Clinical Practice Guidelines
2.0.0 - STU2 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 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cqf-recommendations/ and changes regularly. See the Directory of published versions

Library: Congestive Heart Failure Logic (Experimental)

Official URL: http://hl7.org/fhir/uv/cpg/Library/CHF Version: 2.0.0
Active as of 2024-11-26 Computable Name: CHF
Other Identifiers: OID:2.16.840.1.113883.4.642.40.48.28.1

Logic for an example congestive heart failure pathway

Generated Narrative: Library CHF

Related Artifacts

Depends OnCode System SNOMED-CTSNOMED CT (all versions)
Depends OnCode System LOINCLogical Observation Identifiers, Names and Codes (LOINC)
Depends OnCode System CHFCodesCHF Example Codes
Depends OnCode System Condition Clinical Status CodeCondition Clinical Status Codes
Depends OnCode System Condition Verification Status CodeConditionVerificationStatus

Parameters

Encounterin01Encounter
Patientout01Patient
Body Weightout0*Observation
Body Weight Change Assertionout0*Observation
Daily Body Weightout0*Resource
Daily Body Weight Changeout0*Resource
Body Weight Changeout0*Observation
Current Body Weightout01Observation
Previous Body Weightout01Observation
Current Body Weight Changeout01integer
Urine Outputout0*Observation
Current Urine Outputout01Observation
Net Intake/Outputout0*Observation
Current Net Intake/Outputout01Observation
Jugular Venous Pressureout0*Observation
Oxygen Saturationout0*Observation
Potassiumout0*Observation
Creatinineout0*Observation
eGFRout0*Observation
Eligibility Criteriaout0*Condition

Data Requirements

Type: Observation (Observation)
FilterValue
codeOne of these codes: LOINC 29463-7: Body weight
Type: Observation (Observation)
FilterValue
codeOne of these codes: CHF Example Codes body-weight-change: Body weight change
Type: Observation (Observation)
FilterValue
codeOne of these codes: LOINC 9192-6: Urine output 24 hour
Type: Observation (Observation)
FilterValue
codeOne of these codes: CHF Example Codes net-intake-output: Net intake/output
Type: Observation (Observation)
FilterValue
codeOne of these codes: CHF Example Codes jvp: Jugular venous pressure
Type: Observation (Observation)
FilterValue
codeOne of these codes: LOINC 2708-6: Oxygen saturation in Arterial blood
Type: Observation (Observation)
FilterValue
codeOne of these codes: LOINC 86919-8: Potassium goal [Moles/volume] Serum or Plasma
Type: Observation (Observation)
FilterValue
codeOne of these codes: LOINC 39802-4: Creatinine in dialysis fluid/Creatinine in serum or plasma
Type: Observation (Observation)
FilterValue
codeOne of these codes: CHF Example Codes egfr: eGFR result
Type: Condition (Condition)

Contents

text/cql

library CHF version '1.0.0'

using FHIR version '4.0.1'

include FHIRHelpers version '4.0.1'

codesystem "SNOMED-CT": 'http://snomed.info/sct'
codesystem "LOINC": 'http://loinc.org'
codesystem "CHFCodes": 'http://hl7.org/fhir/uv/cpg/CodeSystem/chf-example-codes'
codesystem "Condition Clinical Status Code": 'http://terminology.hl7.org/CodeSystem/condition-clinical'
codesystem "Condition Verification Status Code": 'http://terminology.hl7.org/CodeSystem/condition-ver-status'

code "Congestive heart failure": '42343007' from "SNOMED-CT"

code "Body weight": '29463-7' from "LOINC"
code "Body weight change": 'body-weight-change' from "CHFCodes"
code "Urine output": '9192-6' from "LOINC"
code "Net intake/output": 'net-intake-output' from "CHFCodes"
code "Jugular venous pressure": 'jvp' from "CHFCodes"
code "Oxygen saturation": '2708-6' from "LOINC"
code "Potassium goal": '86919-8' from "LOINC" display 'Potassium goal [Moles/volume] Serum or Plasma' // meq/L
code "Creatinine in serum": '39802-4' from "LOINC" display 'Creatinine in dialysis fluid/Creatinine in serum or plasma' // NOTE: example shows mg/dL, but no LOINC code has those units?
code "eGFR result": 'egfr' from "CHFCodes" // NOTE: Too many to pick from, needs clinical/terminological SME input, in mol/mm/m2

code "Active condition": 'active' from "Condition Clinical Status Code"
code "Provisional condition": 'provisional' from "Condition Verification Status Code"
code "Confirmed condition": 'confirmed' from "Condition Verification Status Code"

parameter Encounter Encounter

context Patient

// Case Features
define "Body Weight":
  [Observation: "Body weight"] O
    where O.status = 'final'
      and references(O.encounter, Encounter)

define "Body Weight Change Assertion":
  [Observation: "Body weight change"] O
    where O.status = 'final'
      and references(O.encounter, Encounter)

define "Body Weight Change":
  "Daily Body Weight Change" WC
    return Observation {
      id: id { value: Encounter.id + '-bodyweight-change' + ToString(WC.date) },
      extension: {
        Extension {
          url: url { value: 'http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-instantiatesCaseFeature' },
          value: canonical { value: 'http://hl7.org/fhir/uv/cpg/StructureDefinition/chf-bodyweight-change' }
        },
        Extension {
          url: url { value: 'http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-caseFeatureType' },
          value: code { value: 'asserted' }
        }
      },
      status: ObservationStatus { value: 'final' },
      code: CodeableConcept {
        coding: {
          Coding {
            system: uri { value: 'http://hl7.org/fhir/uv/cpg/CodeSystem/chf-example-codes' },
            code: code { value: 'body-weight-change' }
          }
        }
      },
      effective: dateTime { value: WC.date },
      issued: instant { value: Now() },
      subject: referenceTo(Patient),
      encounter: referenceTo(Encounter),
      value: Quantity {
        value: decimal { value: WC.change.value },
        unit: string { value: WC.change.unit },
        system: uri { value: 'http://unitsofmeasure.org' },
        code: code { value: WC.change.unit }
      }
    }

define "Daily Body Weight":
  (expand Encounter.period per day) Date
    let maxWeight: Max("Body Weight" WT where WT.issued same day as Date return WT.value as FHIR.Quantity)
    return { date: Date, weight: maxWeight }

define "Daily Body Weight Change":
  "Daily Body Weight" WT
    let priorWeight: First("Daily Body Weight" PWT where PWT.date < WT.date sort by date descending).weight
    return { date: WT.date, weight: WT.weight, priorWeight: priorWeight, change: WT.weight - priorWeight}

define "Current Body Weight":
  First("Body Weight" WT where WT.issued same day as Today() sort by issued descending)

define "Previous Body Weight":
  First("Body Weight" WT where WT.issued 1 day before day of Today() sort by issued descending)

define "Current Body Weight Change":
  "Current Body Weight".value - "Previous Body Weight".value

define "Urine Output":
  [Observation: "Urine output"] O
    where O.status = 'final'
    and references(O.encounter, Encounter)

define "Current Urine Output":
  First("Urine Output" UO where UO.issued same day as Today() sort by issued descending)

define "Net Intake/Output":
  [Observation: "Net intake/output"] O
    where O.status = 'final'
      and references(O.encounter, Encounter)

define "Current Net Intake/Output":
  First("Net Intake/Output" IO where IO.issued same day as Today() sort by issued descending)

define "Jugular Venous Pressure":
  [Observation: "Jugular venous pressure"] O
    where O.status = 'final'
      and references(O.encounter, Encounter)

define "Oxygen Saturation":
  [Observation: "Oxygen saturation"] O
    where O.status = 'final'
      and references(O.encounter, Encounter)

define "Potassium":
  [Observation: "Potassium goal"] O
    where O.status = 'final'
      and references(O.encounter, Encounter)

define "Creatinine":
  [Observation: "Creatinine in serum"] O
    where O.status = 'final'
      and references(O.encounter, Encounter)

define "eGFR":
  [Observation: "eGFR result"] O
    where O.status = 'final'
      and references(O.encounter, Encounter)


// Eligibility Criteria
define "Eligibility Criteria":
  [Condition] C
    where C.code ~ "Congestive heart failure"
      and C.clinicalStatus ~ "Active condition"
      and C.verificationStatus ~ "Confirmed condition"

// TODO: Handle contained references
// TODO: Handle bundle references
// TODO: Handle remote references
define function references(reference Reference, encounter Encounter):
  EndsWith(reference.reference, '/' + encounter.id)

define function referenceTo(encounter Encounter):
  Reference { reference: string { value: 'Encounter/' + encounter.id } }

define function referenceTo(patient Patient):
  Reference { reference: string { value: 'Patient/' + patient.id } }

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