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 2026-07-14 |
<PlanDefinition xmlns="http://hl7.org/fhir">
<id value="hf-admission-protocol"/>
<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><b>Heart Failure Admission Protocol</b> (<code>clinical-protocol</code>). See <code>Library/AtriusHFAdmission</code> for applicability expressions and <code>Questionnaire/hf-admission-eligibility</code> for the ED gate.</p></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/cqf-cdsHooksEndpoint">
<valueUri
value="https://cds.atrius.in/cds-services/hf-admission-protocol"/>
</extension>
<url
value="https://atrius.in/fhir/r4/atrius-in/PlanDefinition/hf-admission-protocol"/>
<identifier>
<use value="official"/>
<system value="https://atrius.in/fhir/sid/cds-service"/>
<value value="hf-admission-protocol"/>
</identifier>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:1.3.6.1.4.1.66219.1.34.8"/>
</identifier>
<version value="0.1.0"/>
<name value="AtriusHFAdmissionProtocol"/>
<title value="Heart Failure Admission Protocol"/>
<subtitle
value="ED / inpatient admission pathway for acute decompensated HF"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/>
<code value="clinical-protocol"/>
</coding>
</type>
<status value="draft"/>
<experimental value="true"/>
<subjectCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="Patient"/>
</coding>
</subjectCodeableConcept>
<date value="2026-07-14"/>
<publisher value="Atrius"/>
<contact>
<name value="Atrius"/>
<telecom>
<system value="url"/>
<value value="https://atrius.in"/>
</telecom>
</contact>
<description
value="Person with active heart failure on the chart at encounter start: confirm ED eligibility features, then propose daily weight monitoring, sodium-restricted diet, IV furosemide, and an admission BNP when none resulted in the last 24 hours."/>
<useContext>
<code>
<system
value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="venue"/>
</code>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="EMER"/>
<display value="emergency"/>
</coding>
</valueCodeableConcept>
</useContext>
<useContext>
<code>
<system
value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="venue"/>
</code>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="IMP"/>
<display value="inpatient encounter"/>
</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="84114007"/>
<display value="Heart failure (disorder)"/>
</coding>
</valueCodeableConcept>
</useContext>
<useContext>
<code>
<system
value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="venue"/>
</code>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="ICU"/>
<display value="Intensive care unit"/>
</coding>
</valueCodeableConcept>
</useContext>
<purpose
value="Standardize safe initial management of acute decompensated heart failure at admission, aligned with AHA/ACC/HFSA guidance, while avoiding redundant natriuretic peptide draws."/>
<usage
value="Invoke on encounter-start (ED or inpatient). Complete the eligibility questionnaire when the working diagnosis is acute HF, then review and place the proposed admission actions."/>
<copyright
value="© Atrius. Pathway structure is illustrative; institutions must adapt dosing and local formulary."/>
<approvalDate value="2026-07-14"/>
<lastReviewDate value="2026-07-14"/>
<effectivePeriod>
<start value="2026-07-14"/>
</effectivePeriod>
<topic>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/definition-topic"/>
<code value="treatment"/>
</coding>
</topic>
<topic>
<coding>
<system value="http://snomed.info/sct"/>
<code value="84114007"/>
<display value="Heart failure (disorder)"/>
</coding>
</topic>
<author>
<name value="Atrius Cardiology / Clinical Reasoning"/>
</author>
<editor>
<name value="Atrius Clinical Reasoning"/>
</editor>
<relatedArtifact>
<type value="documentation"/>
<display
value="2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure"/>
<citation
value="Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation."/>
<url
value="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063"/>
<document>
<url
value="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063"/>
</document>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="HF admission ED eligibility questionnaire"/>
<resource
value="https://atrius.in/fhir/r4/atrius-in/Questionnaire/hf-admission-eligibility|0.1.0"/>
</relatedArtifact>
<relatedArtifact>
<type value="depends-on"/>
<display value="Atrius HF admission CQL library"/>
<resource
value="https://atrius.in/fhir/r4/atrius-in/Library/AtriusHFAdmission|0.1.0"/>
</relatedArtifact>
<library
value="https://atrius.in/fhir/r4/atrius-in/Library/AtriusHFAdmission|0.1.0"/>
<goal id="euvolemia">
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/goal-category"/>
<code value="safety"/>
</coding>
</category>
<description>
<text
value="Relieve congestion and maintain clinical euvolemia during the admission"/>
</description>
<priority>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/goal-priority"/>
<code value="high-priority"/>
<display value="High Priority"/>
</coding>
</priority>
<addresses>
<coding>
<system value="http://snomed.info/sct"/>
<code value="84114007"/>
<display value="Heart failure (disorder)"/>
</coding>
</addresses>
</goal>
<goal id="daily-weight-trend">
<category>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/goal-category"/>
<code value="nursing"/>
</coding>
</category>
<description>
<text
value="Document reliable daily weights (same scale, before breakfast) to guide diuresis"/>
</description>
<priority>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/goal-priority"/>
<code value="medium-priority"/>
<display value="Medium Priority"/>
</coding>
</priority>
</goal>
<action id="hf-admission-root">
<prefix value="1"/>
<title value="Heart Failure Admission Protocol"/>
<description
value="Active heart failure condition on the chart; run eligibility then admission management."/>
<priority value="urgent"/>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="84114007"/>
<display value="Heart failure (disorder)"/>
</coding>
</code>
<goalId value="euvolemia"/>
<goalId value="daily-weight-trend"/>
<trigger>
<type value="named-event"/>
<name value="encounter-start"/>
</trigger>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql"/>
<expression value="HF Admission Applicable"/>
</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="Condition"/>
<profile
value="https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-condition-encounter-diagnosis|0.1.0"/>
<profile
value="https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-condition-problems-health-concerns|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="Encounter"/>
<profile
value="https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-encounter|0.1.0"/>
</input>
<input>
<type value="QuestionnaireResponse"/>
<profile
value="https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-questionnaireresponse|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"/>
<selectionBehavior value="all"/>
<requiredBehavior value="must-unless-documented"/>
<cardinalityBehavior value="single"/>
<action id="hf-admission-eligibility">
<prefix value="1.1"/>
<title value="Confirm ED eligibility"/>
<description
value="Confirm dyspnea/congestion features and that the working diagnosis is acute decompensated heart failure before placing the admission bundle."/>
<priority value="urgent"/>
<definitionCanonical
value="https://atrius.in/fhir/r4/atrius-in/Questionnaire/hf-admission-eligibility|0.1.0"/>
</action>
<action id="hf-admission-bundle">
<prefix value="1.2"/>
<title value="HF admission bundle"/>
<description
value="Daily weights, sodium restriction, and IV diuresis for decompensated heart failure. Place all elements together unless contraindicated."/>
<priority value="urgent"/>
<documentation>
<type value="documentation"/>
<display value="2022 AHA/ACC/HFSA heart failure guideline"/>
<url
value="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063"/>
<document>
<url
value="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063"/>
</document>
</documentation>
<goalId value="euvolemia"/>
<goalId value="daily-weight-trend"/>
<groupingBehavior value="logical-group"/>
<selectionBehavior value="all"/>
<requiredBehavior value="must-unless-documented"/>
<action id="hf-daily-weight">
<title value="Daily weight (same scale, before breakfast)"/>
<description
value="Nursing task: morning weight on the same scale to trend volume status."/>
<goalId value="daily-weight-trend"/>
<definitionCanonical
value="https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-task-daily-weight|0.1.0"/>
</action>
<action id="hf-low-sodium-diet">
<title value="Sodium-restricted diet (< 2 g/day)"/>
<description value="Dietary order supporting congestion management."/>
<definitionCanonical
value="https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-task-low-sodium-diet|0.1.0"/>
</action>
<action id="hf-furosemide">
<title value="Furosemide IV"/>
<description
value="Initial IV loop diuretic for decongestion; adjust to prior outpatient dose and renal function."/>
<priority value="urgent"/>
<goalId value="euvolemia"/>
<definitionCanonical
value="https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-furosemide|0.1.0"/>
</action>
</action>
<action id="hf-admission-bnp">
<prefix value="1.3"/>
<title value="Baseline natriuretic peptide"/>
<description
value="No BNP or NT-proBNP resulted in the last 24 hours; draw an admission baseline."/>
<documentation>
<type value="documentation"/>
<display value="2022 AHA/ACC/HFSA heart failure guideline"/>
<url
value="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063"/>
<document>
<url
value="https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063"/>
</document>
</documentation>
<condition>
<kind value="applicability"/>
<expression>
<language value="text/cql"/>
<expression value="No Recent BNP"/>
</expression>
</condition>
<groupingBehavior value="logical-group"/>
<selectionBehavior value="all"/>
<action id="hf-bnp-order">
<title value="BNP on admission"/>
<description
value="Admission natriuretic peptide for diagnosis support and trajectory."/>
<definitionCanonical
value="https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-bnp|0.1.0"/>
</action>
</action>
</action>
</PlanDefinition>