<?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.&quot;NUCC Provider Taxonomy&quot; 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>