Clinical Practice Guidelines Example Implementation Guide - Chronic Kidney Disease
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: VA CKD Protocol Pathway - JSON Representation

Active as of 2024-11-18

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{
  "resourceType" : "PlanDefinition",
  "id" : "va-ckd-protocol",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-pathwaydefinition"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: PlanDefinition va-ckd-protocol</b></p><a name=\"va-ckd-protocol\"> </a><a name=\"hcva-ckd-protocol\"> </a><a name=\"va-ckd-protocol-en-US\"> </a><p><b>CQF Knowledge capability</b>: shareable</p><p><b>CQF Knowledge capability</b>: computable</p><p><b>CQF Knowledge capability</b>: publishable</p><p><b>CQF knowledge representation level</b>: structured</p><p><b>url</b>: <a href=\"PlanDefinition-va-ckd-protocol.html\">PlanDefinition VA CKD Protocol Pathway</a></p><p><b>identifier</b>: VA_CKD_Protocol\u00a0(use:\u00a0official,\u00a0)</p><p><b>version</b>: 1.0.0</p><p><b>name</b>: VACKDProtocol</p><p><b>title</b>: VA CKD Protocol Pathway</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/plan-definition-type clinical-protocol}\">Clinical Protocol</span></p><p><b>status</b>: Active</p><p><b>experimental</b>: true</p><p><b>date</b>: 2024-11-18 18:20:09+0000</p><p><b>publisher</b>: HL7 International - Clinical Decision Support WG</p><p><b>contact</b>: HL7 International - Clinical Decision Support WG: <a href=\"http://www.hl7.org/Special/committees/dss/index.cfm\">http://www.hl7.org/Special/committees/dss/index.cfm</a></p><p><b>description</b>: </p><div><p>VA CKD Protocol</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/6.0.2/CodeSystem-usage-context-type.html#usage-context-type-focus\">UsageContextType focus</a>: Clinical Focus</td><td><span title=\"Codes:{http://snomed.info/sct 709044004}\">Chronic kidney disease (disorder)</span></td></tr></table><p><b>jurisdiction</b>: <span title=\"Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}\">World</span></p><p><b>topic</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/definition-topic treatment}\">Treatment</span></p><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>001</blockquote><p><b>title</b>: History and Phyiscal</p><p><b>description</b>: Obtain initial clinical information: medical history (including risk factors for kidney disease), physical examination and review existing laboratory results.</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs history-and-physical}\">History and Physical</span></p></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>002</blockquote><p><b>title</b>: At-Risk Population</p><p><b>description</b>: Evaluate at-risk patients for CKD: obtain SCr, eGFR, urinalysis, &amp; spot urine UAER.</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs history-and-physical}\">History and Physical</span></p></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>003</blockquote><p><b>title</b>: Urgent/Emergent Conditions</p><p><b>description</b>: Does patient have an urgent or emergent condition?</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs triage}\">Triage</span></p><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>003.1</blockquote><p><b>title</b>: Refer to emergency department.</p><p><b>description</b>: Refer to emergency department to manage or stabilize.</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs triage}\">Triage</span></p></blockquote></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>004</blockquote><p><b>title</b>: Criteria for Confirmed CKD</p><p><b>description</b>: Does patient have evidence of CKD?</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs determine-diagnosis}\">Determine Diagnosis</span></p><blockquote><p><b>condition</b></p><p><b>kind</b>: Applicability</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>CQL</td><td>Has evidence of CKD?</td></tr></table></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>004.1</blockquote><p><b>title</b>: Stages of CKD.</p><p><b>description</b>: Complete clinical assessment. Determine stage of CKD.</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs determine-diagnosis}\">Determine Diagnosis</span></p></blockquote><blockquote><p><b>action</b></p><blockquote><p><b>id</b></p>004.2</blockquote><p><b>title</b>: Strategies to Slow Progression.</p><p><b>description</b>: Establish primary etiology of CKD and treatment plan to slow progression.</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs guideline-based-care}\">Guideline-based Care</span></p></blockquote></blockquote></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability",
      "valueCode" : "shareable"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability",
      "valueCode" : "computable"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability",
      "valueCode" : "publishable"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeRepresentationLevel",
      "valueCode" : "structured"
    }
  ],
  "url" : "http://cqframework.org/cpg-example-ckd/PlanDefinition/va-ckd-protocol",
  "identifier" : [
    {
      "use" : "official",
      "value" : "VA_CKD_Protocol"
    }
  ],
  "version" : "1.0.0",
  "name" : "VACKDProtocol",
  "title" : "VA CKD Protocol Pathway",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
        "code" : "clinical-protocol",
        "display" : "Clinical Protocol"
      }
    ]
  },
  "status" : "active",
  "experimental" : true,
  "date" : "2024-11-18T18:20:09+00:00",
  "publisher" : "HL7 International - Clinical Decision Support WG",
  "contact" : [
    {
      "name" : "HL7 International - Clinical Decision Support WG",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/dss/index.cfm"
        }
      ]
    }
  ],
  "description" : "VA CKD Protocol",
  "useContext" : [
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "focus",
        "display" : "Clinical Focus"
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://snomed.info/sct",
            "code" : "709044004",
            "display" : "Chronic kidney disease (disorder)"
          }
        ]
      }
    }
  ],
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code" : "001",
          "display" : "World"
        }
      ]
    }
  ],
  "topic" : [
    {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/definition-topic",
          "code" : "treatment",
          "display" : "Treatment"
        }
      ]
    }
  ],
  "action" : [
    {
      "id" : "001",
      "title" : "History and Phyiscal",
      "description" : "Obtain initial clinical information: medical history (including risk factors for kidney disease), physical examination and review existing laboratory results.",
      "code" : [
        {
          "coding" : [
            {
              "system" : "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs",
              "code" : "history-and-physical",
              "display" : "History and Physical"
            }
          ]
        }
      ]
    },
    {
      "id" : "002",
      "title" : "At-Risk Population",
      "description" : "Evaluate at-risk patients for CKD: obtain SCr, eGFR, urinalysis, & spot urine UAER.",
      "code" : [
        {
          "coding" : [
            {
              "system" : "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs",
              "code" : "history-and-physical",
              "display" : "History and Physical"
            }
          ]
        }
      ]
    },
    {
      "id" : "003",
      "title" : "Urgent/Emergent Conditions",
      "description" : "Does patient have an urgent or emergent condition?",
      "code" : [
        {
          "coding" : [
            {
              "system" : "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs",
              "code" : "triage",
              "display" : "Triage"
            }
          ]
        }
      ],
      "action" : [
        {
          "id" : "003.1",
          "title" : "Refer to emergency department.",
          "description" : "Refer to emergency department to manage or stabilize.",
          "code" : [
            {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs",
                  "code" : "triage",
                  "display" : "Triage"
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "id" : "004",
      "title" : "Criteria for Confirmed CKD",
      "description" : "Does patient have evidence of CKD?",
      "code" : [
        {
          "coding" : [
            {
              "system" : "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs",
              "code" : "determine-diagnosis",
              "display" : "Determine Diagnosis"
            }
          ]
        }
      ],
      "condition" : [
        {
          "kind" : "applicability",
          "expression" : {
            "language" : "text/cql",
            "expression" : "Has evidence of CKD?"
          }
        }
      ],
      "action" : [
        {
          "id" : "004.1",
          "title" : "Stages of CKD.",
          "description" : "Complete clinical assessment. Determine stage of CKD.",
          "code" : [
            {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs",
                  "code" : "determine-diagnosis",
                  "display" : "Determine Diagnosis"
                }
              ]
            }
          ]
        },
        {
          "id" : "004.2",
          "title" : "Strategies to Slow Progression.",
          "description" : "Establish primary etiology of CKD and treatment plan to slow progression.",
          "code" : [
            {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs",
                  "code" : "guideline-based-care",
                  "display" : "Guideline-based Care"
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}