This is addressed in multiple sections in the current IG: http://build.fhir.org/ig/HL7/fhir-medmorph/provisioning.html • Section 5.1.5 • http://build.fhir.org/ig/HL7/fhir-medmorph/provisioning.html#notifications-of-changes-in-knowledge-artifacts o Notifications can be automated or manual and hence there is no expectation that all healthcare organizations automate the KnowledgeArtifact retrieval and operationalization. • Section 5.1.6 • http://build.fhir.org/ig/HL7/fhir-medmorph/provisioning.html#operationalization-of-knowledge-artifacts o There is explicit mention of testing of KnowledgeArtifacts before they are completely operationalized so that the healthcare organizations can understand the use case expectations. • The process of activation/de-activation is also specified in Content IGs (e.g Central Cancer Registry Reporting IG) to avoid automated processing. o https://build.fhir.org/ig/HL7/fhir-central-cancer-registry-reporting-ig/spec.html#knowledge-artifact-processing-requirements   Comments from ONC Team: Request rephrasing in section 5.1.6 " Request re-phrasing: “Knowledge Artifacts have to be understood and operationalized by healthcare organizations during implementation. Before operationalizing the Knowledge Artifact and processing by the HDEA/ Backend Services App or by a Data Source, healthcare organizations shall test and validate the processing of the Knowledge Artifact before reporting to Data Receivers. Specific requirements for the HDEA/ healthcare organization for receiving or producing a Knowledge Artifact shall be specified in the Content IG.”