4.19 Resource OrderSet - Content

4.19.1 Scope and Usage

This resource is a draft proposal for use as part of an approach to Clinical Quality within FHIR, and is documented as part of the Clinical Quality Improvement Framework Implementation Guide.

An order set is a pre-defined and approved group of orders related to a particular clinical condition (e.g. hypertension treatment and monitoring) or stage of care (e.g. hospital admission to Coronary Care Unit). An order set is used as a checklist for the clinician when managing a patient with a specific condition. It is a structured collection of orders relevant to that condition and presented to the clinician in a computerized provider order entry (CPOE) system.

The OrderSet resource represents order sets with three main components:

• Metadata
• Library
• Action

The Metadata component represents topical metadata such as the title, description, publication information and lifecycle, as well as usage documentation and supporting evidence. The Library component allows order sets to reference logic that can be used to control conditional behavior as the order set is realized. And finally, the Action component provides the ability to define hierarchical groups of actions, where each specific action defines an orderable line item, together with behaviors that determine how the orderable items are related to each other.

If the order set contains only static items (i.e. there are no context-dependent values that must be provided to complete the orderable), then the resource element contains a reference to a complete resource instance representing the orderable.

However, each orderable item usually needs to be completed with contextual information based on the particular patient that the order set is being used with. In this case, either the user completing the order set must provide a value, or the order set definition can provide an expression that provides the necessary value based on the patient in context. These expressions are defined for each item using the customization element. Each customization specifies a path and the name of an expression that, when evaluated in context, provides a value for the element defined by the path.

Note that the OrderSet itself does not contain any logic; rather a Library resource is referenced that contains the logic required by the order set, and the various expression elements, such as customization expression, reference named expressions within that library (or libraries). In addition, if the OrderSet references multiple libraries, then any expression references within the resource must be qualified with the name of the library that contains the referenced expression.

This mixture of static and dynamic description of each orderable allows the order set to be presented structurally in terms of native resources, while still allowing for complete flexibility and customization of the contents based on the patient, encounter, and setting at the point-of-care.

As an example, the Low Suicide Risk example order set from the Clinical Decision Support Knowledge Artifact Specification was represented using the OrderSet structure: Low Suicide Risk Example Order Set.

In addition to the representation of OrderSets, the $place operation allows OrderSets to be realized for a specific patient. In general, this operation is expected to place the orders defined by the order set, consistent with the service functional requirements defined by the Order Set Service specification.

• Structure
• UML
• XML
• JSON
• All

Structure

Name	Flags	Card.	Type	Description & Constraints
OrderSet	Σ		DomainResource	The definition of an order set
moduleMetadata	Σ	0..1	ModuleMetadata	The metadata for the orderset
library	Σ	0..*	Reference(Library)	Logic used by the orderset
action	Σ	0..*	ActionDefinition	Groups, sections, and line items of the order set
Documentation for this format

<OrderSet xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <moduleMetadata><!-- 0..1 ModuleMetadata The metadata for the orderset --></moduleMetadata>
 <library><!-- 0..* Reference(Library) Logic used by the orderset --></library>
 <action><!-- 0..* ActionDefinition Groups, sections, and line items of the order set --></action>
</OrderSet>

{
  "resourceType" : "OrderSet",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "moduleMetadata" : { ModuleMetadata }, // The metadata for the orderset
  "library" : [{ Reference(Library) }], // Logic used by the orderset
  "action" : [{ ActionDefinition }] // Groups, sections, and line items of the order set
}

Structure

Name	Flags	Card.	Type	Description & Constraints
OrderSet	Σ		DomainResource	The definition of an order set
moduleMetadata	Σ	0..1	ModuleMetadata	The metadata for the orderset
library	Σ	0..*	Reference(Library)	Logic used by the orderset
action	Σ	0..*	ActionDefinition	Groups, sections, and line items of the order set
Documentation for this format

UML Diagram

XML Template

<OrderSet xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <moduleMetadata><!-- 0..1 ModuleMetadata The metadata for the orderset --></moduleMetadata>
 <library><!-- 0..* Reference(Library) Logic used by the orderset --></library>
 <action><!-- 0..* ActionDefinition Groups, sections, and line items of the order set --></action>
</OrderSet>

JSON Template

{
  "resourceType" : "OrderSet",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "moduleMetadata" : { ModuleMetadata }, // The metadata for the orderset
  "library" : [{ Reference(Library) }], // Logic used by the orderset
  "action" : [{ ActionDefinition }] // Groups, sections, and line items of the order set
}