicValue> 
      </action> 
      <action> 
        <title value="Reason for cardiology consultation"/> 
        <definitionCanonical value="#CollectReferralReason"/> 
      </action> 
      <action> 
        <title value="Goal of cardiology consultation"/> 
        <definitionCanonical value="#CardiologyConsultationGoal"/> 
      </action> 
    </action> 
        <!--   
    <action>
      Imaging and ECG group
    </action>
       -->
        <!--   
    <action>
      Laboratory Tests
    </action>
        -->
         <!--   
    <action>
      Cardiac Risk Stratification
    </action>
        -->
    <action> 
      <title value="Medications"/> 
      <description value="Consider the following medications for stable patients to be initiated prior to
       the cardiology consultation."/> 
      <action> 
        <groupingBehavior value="logical-group"/> 
        <selectionBehavior value="at-most-one"/> 
      </action> 
      <action> 
        <title value="Antianginal Therapy"/> 
        <groupingBehavior value="logical-group"/> 
        <selectionBehavior value="at-most-one"/> 
        <action> 
          <textEquivalent value="metoprolol tartrate 25 mg tablet 1 tablet oral 2 time daily"/> 
          <definitionCanonical value="#metoprololTartrate25Prescription"/> 
          <dynamicValue> 
            <path value="status"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="'draft'"/> 
            </expression> 
          </dynamicValue> 
          <dynamicValue> 
            <path value="patient"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="CardiologyChestPainLogic.Patient"/> 
        </expression> 
          </dynamicValue> 
          <dynamicValue> 
            <path value="prescriber"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="CardiologyChestPainLogic.Practitioner"/> 
        </expression> 
          </dynamicValue> 
        </action> 
        <action> 
          <textEquivalent value="metoprolol tartrate 50 mg tablet 1 tablet oral 2 time daily"/> 
          <definitionCanonical value="#metoprololTartrate50Prescription"/> 
          <dynamicValue> 
            <path value="status"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="'draft'"/> 
        </expression> 
          </dynamicValue> 
          <dynamicValue> 
            <path value="patient"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="CardiologyChestPainLogic.Patient"/> 
            </expression> 
          </dynamicValue> 
          <dynamicValue> 
            <path value="prescriber"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="CardiologyChestPainLogic.Practitioner"/> 
        </expression> 
          </dynamicValue> 
        </action> 
        <action> 
          <textEquivalent value="amlodipine 5  tablet 1 tablet oral  daily"/> 
          <definitionCanonical value="#amlodipinePrescription"/> 
          <dynamicValue> 
            <path value="status"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="'draft'"/> 
        </expression> 
          </dynamicValue> 
          <dynamicValue> 
            <path value="patient"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="CardiologyChestPainLogic.Patient"/> 
        </expression> 
          </dynamicValue> 
          <dynamicValue> 
            <path value="prescriber"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="CardiologyChestPainLogic.Practitioner"/> 
        </expression> 
          </dynamicValue> 
        </action> 
      </action> 
      <action> 
        <title value="Nitroglycerin"/> 
        <groupingBehavior value="logical-group"/> 
        <selectionBehavior value="at-most-one"/> 
            <!--    This is a subgroup with one element    -->
        <action> 
          <textEquivalent value="nitroglycerin 0.4 mg tablet sub-lingual every 5 minutes as needed for chest pain;
           maximum 3 tablets"/> 
          <definitionCanonical value="#nitroglycerinPrescription"/> 
          <dynamicValue> 
            <path value="status"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="'draft'"/> 
        </expression> 
          </dynamicValue> 
          <dynamicValue> 
            <path value="patient"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="CardiologyChestPainLogic.Patient"/> 
        </expression> 
          </dynamicValue> 
          <dynamicValue> 
            <path value="prescriber"/> 
            <expression> 
              <language value="text/cql"/> 
              <expression value="CardiologyChestPainLogic.Practitioner"/> 
        </expression> 
          </dynamicValue> 
        </action> 
      </action> 
          <!--    Original order set has sections for Antiplatelet Therapy and Risk Factor Reduction
       not encoded here    -->
    </action> 
  </action> 
</PlanDefinition> 

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.