From 97456e4bef47b947851424bb0fc44454a52c14b4 Mon Sep 17 00:00:00 2001 From: Isaac Vetter Date: Wed, 22 Dec 2021 11:47:12 -0600 Subject: [PATCH 1/4] propose `order-discontinue` propose `order-discontinue` --- docs/hooks/order-discontinue.md | 46 +++++++++++++++++++++++++++++++++ 1 file changed, 46 insertions(+) create mode 100644 docs/hooks/order-discontinue.md diff --git a/docs/hooks/order-discontinue.md b/docs/hooks/order-discontinue.md new file mode 100644 index 00000000..b48d702c --- /dev/null +++ b/docs/hooks/order-discontinue.md @@ -0,0 +1,46 @@ +`order-discontinue` + +!!! info + This page defines a workflow [hook](../../specification/current/#hooks) for the purpose of providing clinical decision support using CDS Hooks. This is a **build | snapshot | ballot | release** at the level of **[Draft](http://hl7.org/fhir/versions.html#std-processs)** + +| Metadata | Value +| ---- | ---- +| specificationVersion | 1.0 +| hookVersion | 0.1.0 +| hookMaturity | [0 - Draft](../../specification/current/#hook-maturity-model) + +## Workflow + +The `order-discontinue` fires when a signed order is discontinued by a clinician (including orders for medications, procedures, labs and other orders). + +## Context +CDS Services should consider retreiving or prefetch'ing the `toBeDiscontinued` order, and should focus decisions support on the discontinuation of this order. + +Field | Optionality | Prefetch Token | Type | Description +----- | -------- | ---- | ---- | ---- +`userId` | REQUIRED | Yes | *string* | The id of the current user.
For this hook, the user is expected to be of type [Practitioner](https://www.hl7.org/fhir/practitioner.html) or [PractitionerRole](https://www.hl7.org/fhir/practitionerrole.html).
For example, `PractitionerRole/123` or `Practitioner/abc`. +`patientId` | REQUIRED | Yes | *string* | The FHIR `Patient.id` of the current patient in context +`encounterId` | OPTIONAL | Yes | *string* | The FHIR `Encounter.id` of the current encounter in context +`toBeDiscontinued` | REQUIRED | No| *array* | The FHIR id of one or more existing order(s) in the procss of being discontinued.
For example, `MedicationRequest/103`. + +## Examples + +### Example (R4) + +```json +{ + "context":{ + "userId":"PractitionerRole/123", + "patientId":"1288992", + "encounterId":"89284", + "toBeDiscontinued": [ "MedicationRequest/smart-MedicationRequest-103" ] + } +} +``` + + +## Change Log + +Version | Description +---- | ---- +0.1.0 | Proposed From 849e4d1b00bfae35d8eb63e1116b7800abad62b0 Mon Sep 17 00:00:00 2001 From: Isaac Vetter Date: Wed, 22 Dec 2021 11:48:34 -0600 Subject: [PATCH 2/4] clarify build status --- docs/hooks/order-discontinue.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/docs/hooks/order-discontinue.md b/docs/hooks/order-discontinue.md index b48d702c..b1f5d2a7 100644 --- a/docs/hooks/order-discontinue.md +++ b/docs/hooks/order-discontinue.md @@ -1,7 +1,7 @@ `order-discontinue` !!! info - This page defines a workflow [hook](../../specification/current/#hooks) for the purpose of providing clinical decision support using CDS Hooks. This is a **build | snapshot | ballot | release** at the level of **[Draft](http://hl7.org/fhir/versions.html#std-processs)** + This page defines a workflow [hook](../../specification/current/#hooks) for the purpose of providing clinical decision support using CDS Hooks. This is a build at the level of [Draft](http://hl7.org/fhir/versions.html#std-processs). | Metadata | Value | ---- | ---- From 7971ca03695e5232801b1793a8e1e976332a5a6d Mon Sep 17 00:00:00 2001 From: Isaac Vetter Date: Tue, 4 Jan 2022 12:48:42 -0600 Subject: [PATCH 3/4] further clarify hook workflow per zulip review Lloyd asked about an order expiring naturally vs abnormally, see: https://chat.fhir.org/#narrow/stream/179159-cds-hooks/topic/.60order-discontinue.60.20hook.20proposal/near/266652103 --- docs/hooks/order-discontinue.md | 2 +- 1 file changed, 1 insertion(+), 1 deletion(-) diff --git a/docs/hooks/order-discontinue.md b/docs/hooks/order-discontinue.md index b1f5d2a7..af6c736e 100644 --- a/docs/hooks/order-discontinue.md +++ b/docs/hooks/order-discontinue.md @@ -11,7 +11,7 @@ ## Workflow -The `order-discontinue` fires when a signed order is discontinued by a clinician (including orders for medications, procedures, labs and other orders). +The `order-discontinue` fires when a signed order is manually discontinued by a clinician (including orders for medications, procedures, labs and other orders). Note that this hook does not fire when an order expires "naturally", for example at a predictable time, such as a a medication prescription's refills completing. ## Context CDS Services should consider retreiving or prefetch'ing the `toBeDiscontinued` order, and should focus decisions support on the discontinuation of this order. From cd45dad019a4ac6eba9a4f555cd4c142cd904733 Mon Sep 17 00:00:00 2001 From: Isaac Vetter Date: Mon, 17 Jan 2022 16:21:11 -0600 Subject: [PATCH 4/4] switch from order IDs to full resources --- docs/hooks/order-discontinue.md | 107 +++++++++++++++++++++++++++++++- 1 file changed, 105 insertions(+), 2 deletions(-) diff --git a/docs/hooks/order-discontinue.md b/docs/hooks/order-discontinue.md index af6c736e..0bc3c354 100644 --- a/docs/hooks/order-discontinue.md +++ b/docs/hooks/order-discontinue.md @@ -21,7 +21,7 @@ Field | Optionality | Prefetch Token | Type | Description `userId` | REQUIRED | Yes | *string* | The id of the current user.
For this hook, the user is expected to be of type [Practitioner](https://www.hl7.org/fhir/practitioner.html) or [PractitionerRole](https://www.hl7.org/fhir/practitionerrole.html).
For example, `PractitionerRole/123` or `Practitioner/abc`. `patientId` | REQUIRED | Yes | *string* | The FHIR `Patient.id` of the current patient in context `encounterId` | OPTIONAL | Yes | *string* | The FHIR `Encounter.id` of the current encounter in context -`toBeDiscontinued` | REQUIRED | No| *array* | The FHIR id of one or more existing order(s) in the procss of being discontinued.
For example, `MedicationRequest/103`. +`toBeDiscontinued` | REQUIRED | No| *object* | FHIR Bundle with the orders resources bring discontinued.
DSTU2 - FHIR Bundle of MedicationOrder, DiagnosticOrder, DeviceUseRequest, ReferralRequest, ProcedureRequest, NutritionOrder, VisionPrescription.
STU3 - FHIR Bundle of MedicationRequest, ReferralRequest, ProcedureRequest, NutritionOrder, VisionPrescription.
R4 - FHIR Bundle of DeviceRequest, MedicationRequest, NutritionOrder, ServiceRequest, VisionPrescription. ## Examples @@ -33,7 +33,110 @@ Field | Optionality | Prefetch Token | Type | Description "userId":"PractitionerRole/123", "patientId":"1288992", "encounterId":"89284", - "toBeDiscontinued": [ "MedicationRequest/smart-MedicationRequest-103" ] + "toBeDiscontinued": + { + "resourceType":"Bundle", + "entry":[ + { + "resource":{ + "resourceType":"NutritionOrder", + "id":"pureeddiet-simple", + "identifier":[ + { + "system":"http://goodhealthhospital.org/nutrition-requests", + "value":"123" + } + ], + "status":"draft", + "patient":{ + "reference":"Patient/1288992" + }, + "dateTime":"2014-09-17", + "orderer":{ + "reference":"Practitioner/example", + "display":"Dr Adam Careful" + }, + "oralDiet":{ + "type":[ + { + "coding":[ + { + "system":"http://snomed.info/sct", + "code":"226211001", + "display":"Pureed diet" + }, + { + "system":"http://goodhealthhospital.org/diet-type-codes", + "code":"1010", + "display":"Pureed diet" + } + ], + "text":"Pureed diet" + } + ], + "schedule":[ + { + "repeat":{ + "boundsPeriod":{ + "start":"2015-02-10" + }, + "frequency":3, + "period":1, + "periodUnit":"d" + } + } + ], + "texture":[ + { + "modifier":{ + "coding":[ + { + "system":"http://snomed.info/sct", + "code":"228055009", + "display":"Liquidized food" + } + ], + "text":"Pureed" + } + } + ], + "fluidConsistencyType":[ + { + "coding":[ + { + "system":"http://snomed.info/sct", + "code":"439021000124105", + "display":"Dietary liquid consistency - nectar thick liquid" + } + ], + "text":"Nectar thick liquids" + } + ] + }, + "supplement":[ + { + "type":{ + "coding":[ + { + "system":"http://snomed.info/sct", + "code":"442971000124100", + "display":"Adult high energy formula" + }, + { + "system":"http://goodhealthhospital.org/supplement-type-codes", + "code":"1040", + "display":"Adult high energy pudding" + } + ], + "text":"Adult high energy pudding" + }, + "productName":"Ensure Pudding 4 oz container", + "instruction":"Ensure Pudding at breakfast, lunch, supper" + } + ] + } + } + } } } ```