Cqif\cqif-knowledge-artifact-representation

STU 3 Candidate

This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

G.2 Knowledge Artifact Representation

For the purposes of this guide, a Knowledge Artifact is a structured, computable, and shareable representation of clinical knowledge. A comprehensive definition of clinical knowledge is of course beyond the scope of this guide, but we effectively mean any knowledge relevant to improving patient care. For example, "Patients with diabetes should have regular comprehensive foot examinations to identify risk factors predictive of ulcers and amputations" is a statement of clinical knowledge. A knowledge artifact would then be some representation that can be used to integrate that knowledge into existing healthcare delivery systems.

There are any number of ways to accomplish this integration of clinical knowledge, ranging from direct implementation within an existing EHR system all the way up to the use of high-level representation and reasoning systems that can adapt clinical workflow to provide cognitive support to clinicians. Within this guide, we aim to provide a representation that is both flexible enough to represent a broad range of knowledge artifacts, but simple and specific enough to enable automated integration of the content.

To acheive these goals, we define several components that are present in a broad variety of knowledge artifacts:

Component	Description
Metadata	Information about the knowledge artifact such as status, publisher, documentation, and supporting evidence.
Parameters	Values that can be provided at the time of evaluation to influence the behavior of the artifact based on setting-specific configuration.
Data	Clinical information used by the artifact as part of the representation of knowledge
Actions	Descriptions of actions to be taken as part of the implementation of knowledge
Triggers	Information about what events should trigger the use of the artifact
Logic	Expressions used to represent reasoning such as whether or not some criteria is satisfied, or calculation of new values from existing one.

Component

Description

Metadata

Information about the knowledge artifact such as status, publisher, documentation, and supporting evidence.

Parameters

Values that can be provided at the time of evaluation to influence the behavior of the artifact based on setting-specific configuration.

Data

Clinical information used by the artifact as part of the representation of knowledge

Actions

Descriptions of actions to be taken as part of the implementation of knowledge

Triggers

Information about what events should trigger the use of the artifact

Logic

Expressions used to represent reasoning such as whether or not some criteria is satisfied, or calculation of new values from existing one.

These components are then combined in various ways to represent several different types of knowledge artifacts:

Artifact Type	Description	Example
Library	A sharable package of clinical logic expressed in Clinical Quality Language.	Expressions that define the criteria that must be met to determine whether or not a patient has diabetes.
DecisionSupportRule	A decision support rule of the form [on Event] if Condition then Action, defining actions that shoud be taken whenever some condition is met in response to a particular event.	On admission of a patient, if the patient has diabetes and has not had a recent foot examination, place an unsigned order for a comprehensive foot exam.
DocumentationTemplate	A structured form for recording information on a patient into a set of predefined data slots.	A form containing the information that should be gathered during a comprehensive diabetic foot exam.
OrderSet	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). Order sets are used within electronic health record systems as a checklist for physicians when treating a patient with a specific condition. An order set is a structured collection of orders presented to the physician in a computerized physician order entry system (CPOE).	The specific tasks that should be performed to provide effective treatment for a new diagnosis of diabetes.
Measure	A quantitative tool to assess the performance of an individual or organization with respect to a specified process or outcome via the measurement of actions, processes, or outcomes of clinical care. Quality measures are often derived from clinical quidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base.	Percentage of patients aged 18-75 years of age with diabetes who had a foot exam during the measurement period.

Artifact Type

Description

Example

Library

A sharable package of clinical logic expressed in Clinical Quality Language.

Expressions that define the criteria that must be met to determine whether or not a patient has diabetes.

DecisionSupportRule

A decision support rule of the form [on Event] if Condition then Action, defining actions that shoud be taken whenever some condition is met in response to a particular event.

On admission of a patient, if the patient has diabetes and has not had a recent foot examination, place an unsigned order for a comprehensive foot exam.

DocumentationTemplate

A structured form for recording information on a patient into a set of predefined data slots.

A form containing the information that should be gathered during a comprehensive diabetic foot exam.

OrderSet

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). Order sets are used within electronic health record systems as a checklist for physicians when treating a patient with a specific condition. An order set is a structured collection of orders presented to the physician in a computerized physician order entry system (CPOE).

The specific tasks that should be performed to provide effective treatment for a new diagnosis of diabetes.

Measure

A quantitative tool to assess the performance of an individual or organization with respect to a specified process or outcome via the measurement of actions, processes, or outcomes of clinical care. Quality measures are often derived from clinical quidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base.

Percentage of patients aged 18-75 years of age with diabetes who had a foot exam during the measurement period.

In addition to the definitions provided by the base resources, this guide provides additional information on how to use these resources consistent with other decision support service specifications, as described in the following sections.

G.2.1 Artifact Identity

As with any FHIR resource, the instance identity is specified by the id element. In addition, modules may have logical identifiers based on the content or behavior they provide. For example, the CMS or NQF identifiers for measure content. These identifiers can be provided in the identifier element.

In addition to identity, the ModuleMetadata structure allows, but does not require, a version to be specified.

When using the identifier element to provide the Entity Identifier for a module consistent with the Decision Support Service (DSS) specification, the following mappings apply:

DSS Model Element	FHIR Element	Example
businessId	Identifier.value	hemoglobin-control-rule
scopingEntityId	Identifier.system	com.clinica
version	KnowledgeModule.version	1.0.0

G.2.2 Documentation

The ModuleMetadata structure provides several elements related to documentation of the module, including title, description, purpose, and usage. In addition to these elements, additional supporting documentation, citations, and evidence can be provided via the relatedResource element.

G.2.3 Publication Information

The status element of the ModuleMetadata structure describes the lifecycle status of the module, indicating whether the module is a draft, test, active, or retired artifact. This representation is consistent with the states described by the Quality Metadata Conceptual Model. The following table provides a mapping from the states defined here, to the states as defined in the Clinical Decision Support Knowledge Artifact Specification (CDS KAS), as well as the Decision Support Service (DSS) standard:

Status	CDS KAS Mapping	DSS Mapping
draft	Draft	DRAFT
test	InTest	DEFINED
active	Active	APPROVED, PROMOTED
inactive	Inactive	REJECTED, RETIRED

In addition, the ModuleMetadata structure provides elements for tracking publication information including contributor, publisher, steward, and rightsDeclaration.