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DecisionSupportRule FHIR Resource Proposal

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Replaced by ActivityDefinition_FHIR_Resource_Proposal


The DecisionSupportRule resource represents the definition of a decision support rule of the form [on Event] if Condition then Action. Event-Condition-Action rules are a common and flexible mechanism of dynamically affecting clinical workflow by intercepting established points within the workflow, evaluating conditions based on the relevant context, and returning guidance in the form of actions to be taken, either by the system directly, or as part of a recommended intervention with the involvement of clinicians at the point-of-care.

The intent of the resource is to establish a standard mechanism to enable automated sharing of the knowledge defined by the ECA rule. The resource is a concrete realization of the logical model defined by the HL7 Standard: Clinical Decision Support Knowledge Artifact Specification.

Owning committee name

Clinical Decision Support Work Group

Committee Approval Date:

2016-02-24 - Meeting Minutes

Contributing or Reviewing Work Groups

FHIR Resource Development Project Insight ID

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

Scope of coverage

A DecisionSupportRule is a knowledge artifact that enables automated sharing of a certain common pattern of clinical knowledge. Because it is definitional in nature, it is not a patient-specific resource. The resource captures the structure of an Event-Condition-Action rule and is flexible enough to be used to describe behaviors for any discipline and locale. It is intended to be used by decision support content vendors as a means of distributing knowledge artifacts, as well as by decision support service vendors and health care delivery systems as a means of automatically integrating decision support behavior.

RIM scope

Resource appropriateness

Decision support interventions are a critial aspect of health care delivery, but they are often implemented as custom logic, either within an EHR directly, or as part of a decision support service that is exposed via a proprietary interface. Increasingly, decision support content vendors are making these types of rules available, but each vendor uses a proprietary format to enable the distribution of their content.

The Clinical Decision Support Knowledge Artifact Specification provides a standard mechanism for sharing ECA rules, and enabling that content to be represented as a FHIR resource will extend the reach of that specification. In addition, defining the content as a FHIR resource will 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 Knowledge Artifact Repository.

Expected implementations

Multiple decision support vendors have expressed interest in using the DecisionSupportRule resource to enable standards-based distribution of their content.

Content sources

Are there any source specifications that you wish to consult but are concerned about access to or expertise to consider? -->

Example Scenarios

Chlamydia Screening

When seeing a patient that meets the criteria defined by Chlamydia Screening guidelines, clinicians should ensure that the appropriate testing has been performed. The logic to capture this intervention can be represented as a DecisionSupportRule.

Exclusive Breastfeeding

When admitting a new mother for delivery, appropriate interventions to ensure the mother receives education regarding exclusive breastfeeding can be represented as a DecisionSupportRule.

This scenario will be piloted as part of the CQF-on-FHIR track at the May 2016 Connectathon.

Resource Relationships

This resource will make use of the Library resource to represent any logic involved in the ECA rule.

The _evaluate_ operation uses the GuidanceResponse resource to return its results.

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


May 2016 Ballot Cycle in support of the CQF IG.

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