Chest
Pain
Coronary
Artery
Disease
Order
Set
KNART
(id
=
"example-cardiology-os")
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:
: id: bb7ccea6-9744-4743-854a-bcffd87191f6 (OFFICIAL), id: CLIN0004AG, id: KP-914
: 0.1
: ChestPainCoronaryArteryDiseaseOrderSetKNART
: Chest Pain (CP) - Coronary Artery Disease (CAD) Order Set KNART
: Order Set
(
#order-set)
: active
: 2017-08-29
: Department of Veterans Affairs
: 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.
: 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 Cognitive Medical Systems, Inc. 9444 Waples Street Suite 300 San Diego,
CA 92121
: Bruce Bray MD: , Scott Wall MD: , Aiden Abidov MD, PhD:
:
: Consults and Referrals
: logical-group
: any
: Medications
: Consider the following medications for stable patients to be initiated prior to the
cardiology consultation.
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.
nitroglycerin 0.4 mg tablet sub-lingual every 5 minutes as needed for chest pain; maximum
3 tablets
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.
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 Cognitive Medical Systems, Inc. 9444 Waples Street Suite 300 San Diego, CA
92121
Outcome CVD (coronary death, myocardial infarction, coronary insufficiency, angina, ischemic
stroke, hemorrhagic stroke, transient ischemic attack, peripheral artery disease, heart
failure)
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.
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.
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
Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCN
A/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.
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)
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.
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-b8
3d-54dc13a838d3.
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.
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.
LABEL: METOPROLOL SUCCINATE EXTENDED-RELEASE - metoprolol succinate tablet, film coated,
extended release
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.
LABEL: NITROGLYCERIN- nitroglycerin tablet [Internet].: National Library of Medicine;
2017. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=67bf2a15-b115-47ac-ae
28-ce2dafd6b5c9.
LABEL: SIMVASTATIN - simvastatin tablet [Internet].: National Library of Medicine; 2017.
Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5c1c694c-4b08-469e-b538-08e
69df06146.
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.
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.
Code '261QM0850X' from CardiologyChestPainLogic."NUCC Provider Taxonomy" display
'Adult Mental Health'
Consider the following medications for stable patients to be initiated prior to the cardiology
consultation.
nitroglycerin 0.4 mg tablet sub-lingual every 5 minutes as needed for chest pain; maximum
3 tablets
<?xml version="1.0" encoding="UTF-8"?>
<PlanDefinition xmlns="http://hl7.org/fhir"> <id value="example-cardiology-os"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: PlanDefinition</b> <a name="example-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 "example-cardiology-os" </p> </div> <p> <b> url</b> : <code> http://va.gov/kas/orderset/B5-Cardiology-ChestPainCAD-OS</code> </p> <p> <b> identifier</b> : id: urn:oid:2.16.840.1.113883.4.642.11.8, id: bb7ccea6-9744-4743-854a-bcffd87191f6 (use: OF
FICIAL), <span title=" identifierName="Contract: VA118-16-D-1008, Task Order (TO): VA-118-16-F-1008-0007,
CLIN0004AG" ">id: CLIN0004AG</span> , <span title=" identifierName="Jira KP-914" ">id: 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/4.0.0/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> : Department of Veterans Affairs</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> -</td> <td> <b> Code</b> </td> <td> <b> Value[x]</b> </td> </tr> <tr> <td> *</td> <td> Clinical Focus (Details: http://terminology.hl7.org/CodeSystem/usage-context-type
code focus = 'Clinical Focus', stated as 'null')</td> <td> appropriate snomed condition <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #look up value)</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
<identifiers>
<identifier root="https://doi.org/10.1161/CIRCULATIONAHA.107.699579"
identifierName="DOI"/>
<identifier root="D'Agostino RB et al., 2008"
identifierName="LocalDocBook"/>
</identifiers> &#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
<identifiers>
<identifier root="10.1016/j.jtcvs.2014.11.002" identifierName="DOI
"/>
<identifier root="Fihn et al., 2015" identifierName="LocalDocBook&
quot;/>
</identifiers> &#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
<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"/>
">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
<identifiers>
<identifier root="https://doi.org/10.1016/S0735-1097(02)02164-2"
identifierName="DOI"/>
<identifier root="Gibbons et al., 2002" identifierName="LocalDocBo
ok"/>
</identifiers> &#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
<identifiers>
<identifier root="b4064039-2345-4227-b83d-54dc13a838d3"/>
<identifier root="NLM 2017a" identifierName="LocalDocBook"/>
</identifiers> &#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
<identifiers>
<identifier root="edae8df1-caf9-ff72-1304-5ae8b355f8e7"/>
<identifier root="NLM 2017b" identifierName="LocalDocBook"/&g
t;
</identifiers> &#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
<identifiers>
<identifier root="7fe85155-bc00-406b-b097-e8aece187a8a"/>
<identifier root="NLM 2017c" identifierName="LocalDocBook"/>
;
</identifiers> &#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
<identifiers>
<identifier root="2d948600-35d8-4490-983b-918bdce488c8"/>
<identifier root="NLM 2017d" identifierName="LocalDocBook"/>
</identifiers> &#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
<identifiers>
<identifier root="67bf2a15-b115-47ac-ae28-ce2dafd6b5c9"/>
<identifier root="NLM 2017e" identifierName="LocalDocBook"/>
</identifiers> &#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-
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<identifiers>
<identifier root="5c1c694c-4b08-469e-b538-08e69df06146"/>
<identifier root="NLM 2017g" identifierName="LocalDocBook"/>
;
</identifiers> &#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
<identifiers>
<identifier root="10.1136/hrt.2009.190066" identifierName="DOI&qu
ot;/>
<identifier root="Skinner et al., 2010" identifierName="LocalDocB
ook"/>
</identifiers> &#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> </div> </text> <contained>
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other rapidly iterative consult method. A simple consult is included here as the
overarching clinical intent."/>
<kind value="ServiceRequest"/>
<timingTiming> <event>
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<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>
<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 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> <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> <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> <use value="official"/> <system value="urn:va.gov:kbs:knart:artifact:r1"/> <value value="bb7ccea6-9744-4743-854a-bcffd87191f6"/> </identifier>
<identifier> <system value="urn:va.gov:kbs:contract:VA118-16-D-1008:to:VA-118-16-F-1008-0007"/> <value value="CLIN0004AG"/> </identifier> <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="Department of Veterans Affairs"/> <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="look up value"/> <display value="appropriate snomed condition"/> </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"/>
</author> <author> <name value="Scott Wall MD"/>
</author> <author> <name value="Aiden Abidov MD, PhD"/>
</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"/> <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"/>
<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"/>
<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"/>
<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"/>
<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)"/>
<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"/>
<display value="LABEL: ASPIRIN 81 MG- aspirin tablet, coated"/> <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"/>
<display value="LABEL: CLOPIDOGREL- clopidogrel bisulfate tablet, film coated"/> <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"/>
<display value="LABEL: LIPITOR- atorvastatin calcium tablet, film coated"/> <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"/>
<display value="LABEL: METOPROLOL SUCCINATE EXTENDED-RELEASE - metoprolol succinate tablet, film
coated, extended release"/>
<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"/>
<display value="LABEL: NITROGLYCERIN- nitroglycerin tablet"/> <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"/>
<display value="LABEL: SIMVASTATIN - simvastatin tablet"/> <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"/>
<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."/>
<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"/> <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"/>
<dynamicValue> <path value="timing.event"/> <expression> <language value="text/cql"/> <expression value="Now()"/> </expression> </dynamicValue> <dynamicValue> <path value="specialty"/>
<expression> <language value="text/cql"/> <expression value="Code '261QM0850X' from CardiologyChestPainLogic."NUCC Provider Taxonomy"
display 'Adult Mental Health'"/>
</expression> </dynamicValue> <dynamicValue>
<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> <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"/> <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>
</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.
Workflow
.
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versions:
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R4B
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