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 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="atrius-renal-dosing"/>
<meta>
<profile
value="http://hl7.org/fhir/StructureDefinition/cdshooksserviceplandefinition|4.0.1"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>See <code>Library/AtriusRenalDosing</code> for eGFR bands and dose text definitions.</p></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-cdsHooksEndpoint">
<valueUri value="https://cds.atrius.in/cds-services/atrius-renal-dosing"/>
</extension>
<url
value="https://atrius.in/fhir/r4/atrius-in/PlanDefinition/atrius-renal-dosing"/>
<identifier>
<use value="official"/>
<value value="atrius-renal-dosing"/>
</identifier>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:1.3.6.1.4.1.66219.1.34.5"/>
</identifier>
<version value="0.1.0"/>
<name value="AtriusRenalDosing"/>
<title value="Renal Dosing Check"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
<code value="eca-rule"/>
</coding>
</type>
<status value="draft"/>
<experimental value="true"/>
<date value="2026-07-24T19:16:12+05:30"/>
<publisher value="Atrius"/>
<contact>
<name value="Atrius"/>
<telecom>
<system value="url"/>
<value value="https://atrius.in"/>
</telecom>
</contact>
<description
value="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 value="documentation"/>
<display
value="KDIGO CKD guideline — medication dosing in kidney disease"/>
<url value="https://kdigo.org/guidelines/ckd-evaluation-and-management/"/>
<document>
<url
value="https://kdigo.org/guidelines/ckd-evaluation-and-management/"/>
</document>
</relatedArtifact>
<library
value="https://atrius.in/fhir/r4/atrius-in/Library/AtriusRenalDosing|0.1.0"/>
<action id="atrius-renal-dosing-root">
<title value="Renal Dosing Check"/>
<description value="A draft order needs renal dose adjustment."/>
<trigger>
<type value="named-event"/>
<name value="order-sign"/>
</trigger>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql"/>
<expression value="Renal Dose Adjustment Needed"/>
</expression>
</condition>
<input>
<type value="Patient"/>
<profile
value="https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-patient|0.1.0"/>
</input>
<input>
<type value="Observation"/>
<profile
value="https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-observation|0.1.0"/>
</input>
<input>
<type value="MedicationRequest"/>
<profile
value="https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-medicationrequest|0.1.0"/>
</input>
<groupingBehavior value="logical-group"/>
<action id="renal-metformin-contraindicated">
<title value="Metformin contraindicated: eGFR below 30"/>
<description
value="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 value="stat"/>
<documentation>
<type value="documentation"/>
<display value="FDA — metformin use in renal impairment"/>
<url
value="https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-revises-warnings-regarding-use-diabetes-medicine-metformin-certain"/>
<document>
<url
value="https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-revises-warnings-regarding-use-diabetes-medicine-metformin-certain"/>
</document>
</documentation>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql"/>
<expression value="Metformin Contraindicated"/>
</expression>
</condition>
<groupingBehavior value="logical-group"/>
<selectionBehavior value="at-most-one"/>
<action id="renal-metformin-contraindicated-review">
<title value="Clinician review — select alternative agent"/>
<priority value="stat"/>
<definitionCanonical
value="https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-task-clinical-assessment|0.1.0"/>
</action>
</action>
<action id="renal-metformin-reduce">
<title value="Metformin: reduce dose for eGFR 30-45"/>
<description
value="The latest eGFR is 30-45 mL/min/1.73m². Limit metformin to 1000 mg/day and recheck renal function in 3 months."/>
<priority value="urgent"/>
<documentation>
<type value="documentation"/>
<display value="FDA — metformin use in renal impairment"/>
<url
value="https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-revises-warnings-regarding-use-diabetes-medicine-metformin-certain"/>
<document>
<url
value="https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-revises-warnings-regarding-use-diabetes-medicine-metformin-certain"/>
</document>
</documentation>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql"/>
<expression value="Metformin Dose Limited"/>
</expression>
</condition>
<groupingBehavior value="logical-group"/>
<selectionBehavior value="at-most-one"/>
<action id="renal-metformin-reduced-order">
<title value="Metformin at renally-adjusted dose (max 1000 mg/day)"/>
<priority value="urgent"/>
<definitionCanonical
value="https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-metformin|0.1.0"/>
<dynamicValue>
<path value="dosageInstruction[0].text"/>
<expression>
<language value="text/cql"/>
<expression value="Metformin Reduced Dose Text"/>
</expression>
</dynamicValue>
</action>
</action>
<action id="renal-gabapentin-adjust">
<title value="Gabapentin: renal dose adjustment"/>
<description
value="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 value="urgent"/>
<documentation>
<type value="documentation"/>
<display
value="KDIGO CKD guideline — medication dosing in kidney disease"/>
<url
value="https://kdigo.org/guidelines/ckd-evaluation-and-management/"/>
<document>
<url
value="https://kdigo.org/guidelines/ckd-evaluation-and-management/"/>
</document>
</documentation>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql"/>
<expression value="Gabapentin Dose Adjustment Needed"/>
</expression>
</condition>
<groupingBehavior value="logical-group"/>
<selectionBehavior value="at-most-one"/>
<action id="renal-gabapentin-adjusted-order">
<title value="Gabapentin at renally-adjusted dose"/>
<priority value="urgent"/>
<definitionCanonical
value="https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-gabapentin|0.1.0"/>
<dynamicValue>
<path value="dosageInstruction[0].text"/>
<expression>
<language value="text/cql"/>
<expression value="Gabapentin Adjusted Dose Text"/>
</expression>
</dynamicValue>
</action>
</action>
</action>
</PlanDefinition>