Clinical Practice Guidelines
2.0.0-ballot - ballot International flag

Clinical Practice Guidelines, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cqf-recommendations/ and changes regularly. See the Directory of published versions

Profile Definitions and Documentation

FHIR profiles are a key aspect of supporting interoperable computable content, providing a formal mechanism for defining the data elements used by computable content, as well as conformance expectations for the computable content itself. Readers of this implementation guide should be familiar with the Profiling FHIR topic in the base specification.

This page provides overview documentation for the following categories of profiles and documentation:

  • Artifact Profiles: Profiles for computable knowledge artifacts
  • Domain Profiles: Domain profiles such as Case/Plan and Metric
  • Activity Profiles: Activity profiles such as MedicationRequest
  • Content Profiles: Documentation on using profiles with CPG content

For indexes of profiles and extensions defined in this implementation guide, see the following:

Artifact profiles

For definitional artifacts, this implementation guide builds on the capability profiles defined in the Canonical Resource Management Infrastructure (CRMI) Implementation Guide, defining profiles for computable knowledge artifacts used in the representation of clinical guidelines. For background on the CRMI capability profiles, see the Profiles discussion in the CRMI IG.

Capability Computable
Activity CPGComputableActivity
GraphDefinition CPGComputableGraphDefinition
ImplementationGuide CPGComputableGuideline
Metric CPGComputableMetric
PlanDefinition CPGComputablePlanDefinition
Questionnaire CPGComputableQuestionnaire
StructureDefinition CPGCaseFeatureDefinition

In addition, content claiming conformance to this implementation guide SHALL use the Shareable profile and SHOULD use the Publishable profile for the following artifact types:

  • ActivityDefinition
  • CapabilityStatement
  • CodeSystem
  • ConceptMap
  • GraphDefinition
  • ImplementationGuide
  • Library
  • Measure
  • Medication
  • MedicationKnowledge
  • NamingSystem
  • OperationDefinition
  • PlanDefinition
  • Questionnaire
  • SearchParameter
  • StructureDefinition
  • StructureMap
  • TerminologyCapabilities
  • ValueSet

Domain Profiles

LevelDefinitionPlan/Instance
GroupCPGGroupDefinitionCPGGroup
LocationCPGLocationDefinitionCPGLocation
Organization-CPGOrganization
Patient-CPGPatient
Practitioner-CPGPractitioner
PractitionerRoleCPGPractitionerRoleDefinitionCPGPractitionerRole
CareTeamCPGCareTeamDefinitionCPGCareTeam
PathwayCPGPathwayDefinitionCPGCase
CPGCarePlan
StrategyCPGStrategyDefinitionCPGStrategy
RecommendationCPGRecommendationDefinitionCPGAdministerMedication
CPGCommunicationRequest
CPGDispenseMedicationTask
CPGDocumentMedicationTask
CPGEnrollmentTask
CPGGenerateReportTask
CPGImmunizationRequest
CPGMedicationRequest
CPGProposeDiagnosisTask
CPGQuestionnaireTask
CPGRecordDetectedIssueTask
CPGRecordInferenceTask
CPGReportFlagTask
CPGServiceRequest
Goaldefined in PlanDefinition.goalCPGGoal
MetricCPGComputableMetricCPGMetricReport
AssessmentCPGClinicalImpression
Case SummaryCPGCaseSummaryDefinitionCPGCaseSummary
Case Plan SummaryCPGCasePlanSummaryDefinitionCPGCasePlanSummary
Case Plan Progressing NoteCPGCasePlanProgressingNote

Examples of the use of these profiles are available in the Examples page. In particular, see the Congestive Heart Failure Pathway example.

Activity Profiles

To represent the activities in a computable guideline, this implementation guide follows the workflow patterns established by the base FHIR specification, definition, request, and event. For each type of activity, these profiles establish at least:

  • Definitional activity profiles
    • kind - The type of request resource being defined
    • profile - The minimum profile that must be met by request resources produced by the activity definition
    • intent - The target intent, typically proposal, of the request resources
  • Request activity profiles
    • source reference - Typically the instantiatesCanonical element to refer back to the guideline content
    • identity - Typically via an identifier element to establish identity of the activity
  • Event activity profiles
    • source reference - Typically the instantiatesCanonical element to refer back to the guideline content
    • request reference - Typically the basedOn element to refer back to the request which the event is fulfilling
    • identity - Typically via an identifier element to establish identity of the activity

Note that the intent of these profiles is not to establish the content of the activity, only to ensure that requests and events related to guideline-based care can be traced back to the recommendation, strategy, pathway, and ultimately guideline they are representing.

ActivityDefinitionRequestEvent
Send a messageCPGCommunicationActivityCPGCommunicationRequestCPGCommunication
Collect informationCPGCollectInformationActivityCPGQuestionnaireTaskCPGQuestionnaireResponse
Order a medicationCPGMedicationRequestActivityCPGMedicationRequestCPGMedicationDispense
CPGMedicationAdministration
CPGMedicationStatement
Dispense a medicationCPGDispenseMedicationActivityCPGDispenseMedicationTaskCPGMedicationDispense
Administer a medicationCPGAdministerMedicationActivityCPGAdministerMedicationTaskCPGMedicationAdministration
Document a medicationCPGDocumentMedicationActivityCPGDocumentMedicationTaskCPGMedicationStatement
Recommend an immunizationCPGImmunizationActivityCPGImmunizationRequestCPGImmunization
Order a serviceCPGServiceRequestActivityCPGServiceRequestCPGProcedure
CPGObservation
Enroll a patientCPGEnrollmentActivityCPGEnrollmentTaskCPGCase
Generate a reportCPGGenerateReportActivityCPGGenerateReportTaskCPGMetricReport
CPGCaseSummary
CPGCasePlanSummary
CPGCasePlanProgressingNote
Propose a diagnosisCPGProposeDiagnosisActivityCPGProposeDiagnosisTaskCPGCondition
Record a detected issueCPGRecordDetectedIssueActivityCPGRecordDetectedIssueTaskCPGDetectedIssue
Record an inferenceCPGRecordInferenceActivityCPGRecordInferenceTaskCPGObservation
Report a flagCPGReportFlagActivityCPGReportFlagTaskCPGFlag

See the Activity Examples for a complete example of each of the above activity types.

Content Profiles

In addition to the profiles defined by this implementation guide, computable content generally deals with two broad categories of profiles:

  • Interoperability Profiles that establish standards of data exchange between systems
  • Computability Profiles that define the data expectations for computable content

Interoperability Profiles

Interoperability profiles establish standards of data exchange between systems, and are typically defined in and distributed as part of model implementation guides. To be useful, these profiles will generally be established across a broad range of systems, all operating in a particular environment, or in support of a particular set of use cases. Examples of these types of profiles are:

Computability Profiles

Computability profiles describe the data expectations for computable content, and are typically defined in and distributed as part of content implementation guides. For example, given the following condition:

define "Active Ambulatory Opioid Rx":
  [MedicationRequest: "Ambulatory Abuse Potential Opioids"] Rx
    where Rx.status = 'active'
		  and Rx.category contains "Outpatient"

In this example, the condition is referencing the status and category elements of the MedicationRequest resource. In order for this logic to be evaluated effectively, the system providing the MedicationRequest instance must understand these two elements and provide data for them if it is available. Computability profiles are used to communicate this information through FHIR profiles.

Note that for logic expressed in CQL, this information can be inferred by static analysis of the CQL expressions and is exposed statically in the dataRequirement element of the Library resource. In addition, the $data-requirements operation can be used to extract this information from a CQL Library dynamically.

Implementation Considerations

Content conforming to this IG SHOULD select a set of base interoperability profiles appropriate for the intended target. For international usage, implementation guides conforming to this IG SHOULD use International Patient Summary.

In general, implementation of any given computable content is based on the intersection of the interoperability and computability profiles. As such, content authors must take care not to define computability profiles that conflict with interoperability profiles in their intended target scope.