ATTACHMENT 20 - Suicide Risk_Order Set_KNART Conceptual Structure_2018-06-21.pdf

Mental Health: Positive Suicide Risk Screening Order Set

Order Set: Conceptual Structure

Contract: VA118-16-D-1008, Task Order

(TO): VA-118-16-F-1008-0007, CLIN0008BA

Department of Veterans Affairs (VA)

Knowledge Based Systems (KBS) Office of Informatics and Information Governance (OIIG)

Clinical Decision Support (CDS)

Publication date 06/18/2018

Version: 1.0

Mental Health: Positive Suicide Risk Screening Order Set: Order Set:

Conceptual Structure by Knowledge Based Systems (KBS), Office of Informatics and Information Governance (OIIG), and Clinical Decision Support (CDS)

Publication date 06/18/2018 Copyright © 2018 B3 Group, Inc.

Copyright © 2018 Cognitive Medical Systems, Inc.

B3 Group, Inc.

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Table of Contents Preface .............................................................................................................................. v Artifact Applicability .......................................................................................................... vi Models ............................................................................................................................ vii

1. External Data Definitions

2. Expression Definitions

3. Consults

4. Follow up

5. Tabular List

6. Behavior Symbols A. References iii

List of Tables

1. Revision History ............................................................................................................. v

2. Clinical White Paper Contributors ...................................................................................... v

3. Artifact Identifier ............................................................................................................ v

4. Applicability Foci, Description and Codes .......................................................................... vi

5. Model References .......................................................................................................... vii

5.1. Terminology Versions

5.2. Terminology References

6.1. Group Organizational Behavior

6.2. Group Selection Behavior

6.3. Required Behavior

6.4. Precheck Behavior

6.5. Cardinality Behavior

6.6. Item Flags

6.7. Read Only Behavior

iv

Preface Table 1. Revision History

Date Life Cycle Event

June 18, 2018 Published

April 27, 2018 Published

April 27, 2018 Created

April 6, 2018 Created

April 6, 2018 Pre-published

Table 2. Clinical White Paper Contributors

Name Role Affiliation

Rani Hoff, PhD

MPH

Reviewer Director, Northeast Program Evaluation Center Office of Mental Health and Suicide Prevention (10NC5) VA Central Office; Professor of Psychiatry Yale University School of Medicine

Bridget Matarazzo Reviewer Director of Clinical Services Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) Denver, CO 80220

Ira Katz Reviewer Senior Consultant for Mental Health Program Analysis

Edd Post Reviewer VA HSR&D

Table 3. Artifact Identifier

Domain Artifact ID Name urn:va.gov:kbs:knart:artifact:r1 88b26417-85e5-5de4-9267-2848aaf52e71 O20 v

Artifact Applicability Table 4. Applicability Foci, Description and Codes

Focus Description Code System

Code Value Set Value Set Version

TargetUser Mental health providers; other physicians and nurses performing screening

N/A N/A

ClinicalFocus Patients identified as being at risk for suicide;

members of patient cohorts identified for suicide risk screening

N/A N/A

ClinicalVenue Mental Health Primary Care

N/A N/A

ClinicalVenue Outpatient SNOMED

CT

33022008 | Hospital-based outpatient department (environment)|

N/A N/A vi

Models Table 5. Model References

Referenced Model Description urn:solor.io:anf-model:1.0 VA Analysis Normal Form Model vii

Chapter 1. External Data Definitions No externalData expression definitions and no trigger definitions are present.

Chapter 2. Expression Definitions No expression definitions are present.

Chapter 3. Consults # Refer to mental health provider (routine) actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Precoordinated Expression 390866009 |Referral to mental health team (procedure)| priority: Precoordinated Expression 50811001 |Routine (qualifier value)|

# Refer to mental health provider now (same day) actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Precoordinated Expression 390866009 |Referral to mental health team (procedure)|

Chapter 4. Follow up Return Instructions

# Timeframe

# prompt: Enter number of time intervals response: Integer (Single) responseBinding: Property ("returnTimeFrame")

# prompt: Select time interval response: EntityName (Single) response range: EnumerationConstraint (List) item: Days(258703001 |day (qualifier value)|) item: Weeks(258705008 |week (qualifier value)|) item: Months(258706009 |month (qualifier value)|) responseBinding: Property ("returnTimeFrameUnit")

# Details?

prompt:

response: String (Single)

# Return to clinic in a specified time frame actionSentence[type=elm:Instance, classType=anf:ClinicalStatement] statementType: Precoordinated Expression 385644000 |Requested (qualifier value)| topic: Precoordinated Expression 185389009 |Follow-up visit (procedure)| timing.lowerBound: returnTimeFrame timing.upperBound: returnTimeFrame timing.includeLowerBound: true timing.inludeUpperBound: true timing.measureSemantic: returnTimeFrameUnit

Chapter 5. Tabular List Terminology Service Request (TSR) Mappings

Table 5.1. Terminology Versions

Name Identifer Version

SNOMED CT 2.16.840.1.113883.6.96 United States Edition 20180301

Table 5.2. Terminology References

System Code Display Texta Referencesb

SNOMED CT 185389009 |Follow-up visit (procedure)|

Precoordinated Expression 1

SNOMED CT 258703001 |day (qualifier value)|

Days 1

SNOMED CT 258705008 |week (qualifier value)|

Weeks 1

SNOMED CT 258706009 |month (qualifier value)|

Months 1

SNOMED CT 33022008 |Hospital-based outpatient department (environment)|

Outpatient 1

SNOMED CT 385644000 |Requested (qualifier value)|

Precoordinated Expression 3

SNOMED CT 390866009 |Referral to mental health team (procedure)|

Precoordinated Expression 2

SNOMED CT 50811001 |Routine (qualifier value)|

Precoordinated Expression 1 aIf a code is used multiple times in the KNART, only the display text of the first instance is shown.

bCount of the number of times the given code system and code pair is used in the KNART.

http:2.16.840.1.113883.6.96

Chapter 6. Behavior Symbols Table 6.1. Group Organizational Behavior

Symbol Name Definition

# Sentence Group A group of related alternative actions is a sentence group if the item referenced by the action is the same in all the actions, and each action simply constitutes a different variation on how to specify the details for that item. For example, two actions that could be in a SentenceGroup are "aspirin, 500 mg, 2 times per day" and "aspirin, 300 mg, 3 times per day". In both cases, aspirin is the item referenced by the action, and the two actions represent two different options for how aspirin might be ordered for the patient. Note that a SentenceGroup would almost always have an associated selection behavior of "AtMostOne", unless it's a required action, in which case, it would be "ExactlyOne".

# Logical Group A group with this behavior logically groups its sub-elements, and may be shown as a visual group to the end user, but it is not required to do so.

➤ Visual Group Any group marked with this behavior should be displayed as a visual group to the end user.

Table 6.2. Group Selection Behavior

Symbol Name Definition

# Any Any number of the items in the group may be chosen, from zero to all.

# All All the items in the group must be selected as a single unit.

# AllOrNone All the items in the group are meant to be chosen as a single unit: either all must be selected by the end user, or none may be selected.

# ExactlyOne The end user must choose one and only one of the selectable items in the group. The user may not choose none of the items in the group.

✪ AtMostOne The end user may choose zero or at most one of the items in the group.

❂ OneOrMore The end user must choose a minimum of one, and as many additional as desired.

Table 6.3. Required Behavior

Symbol Name Definition

✦ Must An action with this behavior must be included in the actions processed by the end user; the end user may not choose not to include this action.

✧ Could An action with this behavior may be included in the set of actions processed by the end user.

Behavior Symbols

Symbol Name Definition

MustUnlessDocumented An action with this behavior must be included in the set of actions processed by the end user, unless the end user provides documentation as to why the action was not included.

Table 6.4. Precheck Behavior

Symbol Name Definition

▲ Yes An action with this behavior is one of the most frequent actions that is, or should be, included by an end user, for the particular context in which the action occurs. The system displaying the action to the end user should consider "pre-checking" such an action as a convenience for the user.

# No An action with this behavior is one of the less frequent actions included by the end user, for the particular context in which the action occurs. The system displaying the actions to the end user would typically not "pre-check" such an action.

Table 6.5. Cardinality Behavior

Symbol Name Definition

◆ Single An action with this behavior may only be completed once.

❖ Multiple An action with this behavior may be repeated multiple times.

Table 6.6. Item Flags

Symbol Name Definition fillIn This item, in a list entry, allows the user to enter a fill in value that is not present in the set of presented choices.

Table 6.7. Read Only Behavior

Symbol Name Definition

# true For a particular action or action group, specifies whether the elements are read only.

Appendix A. References This appendix contains the list of related resources and supporting documents used in creating this

KNART.

List of References Related Resources [CCWP] Mental Health: Suicidality Clinical Content White Paper

[CSD] Mental Health: Positive Suicide Risk Screening Order Set Conceptual Structure Document

[KVRpt] Mental Health: Positive Suicide Risk Screening Order Set KNART Validation Report

Supporting Evidence [CLP 2017] Columbia–Suicide Severity Rating Scale Screen Version – Recent. Columbia Lighthouse Project website.

Accessed October 2017 (link [https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare])

[IOM 2013] Committee on the Assessment of the Readjustment Needs of Military Personnel, Veterans, and Their Families, Board on the Health of Select Populations, Institute of Medicine. Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families.

Washington (DC): National Academies Press (US); Mar 2013. Available from https://www.ncbi.nlm.nih.gov/ books/NBK206864/. (link [https://www.ncbi.nlm.nih.gov/books/NBK206864/])

[Kroenke 2001] Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. (link [J Gen Intern Med.])

[OMHSP 2017] Office of Mental Health and Suicide Prevention. Suicide Among Veterans and Other Americans 2001–2014. U.S. Department of Veterans Affairs Mental Health website.

https://www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf. Updated August 2017. (link [https:// www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf])

[FedRegist 2012] Title 42 - Public Health. Condition of participation: Patient's rights. 71 FedRegist 71426, Dec.

8, 2006, as amended at 75 FedRegist 70844, Nov. 19, 2010; 77 FedRegist 29074, May 16, 2012. 42 CFR §482.13. (link [https://www.federalregister.gov/])

[TSWF 2017] Tri-Service Workflow (TSWF). TSWF-CORE AIM Form Version Jan-Apr 2017.

TSWF CORE Paper Backup Jan Apr 2017.pdf. (Veterans Administration, materials provided in Mental Health-20170921T220116Z-001.zip, September 21, 2017). (link [Mental Health-20170921T220116Z-001.zip September 21, 2017])

[VA 2016] U.S. Department of Veterans Affairs. VA Suicide Prevention Program Facts about Veteran Suicide. U.S. Department of Veterans Affairs Office of Public and Intergovernmental Affairs website. https://www.va.gov/opa/publications/factsheets/ Suicide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdf. Published July 2016. (link [https:// www.va.gov/opa/publications/factsheets/ Suicide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdf]) https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare https://cssrs.columbia.edu/the-columbia-scale-c-ssrs/cssrs-for-communities-and-healthcare https://www.ncbi.nlm.nih.gov/books/NBK206864/ https://www.ncbi.nlm.nih.gov/books/NBK206864/ J%20Gen%20Intern%20Med.

J%20Gen%20Intern%20Med.

https://www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf https://www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf https://www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf https://www.federalregister.gov/ https://www.federalregister.gov/ Mental%20Health-20170921T220116Z-001.zip%20September%2021,%202017 Mental%20Health-20170921T220116Z-001.zip%20September%2021,%202017 Mental%20Health-20170921T220116Z-001.zip%20September%2021,%202017 https://www.va.gov/opa/publications/factsheets/Suicide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdf https://www.va.gov/opa/publications/factsheets/Suicide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdf https://www.va.gov/opa/publications/factsheets/Suicide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdf https://www.va.gov/opa/publications/factsheets/Suicide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdf https://www.va.gov/opa/publications/factsheets https://www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf http:https://www.ncbi.nlm.nih.gov

References

[VADOD 2013] U.S. Department of Veterans Affairs; U.S. Department of Defense (DoD0. VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide. Version 1.0 – June 2013. VA/DoD Clinical Practice Guidelines website. https://www.healthquality.va.gov/guidelines/MH/srb/ VADODCP_SuicideRisk_Full.pdf. Published June 2013. (link [https://www.healthquality.va.gov/guidelines/ MH/srb/VADODCP_SuicideRisk_Full.pdf])

[VADOD 2016] U.S. Department of Veterans Affairs; U.S. Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Major Depressive Disorder. Version 3.0 – 2016.

VA/DoD Clinical Practice Guidelines website. https://www.healthquality.va.gov/guidelines/MH/mdd/ VADoDMDDCPGFINAL82916.pdf. Published April 2016. (link [https://www.healthquality.va.gov/ guidelines/MH/mdd/VADoDMDDCPGFINAL82916.pdf]) https://www.healthquality.va.gov/guidelines/MH/srb/VADODCP_SuicideRisk_Full.pdf https://www.healthquality.va.gov/guidelines/MH/srb/VADODCP_SuicideRisk_Full.pdf https://www.healthquality.va.gov/guidelines/MH/srb/VADODCP_SuicideRisk_Full.pdf https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFINAL82916.pdf https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFINAL82916.pdf https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFINAL82916.pdf https://www.healthquality.va.gov/guidelines/MH/mdd https://www.healthquality.va.gov/guidelines/MH/srb

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