VA CKD Protocol
Transformation of an adapted version of the VA CKD Protocol process as defined here.
Discussions
- Action 3 / 3.1 “Refer to emergency department” are probably not modelled correctly. They should be surrounded by an xor and a condition, rather than defining a action with a subaction which results in a subprocess to perform a check.
Graph
Usage: Mouse Click + Move: Scroll around. Ctrl + Mouse Wheel: Zoom.HL7 FHIR
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<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="va-ckd-protocol"/>
<meta>
<profile
value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-protocoldefinition"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: va-ckd-protocol</p><p><b>meta</b>: </p><p><b>url</b>: <a href="http://hl7.org/fhir/uv/cpg/PlanDefinition/va-ckd-protocol">http://hl7.org/fhir/uv/cpg/PlanDefinition/va-ckd-protocol</a></p><p><b>identifier</b>: VA_CKD_Protocol (OFFICIAL)</p><p><b>version</b>: 0.1.0</p><p><b>name</b>: VA_CKD_Protocol</p><p><b>title</b>: VA CKD Protocol</p><p><b>type</b>: Clinical Protocol <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/plan-definition-type code 'clinical-protocol' = 'Clinical Protocol', given as 'Clinical Protocol'})</span></p><p><b>status</b>: draft</p><p><b>experimental</b>: true</p><p><b>date</b>: Jul 27, 2019 8:00:00 PM</p><p><b>publisher</b>: HL7 FHIR Clinical Guidelines Example Artifact</p><p><b>description</b>: VA CKD Protocol</p><p><b>useContext</b>: </p><p><b>jurisdiction</b>: World <span style="background: LightGoldenRodYellow">(Details : {http://unstats.un.org/unsd/methods/m49/m49.htm code '001' = 'World', given as 'World'})</span></p><p><b>copyright</b>: Copyright © Example.org 2019.</p><p><b>approvalDate</b>: Jul 28, 2019</p><p><b>lastReviewDate</b>: Jul 28, 2019</p><p><b>effectivePeriod</b>: Jul 28, 2019 12:00:00 AM --> (ongoing)</p><p><b>topic</b>: Treatment <span style="background: LightGoldenRodYellow">(Details : {http://terminology.hl7.org/CodeSystem/definition-topic code 'treatment' = 'Treatment', given as 'Treatment'})</span></p><p><b>author</b>: </p><blockquote><p><b>action</b></p><p><b>id</b>: 001</p><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>: History and Physical <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process code 'history-and-physical' = 'History and Physical', given as 'History and Physical'})</span></p></blockquote><blockquote><p><b>action</b></p><p><b>id</b>: 002</p><p><b>title</b>: At-Risk Population</p><p><b>description</b>: Evaluate at-risk patients for CKD: obtain SCr, eGFR, urinalysis, & spot urine UAER.</p><p><b>code</b>: History and Physical <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process code 'history-and-physical' = 'History and Physical', given as 'History and Physical'})</span></p></blockquote><blockquote><p><b>action</b></p><p><b>id</b>: 003</p><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>: Triage <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process code 'triage' = 'Triage', given as 'Triage'})</span></p><h3>Actions</h3><table class="grid"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>action</b></p><p><b>id</b>: 004</p><p><b>title</b>: Criteria for Confirmed CKD</p><p><b>description</b>: Does patient have evidence of CKD?</p><p><b>code</b>: Determine Diagnosis <span style="background: LightGoldenRodYellow">(Details : {http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process code 'determine-diagnosis' = 'Determine Diagnosis', given as 'Determine Diagnosis'})</span></p><h3>Conditions</h3><table class="grid"><tr><td>-</td><td><b>Kind</b></td><td><b>Expression</b></td></tr><tr><td>*</td><td>applicability</td><td/></tr></table><h3>Actions</h3><table class="grid"><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote></div>
</text>
<url value="http://hl7.org/fhir/uv/cpg/PlanDefinition/va-ckd-protocol"/>
<identifier>
<use value="official"/>
<value value="VA_CKD_Protocol"/>
</identifier>
<version value="0.1.0"/>
<name value="VA_CKD_Protocol"/>
<title value="VA CKD Protocol"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
<code value="clinical-protocol"/>
<display value="Clinical Protocol"/>
</coding>
</type>
<status value="draft"/>
<experimental value="true"/>
<date value="2019-07-27T20:00:00-04:00"/>
<publisher value="HL7 FHIR Clinical Guidelines Example Artifact"/>
<description value="VA CKD Protocol"/>
<useContext>
<code>
<system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="focus"/>
<display value="Clinical Focus"/>
</code>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="709044004"/>
<display value="Chronic kidney disease (disorder)"/>
</coding>
</valueCodeableConcept>
</useContext>
<jurisdiction>
<coding>
<system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
<code value="001"/>
<display value="World"/>
</coding>
</jurisdiction>
<copyright value="Copyright © Example.org 2019."/>
<approvalDate value="2019-07-28"/>
<lastReviewDate value="2019-07-28"/>
<effectivePeriod>
<start value="2019-07-28T00:00:00-04:00"/>
</effectivePeriod>
<topic>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/definition-topic"/>
<code value="treatment"/>
<display value="Treatment"/>
</coding>
</topic>
<author>
<name value="Dave Carlson"/>
</author>
<action id="id_001">
<title value="History and Phyiscal"/>
<description value="Obtain initial clinical information: medical history (including risk factors for kidney disease), physical examination and review existing laboratory results."/>
<code>
<coding>
<system value="http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process"/>
<code value="history-and-physical"/>
<display value="History and Physical"/>
</coding>
</code>
<relatedAction> <!-- added -->
<actionId value="id_002"/> <!-- added -->
<relationship value="before-start"/> <!-- added -->
</relatedAction> <!-- added -->
</action>
<action id="id_002">
<title value="At-Risk Population"/>
<description value="Evaluate at-risk patients for CKD: obtain SCr, eGFR, urinalysis, & spot urine UAER."/>
<code>
<coding>
<system value="http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process"/>
<code value="history-and-physical"/>
<display value="History and Physical"/>
</coding>
</code>
<relatedAction> <!-- added -->
<actionId value="id_003"/> <!-- added -->
<relationship value="before-start"/> <!-- added -->
</relatedAction> <!-- added -->
</action>
<action id="id_003">
<title value="Urgent/Emergent Conditions"/>
<description value="Does patient have an urgent or emergent condition?"/> <!-- Note: This should probably become some condition with surrounding xor_group to make sense-->
<code>
<coding>
<system value="http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process"/>
<code value="triage"/>
<display value="Triage"/>
</coding>
</code>
<action id="id_003.1">
<title value="Refer to emergency department."/>
<description value="Refer to emergency department to manage or stabilize."/>
<code>
<coding>
<system value="http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process"/>
<code value="triage"/>
<display value="Triage"/>
</coding>
</code>
</action>
<relatedAction> <!-- added -->
<actionId value="xor_group"/> <!-- added -->
<relationship value="before-start"/> <!-- added -->
</relatedAction> <!-- added -->
</action>
<action> <!-- added -->
<id value="xor_group"/> <!-- added -->
<title value="Xor_group"/> <!-- added -->
<groupingBehavior value="logical-group"/> <!-- added -->
<selectionBehavior value="at-most-one"/> <!-- added -->
<action id="id_004"> <!-- moved to xor -->
<title value="Criteria for Confirmed CKD"/>
<description value="Does patient have evidence of CKD?"/>
<code>
<coding>
<system value="http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process"/>
<code value="determine-diagnosis"/>
<display value="Determine Diagnosis"/>
</coding>
</code>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql"/>
<expression value="Has evidence of CKD?"/>
</expression>
</condition>
<action id="id_004.1">
<title value="Stages of CKD."/>
<description value="Complete clinical assessment. Determine stage of CKD."/>
<code>
<coding>
<system value="http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process"/>
<code value="determine-diagnosis"/>
<display value="Determine Diagnosis"/>
</coding>
</code>
<relatedAction> <!-- added -->
<actionId value="id_004.2"/> <!-- added -->
<relationship value="before-start"/> <!-- added -->
</relatedAction> <!-- added -->
</action>
<action id="id_004.2">
<title value="Strategies to Slow Progression."/>
<description value="Establish primary etiology of CKD and treatment plan to slow progression."/>
<code>
<coding>
<system value="http://hl7.org/fhir/uv/cpg/CodeSystem/cpg-common-process"/>
<code value="guideline-based-care"/>
<display value="Guideline-based Care"/>
</coding>
</code>
</action>
<relatedAction> <!-- added -->
<actionId value="xor_group"/> <!-- added -->
<relationship value="before-end"/> <!-- added -->
</relatedAction> <!-- added -->
</action>
</action>
</PlanDefinition>
BPMN
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<startEvent isInterrupting="false" parallelMultiple="false" name="start" id="id_start64">
<outgoing>sf_start64_id_001</outgoing>
</startEvent>
<sequenceFlow sourceRef="id_start64" targetRef="id_id_001" id="sf_start64_id_001"/>
<userTask name="History and Phyiscal" id="id_id_001">
<incoming>sf_start64_id_001</incoming>
<outgoing>sf_id_001_id_002</outgoing>
</userTask>
<sequenceFlow sourceRef="id_id_001" targetRef="id_id_002" id="sf_id_001_id_002"/>
<userTask name="At-Risk Population" id="id_id_002">
<incoming>sf_id_001_id_002</incoming>
<outgoing>sf_id_002_id_003</outgoing>
</userTask>
<sequenceFlow sourceRef="id_id_002" targetRef="id_id_003" id="sf_id_002_id_003"/>
<subProcess name="Urgent/Emergent Conditions" id="id_id_003">
<incoming>sf_id_002_id_003</incoming>
<outgoing>sf_id_003_xor_group</outgoing>
<startEvent isInterrupting="false" parallelMultiple="false" name="start" id="id_start66">
<outgoing>sf_start66_id_003.1</outgoing>
</startEvent>
<sequenceFlow sourceRef="id_start66" targetRef="id_id_003.1" id="sf_start66_id_003.1"/>
<userTask name="Refer to emergency department." id="id_id_003.1">
<incoming>sf_start66_id_003.1</incoming>
<outgoing>sf_id_003.1_end67</outgoing>
</userTask>
<sequenceFlow sourceRef="id_id_003.1" targetRef="id_end67" id="sf_id_003.1_end67"/>
<endEvent name="end" id="id_end67">
<incoming>sf_id_003.1_end67</incoming>
</endEvent>
</subProcess>
<sequenceFlow sourceRef="id_id_003" targetRef="id_xor_group" id="sf_id_003_xor_group"/>
<exclusiveGateway name="Xor_group" id="id_xor_group">
<incoming>sf_id_003_xor_group</incoming>
<outgoing>sf_xor_group_id_004</outgoing>
<outgoing>sf_xor_group_join_of_xor_group</outgoing>
</exclusiveGateway>
<sequenceFlow sourceRef="id_xor_group" targetRef="id_id_004" name="Has evidence of CKD?" id="sf_xor_group_id_004">
<conditionExpression id="sf_xor_group_id_004_condition">Has evidence of CKD?</conditionExpression>
</sequenceFlow>
<sequenceFlow sourceRef="id_xor_group" targetRef="id_join_of_xor_group" name="else" id="sf_xor_group_join_of_xor_group">
<conditionExpression id="sf_xor_group_join_of_xor_group_condition">else</conditionExpression>
</sequenceFlow>
<subProcess name="Criteria for Confirmed CKD" id="id_id_004">
<incoming>sf_xor_group_id_004</incoming>
<outgoing>sf_id_004_join_of_xor_group</outgoing>
<startEvent isInterrupting="false" parallelMultiple="false" name="start" id="id_start68">
<outgoing>sf_start68_id_004.1</outgoing>
</startEvent>
<sequenceFlow sourceRef="id_start68" targetRef="id_id_004.1" id="sf_start68_id_004.1"/>
<userTask name="Stages of CKD." id="id_id_004.1">
<incoming>sf_start68_id_004.1</incoming>
<outgoing>sf_id_004.1_id_004.2</outgoing>
</userTask>
<sequenceFlow sourceRef="id_id_004.1" targetRef="id_id_004.2" id="sf_id_004.1_id_004.2"/>
<userTask name="Strategies to Slow Progression." id="id_id_004.2">
<incoming>sf_id_004.1_id_004.2</incoming>
<outgoing>sf_id_004.2_end69</outgoing>
</userTask>
<sequenceFlow sourceRef="id_id_004.2" targetRef="id_end69" id="sf_id_004.2_end69"/>
<endEvent name="end" id="id_end69">
<incoming>sf_id_004.2_end69</incoming>
</endEvent>
</subProcess>
<sequenceFlow sourceRef="id_id_004" targetRef="id_join_of_xor_group" id="sf_id_004_join_of_xor_group"/>
<exclusiveGateway name="join" id="id_join_of_xor_group">
<incoming>sf_id_004_join_of_xor_group</incoming>
<incoming>sf_xor_group_join_of_xor_group</incoming>
<outgoing>sf_join_of_xor_group_end65</outgoing>
</exclusiveGateway>
<sequenceFlow sourceRef="id_join_of_xor_group" targetRef="id_end65" id="sf_join_of_xor_group_end65"/>
<endEvent name="end" id="id_end65">
<incoming>sf_join_of_xor_group_end65</incoming>
</endEvent>
</process>
<ns4:BPMNDiagram>
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