This page is part of the Canonical Resource Management Infrastructure Implementation Guide (v1.0.0: STU1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

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Official URL: http://hl7.org/fhir/uv/crmi/ImplementationGuide/hl7.fhir.uv.crmi				Version: 1.0.0
Active as of 2024-05-08				Computable Name: CRMI
Other Identifiers: OID:2.16.840.1.113883.4.642.40.38

Summary

The Canonical Resource Management Infrastructure implementation guide defines profiles, operations, capability statements and guidance to facilitate the content management lifecycle for authoring, publishing, distribution, and implementation of FHIR knowledge artifacts such as value sets, profiles, libraries, rules, and measures. The guide is intended to be used by specification and content implementation guide authors as both a dependency for validation of published artifacts, and a guide for construction and publication of content.

This implementation guide is based upon work in multiple quality improvement and reporting domains. Various implementation guides have developed similar infrastructure-level profiles for conformance and knowledge artifacts. These profiles are being refactored into universal-realm, domain-independent profiles that can then be re-used in future versions of those specifications, as well as included in future versions of the base FHIR specification.

Scope of Use

This implementation guide is focused on facilitating consistent exchange of knowledge artifacts throughout the artifact management lifecycle, from authoring, through publishing and distribution, to implementation. At the highest level, this is done through the definition of capability categories that roughly correspond to these lifecycle phases:

These categories are proposed as a way to help facilitate management of expectations in the artifact development lifecycle, as well as address common challenges that have been encountered in the development of knowledge artifacts across the quality improvement spectrum, including guideline development, public health reporting specifications, clinical decision support rules, and quality measures. The expectation is that these same challenges will arise in any knowledge artifact development effort, and that the profiles and solutions proposed here will be useful in addressing those challenges.

The implementation guide defines:

• Capability profiles to establish expectations for artifacts at the various phases of the artifact lifecycle
• Guidance for artifact versioning and dependency management
• Operations to support artifact authoring and publishing
• Service descriptions to support a knowledge artifact ecosystem

In particular, this implementation guide enables a consistent approach to developing knowledge artifacts as FHIR resources so that they can be seamlessly integrated with the existing FHIR publishing ecosystem, and can be easily deployed and implemented as part of existing FHIR infrastructures. At the same time, the additional capabilities for packaging and distribution enable use cases that cannot be easily achieved with current FHIR packages, such as:

1. Focused packaging: Retrieving a package a specific artifact with its dependencies. For example a package for a Questionnaire that includes all and only the resources required to fill out that questionnaire.
2. Artifact selection: Retrieving a set of artifacts together with their related depedencies, independent of the publication grouping. For example, a measure set may include fifty (50) measures, but a provider system is only reporting on five (5) of those measures.
3. Platform-specific packaging: Retrieving a package tailored for the capabilities of a particular implementation environment. For example, a set of guideline recommendations together with pre-expanded value sets

Artifacts

An artifact in this implementation guide is a FHIR resource whose primary focus is the representation of context-independent knowledge such as a profile, a value set, a decision support rule, or a quality measure specification, as opposed to FHIR resources such as Patient, Organization, or Observation, that are typically focused on the representation of instance data for patients and other healthcare related entities. Most of the resources types for representing artifacts in FHIR are also canonical resources, and often metadata resources. However, some FHIR resources are not defined by FHIR as canonical resources, but may still be used to represent context-independent knowledge (e.g. Medication, or Substance). The use of the term artifact in this IG applies to both canonical resources as defined by the base specification, as well as these non-canonical artifact resources.

The following table lists the resource types that are considered artifacts, along with a categorization of those artifacts.

Artifact Category	Description	Resources
Knowledge Artifacts	Representing decision support rules, quality measures, logic libraries, and activity definitions	ActivityDefinition Library Measure PlanDefinition Questionnaire
Terminology Artifacts	Code systems, value sets, naming systems, and concept maps	ValueSet CodeSystem ConceptMap NamingSystem
Conformance Artifacts	Profiles, extensions, structure maps, and artifacts related to defining and testing conformance	GraphDefinition ImplementationGuide StructureDefinition StructureMap
Domain Artifacts	Medications, substances, groups, and other domain-related artifacts	CareTeam (profiled) Group (non-canonical artifact) Location (profiled) Medication (non-canonical artifact) MedicationKnowledge (non-canonical artifact) Practitioner (profiled) PractitionerRole (profiled) Organization (profiled) Substance (non-canonical artifact)
Evidence-based Medicine (EBM) Artifacts (Roadmap)	Artifacts related to supporting evidence-based medicine	Evidence EvidenceVariable

(profiled) For entity-related Domain Artifacts (i.e. Organization, Location, Practitioner, Patient, and CareTeam), this implementation guide uses profiling to address references to these types of resources in the artifact space (i.e. when a PlanDefinition references a particular type of CareTeam for example, the canonical reference is to a profile of the CareTeam resource.

Audience

The audience for this IG includes modelers (authors of FHIR profiles); terminologists; knowledge developers (authors of measures, guidelines, order catalogs, clinical logic/rules, assessments); and healthcare system and software developers using FHIR-based knowledge artifacts.

How to read this Guide

This Guide is divided into several pages which are listed at the top of each page in the menu bar:

• Home: Summary and background information for the Canonical Resource Management Infrastructure Implementation Guide
• Introduction: Detailed overview of the content management lifecycle and the background for this guide
• Artifact Management
  • Artifact lifecycle: Content lifecycle of knowledge artifacts
  • Packaging: Packaging considerations for canonical resources and knowledge artifacts
  • Publishing: Publishing considerations for canonical resources and knowledge artifacts
  • Distribution: Distribution considerations for canonical resources and knowledge artifacts
• FHIR Artifacts
  • Profiles: List of profiles defined for use by knowledge artifacts
  • Extensions: List of extensions defined and used by knowledge artifacts
  • Operations: List of operations and operation pattern profiles
  • Capabilities: Definitions of services and operations in support of authoring, publishing, and distributing canonical resources and knowledge artifacts
  • Terminology: Terminology defined in this implementation guide.
  • Artifact Summary: Index of all conformance artifacts defined in this implementation guide.
• Downloads: Links to downloadable artifacts for implementations.
• Version History: Version and change history

Acknowledgements

This Implementation Guide was made possible by the thoughtful contributions of the following people and organizations:

• Taha Attari, Smile Digital Health - Contributor
• Martijn Harthoorn, Firely - Contributor
• Brian Kaney, Vermonster - Editor
• Ewout Kramer, Firely - Contributor
• Taylor Le, Vermonster - Editor
• Carl Leitner - Contributor
• Rob McClure, Md Partners - Contributor
• Evan Muchasak, NCQA - Contributor
• Brian Postlethwaite, Microsoft - Contributor
• Rob Reynolds, Smile Digital Health - Contributor
• Brenin Rhodes, Smile Digital Health - Contributor
• Bryn Rhodes, Smile Digital Health - Editor
• Derek Ritz - Contributor
• Chris Schuler, Smile Digital Health - Contributor
• Adam Stevenson, Smile Digital Health - Contributor
• Ward Weistra, Firely - Contributor

References

Health level seven. Clinical Quality Framework - HL7 Clinical Decision Support Work Group Confluence Page. [Online]. Available from: https://confluence.hl7.org/display/CQIWC/Clinical Quality Framework [Accessed 11 October 2019].

Health level seven. Publishing terminology to the FHIR Ecosystem - FHIR Product Family Confluence Page. [Online]. Available from: https://confluence.hl7.org/display/FHIR/Publishing+terminology+to+the+FHIR+Ecosystem [Accessed 17 May 2022]

Health Level Seven. FHIR Clinical Guidelines. [Online]. Available from: http://hl7.org/fhir/uv/cpg [Accessed October 2023].

Health Level Sevent. Electronic Case Reporting. [Online]. Available from: http://hl7.org/fhir/us/ecr [Accessed October 2023].

Health Level Seven. Quality Measure Implementation Guide. [Online]. Available from: http://hl7.org/fhir/us/cqfmeasures [Accessed October 2023].

Health Level Seven. FHIR Quality Profile. [Online]. Available from: http://hl7.org/fhir/us/qicore [Accessed March 2024].

Health Level Seven. US Core. [Online]. Available from: http://hl7.org/fhir/us/core [Accessed March 2024].

Dependencies

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (hl7.fhir.uv.crmi.r4) and R4B (hl7.fhir.uv.crmi.r4b) are available.

Global Profiles

There are no Global profiles defined

IP Statements

This publication includes IP covered under the following statements.

• The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
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  • Unified Code for Units of Measure (UCUM): Medication/definition-example, PublishableActivityDefinitionExample, ShareableActivityDefinitionExample and ShareableActivityDefinitionExampleArtifactReference
• This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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  • SNOMED Clinical Terms® (SNOMED CT®): Medication/definition-example, MedicationKnowledge/definition-example, PublishableActivityDefinitionExample, ShareableActivityDefinitionExample and ShareableActivityDefinitionExampleArtifactReference
• This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license
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  • Condition Category Codes: OpioidCDSREC10ModuleConfiguration
  • Condition Clinical Status Codes: OpioidCDSREC10ModuleConfiguration
  • DoseAndRateType: PublishableActivityDefinitionExample, ShareableActivityDefinitionExample and ShareableActivityDefinitionExampleArtifactReference
  • LibraryType: ANCCohort, ANCIND01Publishable... Show 12 more, ANCIND01Shareabale, ANCMDangerSignsPackage, CRMIManifestLibrary, CRMIModuleConfigurationLibrary, CRMIModuleDefinitionLibrary, EXMLogicModuleDefinition, FHIRCommon, FHIRCommonComputable, FHIRCommonExecutable, FHIRCommonPublishable, FHIRCommonShareable and OpioidCDSREC10ModuleConfiguration
  • MeasureImprovementNotation: ANCIND01Publishable and ANCIND01Shareabale
  • MeasurePopulationType: ANCIND01Publishable, ANCIND01Shareabale and MeasureReport/result-example
  • MeasureScoring: ANCIND01Publishable and ANCIND01Shareabale
  • MeasureType: ANCIND01Publishable and ANCIND01Shareabale
  • MedicationRequest Category Codes: OpioidCDSREC10ModuleConfiguration
  • Observation Category Codes: OpioidCDSREC10ModuleConfiguration
  • PlanDefinitionType: ANCDT01Publishable and ANCDT01Shareable
  • Substance Category Codes: Substance/artifact-reference-example
  • UsageContextType: ANCB5Publishable, ANCB5Shareable... Show 11 more, ANCDT01Publishable, ANCDT01Shareable, ANCMDangerSignsPackage, Dangersigns, PublishableConceptMapExample, PublishableOperationDefinitionExample, PublishableSearchParameterExample, ShareableConceptMapExample, ShareableOperationDefinitionExample, ShareableSearchParameterExample and Specifichealthconcerns
  • sequenceStatus: PublishableSearchParameterExample and ShareableSearchParameterExample
• This material derives from the HL7 Terminology THO. THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license
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  • Software System Type Codes: CRMISoftwareSystemDevice and Device/cqf-tooling
  • ActCode: PublishableOperationDefinitionExample and ShareableOperationDefinitionExample
• Using RxNorm codes of type SAB=RXNORM as this specification describes does not require a UMLS license. Access to the full set of RxNorm definitions, and/or additional use of other RxNorm structures and information requires a UMLS license. The use of RxNorm in this specification is pursuant to HL7's status as a licensee of the NLM UMLS. HL7's license does not convey the right to use RxNorm to any users of this specification; implementers must acquire a license to use RxNorm in their own right.
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  • RxNorm: Medication/definition-example