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  1. FHIR Specification Feedback
  2. FHIR-37891

GuidanceResponse underspecified and oddly constrained

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • FHIR Core (FHIR)
    • R4
    • Clinical Decision Support
    • GuidanceResponse
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      We will constrain evaluationMessage to 0..1, given that OperationOutcome allows multiple repititions already, this was an oversight.

      We will expand cardinality of response to 0..* and allow it to reference any Request resource type (including Task).

      However, there is a mapping from CDSHooks response to GuidanceResponse/RequestOrchestration specified in the Clinical Decision Support topic of the Clinical Reasoning module, we will add a link to that documentation from the Overview of the GuidanceResponse resource.

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      We will constrain evaluationMessage to 0..1, given that OperationOutcome allows multiple repititions already, this was an oversight. We will expand cardinality of response to 0..* and allow it to reference any Request resource type (including Task). However, there is a mapping from CDSHooks response to GuidanceResponse/RequestOrchestration specified in the Clinical Decision Support topic of the Clinical Reasoning module, we will add a link to that documentation from the Overview of the GuidanceResponse resource.
    • Kensaku Kawamoto/Alex Goel: 20-0-1
    • Enhancement
    • Non-compatible
    • R5

    Description

      evaluationMessage is 0..*, but OperationOutcome already allows multiple repetitions.  If we need repetitions within repetitions, should explain when and how to use each layer.  Also, some guidance about how to use the elements other than OperationOutcome.details.text (and even the fact the messages is supposed to go in OperationOutcome.details.text) would be useful.  For example, how are severity, code, diagnostics, and location supposed to be populated?  What does 'fatal' decision support even mean?

      Why is GuidanceResponse limited to 0..1 and only CarePlan and RequestGroup?  If I only want to recommend one action, why the overhead of RequestGroup?  Why can't I choose between all of the Request resources?  Also, why can't I return multiple options?

      Finally, in CDS Hooks, we can provide multiple cards.  Each card has a message and a set of possible actions, and each 'action' can involve multiple things happening.  I have no idea how that would be mapped into this resource.

      Please provide more clarifying guidance and perhaps revisit the constraints and model.

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            lloyd Lloyd McKenzie
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