{"patient_id":"P31","encounter_id":"KE-P31","note_id":"KN-P31-1","signed":false,"ignored_instructions":[],"origin":"clinician","origin_label":"Clinician-typed","origin_note":"as declared by the source system","needs_look":0,"extended":{"on":false,"front":[],"library":[],"banner":"Extended capabilities: published criteria cited by title and restated in our own words, no text reproduced; a licence or permission is needed before commercial use.","title":"Extended capabilities","n":0,"n_hidden":0},"check_current":true,"needs_look_kidney":0,"surfaced":[{"source":"front","family":"heart_failure"},{"source":"kidney","family":"kidney"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00031","replay_hash":"629f097fabe5c14eed10286f97d7ca3e8c735d92b5b65d97e42e216bc15d4761","measurement_replay_hash":"95d310715346ec370a2894eb9737c98dadd856c7ea47cb525938f077411f1d20","engine":"kidney-engine 2.0","rules":[{"rule":"ckd_epi_2009@1.0","source":"Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check)","url":"https://www.acpjournals.org/doi/10.7326/0003-4819-150-9-200905050-00006"},{"rule":"ckd_epi_2021@1.0","source":"Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation)","url":"https://www.kidney.org/ckd-epi-creatinine-equation-2021"},{"rule":"kdigo_aki_2012@1.1","source":"KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2)","url":"https://kdigo.org/guidelines/acute-kidney-injury/"},{"rule":"kdigo_ckd_2024@1.1","source":"KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"kidney_compare@1.1","source":"Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update","url":"https://www.cms.gov/medicare/coding-billing/icd-10-codes"},{"rule":"kidney_exclusions@1.0","source":"KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"lab_units@1.1","source":"KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"}],"last_replay":null,"library":{"run_id":"LRUN-00031","encounter_id":"KE-P31","note_id":"KN-P31-1","config":"library_default_set@1.1","engine":"library-engine 1.1","replay_hash":"a4ba8a28b7386b3eab62da34eeab9299a6df1c1f27b766af36b33e701a313969","measurement_replay_hash":"9d071b7d8263d578e17e9152b9721c35516ecc36279162a6cb77cbb427a4293f","surfaced":[],"more":[],"extended":[],"extended_on":false,"n_hidden_extended":0,"n_extended_needs":0,"n_needs":0,"limit":3,"dismissed":0,"ctcae_on":false,"draft_label":"Draft definition: pending clinical and coding review","dismiss_reasons":{"addressed_elsewhere":"Already addressed elsewhere in the record","not_representative":"Values not representative (for example acute illness or a lab error)","not_relevant":"Not relevant to this visit","definition_not_applicable":"The definition does not apply to this patient","other":"Other (explain)"}},"findings":[{"family":"kidney","topic":"Kidney filtering rate (eGFR) over time","status":"agrees","label":"Agrees: nothing to do","sentence":"Kidney results 180 days apart are 60 or above (filtering rate 71.8 on 2026-05-15 and 71.8 on 2026-11-11) and the note doesn't mention kidney function.","quote":null,"threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":null,"note_mentions":false,"lab_ids":["L-0071","L-0072"]}],"front":{"run_id":"FRUN-00031","cards":[{"family":"heart_failure","topic":"Heart pumping fraction (ejection fraction, EF)","status":"agrees","label":"Agrees: nothing to do","sentence":"The note says “heart failure with reduced ejection fraction” and the latest ejection fraction, 32% on 2026-09-12, fits the type written.","quote":"heart failure with reduced ejection fraction","threshold":"Categories by ejection fraction: 40% or lower; 41% to 49%; 50% or higher; improved (earlier 40% or lower, now above 40%, a rise of at least 10 points). Acuity is a clinical judgement: indicators are shown, nothing is concluded.","span":[133,177],"note_mentions":true,"lab_ids":[],"direction":"CONSISTENT","definition":"front_hf_ef_type@1.0","reviewed":false,"evidence":[{"text":"Ejection fraction 32% · echocardiogram 2026-09-12 (transthoracic, biplane)","quote":"Left ventricular ejection fraction 32% by biplane method.","by":"Dr. Leopold Nairn (cardiology)","item":"ECHO-P31-2"},{"text":"Ejection fraction 28% · echocardiogram 2025-10-07 (transthoracic, biplane)","quote":"Left ventricular ejection fraction 28% by biplane method.","by":"Dr. Leopold Nairn (cardiology)","item":"ECHO-P31-1"}],"acuity":[{"text":"Acuity words in the note","quote":"chronic","item":null}],"options":[{"key":"reduced","kind":"wording","requires":"latest ejection fraction 40% or lower","shows":"latest 32% on 2026-09-12","status":"met","status_label":"met","wording":"Heart failure with reduced ejection fraction (HFrEF)"},{"key":"mildly_reduced","kind":"wording","requires":"latest ejection fraction 41% to 49%","shows":"latest 32% on 2026-09-12","status":"not_met","status_label":"not met","wording":"Heart failure with mildly reduced ejection fraction (HFmrEF)"},{"key":"preserved","kind":"wording","requires":"latest ejection fraction 50% or higher","shows":"latest 32% on 2026-09-12","status":"not_met","status_label":"not met","wording":"Heart failure with preserved ejection fraction (HFpEF)"},{"key":"improved","kind":"wording","requires":"an earlier ejection fraction of 40% or lower, the latest above 40%, and a rise of at least 10 points","shows":"earlier 28% on 2025-10-07, latest 32% on 2026-09-12 (change +4 points)","status":"not_met","status_label":"not met","wording":"Heart failure with improved ejection fraction (HFimpEF)"},{"key":"other","kind":"fixed","wording":"Other (I will write it)"},{"key":"unable","kind":"fixed","wording":"Clinically unable to determine"},{"key":"not_supported","kind":"fixed","wording":"Not clinically supported (I will revise the note myself)"}],"chosen":null}],"dismissed":0}}