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propose order-discontinue #599

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97456e4
propose `order-discontinue`
isaacvetter Dec 22, 2021
849e4d1
clarify build status
isaacvetter Dec 22, 2021
7971ca0
further clarify hook workflow per zulip review
isaacvetter Jan 4, 2022
0098cf9
Merge branch 'master' into order-discontinue
isaacvetter Jan 4, 2022
cd45dad
switch from order IDs to full resources
isaacvetter Jan 17, 2022
6bf28c5
Merge branch 'master' into order-discontinue
isaacvetter Feb 28, 2022
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149 changes: 149 additions & 0 deletions docs/hooks/order-discontinue.md
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`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 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 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.

Field | Optionality | Prefetch Token | Type | Description
----- | -------- | ---- | ---- | ----
`userId` | REQUIRED | Yes | *string* | The id of the current user.<br />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).<br />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| *object* | FHIR Bundle with the orders resources bring discontinued. <br/ > DSTU2 - FHIR Bundle of MedicationOrder, DiagnosticOrder, DeviceUseRequest, ReferralRequest, ProcedureRequest, NutritionOrder, VisionPrescription. <br/ > STU3 - FHIR Bundle of MedicationRequest, ReferralRequest, ProcedureRequest, NutritionOrder, VisionPrescription. <br/ > R4 - FHIR Bundle of DeviceRequest, MedicationRequest, NutritionOrder, ServiceRequest, VisionPrescription.

## Examples

### Example (R4)

```json
{
"context":{
"userId":"PractitionerRole/123",
"patientId":"1288992",
"encounterId":"89284",
"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"
}
]
}
}
}
}
}
```


## Change Log

Version | Description
---- | ----
0.1.0 | Proposed