Atrius India Core FHIR Implementation Guide
0.1.0 - ci-build
Atrius India Core FHIR Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Draft as of 2026-07-24 |
{
"resourceType" : "PlanDefinition",
"id" : "atrius-renal-dosing",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/StructureDefinition/cdshooksserviceplandefinition|4.0.1"
]
},
"language" : "en",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>See <code>Library/AtriusRenalDosing</code> for eGFR bands and dose text definitions.</p></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-cdsHooksEndpoint",
"valueUri" : "https://cds.atrius.in/cds-services/atrius-renal-dosing"
}
],
"url" : "https://atrius.in/fhir/r4/atrius-in/PlanDefinition/atrius-renal-dosing",
"identifier" : [
{
"use" : "official",
"value" : "atrius-renal-dosing"
},
{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:oid:1.3.6.1.4.1.66219.1.34.5"
}
],
"version" : "0.1.0",
"name" : "AtriusRenalDosing",
"title" : "Renal Dosing Check",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
"code" : "eca-rule"
}
]
},
"status" : "draft",
"experimental" : true,
"date" : "2026-07-24T19:16:12+05:30",
"publisher" : "Atrius",
"contact" : [
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"name" : "Atrius",
"telecom" : [
{
"system" : "url",
"value" : "https://atrius.in"
}
]
}
],
"description" : "At order signing, compare draft metformin and gabapentin orders against the most recent eGFR (last 12 months): metformin is contraindicated below eGFR 30 and dose-limited at 30-45; gabapentin is dose-banded below 60. Replacement orders carry the renally-adjusted dose via dynamicValue.",
"relatedArtifact" : [
{
"type" : "documentation",
"display" : "KDIGO CKD guideline — medication dosing in kidney disease",
"url" : "https://kdigo.org/guidelines/ckd-evaluation-and-management/",
"document" : {
"url" : "https://kdigo.org/guidelines/ckd-evaluation-and-management/"
}
}
],
"library" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/Library/AtriusRenalDosing|0.1.0"
],
"action" : [
{
"id" : "atrius-renal-dosing-root",
"title" : "Renal Dosing Check",
"description" : "A draft order needs renal dose adjustment.",
"trigger" : [
{
"type" : "named-event",
"name" : "order-sign"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"language" : "text/cql",
"expression" : "Renal Dose Adjustment Needed"
}
}
],
"input" : [
{
"type" : "Patient",
"profile" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-patient|0.1.0"
]
},
{
"type" : "Observation",
"profile" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-observation|0.1.0"
]
},
{
"type" : "MedicationRequest",
"profile" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-medicationrequest|0.1.0"
]
}
],
"groupingBehavior" : "logical-group",
"action" : [
{
"id" : "renal-metformin-contraindicated",
"title" : "Metformin contraindicated: eGFR below 30",
"description" : "The latest eGFR is below 30 mL/min/1.73m². Metformin is contraindicated (lactic acidosis risk) — do not sign; choose an alternative antihyperglycemic agent.",
"priority" : "stat",
"documentation" : [
{
"type" : "documentation",
"display" : "FDA — metformin use in renal impairment",
"url" : "https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-revises-warnings-regarding-use-diabetes-medicine-metformin-certain",
"document" : {
"url" : "https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-revises-warnings-regarding-use-diabetes-medicine-metformin-certain"
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}
],
"condition" : [
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"expression" : {
"language" : "text/cql",
"expression" : "Metformin Contraindicated"
}
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"selectionBehavior" : "at-most-one",
"action" : [
{
"id" : "renal-metformin-contraindicated-review",
"title" : "Clinician review — select alternative agent",
"priority" : "stat",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-task-clinical-assessment|0.1.0"
}
]
},
{
"id" : "renal-metformin-reduce",
"title" : "Metformin: reduce dose for eGFR 30-45",
"description" : "The latest eGFR is 30-45 mL/min/1.73m². Limit metformin to 1000 mg/day and recheck renal function in 3 months.",
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}
],
"condition" : [
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"expression" : {
"language" : "text/cql",
"expression" : "Metformin Dose Limited"
}
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],
"groupingBehavior" : "logical-group",
"selectionBehavior" : "at-most-one",
"action" : [
{
"id" : "renal-metformin-reduced-order",
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"priority" : "urgent",
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"dynamicValue" : [
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"expression" : "Metformin Reduced Dose Text"
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}
]
}
]
},
{
"id" : "renal-gabapentin-adjust",
"title" : "Gabapentin: renal dose adjustment",
"description" : "Gabapentin is entirely renally cleared and the latest eGFR is below 60 mL/min/1.73m². Use the eGFR-banded dose on the suggested replacement order.",
"priority" : "urgent",
"documentation" : [
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"display" : "KDIGO CKD guideline — medication dosing in kidney disease",
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}
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"condition" : [
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"groupingBehavior" : "logical-group",
"selectionBehavior" : "at-most-one",
"action" : [
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"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-gabapentin|0.1.0",
"dynamicValue" : [
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"path" : "dosageInstruction[0].text",
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"expression" : "Gabapentin Adjusted Dose Text"
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}
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]
}
]
}