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

Active as of 2024-11-18

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:PlanDefinition ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "va-ckd-protocol"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-pathwaydefinition"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-pathwaydefinition>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir: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 (use: official, )</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>"
  ] ; # 
  fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability"^^xsd:anyURI ] ;
fhir:value [ fhir:v "shareable" ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability"^^xsd:anyURI ] ;
fhir:value [ fhir:v "computable" ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeCapability"^^xsd:anyURI ] ;
fhir:value [ fhir:v "publishable" ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-knowledgeRepresentationLevel"^^xsd:anyURI ] ;
fhir:value [ fhir:v "structured" ]
  ] ) ; # 
  fhir:url [ fhir:v "http://cqframework.org/cpg-example-ckd/PlanDefinition/va-ckd-protocol"^^xsd:anyURI] ; # 
  fhir:identifier ( [
fhir:use [ fhir:v "official" ] ;
fhir:value [ fhir:v "VA_CKD_Protocol" ]
  ] ) ; # 
  fhir:version [ fhir:v "1.0.0"] ; # 
  fhir:name [ fhir:v "VACKDProtocol"] ; # 
  fhir:title [ fhir:v "VA CKD Protocol Pathway"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/plan-definition-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "clinical-protocol" ] ;
fhir:display [ fhir:v "Clinical Protocol" ]     ] )
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:experimental [ fhir:v "true"^^xsd:boolean] ; # 
  fhir:date [ fhir:v "2024-11-18T18:20:09+00:00"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "HL7 International - Clinical Decision Support WG"] ; # 
  fhir:contact ( [
fhir:name [ fhir:v "HL7 International - Clinical Decision Support WG" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/dss/index.cfm" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "VA CKD Protocol"] ; # 
  fhir:useContext ( [
fhir:code [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/usage-context-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "focus" ] ;
fhir:display [ fhir:v "Clinical Focus" ]     ] ;
fhir:value [
a fhir:CodeableConcept ;
      ( fhir:coding [
a sct:709044004 ;
fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
fhir:code [ fhir:v "709044004" ] ;
fhir:display [ fhir:v "Chronic kidney disease (disorder)" ]       ] )     ]
  ] ) ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm"^^xsd:anyURI ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]     ] )
  ] ) ; # 
  fhir:topic ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/definition-topic"^^xsd:anyURI ] ;
fhir:code [ fhir:v "treatment" ] ;
fhir:display [ fhir:v "Treatment" ]     ] )
  ] ) ; # 
  fhir:action ( [
fhir:id [ fhir:v "001" ] ;
fhir:title [ fhir:v "History and Phyiscal" ] ;
fhir:description [ fhir:v "Obtain initial clinical information: medical history (including risk factors for kidney disease), physical examination and review existing laboratory results." ] ;
    ( fhir:code [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs"^^xsd:anyURI ] ;
fhir:code [ fhir:v "history-and-physical" ] ;
fhir:display [ fhir:v "History and Physical" ]       ] )     ] )
  ] [
fhir:id [ fhir:v "002" ] ;
fhir:title [ fhir:v "At-Risk Population" ] ;
fhir:description [ fhir:v "Evaluate at-risk patients for CKD: obtain SCr, eGFR, urinalysis, & spot urine UAER." ] ;
    ( fhir:code [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs"^^xsd:anyURI ] ;
fhir:code [ fhir:v "history-and-physical" ] ;
fhir:display [ fhir:v "History and Physical" ]       ] )     ] )
  ] [
fhir:id [ fhir:v "003" ] ;
fhir:title [ fhir:v "Urgent/Emergent Conditions" ] ;
fhir:description [ fhir:v "Does patient have an urgent or emergent condition?" ] ;
    ( fhir:code [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs"^^xsd:anyURI ] ;
fhir:code [ fhir:v "triage" ] ;
fhir:display [ fhir:v "Triage" ]       ] )     ] ) ;
    ( fhir:action [
fhir:id [ fhir:v "003.1" ] ;
fhir:title [ fhir:v "Refer to emergency department." ] ;
fhir:description [ fhir:v "Refer to emergency department to manage or stabilize." ] ;
      ( fhir:code [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs"^^xsd:anyURI ] ;
fhir:code [ fhir:v "triage" ] ;
fhir:display [ fhir:v "Triage" ]         ] )       ] )     ] )
  ] [
fhir:id [ fhir:v "004" ] ;
fhir:title [ fhir:v "Criteria for Confirmed CKD" ] ;
fhir:description [ fhir:v "Does patient have evidence of CKD?" ] ;
    ( fhir:code [
      ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs"^^xsd:anyURI ] ;
fhir:code [ fhir:v "determine-diagnosis" ] ;
fhir:display [ fhir:v "Determine Diagnosis" ]       ] )     ] ) ;
    ( fhir:condition [
fhir:kind [ fhir:v "applicability" ] ;
fhir:expression [
fhir:language [ fhir:v "text/cql" ] ;
fhir:expression [ fhir:v "Has evidence of CKD?" ]       ]     ] ) ;
    ( fhir:action [
fhir:id [ fhir:v "004.1" ] ;
fhir:title [ fhir:v "Stages of CKD." ] ;
fhir:description [ fhir:v "Complete clinical assessment. Determine stage of CKD." ] ;
      ( fhir:code [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs"^^xsd:anyURI ] ;
fhir:code [ fhir:v "determine-diagnosis" ] ;
fhir:display [ fhir:v "Determine Diagnosis" ]         ] )       ] )     ] [
fhir:id [ fhir:v "004.2" ] ;
fhir:title [ fhir:v "Strategies to Slow Progression." ] ;
fhir:description [ fhir:v "Establish primary etiology of CKD and treatment plan to slow progression." ] ;
      ( fhir:code [
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process-cs"^^xsd:anyURI ] ;
fhir:code [ fhir:v "guideline-based-care" ] ;
fhir:display [ fhir:v "Guideline-based Care" ]         ] )       ] )     ] )
  ] ) . #