Guidance Response FHIR Resource Proposal

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The GuidanceResponse resource provides a container to describe the results of a particular evaluation of a decision support artifact. It is used to capture the results of the _evaluate_ operation of both the DecisionSupportRule and DecisionSupportServiceModule resources.

In addition to describing the results of a decision support invocation, the resource supports the implementation of a conversational interface between decision support consumers and providers, allowing the provider to indicate that more data is required in order to achieve a correct evaluation, or that more data is requested in order to obtain a potentially more accurate result. This interface pattern supports a broad variety of decision support use cases, as well as enabling dynamic tuning of payload sizes to facilitate real-time clinical decision support.

The resource is derived from both the HL7 Standard: Clinical Decision Support Knowledge Artifact Specification (specifically the _Action_ component) and the HL7 Version 3 Standard: Decision Support Service (DSS), Release 2.

Owning committee name

Clinical Decision Support Work Group

Committee Approval Date:

Contributing or Reviewing Work Groups

FHIR Resource Development Project Insight ID

1234: FHIR-Based Clinical Quality Framework (CQF-on-FHIR)

Scope of coverage

A GuidanceResponse is a structured representation of the result of an invocation of the _evaluate_ operation of both the DecisionSupportRule and DecisionSupportServiceModule resources. As with those resources, the GuidanceResponse is flexible enough to be used to describe behaviors for a broad range of decision support applications and could potentially be used in any discipline and locale. It is intended to be used by Decision Support Service Provides as part of the public interface for their service definition.

RIM scope

Resource appropriateness

Decision Support Services are a critical aspect of healthcare delivery with numerous products in the space, both as stand-alone quality improvement services, as well as built-in rule-engine deployments within EHRs.

The Decision Support Service Specification defines a standard, production-level mechanism for exposing a decision support service, and enabling that mechanism to be realized as FHIR resources and operations will extend the reach of that standard, as well as allow implementers to use the FHIR stack and all its associated tooling and specifications to expose the content, effectively enabling another potential role of a FHIR server as a Decision Support Service.

Expected implementations

In addition to general interest from the Clinical Quality and Decision Support communities, the CQF initiative has several pilot projects in various phases of completion:

Clinical Quality Framework Pilots

Content sources

Example Scenarios

See the example scenarios for the DecisionSupportServiceModule and DecisionSupportRule resource proposals.

This resource was tested as part of the January 2016 Connectathon CDS-on-FHIR track, and will be used to support the CQF-on-FHIR track at the May 2016 Connectathon.

Resource Relationships

Each GuidanceResponse will reference a single DecisionSupportRule or DecisionSupportServiceModule to identify the artifact describing the guidance being returned.

The resource uses the OperationOutcome resource to describe any warning or informational messages returned by the service as part of a successful evaluation.

The resource uses the Parameters resource to communicate any specific output parameters returned by the service.

In addition, the resource makes use of the following common data types:


May 2016 Ballot Cycle in support of the CQF IG.

gForge Users


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