Examples

The Lung Cancer Diagnosis Pathway from Ontario Health is modeled using a FHIR PlanDefinition. This umbrella instance holds sub PlanDefinitions that correspond to the scores and outcomes of the Low-Dose chest CT scan. Theses decision points determine the path a patient will follow as they progress through the pathway map.

An exmaple of the overarching PlanDefinition - An Example of a PlanDefinition

PlanDefinition.identifier[0].system[0]http://someIdentifier.com
PlanDefinition.identifier[0].value[0]LungDiagnosis_PD
PlanDefinition.name[0]LungCancerDiagnosis
PlanDefinition.title[0]Lung Cancer Diagnosis
PlanDefinition.type[0].coding[0].code[0]workflow-definition
PlanDefinition.status[0]active
PlanDefinition.action[0].title[0]LDCT Lung
PlanDefinition.action[0].trigger[0].type[0]data-added
PlanDefinition.action[0].trigger[0].data[0].type[0]Observation
PlanDefinition.action[0].trigger[0].data[0].codeFilter[0].code[0].system[0]http://snomed.org
PlanDefinition.action[0].trigger[0].data[0].codeFilter[0].code[0].code[0]66857006
PlanDefinition.action[0].trigger[0].data[0].codeFilter[0].code[0].display[0]Hemoptysis
PlanDefinition.action[0].condition[0].kind[0]start
PlanDefinition.action[0].condition[0].expression[0].expression[0]START EXP TO BE FILLED IN
PlanDefinition.action[0].condition[1].kind[0]stop
PlanDefinition.action[0].condition[1].expression[0].expression[0]STOP EXP TO BE FILLED IN
PlanDefinition.action[0].definition[0]ActivityDefinition/LDCTLungActDef1
PlanDefinition.action[1].title[0]Lung Rads 1
PlanDefinition.action[1].trigger[0].type[0]data-added
PlanDefinition.action[1].trigger[0].data[0].type[0]Observation
PlanDefinition.action[1].trigger[0].data[0].codeFilter[0].code[0].system[0]http://snomed.org
PlanDefinition.action[1].trigger[0].data[0].codeFilter[0].code[0].code[0]16334891000119106
PlanDefinition.action[1].trigger[0].data[0].codeFilter[0].code[0].display[0]Low dose computed tomography of chest without contrast (procedure)
PlanDefinition.action[1].condition[0].kind[0]start
PlanDefinition.action[1].condition[0].expression[0].language[0]application/x-fhir-query
PlanDefinition.action[1].condition[0].expression[0].expression[0]/Observation?subject:Patient/{id}/&value-concept=http://radlex.org|RID50136
PlanDefinition.action[1].condition[1].kind[0]stop
PlanDefinition.action[1].condition[1].expression[0].language[0]text/cql
PlanDefinition.action[1].condition[1].expression[0].expression[0]TO BE FILLED IN - 5 years of follow up
PlanDefinition.action[1].definition[0]PlanDefinition/LungDiagnosis_PD1
PlanDefinition.action[2].title[0]Lung Rads 2
PlanDefinition.action[2].trigger[0].type[0]data-added
PlanDefinition.action[2].trigger[0].data[0].type[0]Observation
PlanDefinition.action[2].trigger[0].data[0].codeFilter[0].code[0].system[0]http://snomed.org
PlanDefinition.action[2].trigger[0].data[0].codeFilter[0].code[0].code[0]16334891000119106
PlanDefinition.action[2].trigger[0].data[0].codeFilter[0].code[0].display[0]Low dose computed tomography of chest without contrast (procedure)
PlanDefinition.action[2].condition[0].kind[0]start
PlanDefinition.action[2].condition[0].expression[0].language[0]application/x-fhir-query
PlanDefinition.action[2].condition[0].expression[0].expression[0]/Observation?subject:Patient/{id}/&value-concept=http://radlex.org|RID50137
PlanDefinition.action[2].condition[1].kind[0]stop
PlanDefinition.action[2].condition[1].expression[0].language[0]text/cql
PlanDefinition.action[2].condition[1].expression[0].expression[0]Low Dose Chest CT Within 5 Years
PlanDefinition.action[2].definition[0]PlanDefinition/LungDiagnosis_PD2
PlanDefinition.action[3].title[0]Lung Rads 3
PlanDefinition.action[3].trigger[0].type[0]data-added
PlanDefinition.action[3].trigger[0].data[0].type[0]Observation
PlanDefinition.action[3].trigger[0].data[0].codeFilter[0].code[0].system[0]http://snomed.org
PlanDefinition.action[3].trigger[0].data[0].codeFilter[0].code[0].code[0]16334891000119106
PlanDefinition.action[3].trigger[0].data[0].codeFilter[0].code[0].display[0]Low dose computed tomography of chest without contrast (procedure)
PlanDefinition.action[3].condition[0].kind[0]start
PlanDefinition.action[3].condition[0].expression[0].language[0]application/x-fhir-query
PlanDefinition.action[3].condition[0].expression[0].expression[0]/Observation?subject:Patient/{id}/&value-concept=http://radlex.org|RID50138
PlanDefinition.action[3].definition[0]PlanDefinition/LungDiagnosis_PD3
PlanDefinition.action[4].title[0]Lung Rads 4A
PlanDefinition.action[4].trigger[0].type[0]data-added
PlanDefinition.action[4].trigger[0].data[0].type[0]Observation
PlanDefinition.action[4].trigger[0].data[0].codeFilter[0].code[0].system[0]http://snomed.org
PlanDefinition.action[4].trigger[0].data[0].codeFilter[0].code[0].code[0]16334891000119106
PlanDefinition.action[4].trigger[0].data[0].codeFilter[0].code[0].display[0]Low dose computed tomography of chest without contrast (procedure)
PlanDefinition.action[4].condition[0].kind[0]start
PlanDefinition.action[4].condition[0].expression[0].language[0]application/x-fhir-query
PlanDefinition.action[4].condition[0].expression[0].expression[0]/Observation?subject:Patient/{id}/&value-concept=http://radlex.org|RID50139
PlanDefinition.action[4].definition[0]PlanDefinition/LungDiagnosis_PD4A
PlanDefinition.action[5].title[0]Lung Rads 4B
PlanDefinition.action[5].trigger[0].type[0]data-added
PlanDefinition.action[5].trigger[0].data[0].type[0]Observation
PlanDefinition.action[5].trigger[0].data[0].codeFilter[0].code[0].system[0]http://snomed.org
PlanDefinition.action[5].trigger[0].data[0].codeFilter[0].code[0].code[0]16334891000119106
PlanDefinition.action[5].trigger[0].data[0].codeFilter[0].code[0].display[0]Low dose computed tomography of chest without contrast (procedure)
PlanDefinition.action[5].condition[0].kind[0]start
PlanDefinition.action[5].condition[0].expression[0].language[0]application/x-fhir-query
PlanDefinition.action[5].condition[0].expression[0].expression[0]/Observation?subject:Patient/{id}/&value-concept=http://radlex.org|RID50140
PlanDefinition.action[5].definition[0]PlanDefinition/LungDiagnosis_PD4B
PlanDefinition.action[6].title[0]Lung Rads 4X
PlanDefinition.action[6].trigger[0].type[0]data-added
PlanDefinition.action[6].trigger[0].data[0].type[0]Observation
PlanDefinition.action[6].trigger[0].data[0].codeFilter[0].code[0].system[0]http://snomed.org
PlanDefinition.action[6].trigger[0].data[0].codeFilter[0].code[0].code[0]16334891000119106
PlanDefinition.action[6].trigger[0].data[0].codeFilter[0].code[0].display[0]Low dose computed tomography of chest without contrast (procedure)
PlanDefinition.action[6].condition[0].kind[0]start
PlanDefinition.action[6].condition[0].expression[0].language[0]application/x-fhir-query
PlanDefinition.action[6].condition[0].expression[0].expression[0]/Observation?subject:Patient/{id}/&value-concept=http://radlex.org|RID50141
PlanDefinition.action[6].definition[0]PlanDefinition/LungDiagnosis_PD4X

The corresponding decision points are represented as sub PlanDefinitions

Lung RADS-1 - 12 month follow up - An Example of a PlanDefinition
Lung RADS-3 - 6 month follow up - An Example of a PlanDefinition
Lung RADS-4A - 3 month follow up - An Example of a PlanDefinition

Each PlanDefinition is associated with one or ore actions. The triggering of the Low dose computed tomography is achieved when the symptom that is associated with triggering the PlanDefinition is added using the action.trigger.type="data-added".

The action.definitionCanonical is path to the ActivityDefinition that will produce the service request for the procedure. The ActivityDefinition.kind denotes the expected resource as a result of the $apply operation.

ActivityDefinition.identifier[0].system[0]http://someIdentifier.com
ActivityDefinition.identifier[0].value[0]LDCTLungActDef1
ActivityDefinition.status[0]active
ActivityDefinition.relatedArtifact[0].type[0]composed-of
ActivityDefinition.relatedArtifact[0].display[0]CCO LDCT Lung Radiology Reporting Template
ActivityDefinition.relatedArtifact[0].url[0]https://somehospital.on.ca/SDC/LDCT_Lung1
ActivityDefinition.kind[0]ServiceRequest
ActivityDefinition.code[0].coding[0].system[0]http://snomed.org/
ActivityDefinition.code[0].coding[0].code[0]16334891000119106
ActivityDefinition.code[0].coding[0].display[0]Low dose computed tomography of chest without contrast (procedure)

Service request for chest CT - An Example of a ServiceRequest