--- type: "example" title: "PlanDefinition Example: plandefinition-example" resource: "PlanDefinition" example: "plandefinition-example" --- # PlanDefinition Example: plandefinition-example ## Narrative | **Id:** | | --- | | PlanDefinition/low-suicide-risk-order-set | | **Identifier:** | | --- | | **value:** mmi:low-suicide-risk-order-set | | **Title:** | | --- | | Low Suicide Risk Order Set | | **Status:** | | --- | | draft | | **Description:** | | --- | | Orders to be applied to a patient characterized as low suicide risk. | | **Purpose:** | | --- | | This order set helps ensure consistent application of appropriate orders for the care of low suicide risk patients. | | **Usage:** | | --- | | 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. | | **Context:** | | --- | | **system:** http://terminology.hl7.org/CodeSystem/usage-context-type **code:** age **value:** **system:** https://meshb.nlm.nih.gov **code:** D000328 **display:** Adult | | **Context:** | | --- | | **system:** http://terminology.hl7.org/CodeSystem/usage-context-type **code:** focus **value:** **system:** http://snomed.info/sct **code:** 87512008 **display:** Mild major depression | | **Context:** | | --- | | **system:** http://terminology.hl7.org/CodeSystem/usage-context-type **code:** focus **value:** **system:** http://snomed.info/sct **code:** 40379007 **display:** Mild recurrent major depression | | **Context:** | | --- | | **system:** http://terminology.hl7.org/CodeSystem/usage-context-type **code:** focus **value:** **system:** http://snomed.info/sct **code:** 394687007 **display:** Low suicide risk | | **Context:** | | --- | | **system:** http://terminology.hl7.org/CodeSystem/usage-context-type **code:** focus **value:** **system:** http://snomed.info/sct **code:** 225337009 **display:** Suicide risk assessment | | **Context:** | | --- | | **system:** http://terminology.hl7.org/CodeSystem/usage-context-type **code:** user **value:** **system:** http://snomed.info/sct **code:** 309343006 **display:** Physician | | **Context:** | | --- | | **system:** http://terminology.hl7.org/CodeSystem/usage-context-type **code:** venue **value:** **system:** http://snomed.info/sct **code:** 440655000 **display:** Outpatient environment | | **Topic:** | | --- | | **text:** Suicide risk assessment | | **Contributor:** | | --- | | **author:** | | Motive Medical Intelligence | | **Library:** | | --- | | **reference:** Library/suiciderisk-orderset-logic | | **display:** SuicideRiskLogic | ## Actions **Step:** **title:** Suicide Risk Assessment and Outpatient Management **Step:** **title:** Consults and Referrals **Step:** **text:** Refer to outpatient mental health program for evaluation and treatment of mental health conditions now **condition:** **reference:** #referralToMentalHealthCare **description:** refer to primary care mental-health integrated care program for evaluation and treatment of mental health conditions now **category:** referral **Step:** **title:** Medications **Step:** **title:** First-Line Antidepressants **Step:** **title:** Selective Serotonin Reuptake Inhibitors (Choose a mazimum of one or document reasons for exception) **Step:** **text:** citalopram 20 mg tablet 1 tablet oral 1 time daily now (30 table; 3 refills) **condition:** **reference:** #citalopramPrescription **category:** drug **Step:** **text:** escitalopram 10 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills) **Step:** **text:** fluoxetine 20 mg capsule 1 capsule oral 1 time daily now (30 tablet; 3 refills) **Step:** **text:** paroxetine 20 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills) **Step:** **text:** sertraline 50 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills) **Step:** **text:** Dopamine Norepinephrine Reuptake Inhibitors (Choose a maximum of one or document reasons for exception) **Step:** **text:** Serotonin Norepinephrine Reuptake Inhibitors (Choose a maximum of one or doument reasons for exception) **Step:** **text:** Norepinephrine-Serotonin Modulators (Choose a maximum of one or document reasons for exception) ## Example XML ```xml
Id:
PlanDefinition/low-suicide-risk-order-set

Identifier:
value: mmi:low-suicide-risk-order-set

Title:
Low Suicide Risk Order Set

Status:
draft

Description:
Orders to be applied to a patient characterized as low suicide risk.

Purpose:
This order set helps ensure consistent application of appropriate orders for the care of low suicide risk patients.

Usage:
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.

Context:

system: http://terminology.hl7.org/CodeSystem/usage-context-type

code: age

value:
system: https://meshb.nlm.nih.gov
code: D000328
display: Adult

Context:

system: http://terminology.hl7.org/CodeSystem/usage-context-type

code: focus

value:
system: http://snomed.info/sct
code: 87512008
display: Mild major depression

Context:

system: http://terminology.hl7.org/CodeSystem/usage-context-type

code: focus

value:
system: http://snomed.info/sct
code: 40379007
display: Mild recurrent major depression

Context:

system: http://terminology.hl7.org/CodeSystem/usage-context-type

code: focus

value:
system: http://snomed.info/sct
code: 394687007
display: Low suicide risk

Context:

system: http://terminology.hl7.org/CodeSystem/usage-context-type

code: focus

value:
system: http://snomed.info/sct
code: 225337009
display: Suicide risk assessment

Context:

system: http://terminology.hl7.org/CodeSystem/usage-context-type

code: user

value:
system: http://snomed.info/sct
code: 309343006
display: Physician

Context:

system: http://terminology.hl7.org/CodeSystem/usage-context-type

code: venue

value:
system: http://snomed.info/sct
code: 440655000
display: Outpatient environment

Topic:
text: Suicide risk assessment

Contributor:
author:
Motive Medical Intelligence

Library:
reference: Library/suiciderisk-orderset-logic
display: SuicideRiskLogic

Actions

Step:
title: Suicide Risk Assessment and Outpatient Management
Step:
title: Consults and Referrals
Step:
text: Refer to outpatient mental health program for evaluation and treatment of mental health conditions now
condition:
reference:
#referralToMentalHealthCare
description: refer to primary care mental-health integrated care program for evaluation and treatment of mental health conditions now
category: referral
Step:
title: Medications
Step:
title: First-Line Antidepressants
Step:
title: Selective Serotonin Reuptake Inhibitors (Choose a mazimum of one or document reasons for exception)
Step:
text: citalopram 20 mg tablet 1 tablet oral 1 time daily now (30 table; 3 refills)
condition:
reference:
#citalopramPrescription
category: drug
Step:
text: escitalopram 10 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills)
Step:
text: fluoxetine 20 mg capsule 1 capsule oral 1 time daily now (30 tablet; 3 refills)
Step:
text: paroxetine 20 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills)
Step:
text: sertraline 50 mg tablet 1 tablet oral 1 time daily now (30 tablet; 3 refills)
Step:
text: Dopamine Norepinephrine Reuptake Inhibitors (Choose a maximum of one or document reasons for exception)
Step:
text: Serotonin Norepinephrine Reuptake Inhibitors (Choose a maximum of one or doument reasons for exception)
Step:
text: Norepinephrine-Serotonin Modulators (Choose a maximum of one or document reasons for exception)

<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="Mild recurrent 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="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"/> <document> <url value="http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf"/> </document> </relatedArtifact> <relatedArtifact> <type value="composed-of"/> <resource value="http://example.org/fhir/ActivityDefinition/referralPrimaryCareMentalHealth"/> </relatedArtifact> <relatedArtifact> <type value="composed-of"/> <resource value="http://example.org/fhir/ActivityDefinition/citalopramPrescription"/> </relatedArtifact> <library value="http://example.org/fhir/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"/> <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"/> <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"/> <expression value="SuicideRiskLogic.ServiceRequestFulfillmentTime"/> </expression> </dynamicValue> <dynamicValue> <path value="subject"/> <expression> <language value="text/cql-expression"/> <expression value="SuicideRiskLogic.Patient"/> </expression> </dynamicValue> <dynamicValue> <path value="requester.agent"/> <expression> <language value="text/cql-expression"/> <expression value="SuicideRiskLogic.Practitioner"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode"/> <expression> <language value="text/cql-expression"/> <expression value="SuicideRiskLogic.RiskAssessmentScore"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonReference"/> <expression> <language value="text/cql-expression"/> <expression value="SuicideRiskLogic.RiskAssessment"/> </expression> </dynamicValue> </action> </action> <action> <title value="Medications"/> <groupingBehavior value="logical-group"/> <selectionBehavior value="at-most-one"/> <action> <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> <title value="First-Line Antidepressants"/> <documentation> <type value="citation"/> <document> <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"/> <expression value="'draft'"/> </expression> </dynamicValue> <dynamicValue> <path value="patient"/> <expression> <language value="text/cql-expression"/> <expression value="SuicideRiskLogic.Patient"/> </expression> </dynamicValue> <dynamicValue> <path value="prescriber"/> <expression> <language value="text/cql-expression"/> <expression value="SuicideRiskLogic.Practitioner"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode"/> <expression> <language value="text/cql-expression"/> <expression value="SuicideRiskLogic.RiskAssessmentScore"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonReference"/> <expression> <language value="text/cql-expression"/> <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> ```