R4 Ballot #2 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.5.0: R4 Ballot #2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

14.9 Resource GuidanceResponse - Content

Clinical Decision Support Work GroupMaturity Level: 2 Trial Use Compartments: Not linked to any defined compartments

A guidance response is the formal response to a guidance request, including any output parameters returned by the evaluation, as well as the description of any proposed actions to be taken.

Note to balloters The Clinical Decision Support workgroup is seeking feedback on the use of the GuidanceResponse resource as a persistent resource for keeping a record of past service requests, as well as for passing to downstream processing functionality. Specifically, are there implementations using GuidanceResponse for this purpose, and what gaps exist in the resource when used in this context.

14.9.1 Scope and Usage

The GuidanceResponse resource is used to represent the result of invoking a decision support service. It provides a container for the status of the response, any warnings or messages returned by the service, as well as any output data from the service and any suggested actions to be performed.

Use cases for the GuidanceResponse resource include:

  • Keeping a record of past service requests, including the ability to reference the context of the request such as the disease state
  • Representing additional data requirements for subsequent service requests
  • Representing Public Health case reporting and recording
  • Sharing the results of decision support guidance and determination of reportability with clinicians and public health agencies

In addition, the GuidanceResponse resource is aligned with the CDS Hooks response structure and so provides a mechanism to record the results of CDS Hooks interactions. For a detailed discussion of how the GuidanceResponse resource can be used for this purpose, refer to the Evaluation topic in the Clinical Reasoning module.

14.9.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. GuidanceResponse TUDomainResourceThe formal response to a guidance request
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... requestIdentifier Σ0..1IdentifierThe identifier of the request associated with this response, if any
... identifier Σ0..*IdentifierBusiness identifier
... module[x] Σ1..1What guidance was requested
.... moduleUriuri
.... moduleCanonicalcanonical()
.... moduleCodeableConceptCodeableConcept
... status ?!Σ1..1codesuccess | data-requested | data-required | in-progress | failure | entered-in-error
GuidanceResponseStatus (Required)
... subject 0..1Reference(Patient | Group)Patient the request was performed for
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter or Episode during which the response was returned
... occurrenceDateTime 0..1dateTimeWhen the guidance response was processed
... performer 0..1Reference(Device)Device returning the guidance
... reasonCode 0..*CodeableConceptWhy guidance is needed
... reasonReference 0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)Why guidance is needed
... note 0..*AnnotationAdditional notes about the response
... evaluationMessage 0..*Reference(OperationOutcome)Messages resulting from the evaluation of the artifact or artifacts
... outputParameters 0..1Reference(Parameters)The output parameters of the evaluation, if any
... result 0..1Reference(CarePlan | RequestGroup)Proposed actions, if any
... dataRequirement 0..*DataRequirementAdditional required data

doco Documentation for this format

UML Diagram (Legend)

GuidanceResponse (DomainResource)The identifier of the request associated with this response. If an identifier was given as part of the request, it will be reproduced here to enable the requester to more easily identify the response in a multi-request scenariorequestIdentifier : Identifier [0..1]Allows a service to provide unique, business identifiers for the responseidentifier : Identifier [0..*]An identifier, CodeableConcept or canonical reference to the guidance that was requestedmodule[x] : Type [1..1] « uri|canonical|CodeableConcept »The status of the response. If the evaluation is completed successfully, the status will indicate success. However, in order to complete the evaluation, the engine may require more information. In this case, the status will be data-required, and the response will contain a description of the additional required information. If the evaluation completed successfully, but the engine determines that a potentially more accurate response could be provided if more data was available, the status will be data-requested, and the response will contain a description of the additional requested information (this element modifies the meaning of other elements)status : code [1..1] « The status of a guidance response. (Strength=Required)GuidanceResponseStatus! »The patient for which the request was processedsubject : Reference [0..1] « Patient|Group »Allows the context of the guidance response to be provided if available. In a service context, this would likely be unavailablecontext : Reference [0..1] « Encounter|EpisodeOfCare »Indicates when the guidance response was processedoccurrenceDateTime : dateTime [0..1]Provides a reference to the device that performed the guidanceperformer : Reference [0..1] « Device »Describes the reason for the guidance response in coded or textual formreasonCode : CodeableConcept [0..*]Indicates the reason the request was initiated. This is typically provided as a parameter to the evaluation and echoed by the service, although for some use cases, such as subscription- or event-based scenarios, it may provide an indication of the cause for the responsereasonReference : Reference [0..*] « Condition|Observation| DiagnosticReport|DocumentReference »Provides a mechanism to communicate additional information about the responsenote : Annotation [0..*]Messages resulting from the evaluation of the artifact or artifacts. As part of evaluating the request, the engine may produce informational or warning messages. These messages will be provided by this elementevaluationMessage : Reference [0..*] « OperationOutcome »The output parameters of the evaluation, if any. Many modules will result in the return of specific resources such as procedure or communication requests that are returned as part of the operation result. However, modules may define specific outputs that would be returned as the result of the evaluation, and these would be returned in this elementoutputParameters : Reference [0..1] « Parameters »The actions, if any, produced by the evaluation of the artifactresult : Reference [0..1] « CarePlan|RequestGroup »If the evaluation could not be completed due to lack of information, or additional information would potentially result in a more accurate response, this element will a description of the data required in order to proceed with the evaluation. A subsequent request to the service should include this datadataRequirement : DataRequirement [0..*]

XML Template

<GuidanceResponse xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <requestIdentifier><!-- 0..1 Identifier The identifier of the request associated with this response, if any --></requestIdentifier>
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <module[x]><!-- 1..1 uri|canonical|CodeableConcept What guidance was requested --></module[x]>
 <status value="[code]"/><!-- 1..1 success | data-requested | data-required | in-progress | failure | entered-in-error -->
 <subject><!-- 0..1 Reference(Patient|Group) Patient the request was performed for --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter or Episode during which the response was returned --></context>
 <occurrenceDateTime value="[dateTime]"/><!-- 0..1 When the guidance response was processed -->
 <performer><!-- 0..1 Reference(Device) Device returning the guidance --></performer>
 <reasonCode><!-- 0..* CodeableConcept Why guidance is needed --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|Observation|DiagnosticReport|
   DocumentReference) Why guidance is needed --></reasonReference>
 <note><!-- 0..* Annotation Additional notes about the response --></note>
 <evaluationMessage><!-- 0..* Reference(OperationOutcome) Messages resulting from the evaluation of the artifact or artifacts --></evaluationMessage>
 <outputParameters><!-- 0..1 Reference(Parameters) The output parameters of the evaluation, if any --></outputParameters>
 <result><!-- 0..1 Reference(CarePlan|RequestGroup) Proposed actions, if any --></result>
 <dataRequirement><!-- 0..* DataRequirement Additional required data --></dataRequirement>
</GuidanceResponse>

JSON Template

{doco
  "resourceType" : "GuidanceResponse",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "requestIdentifier" : { Identifier }, // The identifier of the request associated with this response, if any
  "identifier" : [{ Identifier }], // Business identifier
  // module[x]: What guidance was requested. One of these 3:
  "moduleUri" : "<uri>",
  "moduleCanonical" : "<canonical>",
  "moduleCodeableConcept" : { CodeableConcept },
  "status" : "<code>", // R!  success | data-requested | data-required | in-progress | failure | entered-in-error
  "subject" : { Reference(Patient|Group) }, // Patient the request was performed for
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter or Episode during which the response was returned
  "occurrenceDateTime" : "<dateTime>", // When the guidance response was processed
  "performer" : { Reference(Device) }, // Device returning the guidance
  "reasonCode" : [{ CodeableConcept }], // Why guidance is needed
  "reasonReference" : [{ Reference(Condition|Observation|DiagnosticReport|
   DocumentReference) }], // Why guidance is needed
  "note" : [{ Annotation }], // Additional notes about the response
  "evaluationMessage" : [{ Reference(OperationOutcome) }], // Messages resulting from the evaluation of the artifact or artifacts
  "outputParameters" : { Reference(Parameters) }, // The output parameters of the evaluation, if any
  "result" : { Reference(CarePlan|RequestGroup) }, // Proposed actions, if any
  "dataRequirement" : [{ DataRequirement }] // Additional required data
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:GuidanceResponse;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:GuidanceResponse.requestIdentifier [ Identifier ]; # 0..1 The identifier of the request associated with this response, if any
  fhir:GuidanceResponse.identifier [ Identifier ], ... ; # 0..* Business identifier
  # GuidanceResponse.module[x] : 1..1 What guidance was requested. One of these 3
    fhir:GuidanceResponse.moduleUri [ uri ]
    fhir:GuidanceResponse.moduleCanonical [ canonical ]
    fhir:GuidanceResponse.moduleCodeableConcept [ CodeableConcept ]
  fhir:GuidanceResponse.status [ code ]; # 1..1 success | data-requested | data-required | in-progress | failure | entered-in-error
  fhir:GuidanceResponse.subject [ Reference(Patient|Group) ]; # 0..1 Patient the request was performed for
  fhir:GuidanceResponse.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter or Episode during which the response was returned
  fhir:GuidanceResponse.occurrenceDateTime [ dateTime ]; # 0..1 When the guidance response was processed
  fhir:GuidanceResponse.performer [ Reference(Device) ]; # 0..1 Device returning the guidance
  fhir:GuidanceResponse.reasonCode [ CodeableConcept ], ... ; # 0..* Why guidance is needed
  fhir:GuidanceResponse.reasonReference [ Reference(Condition|Observation|DiagnosticReport|DocumentReference) ], ... ; # 0..* Why guidance is needed
  fhir:GuidanceResponse.note [ Annotation ], ... ; # 0..* Additional notes about the response
  fhir:GuidanceResponse.evaluationMessage [ Reference(OperationOutcome) ], ... ; # 0..* Messages resulting from the evaluation of the artifact or artifacts
  fhir:GuidanceResponse.outputParameters [ Reference(Parameters) ]; # 0..1 The output parameters of the evaluation, if any
  fhir:GuidanceResponse.result [ Reference(CarePlan|RequestGroup) ]; # 0..1 Proposed actions, if any
  fhir:GuidanceResponse.dataRequirement [ DataRequirement ], ... ; # 0..* Additional required data
]

Changes since R3

GuidanceResponse
GuidanceResponse.requestIdentifier
  • Added Element
GuidanceResponse.identifier
  • Max Cardinality changed from 1 to *
GuidanceResponse.module[x]
  • Renamed from module to module[x]
  • Remove Reference(ServiceDefinition), Add uri, Add canonical, Add CodeableConcept
GuidanceResponse.reasonCode
  • Added Element
GuidanceResponse.reasonReference
  • Added Element
GuidanceResponse.requestId
  • deleted
GuidanceResponse.reason[x]
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 1 test of which 1 fail to execute.)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. GuidanceResponse TUDomainResourceThe formal response to a guidance request
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... requestIdentifier Σ0..1IdentifierThe identifier of the request associated with this response, if any
... identifier Σ0..*IdentifierBusiness identifier
... module[x] Σ1..1What guidance was requested
.... moduleUriuri
.... moduleCanonicalcanonical()
.... moduleCodeableConceptCodeableConcept
... status ?!Σ1..1codesuccess | data-requested | data-required | in-progress | failure | entered-in-error
GuidanceResponseStatus (Required)
... subject 0..1Reference(Patient | Group)Patient the request was performed for
... context 0..1Reference(Encounter | EpisodeOfCare)Encounter or Episode during which the response was returned
... occurrenceDateTime 0..1dateTimeWhen the guidance response was processed
... performer 0..1Reference(Device)Device returning the guidance
... reasonCode 0..*CodeableConceptWhy guidance is needed
... reasonReference 0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)Why guidance is needed
... note 0..*AnnotationAdditional notes about the response
... evaluationMessage 0..*Reference(OperationOutcome)Messages resulting from the evaluation of the artifact or artifacts
... outputParameters 0..1Reference(Parameters)The output parameters of the evaluation, if any
... result 0..1Reference(CarePlan | RequestGroup)Proposed actions, if any
... dataRequirement 0..*DataRequirementAdditional required data

doco Documentation for this format

UML Diagram (Legend)

GuidanceResponse (DomainResource)The identifier of the request associated with this response. If an identifier was given as part of the request, it will be reproduced here to enable the requester to more easily identify the response in a multi-request scenariorequestIdentifier : Identifier [0..1]Allows a service to provide unique, business identifiers for the responseidentifier : Identifier [0..*]An identifier, CodeableConcept or canonical reference to the guidance that was requestedmodule[x] : Type [1..1] « uri|canonical|CodeableConcept »The status of the response. If the evaluation is completed successfully, the status will indicate success. However, in order to complete the evaluation, the engine may require more information. In this case, the status will be data-required, and the response will contain a description of the additional required information. If the evaluation completed successfully, but the engine determines that a potentially more accurate response could be provided if more data was available, the status will be data-requested, and the response will contain a description of the additional requested information (this element modifies the meaning of other elements)status : code [1..1] « The status of a guidance response. (Strength=Required)GuidanceResponseStatus! »The patient for which the request was processedsubject : Reference [0..1] « Patient|Group »Allows the context of the guidance response to be provided if available. In a service context, this would likely be unavailablecontext : Reference [0..1] « Encounter|EpisodeOfCare »Indicates when the guidance response was processedoccurrenceDateTime : dateTime [0..1]Provides a reference to the device that performed the guidanceperformer : Reference [0..1] « Device »Describes the reason for the guidance response in coded or textual formreasonCode : CodeableConcept [0..*]Indicates the reason the request was initiated. This is typically provided as a parameter to the evaluation and echoed by the service, although for some use cases, such as subscription- or event-based scenarios, it may provide an indication of the cause for the responsereasonReference : Reference [0..*] « Condition|Observation| DiagnosticReport|DocumentReference »Provides a mechanism to communicate additional information about the responsenote : Annotation [0..*]Messages resulting from the evaluation of the artifact or artifacts. As part of evaluating the request, the engine may produce informational or warning messages. These messages will be provided by this elementevaluationMessage : Reference [0..*] « OperationOutcome »The output parameters of the evaluation, if any. Many modules will result in the return of specific resources such as procedure or communication requests that are returned as part of the operation result. However, modules may define specific outputs that would be returned as the result of the evaluation, and these would be returned in this elementoutputParameters : Reference [0..1] « Parameters »The actions, if any, produced by the evaluation of the artifactresult : Reference [0..1] « CarePlan|RequestGroup »If the evaluation could not be completed due to lack of information, or additional information would potentially result in a more accurate response, this element will a description of the data required in order to proceed with the evaluation. A subsequent request to the service should include this datadataRequirement : DataRequirement [0..*]

XML Template

<GuidanceResponse xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <requestIdentifier><!-- 0..1 Identifier The identifier of the request associated with this response, if any --></requestIdentifier>
 <identifier><!-- 0..* Identifier Business identifier --></identifier>
 <module[x]><!-- 1..1 uri|canonical|CodeableConcept What guidance was requested --></module[x]>
 <status value="[code]"/><!-- 1..1 success | data-requested | data-required | in-progress | failure | entered-in-error -->
 <subject><!-- 0..1 Reference(Patient|Group) Patient the request was performed for --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Encounter or Episode during which the response was returned --></context>
 <occurrenceDateTime value="[dateTime]"/><!-- 0..1 When the guidance response was processed -->
 <performer><!-- 0..1 Reference(Device) Device returning the guidance --></performer>
 <reasonCode><!-- 0..* CodeableConcept Why guidance is needed --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|Observation|DiagnosticReport|
   DocumentReference) Why guidance is needed --></reasonReference>
 <note><!-- 0..* Annotation Additional notes about the response --></note>
 <evaluationMessage><!-- 0..* Reference(OperationOutcome) Messages resulting from the evaluation of the artifact or artifacts --></evaluationMessage>
 <outputParameters><!-- 0..1 Reference(Parameters) The output parameters of the evaluation, if any --></outputParameters>
 <result><!-- 0..1 Reference(CarePlan|RequestGroup) Proposed actions, if any --></result>
 <dataRequirement><!-- 0..* DataRequirement Additional required data --></dataRequirement>
</GuidanceResponse>

JSON Template

{doco
  "resourceType" : "GuidanceResponse",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "requestIdentifier" : { Identifier }, // The identifier of the request associated with this response, if any
  "identifier" : [{ Identifier }], // Business identifier
  // module[x]: What guidance was requested. One of these 3:
  "moduleUri" : "<uri>",
  "moduleCanonical" : "<canonical>",
  "moduleCodeableConcept" : { CodeableConcept },
  "status" : "<code>", // R!  success | data-requested | data-required | in-progress | failure | entered-in-error
  "subject" : { Reference(Patient|Group) }, // Patient the request was performed for
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Encounter or Episode during which the response was returned
  "occurrenceDateTime" : "<dateTime>", // When the guidance response was processed
  "performer" : { Reference(Device) }, // Device returning the guidance
  "reasonCode" : [{ CodeableConcept }], // Why guidance is needed
  "reasonReference" : [{ Reference(Condition|Observation|DiagnosticReport|
   DocumentReference) }], // Why guidance is needed
  "note" : [{ Annotation }], // Additional notes about the response
  "evaluationMessage" : [{ Reference(OperationOutcome) }], // Messages resulting from the evaluation of the artifact or artifacts
  "outputParameters" : { Reference(Parameters) }, // The output parameters of the evaluation, if any
  "result" : { Reference(CarePlan|RequestGroup) }, // Proposed actions, if any
  "dataRequirement" : [{ DataRequirement }] // Additional required data
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:GuidanceResponse;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:GuidanceResponse.requestIdentifier [ Identifier ]; # 0..1 The identifier of the request associated with this response, if any
  fhir:GuidanceResponse.identifier [ Identifier ], ... ; # 0..* Business identifier
  # GuidanceResponse.module[x] : 1..1 What guidance was requested. One of these 3
    fhir:GuidanceResponse.moduleUri [ uri ]
    fhir:GuidanceResponse.moduleCanonical [ canonical ]
    fhir:GuidanceResponse.moduleCodeableConcept [ CodeableConcept ]
  fhir:GuidanceResponse.status [ code ]; # 1..1 success | data-requested | data-required | in-progress | failure | entered-in-error
  fhir:GuidanceResponse.subject [ Reference(Patient|Group) ]; # 0..1 Patient the request was performed for
  fhir:GuidanceResponse.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Encounter or Episode during which the response was returned
  fhir:GuidanceResponse.occurrenceDateTime [ dateTime ]; # 0..1 When the guidance response was processed
  fhir:GuidanceResponse.performer [ Reference(Device) ]; # 0..1 Device returning the guidance
  fhir:GuidanceResponse.reasonCode [ CodeableConcept ], ... ; # 0..* Why guidance is needed
  fhir:GuidanceResponse.reasonReference [ Reference(Condition|Observation|DiagnosticReport|DocumentReference) ], ... ; # 0..* Why guidance is needed
  fhir:GuidanceResponse.note [ Annotation ], ... ; # 0..* Additional notes about the response
  fhir:GuidanceResponse.evaluationMessage [ Reference(OperationOutcome) ], ... ; # 0..* Messages resulting from the evaluation of the artifact or artifacts
  fhir:GuidanceResponse.outputParameters [ Reference(Parameters) ]; # 0..1 The output parameters of the evaluation, if any
  fhir:GuidanceResponse.result [ Reference(CarePlan|RequestGroup) ]; # 0..1 Proposed actions, if any
  fhir:GuidanceResponse.dataRequirement [ DataRequirement ], ... ; # 0..* Additional required data
]

Changes since Release 3

GuidanceResponse
GuidanceResponse.requestIdentifier
  • Added Element
GuidanceResponse.identifier
  • Max Cardinality changed from 1 to *
GuidanceResponse.module[x]
  • Renamed from module to module[x]
  • Remove Reference(ServiceDefinition), Add uri, Add canonical, Add CodeableConcept
GuidanceResponse.reasonCode
  • Added Element
GuidanceResponse.reasonReference
  • Added Element
GuidanceResponse.requestId
  • deleted
GuidanceResponse.reason[x]
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 1 test of which 1 fail to execute.)

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

14.9.2.1 Terminology Bindings

PathDefinitionTypeReference
GuidanceResponse.status The status of a guidance response.RequiredGuidanceResponseStatus

14.9.3 GuidanceResponse Search

Although the GuidanceResponse resource does define search parameters, it is up to the individual decision support service whether or not historical records of guidance requests are preserved. A service might not support searching on GuidanceResponses at all, or it may support searching only for a pre-defined expiration period. The search parameters are defined to provide consumers with a consistent interface to searching if it is available for a specific service implementation. In any case, services should detail the support they do provide using a CapabilityStatement.

14.9.4 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
identifiertokenThe identifier of the guidance responseGuidanceResponse.identifier
patientreferenceThe identity of a patient to search for guidance response resultsGuidanceResponse.subject.where(resolve() is Patient)
(Patient)
requesttokenThe identifier of the request associated with the response
subjectreferenceThe subject that the guidance response is aboutGuidanceResponse.subject
(Group, Patient)