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HL7 FHIR Implementation Guide: CDS Hooks, Release 1

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Basics

HL7 FHIR Implementation Guide: CDS Hooks, Release 1

1234
Ballot - STU to Normative


FHIR Implementation Guide; FHIR Profile; FHIR Resources

Revise Current Standard, Implementation Guide

Details

This project will investigate the use of FHIR in a Clinical Quality Framework context with the goal of identifying best practices for the use of FHIR in support of the primary use cases of Clinical Decision Support and Clinical Quality Measurement, namely 1) Sharing knowledge artifacts, and 2) Obtaining Clinical Decision Support guidance as part of a clinical workflow.

Areas of focus will include: 1) The use of FHIR for the representation and sharing of Clinical Quality Knowledge Artifacts 2) The use of FHIR for supporting Clinical Decision Support Guidance Services. 3) The use of FHIR for communicating the results of Quality Measurement evaluation.

The deliverable will be a specification and Implementation Guides that include conformance statements, profile definitions, and documentation required to support Clinical Decision Support and Clinical Quality Measurement use cases. These structures may include:

- CDS Knowledge Artifacts - including Metadata, Logic, and Actions.

- Clinical Quality Measurement Artifacts.

- Decision Support Service. We anticipate, based on the growing community and vendor adoption of CDS Hooks, that the approach will be driven heavily by CDS Hooks and may potentially be foundationally CDS Hooks with modifications as needed to meet stakeholder needs.

- CDS Context. This element contains information such as the sender, receiver, workflow context, and other transient information relevant specifically to the request.

- CDS Input and Input Specification. The CDS Input element serves as the container for the input information for the call, including the context described above and the required patient information. CDS Input Specification allows a specification of required parameter values.

- CDS Output and Output Specification. CDS Output serves as the container for the response. CDS Output Specification allows a specification of what will be returned in the output.

- CDS Action Response. This element represents actions as described by the CDS Knowledge Artifact Specification.

- CDS Execution Message. This element defines a CDS Execution Message that may be returned in addition to or instead of the expected response such as warnings or errors generated by the evaluation of the request.

- Potentially other FHIR profiles and implementation guides that are needed for CDS and not covered in other FHIR profiles or implementation guides.

In addition, the Parameter, OperationDefinition and OperationOutcome resources, as well as CDS Hooks Card structures, will be considered, as well as the FHIR Messaging protocol, as a way to specify the CDS request/response interaction. This project will coordinate with relevant existing efforts, in particular CDS Hooks.


Given industry movement towards FHIR, there is a strong desire to migrate existing Quality standards to align with FHIR. While the QICore FHIR profiles developed in collaboration with the Clinical Quality Information Work Group is an important and needed step in this alignment, it alone is insufficient to fully meet the full requirements of a FHIR-based Clinical Quality Framework. This project will address this gap.



FHIR Project Tasks: Resource and/or Profile proposals have been submitted and endorsed for development by FHIR Management Group (FMG) April 2016 For Comment ballot of proposed FHIR Resources and Profiles May 2016 Ballot All comments reconciled July 2016 FHIR content ready for inclusion in FHIR DSTU ballot August 2016 STU Ballot concurrent w/ FHIR 3.0 September 2016 Content published as STU (under the FHIR Clinical Reasoning module) - Target: In concert with FHIR STU 3.0 Initial approach to CDS Hooks integration being evaluated at Connect-a-Thon - Target: May 2017, September 2017 Specification and Implementation Guides balloted for STU, including CDS Hooks integration and Guideline Appropriate Ordering - Target: Sep 2017 - Sep 2018 Specification and Implementation Guides published as STU - Target: Oct 2017 - Jan 2019


http://wiki.hl7.org/index.php?title=CDS_on_FHIR


Quality FHIR Profiles - 1,125 Clinical Decision Support Knowledge Artifact Specification - 931 Decision Support Service Implementation Guide - 1,018 Health Quality Measure Format R2 CQL-Based HQMF IG Measure Report using FHIR - 1,140 NOTE Regarding Universal Realm: Although some of the dependencies identified here are US Realm specific, it is the intent of this specification to pursue Universal Realm, and to ensure that any US Realm dependencies are either isolated from this specification, or promoted to Universal Realm as appropriate.

Clinical and Public Health Laboratories, Immunization Registries, Quality Reporting Agencies, Regulatory Agency, Standards Development Organizations (SDOs), Payors,Clinical and Public Health Laboratories; Emergency Services; Local and State Departments of Health; Medical Imaging Service; Healthcare Institutions (hospitals, long term care, home care, mental health),Pharmaceutical; EHR, PHR; Equipment; Health Care IT; Clinical Decision Support Systems; Lab; HIS; Other (specify in Misc. Notes below)

1) HLN Consulting w/ OpenCDS 2) Cognitive Medical 3) CDS Hooks Community


CQF on FHIR, CDS on FHIR, FHIR eCQM, FHIR CDS Profiles, FHIR-based DSS IG, FHIR-based CDS KAS



N/A

No

2024 November: TSC Approved STU Extension Request for HL7 Cross-Paradigm Specification: CDS Hooks, Release 1, STU2 for two years 2022 August: TSC approved STU Publication Request for HL7 Cross Paradigm Specification: CDS Hooks, Release 1 for 2 years 2021 Mar: TSC approved STU Extension Request for HL7 Cross-Paradigm Specification: CDS Hooks, Release 1 for 24 months 2020 Mar: TSC approved STU Extension Request for HL7 Cross-Paradigm Specification: CDS Hooks, Release 1 for 24 months 2020 Jan: B.Rhodes: Next ballot Sept of 2020 2019 Nov: TSC approved STU Publication Request for HL7 Cross-Paradigm Specification: CDS Hooks, Release 1 2019 March: TSC approved STU Publication Request for HL7 Cross-Paradigm Specification: CDS Hooks, Release 1 2019 Feb: TSC approved STU Extension Request for HL7 Cross-Paradigm Specification: CDS Hooks, Release 1 2018 April - Received Joint Copyright Letter of Agreement signed by Boston Children's Hospital for the CDS Hooks specification. 2017 Dec: Revised PSS submitted. Former Project Name was 'FHIR-Based Quality Framework (CQF on FHIR)' Implementation Guides may include Universal or realm-specific guides, in particular for the US. 2017 Nov: CDS WG wants to proceed with the PSS that doesn't contain CDS Hooks work in it. Cosponsor Approval: CDS 2017-01-19 2017 Jan: Revised PSS submitted. Per Bryn Rhodes: This CQF-on-FHIR project is replacing both project #1187 'CDS-on-FHIR' and project #1189 'FHIR eCQM Profile' Other Vendor: Knowledge Content Vendors
Organization & Realm

Universal

People

Bryn Rhodes



Clinical Decision Support Work Group, Clinical Quality Information Work Group

FHIR Infrastructure Work Group; Orchestration, Services, and Architecture Work Group

Status & Dates

Active

STU - Test Period/Accepting Comments

02/04/2016

09/01/2033

2033 Sept WGM/Ballot

09/01/2033

2033 Sept WGM/Ballot

2026 Jan Ballot Cycle Info: NORMATIVE Ballot results: Did Not meet basic vote requirements. 23 Negatives to reconcile Document Name: HL7 Specification: CDS Hooks, Release 1 2020 Sept Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 34 Negatives to reconcile Document Name: HL7 Cross-Paradigm Specification: CDS Hooks, Release 1 2018 May Ballot Cycle Info: STU Ballot results: Met basic vote requirements. 21 Negatives to reconcile Document Name: HL7 Cross-Paradigm Specification: CDS Hooks, Release 1 2018 Jan Ballot Cycle Info: STU Ballot results: WITHDRAWN Document Name: HL7 Cross-Paradigm Specification: CDS Hooks, Release 1 2017 Sept Ballot Cycle Info: STU Ballot results: Postponed Document Name: HL7 Cross-Paradigm Specification: CDS Hooks, Release 1 2016 Sept Ballot Cycle Info: STU Ballot results: Did not meet basic vote requirements Document Name: HL7 FHIR Implementation Guide: Clinical Quality Framework (CQF on FHIR), Release 1 2016 May Ballot Cycle Info: COMMENT Ballot results: 8 comments to consider Document Name: HL7 FHIR IG: Clinical Quality Framework (CQF) Requesting alternate ballot title HL7 FHIR Implementation Guide: Clinical Quality Framework (CQF on FHIR), Release 1
Approvals

12/21/2017


Received


All Received




System Info



View Ballot Items (with NIBs)



04/09/2026

Anne Wizauer
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