<?xml version=“1.0” encoding=“UTF-8”?> <PlanDefinition xmlns=“hl7.org/fhir”>
<id value="low-suicide-risk-order-set"/> <meta> <security> <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/> <code value="HTEST"/> <display value="test health data"/> </security> </meta> <!-- The referral and medication requests here are only partially specified, additional information will be provided from context, see the action definitions in the body of the plan definition below --> <contained> <ActivityDefinition> <id value="referralToMentalHealthCare"/> <status value="draft"/> <description value="refer to primary care mental-health integrated care program for evaluation and treatment of mental health conditions now"/> <!-- Kind indicates the type of resource that is defined by this activity, a ServiceRequest in this case --> <kind value="ServiceRequest"/> <code> <coding> <system value="http://snomed.info/sct"/> <code value="306206005"/> </coding> <text value="Referral to service (procedure)"/> </code> <timingTiming> <event> <!-- The expression here specifies the value for the timing of the resulting resource. In this case, referralRequest.fulfillmentTime.start --> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <language value="text/cql"/> <expression value="Now()"/> </valueExpression> </extension> </event> </timingTiming> <participant> <type value="practitioner"/> </participant> </ActivityDefinition> </contained> <contained> <ActivityDefinition> <id value="citalopramPrescription"/> <status value="draft"/> <kind value="MedicationRequest"/> <productReference> <reference value="#citalopramMedication"/> </productReference> <dosage> <text value="1 tablet oral 1 time daily"/> <timing> <repeat> <frequency value="1"/> <period value="1"/> <periodUnit value="d"/> </repeat> </timing> <route> <coding> <code value="26643006"/> <display value="Oral route (qualifier value)"/> </coding> <text value="Oral route (qualifier value)"/> </route> <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> </dosage> <dynamicValue> <path value="dispenseRequest.numberOfRepeatsAllowed"/> <expression> <language value="text/cql"/> <expression value="3"/> </expression> </dynamicValue> <dynamicValue> <path value="dispenseRequest.quantity"/> <expression> <language value="text/cql"/> <expression value="30 '{tbl}'"/> </expression> </dynamicValue> </ActivityDefinition> </contained> <contained> <Medication> <id value="citalopramMedication"/> <code> <coding> <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> <code value="200371"/> </coding> <text value="citalopram"/> </code> <form> <coding> <system value="http://snomed.info/sct"/> <code value="385055001"/> <display value="Tablet dose form"/> </coding> <text value="Tablet dose form"/> </form> <ingredient> <itemReference> <reference value="#citalopramSubstance"/> </itemReference> <strength> <numerator> <value value="20"/> <unit value="mg"/> </numerator> <denominator> <value value="1"/> <unit value="{tbl}"/> </denominator> </strength> </ingredient> </Medication> </contained> <contained> <Substance> <id value="citalopramSubstance"/> <code> <coding> <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/> <code value="2556"/> </coding> <text value="citalopram"/> </code> </Substance> </contained> <url value="http://motivemi.com/artifacts/PlanDefinition/low-suicide-risk-order-set"/> <identifier> <use value="official"/> <system value="http://motivemi.com/artifacts"/> <value value="mmi:low-suicide-risk-order-set"/> </identifier> <version value="1.0.0"/> <name value="LowSuicideRiskOrderSet"/> <title value="Low Suicide Risk Order Set"/> <status value="active"/> <experimental value="true"/> <date value="2015-08-15"/> <publisher value="Motive Medical Intelligence"/> <contact> <telecom> <system value="phone"/> <value value="415-362-4007"/> <use value="work"/> </telecom> <telecom> <system value="email"/> <value value="info@motivemi.com"/> <use value="work"/> </telecom> </contact> <description value="Orders to be applied to a patient characterized as low suicide risk."/> <useContext> <code> <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> <code value="age"/> </code> <valueCodeableConcept> <coding> <system value="https://meshb.nlm.nih.gov"/> <code value="D000328"/> <display value="Adult"/> </coding> </valueCodeableConcept> </useContext> <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="87512008"/> <display value="Mild major depression"/> </coding> </valueCodeableConcept> </useContext> <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="40379007"/> <display value="Major depression, recurrent, mild"/> </coding> </valueCodeableConcept> </useContext> <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="394687007"/> <display value="Low suicide risk"/> </coding> </valueCodeableConcept> </useContext> <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="225337009"/> <display value="Suicide risk assessment"/> </coding> </valueCodeableConcept> </useContext> <useContext> <code> <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> <code value="user"/> </code> <valueCodeableConcept> <coding> <system value="http://snomed.info/sct"/> <code value="309343006"/> <display value="Physician"/> </coding> </valueCodeableConcept> </useContext> <useContext> <code> <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/> <code value="venue"/> </code> <valueCodeableConcept> <coding> <system value="http://snomed.info/sct"/> <code value="440655000"/> <display value="Outpatient environment"/> </coding> </valueCodeableConcept> </useContext> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="US"/> </coding> </jurisdiction> <purpose value="This order set helps ensure consistent application of appropriate orders for the care of low suicide risk patients."/> <usage value="This order set should be applied after assessing a patient for suicide risk, when the findings of that assessment indicate the patient has low suicide risk."/> <copyright value="© Copyright 2016 Motive Medical Intelligence. All rights reserved."/> <approvalDate value="2016-03-12"/> <lastReviewDate value="2016-08-15"/> <effectivePeriod> <start value="2016-01-01"/> <end value="2017-12-31"/> </effectivePeriod> <topic> <text value="Suicide risk assessment"/> </topic> <author> <name value="Motive Medical Intelligence"/> <telecom> <system value="phone"/> <value value="415-362-4007"/> <use value="work"/> </telecom> <telecom> <system value="email"/> <value value="info@motivemi.com"/> <use value="work"/> </telecom> </author> <relatedArtifact> <type value="derived-from"/> <display value="Practice Guideline for the Treatment of Patients with Major Depressive Disorder"/> <url value="http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf"/> </relatedArtifact> <relatedArtifact> <type value="composed-of"/> <resource value="ActivityDefinition/referralPrimaryCareMentalHealth"/> </relatedArtifact> <relatedArtifact> <type value="composed-of"/> <resource value="ActivityDefinition/citalopramPrescription"/> </relatedArtifact> <library value="Library/suiciderisk-orderset-logic"/> <!-- Actions --> <action> <title value="Suicide Risk Assessment and Outpatient Management"/> <action> <title value="Consults and Referrals"/> <groupingBehavior value="logical-group"/> <selectionBehavior value="any"/> <action> <textEquivalent value="Refer to outpatient mental health program for evaluation and treatment of mental health conditions now"/> <definitionCanonical value="#referralToMentalHealthCare"/> <!-- These expressions will be evaluated with the library referenced above as an include --> <dynamicValue> <path value="timing.event"/> <expression> <language value="text/cql"/> <expression value="Now()"/> </expression> </dynamicValue> <dynamicValue> <path value="specialty"/> <!-- This expression is code selector syntax in CQL, returning the code from the NPI provider taxonomy --> <expression> <language value="text/cql"/> <expression value="Code '261QM0850X' from SuicideRiskLogic."NUCC Provider Taxonomy" display 'Adult Mental Health'"/> </expression> </dynamicValue> <dynamicValue> <!-- The fulfillmentTime element of the resulting ServiceRequest will be set to the result of the ServiceRequestFulfillmentTime expression defined in the SuicideRiskLogic library --> <path value="occurrenceDateTime"/> <expression> <language value="text/cql"/> <expression value="SuicideRiskLogic.ServiceRequestFulfillmentTime"/> </expression> </dynamicValue> <dynamicValue> <path value="subject"/> <expression> <language value="text/cql"/> <expression value="SuicideRiskLogic.Patient"/> </expression> </dynamicValue> <dynamicValue> <path value="requester.agent"/> <expression> <language value="text/cql"/> <expression value="SuicideRiskLogic.Practitioner"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode"/> <expression> <language value="text/cql"/> <expression value="SuicideRiskLogic.RiskAssessmentScore"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonReference"/> <expression> <language value="text/cql"/> <expression value="SuicideRiskLogic.RiskAssessment"/> </expression> </dynamicValue> </action> </action> <action> <title value="Medications"/> <groupingBehavior value="logical-group"/> <selectionBehavior value="at-most-one"/> <action> <title value="First-Line Antidepressants"/> <documentation> <type value="citation"/> <document> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-qualityOfEvidence"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/evidence-quality"/> <code value="high"/> </coding> <text value="High Quality"/> </valueCodeableConcept> </extension> <contentType value="text/html"/> <url value="http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf"/> <title value="Practice Guideline for the Treatment of Patients with Major Depressive Disorder"/> </document> </documentation> <groupingBehavior value="logical-group"/> <selectionBehavior value="at-most-one"/> <action> <title value="Selective Serotonin Reuptake Inhibitors (Choose a mazimum of one or document reasons for exception)"/> <documentation> <type value="citation"/> <document> <contentType value="text/html"/> <url value="http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6daeb45c-451d-b135-bf8f-2d6dff4b6b01"/> <title value="National Library of Medicine. DailyMed website. CITALOPRAM- citalopram hydrobromide tablet, film coated."/> </document> </documentation> <groupingBehavior value="logical-group"/> <selectionBehavior value="at-most-one"/> <action> <textEquivalent value="citalopram 20 mg tablet 1 tablet oral 1 time daily now (30 table; 3 refills)"/> <definitionCanonical value="#citalopramPrescription"/> <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="SuicideRiskLogic.Patient"/> </expression> </dynamicValue> <dynamicValue> <path value="prescriber"/> <expression> <language value="text/cql"/> <expression value="SuicideRiskLogic.Practitioner"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode"/> <expression> <language value="text/cql"/> <expression value="SuicideRiskLogic.RiskAssessmentScore"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonReference"/> <expression> <language value="text/cql"/> <expression value="SuicideRiskLogic.RiskAssessment"/> </expression> </dynamicValue> </action> <action> <textEquivalent value="escitalopram 10 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills)"/> <!-- Follows pattern established above --> </action> <action> <textEquivalent value="fluoxetine 20 mg capsule 1 capsule oral 1 time daily now (30 tablet; 3 refills)"/> <!-- Follows pattern established above --> </action> <action> <textEquivalent value="paroxetine 20 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills)"/> <!-- Follows pattern established above --> </action> <action> <textEquivalent value="sertraline 50 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills)"/> <!-- Follows pattern established above --> </action> </action> <action> <textEquivalent value="Dopamine Norepinephrine Reuptake Inhibitors (Choose a maximum of one or document reasons for exception)"/> <!-- Follows pattern established above --> </action> <action> <textEquivalent value="Serotonin Norepinephrine Reuptake Inhibitors (Choose a maximum of one or doument reasons for exception)"/> <!-- Follows pattern established above --> </action> <action> <textEquivalent value="Norepinephrine-Serotonin Modulators (Choose a maximum of one or document reasons for exception)"/> <!-- Follows pattern established above --> </action> </action> </action> </action>
</PlanDefinition>