Stream: implementers
Topic: Justification in CDS Response
Pankaj Grover (Aug 02 2019 at 22:13):
Hi- Where can we incorporate justification reason for a CDS hooks response, as this list of Fhir resources triggered this action of a CDSCard? I don't see any such placeholder or provision in the CDSHooks response model. Can we use GuidanceResponse for this, as it has provision to capture 'reason' and 'reason reference'? CDSHooks structure for a request and response as GuidanceResponse.
Pankaj Grover (Aug 02 2019 at 22:14):
@Bryn Rhodes : Can you please help me on this?
Bryn Rhodes (Aug 02 2019 at 22:52):
GuidanceResponse maps more to the overall response, so we've typically seen it used as a way to persist the response from a CDS Hooks service, rather than returned as part of a CDS Hooks response. For justification in general, you're right, there's not really a slot in the CDS Hooks response for that. However, we've typically associated that information more with the specific resources, so your response might be "recommendation to order a medication", and that would be represented as a MedicationRequest, and that would have the reason and reason reference associated with it.
Bryn Rhodes (Aug 02 2019 at 22:53):
In what we're balloting this cycle, we've defined these types of profiles for the various types of recommendations that will come back from decision support, here's the MedicationRequest profile, for example: http://build.fhir.org/ig/HL7/cqf-recommendations/StructureDefinition-cpg-medicationrequest.html
Bryn Rhodes (Aug 02 2019 at 22:54):
And we say that systems must support the reasonCode and reasonReference attributes, specifically to ensure that type of information can be returned with the result.
Bryn Rhodes (Aug 02 2019 at 22:55):
We also use the cqf-strengthOfRecommendation and cqf-qualityOfEvidence extensions to indicate how well-supported the recommendation is.
Pankaj Grover (Aug 02 2019 at 23:11):
Thanks for your response. Can you please point to an example of MedicationRequest or like profile(s) where reasonCode and reasonReference are used?
Pankaj Grover (Aug 02 2019 at 23:18):
Actually, we are trying to implement in a way that we want to provide reason/justification criteria/resources for publishing a particular alert i.e CDSHooks Card. A 'recommendation order' is an action item but we want to tell the reason in the form of list of Fhir Clinical resources ( reason/justification criteria)/Condition/Procedure/Encounter etc.
Lloyd McKenzie (Aug 03 2019 at 00:34):
Keep in mind that the information in the cards being passed back in a hook response are intended to be seen by a clinican. Typically you want to provide only 'essential' information, as every word takes time and represents an interference in workflow. So make sure that the clinicians/users really want the information you're passing back. (It may be better to provide a link to a separate website titled "justification" or "rationale" that can be clicked on if/when providers actually care.)
Last updated: Apr 12 2022 at 19:14 UTC
