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 2026-08-30 |
{
"resourceType" : "PlanDefinition",
"id" : "er-acute-breathlessness-pathway",
"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/AtriusEDAcuteBreathlessness</code> for CQL expression definitions.</p></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/cqf-cdsHooksEndpoint",
"valueUri" : "https://cds.atrius.in/cds-services/er-acute-breathlessness-pathway"
}
],
"url" : "https://atrius.in/fhir/r4/atrius-in/PlanDefinition/er-acute-breathlessness-pathway",
"identifier" : [
{
"use" : "official",
"value" : "er-acute-breathlessness-pathway"
},
{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:oid:1.3.6.1.4.1.66219.1.34.12"
}
],
"version" : "0.1.0",
"name" : "EDAcuteBreathlessnessPathway",
"title" : "Emergency Department Acute Breathlessness Pathway",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
"code" : "clinical-protocol"
}
]
},
"status" : "draft",
"experimental" : true,
"date" : "2026-08-30T18:15:29+05:30",
"publisher" : "Atrius",
"contact" : [
{
"name" : "Atrius",
"telecom" : [
{
"system" : "url",
"value" : "https://atrius.in"
}
]
}
],
"description" : "Person presenting to the emergency department with acute breathlessness: danger-sign review, airway rescue when indicated, parallel stabilization (access, monitoring, imaging, labs), working etiology classification, then branch-specific management.",
"library" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/Library/AtriusEDAcuteBreathlessness|0.1.4"
],
"action" : [
{
"id" : "er-acute-breathlessness-pathway-root",
"title" : "ED Acute Breathlessness Pathway",
"description" : "Active ED encounter with dyspnea / acute breathlessness chief complaint.",
"trigger" : [
{
"type" : "named-event",
"name" : "encounter-start"
}
],
"condition" : [
{
"kind" : "applicability",
"expression" : {
"language" : "text/cql",
"expression" : "In Scope"
}
}
],
"input" : [
{
"type" : "Patient",
"profile" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-patient|0.1.0"
]
},
{
"type" : "Encounter",
"profile" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-encounter|0.1.0"
]
},
{
"type" : "Condition",
"profile" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-condition-encounter-diagnosis|0.1.0"🔗 ,
"https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-condition-problems-health-concerns|0.1.0"
]
},
{
"type" : "Observation",
"profile" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-observation|0.1.0"
]
},
{
"type" : "QuestionnaireResponse",
"profile" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-questionnaireresponse|0.1.0"
]
},
{
"type" : "ServiceRequest",
"profile" : [
🔗 "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-servicerequest|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" : "danger-signs-review",
"title" : "Review Danger Signs",
"description" : "Confirm whether any danger sign mandates immediate airway and ventilation escalation.",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/Questionnaire/er-acute-breathlessness-danger-signs|0.2.0"
},
{
"id" : "airway-rescue",
"title" : "Airway Rescue",
"description" : "Senior help, NIV preparation, and intubation readiness when danger signs are present.",
"condition" : [
{
"kind" : "applicability",
"expression" : {
"language" : "text/cql",
"expression" : "Airway Endangered"
}
}
],
"groupingBehavior" : "logical-group",
"selectionBehavior" : "all",
"action" : [
{
"id" : "airway-call-senior",
"title" : "Call senior / ICU",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-airway-call-senior|0.1.0"
},
{
"id" : "airway-prepare-niv",
"title" : "Prepare NIV",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-prepare-niv|0.1.0"
},
{
"id" : "airway-prepare-intubation",
"title" : "Prepare intubation (RSI)",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-prepare-intubation|0.1.0"
}
]
},
{
"id" : "parallel-stabilization",
"title" : "Parallel Stabilization",
"description" : "IV access, oxygen, imaging, and baseline labs while etiology is evaluated.",
"groupingBehavior" : "logical-group",
"selectionBehavior" : "all",
"action" : [
{
"id" : "stabilize-iv-access",
"title" : "IV access",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-iv-access|0.1.0"
},
{
"id" : "stabilize-oxygen",
"title" : "Start supplemental oxygen",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-supplemental-oxygen|0.1.0"
},
{
"id" : "stabilize-cxr",
"title" : "Chest radiograph",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-rad-cxr|0.1.0"
},
{
"id" : "stabilize-ecg",
"title" : "12-lead ECG",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-rad-ecg-12-lead|0.1.0"
},
{
"id" : "stabilize-bmp",
"title" : "Basic metabolic panel",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-bmp|0.1.0"
},
{
"id" : "stabilize-lactate",
"title" : "Lactate",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-lactate|0.1.0"
},
{
"id" : "stabilize-troponin",
"title" : "Cardiac troponin",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-troponin-cardiac|0.2.0"
},
{
"id" : "stabilize-bnp",
"title" : "BNP / NT-proBNP",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-bnp|0.1.0"
}
]
},
{
"id" : "capture-classification",
"title" : "Record Working Classification",
"description" : "Clinician selects working etiology after danger-sign review and initial stabilization.",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/Questionnaire/er-acute-breathlessness-classification|0.2.0"
},
{
"id" : "breathlessness-classification",
"title" : "Apply Pathway Branch",
"description" : "Cardiogenic/HF; COPD/asthma; PE; pneumonia; pneumothorax; upper airway; other.",
"groupingBehavior" : "logical-group",
"selectionBehavior" : "exactly-one",
"action" : [
{
"id" : "branch-cardiogenic",
"title" : "Cardiogenic pulmonary edema / acute HF",
"condition" : [
{
"kind" : "applicability",
"expression" : {
"language" : "text/cql",
"expression" : "Classification Is Cardiogenic Pulmonary Edema"
}
}
],
"groupingBehavior" : "logical-group",
"action" : [
{
"id" : "cardiogenic-guidance",
"title" : "Cardiogenic workup guidance",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-branch-cardiogenic|0.1.0"
},
{
"id" : "cardiogenic-niv",
"title" : "Prepare NIV (flash edema)",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-prepare-niv|0.1.0"
},
{
"id" : "cardiogenic-furosemide",
"title" : "IV furosemide",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-furosemide|0.1.0"
},
{
"id" : "cardiogenic-bnp",
"title" : "BNP / NT-proBNP",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-bnp|0.1.0"
},
{
"id" : "cardiogenic-echo",
"title" : "Transthoracic echocardiogram",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-rad-echo-transthoracic|0.1.0"
},
{
"id" : "cardiogenic-daily-weight",
"title" : "Daily weight",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-task-daily-weight|0.1.0"
},
{
"id" : "cardiogenic-cardiology",
"title" : "Cardiology consult",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-referral-cardiology|0.1.0"
}
]
},
{
"id" : "branch-copd-asthma",
"title" : "COPD / asthma exacerbation",
"condition" : [
{
"kind" : "applicability",
"expression" : {
"language" : "text/cql",
"expression" : "Classification Is COPD Asthma Exacerbation"
}
}
],
"groupingBehavior" : "logical-group",
"action" : [
{
"id" : "copd-guidance",
"title" : "COPD / asthma workup guidance",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-branch-copd-asthma|0.1.0"
},
{
"id" : "copd-salbutamol",
"title" : "Salbutamol nebulizer",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-salbutamol-nebulizer|0.1.0"
},
{
"id" : "copd-prednisolone",
"title" : "Prednisolone",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-prednisolone|0.1.0"
},
{
"id" : "copd-peak-flow",
"title" : "Peak expiratory flow",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-peak-flow|0.1.0"
},
{
"id" : "copd-pulmonology",
"title" : "Pulmonology consult",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-referral-pulmonology|0.1.0"
}
]
},
{
"id" : "branch-pe",
"title" : "Pulmonary embolism",
"condition" : [
{
"kind" : "applicability",
"expression" : {
"language" : "text/cql",
"expression" : "Classification Is Pulmonary Embolism"
}
}
],
"groupingBehavior" : "logical-group",
"action" : [
{
"id" : "pe-guidance",
"title" : "PE workup guidance",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-branch-pe|0.1.0"
},
{
"id" : "pe-d-dimer",
"title" : "D-dimer",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-d-dimer|0.1.0"
},
{
"id" : "pe-ct-chest",
"title" : "CT chest (PE protocol)",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-rad-ct-chest|0.1.0"
},
{
"id" : "pe-enoxaparin",
"title" : "Enoxaparin (therapeutic LMWH)",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-enoxaparin|0.1.0"
},
{
"id" : "pe-general-medicine",
"title" : "General medicine consult",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-referral-general-medicine|0.1.0"
}
]
},
{
"id" : "branch-pneumonia",
"title" : "Pneumonia / infection",
"condition" : [
{
"kind" : "applicability",
"expression" : {
"language" : "text/cql",
"expression" : "Classification Is Pneumonia"
}
}
],
"groupingBehavior" : "logical-group",
"action" : [
{
"id" : "pneumonia-guidance",
"title" : "Pneumonia workup guidance",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-branch-pneumonia|0.1.0"
},
{
"id" : "pneumonia-cbc",
"title" : "Complete blood count",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-cbc|0.1.0"
},
{
"id" : "pneumonia-blood-culture",
"title" : "Blood culture",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-blood-culture|0.1.0"
},
{
"id" : "pneumonia-ceftriaxone",
"title" : "Ceftriaxone",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-ceftriaxone|0.1.0"
},
{
"id" : "pneumonia-azithromycin",
"title" : "Azithromycin",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-med-azithromycin|0.1.0"
},
{
"id" : "pneumonia-general-medicine",
"title" : "General medicine consult",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-referral-general-medicine|0.1.0"
}
]
},
{
"id" : "branch-pneumothorax",
"title" : "Pneumothorax",
"condition" : [
{
"kind" : "applicability",
"expression" : {
"language" : "text/cql",
"expression" : "Classification Is Pneumothorax"
}
}
],
"groupingBehavior" : "logical-group",
"action" : [
{
"id" : "pneumothorax-guidance",
"title" : "Pneumothorax workup guidance",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-branch-pneumothorax|0.1.0"
},
{
"id" : "pneumothorax-cxr",
"title" : "Chest X-ray",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-rad-cxr|0.1.0"
},
{
"id" : "pneumothorax-chest-drain",
"title" : "Prepare chest drain / needle decompression",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-prepare-chest-drain|0.1.0"
},
{
"id" : "pneumothorax-senior",
"title" : "Call senior / ICU",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-airway-call-senior|0.1.0"
}
]
},
{
"id" : "branch-upper-airway",
"title" : "Upper airway obstruction",
"condition" : [
{
"kind" : "applicability",
"expression" : {
"language" : "text/cql",
"expression" : "Classification Is Upper Airway Obstruction"
}
}
],
"groupingBehavior" : "logical-group",
"action" : [
{
"id" : "upper-airway-guidance",
"title" : "Upper airway workup guidance",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-branch-upper-airway|0.1.0"
},
{
"id" : "upper-airway-senior",
"title" : "Call senior / ICU",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-airway-call-senior|0.1.0"
},
{
"id" : "upper-airway-ent",
"title" : "ENT consult",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-referral-ent|0.1.0"
},
{
"id" : "upper-airway-rsi",
"title" : "Prepare intubation (RSI)",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-prepare-intubation|0.1.0"
}
]
},
{
"id" : "branch-other",
"title" : "Other / unclear",
"condition" : [
{
"kind" : "applicability",
"expression" : {
"language" : "text/cql",
"expression" : "Classification Is Other Unclear"
}
}
],
"groupingBehavior" : "logical-group",
"action" : [
{
"id" : "other-guidance",
"title" : "Other / unclear workup guidance",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/er-breathlessness-branch-other|0.1.0"
},
{
"id" : "other-assessment",
"title" : "Clinical reassessment",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-task-clinical-assessment|0.1.0"
},
{
"id" : "other-cbc",
"title" : "Complete blood count",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-lab-cbc|0.1.0"
},
{
"id" : "other-general-medicine",
"title" : "General medicine consult",
"definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-referral-general-medicine|0.1.0"
}
]
}
]
}
]
}
]
}