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| Clinical Decision Support Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: No defined compartments |
This is the narrative for the resource. See also the XML, JSON or Turtle format. This example conforms to the profile PlanDefinition.
Generated Narrative: PlanDefinition example-cardiology-os
StructureDefinition Work Group: cds
url: http://va.gov/kas/orderset/B5-Cardiology-ChestPainCAD-OS
identifier: Uniform Resource Identifier (URI)/urn:oid:2.16.840.1.113883.4.642.11.8, urn:va.gov:kbs:knart:artifact:r1/bb7ccea6-9744-4743-854a-bcffd87191f6 (use: official, ), urn:va.gov:kbs:contract:VA118-16-D-1008:to:VA-118-16-F-1008-0007/CLIN0004AG, urn:cognitivemedicine.com:lab:jira/KP-914
version: 0.1
name: ChestPainCoronaryArteryDiseaseOrderSetKNART
title: Chest Pain (CP) - Coronary Artery Disease (CAD) Order Set KNART
type: Order Set
status: active
date: 2017-08-29
publisher: HL7 International / Clinical Decision Support
contact: http://www.hl7.org/Special/committees/dss
description:
The Cardiology chest pain (CP) and coronary artery disease (CAD) group of KNARTs are intended to assist primary care providers in the management of adult patients with stable chest pain (with or without known CAD); aid in determining when a cardiology consultation is appropriate; provide guidance for initial noninvasive diagnostic orders (stress testing) and provide a structured documentation template for the process. Stable patients with cardiac chest pain require risk stratification, office-based workup, initiation of disease-specific medications, and subspecialty referral to a cardiologist.
| Code | Value[x] |
| UsageContextType focus: Clinical Focus | Heart disease (disorder) |
usage:
The Cardiology chest pain (CP) and coronary artery disease (CAD) group of KNARTs are intended to assist primary care providers in the management of adult patients with stable chest pain (with or without known CAD); aid in determining when a cardiology consultation is appropriate; provide guidance for initial noninvasive diagnostic orders (stress testing) and provide a structured documentation template for the process. Stable patients with cardiac chest pain require risk stratification, office-based workup, initiation of disease-specific medications, and subspecialty referral to a cardiologist. This context excludes emergent patients (new/ongoing/unstable pattern CP). Included are those patients with stable CP with or without known CAD, to be considered for evaluation by cardiology.
copyright:
© Copyright Cognitive Medical Systems, Inc. 9444 Waples Street Suite 300 San Diego, CA 92121
author: Bruce Bray MD: , Scott Wall MD: , Aiden Abidov MD, PhD:
relatedArtifact
type: derived-from
display: Cardiology: Chest Pain (CP) / Coronary Artery Disease (CAD) Clinical Content White Paper
Documents
Url NEED-A-URL-HERE
relatedArtifact
type: justification
display: Outcome CVD (coronary death, myocardial infarction, coronary insufficiency, angina, ischemic stroke, hemorrhagic stroke, transient ischemic attack, peripheral artery disease, heart failure)
citation:
Cardiovascular disease (10-year risk) [Internet].: Framingham Heart Study; cited 2017]. Available from: https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php.
Documents
Url https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php
relatedArtifact
type: justification
display: General cardiovascular risk profile for use in primary care: the Framingham Heart Study
citation:
Cardiovascular disease (10-year risk) [Internet].: Framingham Heart Study; cited 2017]. Available from: https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php.
Documents
Url https://www.framinghamheartstudy.org/risk-functions/cardiovascular-disease/10-year-risk.php
relatedArtifact
type: justification
display: 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
citation:
Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the american college of cardiology/american heart association task force on practice guidelines, and the american association for thoracic surgery, preventive cardiovascular nurses association, society for cardiovascular angiography and interventions, and society of thoracic surgeons. J Thorac Cardiovasc Surg. 2015 March 01;149(3):5.
Documents
Url NEED-A-URL-HERE
relatedArtifact
type: justification
display: 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)
citation:
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.
Documents
Url NEED-A-URL-HERE
relatedArtifact
type: justification
display: LABEL: ASPIRIN 81 MG- aspirin tablet, coated
citation:
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.
Documents
Url https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b4064039-2345-4227-b83d-54dc13a838d3
relatedArtifact
type: justification
display: LABEL: CLOPIDOGREL- clopidogrel bisulfate tablet, film coated
citation:
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.
Documents
Url https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155-bc00-406b-b097-e8aece187a8a
relatedArtifact
type: justification
display: LABEL: LIPITOR- atorvastatin calcium tablet, film coated
citation:
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.
Documents
Url https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7fe85155-bc00-406b-b097-e8aece187a8a
relatedArtifact
type: justification
display: LABEL: METOPROLOL SUCCINATE EXTENDED-RELEASE - metoprolol succinate tablet, film coated, extended release
citation:
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.
Documents
Url https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2d948600-35d8-4490-983b-918bdce488c8
relatedArtifact
type: justification
display: LABEL: NITROGLYCERIN- nitroglycerin tablet
citation:
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.
Documents
Url https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=67bf2a15-b115-47ac-ae28-ce2dafd6b5c9
relatedArtifact
type: justification
display: LABEL: SIMVASTATIN - simvastatin tablet
citation:
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.
Documents
Url https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5c1c694c-4b08-469e-b538-08e69df06146
relatedArtifact
type: justification
display: 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.
citation:
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.
Documents
Url http://heart.bmj.com/content/96/12/974.long
library: cardiology-chestPain-logic
action
action
title: Consults and Referrals
groupingBehavior: logical-group
selectionBehavior: any
action
textEquivalent:
Referral to cardiology to evaluate chest pain (routine)
dynamicValue
path: timing.event
Expressions
Language Expression text/cql Now() dynamicValue
path: specialty
Expressions
Language Expression text/cql Code '261QM0850X' from CardiologyChestPainLogic."NUCC Provider Taxonomy" display 'Adult Mental Health' dynamicValue
path: occurrenceDateTime
Expressions
Language Expression text/cql CardiologyChestPainLogic.ServiceRequestFulfillmentTime dynamicValue
path: subject
Expressions
Language Expression text/cql CardiologyChestPainLogic.Patient dynamicValue
path: requester.agent
Expressions
Language Expression text/cql CardiologyChestPainLogic.Practitioner dynamicValue
path: reasonCode
Expressions
Language Expression text/cql CardiologyChestPainLogic.CardiologyReferralReason dynamicValue
path: reasonReference
Expressions
Language Expression text/cql CardiologyChestPainLogic.RiskAssessment action
title: Reason for cardiology consultation
definition: CollectReferralReason
action
title: Goal of cardiology consultation
definition: CardiologyConsultationGoal
action
title: Medications
description:
Consider the following medications for stable patients to be initiated prior to the cardiology consultation.
action
groupingBehavior: logical-group
selectionBehavior: at-most-one
action
title: Antianginal Therapy
groupingBehavior: logical-group
selectionBehavior: at-most-one
action
textEquivalent:
metoprolol tartrate 25 mg tablet 1 tablet oral 2 time daily
dynamicValue
path: status
Expressions
Language Expression text/cql 'draft' dynamicValue
path: patient
Expressions
Language Expression text/cql CardiologyChestPainLogic.Patient dynamicValue
path: prescriber
Expressions
Language Expression text/cql CardiologyChestPainLogic.Practitioner action
textEquivalent:
metoprolol tartrate 50 mg tablet 1 tablet oral 2 time daily
dynamicValue
path: status
Expressions
Language Expression text/cql 'draft' dynamicValue
path: patient
Expressions
Language Expression text/cql CardiologyChestPainLogic.Patient dynamicValue
path: prescriber
Expressions
Language Expression text/cql CardiologyChestPainLogic.Practitioner action
textEquivalent:
amlodipine 5 tablet 1 tablet oral daily
definition:
#amlodipinePrescriptiondynamicValue
path: status
Expressions
Language Expression text/cql 'draft' dynamicValue
path: patient
Expressions
Language Expression text/cql CardiologyChestPainLogic.Patient dynamicValue
path: prescriber
Expressions
Language Expression text/cql CardiologyChestPainLogic.Practitioner action
title: Nitroglycerin
groupingBehavior: logical-group
selectionBehavior: at-most-one
action
textEquivalent:
nitroglycerin 0.4 mg tablet sub-lingual every 5 minutes as needed for chest pain; maximum 3 tablets
definition: ActivityDefinition: status = draft; kind = MedicationRequest; product[x] = ->Medication nitroglycerin 0.4 MG
dynamicValue
path: status
Expressions
Language Expression text/cql 'draft' dynamicValue
path: patient
Expressions
Language Expression text/cql CardiologyChestPainLogic.Patient dynamicValue
path: prescriber
Expressions
Language Expression text/cql CardiologyChestPainLogic.Practitioner
Generated Narrative: ActivityDefinition #referralToCardiologyConsult
status: draft
description:
Consider other consult modalities which might be available (e.g., e-consult or other rapidly iterative consult method. A simple consult is included here as the overarching clinical intent.
kind: ServiceRequest
timing: Events: ??
Participants
Type practitioner
Generated Narrative: ActivityDefinition #metoprololTartrate25Prescription
status: draft
kind: MedicationRequest
product: Medication metoprolol tartrate 25 MG
dosage
text: 1 tablet oral 2 time daily
timing: 2 per 1 days
route: Oral route (qualifier value)
DoseAndRates
Type Dose[x] Ordered 1 {tbl} dynamicValue
path: medicationRequest.priority
Expressions
Language Expression text/cql routine
Generated Narrative: Medication #metoprololTartrate25Medication
code: Metoprolol Tartrate 25 MG
doseForm: Tablet dose form
ingredient
Items
Reference Substance metoprolol strength: 25 mg/1 {tbl}
Generated Narrative: Substance #metoprololTartrate25Substance
instance: false
Codes
Concept Metoprolol
Generated Narrative: ActivityDefinition #metoprololTartrate50Prescription
status: draft
kind: MedicationRequest
product: Medication metoprolol tartrate 50 MG
dosage
text: 1 tablet oral 2 time daily
timing: 2 per 1 days
route: Oral route (qualifier value)
DoseAndRates
Type Dose[x] Ordered 1 {tbl} dynamicValue
path: medicationRequest.priority
Expressions
Language Expression text/cql routine
Generated Narrative: Medication #metoprololTartrate50Medication
code: Metoprolol Tartrate 50 MG
doseForm: Tablet dose form
ingredient
Items
Reference Substance metoprolol strength: 50 mg/1 {tbl}
Generated Narrative: Substance #metoprololTartrate50Substance
instance: false
Codes
Concept Metoprolol
Generated Narrative: ActivityDefinition #nitroglycerinPrescription
status: draft
kind: MedicationRequest
product: Medication nitroglycerin 0.4 MG
dosage
text: nitroglycerin 0.4 mg tablet sub-lingual every 5 minutes as needed for chest pain; maximum 3 tablets
timing: Once per 5 minutes
DoseAndRates
Type Dose[x] Ordered 1 {tbl} maxDosePerAdministration: 3 {tbl}
dynamicValue
path: medicationRequest.priority
Expressions
Language Expression text/cql routine
Generated Narrative: Medication #nitroglycerinMedication
code: Nitroglycerin 0.4 MG
doseForm: Tablet dose form
ingredient
Items
Reference Substance nitroglycerin strength: 0.4 mg/1 {tbl}
Generated Narrative: Substance #nitroglycerinSubstance
instance: false
Codes
Concept Nitroglycerin
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.
FHIR ®© HL7.org 2011+. FHIR R6 hl7.fhir.core#6.0.0-ballot2 generated on Tue, Nov 12, 2024 03:29+0000.
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