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201701 Clinical Reasoning Track

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Return to January 2017 Proposals

Clinical Reasoning Track

This track defines several scenarios related to clinical quality that exercise the resources defined by the Clinical Decision Support and Clinical Quality Information Work Groups, as well as profiles and usage guidance defined in the Clinical Quality Framework Implementation Guide.

Submitting WG/Project/Implementer Group


The CDS and CQI Work Groups are incorporating feedback from previous ballots, prior connect-a-thons, as well as other work groups to refine and improve the structures used to enable the representation and evaluation of quality artifacts using FHIR. These efforts have resulted in several resources and related implementation guides that will be balloted both as part of the FHIR STU 3 ballot and as separate implementation guides in the upcoming September 2016 ballot cycle. The scenarios in this connect-a-thon track proposal are intended to support that ballot by exercising key resources and use cases in the implementation guides.

Proposed Track Lead

  • Bryn Rhodes
    • Email: bryn at databaseconsultinggroup dot com
    • Skype: bryn.rhodes

See Connectathon_Track_Lead_Responsibilities

Expected participants

  • National Comprehensive Cancer Care Network (NCCN)
  • Evinance
  • ESAC, Inc.
  • HarmonIQ Health Systems Corporation


Guidance Service

The Guidance Service role provides real-time clinical decision support services. This component enables a consumer to request clinical decision support based on the current context. The consumer provides relevant contextual information as part of the request, and receives clinically relevant guidance as a set of resources describing potential actions to be taken.

Guidance Client

The Guidance Client role consumes real-time clinical decision support services. The client integrates decision support at appropriate points in clinical workflow, allowing users of the system to respond to the guidance presented by the decision support system.

Knowledge Management Repository

A FHIR Server that implements search and retrieval functionality for the various quality artifact resources.

Knowledge Artifact Consumer

A system that consumes knowledge artifacts from a knowledge management repository

Order Set Service

A service capable of evaluating order set definitions to produce order sets applicable to a specific patient and/or context.

Order Set Client

A client capable of requesting the evaluation of an order set definition for a specific patient and/or context, and consuming the resulting order set instance.

InfoButton Service

A service that exposes an InfoButton decision support service module and implements the $evaluate operation to return InfoButton guidance.

InfoButton Client

A client that consumes InfoButton documentation via the $evaluate operation and a GuidanceResponse.

Measure Reporting Service

A system that provides measure evaluation results


The Clinical Reasoning Module provides documentation for the resources that will be exercised by the above roles. Specifically, the following resources are utilized as part of those scenarios:

Scenario Step 1 Name

Success Criteria:
Bonus point:

NCCN Chemotherapy Regimen Scenario

In this scenario, a Knowledge Artifact Provider defines and distributes an NCCN Chemotherapy Regimen to a Knowledge Artifact Consumer.

Create an Order Template

Search for an Order Template

Ingest an Order Template

Apply an Order Template for a specific patient

Determine Adherence (On/Off Protocol)

Zika Virus Reporting Scenario

In this scenario, a patient presents at the point-of-care, and Zika Virus management is triggered if the patient is a woman of child-bearing age. As an alternative, Zika Virus management may be triggered by a mobile application that detects travel to an area where Zika exposure is an identified risk.

Payer Extract Scenario

In this scenario, a Payer uses a Measure Processing Component to extract relevant data from an EHR to enable computation of payer quality measures.