CDS Hooks
3.0.0-ballot - R3 Normative Ballot

CDS Hooks, published by Clinical Decision Support WG. This guide is not an authorized publication; it is the continuous build for version 3.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cds-hooks/ and changes regularly. See the Directory of published versions

## ValueSet: Non-Adherence Reason

Official URL: http://terminology.hl7.org/ValueSet/non-adherence-reason | Version: 3.0.0-ballot
Standards status: Trial-use Active as of 2025-12-14 | Maturity Level: 1 | Computable Name: NonAdherenceReason

A set of codes capturing all reasons why a Patient Care Clinical Decision Support (PC CDS) recommendation may not be followed, drawn from the CDS-NonAdherence-Reason CodeSystem.

References

This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

### Logical Definition (CLD)

- Include all codes defined in `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` version 📦3.0.0-ballot

### Expansion

Expansion performed internally based on codesystem Non-Adherence Reason Codes v3.0.0-ballot (CodeSystem)

This value set contains 35 concepts

Level | System | Code | Display (en) | Definition | JSON | XML
1 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | cds-not-applicable | PC CDS does not apply to patient | The CDS recommendation is irrelevant, completed, or the patient does not meet the criteria. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | patient-ineligible | Patient does not meet eligibility for recommended action | The patient does not satisfy the criteria (e.g., age, condition, lab result) for the recommended action. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | indication-order-exists | Patient has indication/order for intended action | The recommended action is already indicated or ordered in the patient's record, making the CDS redundant. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | action-completed | Recommended action was already completed | The action or procedure recommended by the CDS has already been performed. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | action-unsuccessful | Recommended action was previously unsuccessful | The recommended action was attempted before and failed to achieve the desired outcome. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | action-performed-no-adverse-effect | Intended action was performed previously without adverse effect | A previously performed action that was the subject of the CDS did not cause harm, suggesting the action is safe despite the CDS warning. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | action-not-priority | Recommended action is not relevant or a priority in current state of health | The patient's acute or chronic conditions require more immediate attention than the action recommended by the CDS. |  |
1 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | cds-suboptimal-context | PC CDS delivered in suboptimal context | The CDS was delivered at a time or to a recipient that made the action impossible or impractical to address. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | limited-time | Could not address recommended action due to limited time | The recipient had insufficient time during the current patient encounter or workflow step to act on the recommendation. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | wrong-time-workflow | PC CDS delivered at wrong time in workflow or patient lifecycle | The alert appeared at a point in the workflow or patient's care journey where it could not be practically acted upon. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | inappropriate-recipient | PC CDS delivered to inappropriate recipient/role | The person receiving the recommendation (e.g., a nurse, clerk) is not authorized or responsible for performing the action. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | need-more-info | Could not address recommended action due to need for more information/pending results/pending consult | The recipient requires additional data (e.g., a lab result, imaging) or a specialist's opinion before the action can be safely or definitively taken. |  |
1 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | recipient-disagrees-evidence | Recipient disagrees with recommendation because of issues with the evidence | The recipient (clinician or patient) has an objection based on the supporting evidence or conflicting advice/policy. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | does-not-align-latest-evidence | Recommended action does not align with the latest evidence | The recipient believes the CDS rule is outdated compared to current medical literature or best practices. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | expert-contradicts | Advice from expert contradicts the recommended action | Guidance received from a specialist or recognized authority conflicts with the CDS recommendation. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | policy-contradicts | Institutional policy/guideline contradicts the recommended action | The recommendation conflicts with the official procedures, policies, or local guidelines of the healthcare facility. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | recipient-does-not-trust | Recipient does not agree with or trust the recommended action | The recipient fundamentally disbelieves the validity or necessity of the CDS action. |  |
1 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | recipient-concerns-outcomes | Recipient has concerns regarding potential health outcomes | Concerns about the action's risk/benefit ratio, potential negative outcomes, or contraindications. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | risk-benefit-ratio | Recipient assessment of risk/benefit ratio | The recipient determines that the potential risks of the action outweigh the anticipated benefits for this specific patient. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | mitigate-risk-negative-outcome | Action taken to mitigate risk of negative outcome | The recommended action was superseded by an alternative measure taken to specifically avoid a known potential adverse event. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | likely-negative-health-outcomes | Recommended action likely to have negative health outcomes | The recipient believes the action, if taken, would predictably lead to an adverse patient outcome (e.g., severe side effect). |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | patient-contraindication | Patient has contraindication to recommended action | A patient factor (e.g., allergy, existing condition, previous reaction) explicitly rules out the recommended action. |  |
1 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | does-not-align-preferences | Recommendation does not align with patient preferences or values | The action conflicts with the patient's personal, cultural, or religious beliefs, or they prefer an alternative. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | patient-fears-discomfort | Patient fears discomfort from complying with recommended action | The patient is unwilling to proceed due to anticipated pain, anxiety, or general discomfort associated with the action. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | patient-does-not-want-change | Patient does not want to change behavior or believes the change is unnecessary | The patient lacks motivation for lifestyle change or disagrees with the premise that a change is needed for their health. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | cultural-religious-reason | Patient has a cultural or religious reason for not following recommended action | The patient's deeply held cultural or religious beliefs prohibit them from accepting the recommendation (e.g., blood transfusions). |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | prefers-alternative | Patient prefers an alternative approach or treatment | The patient wishes to pursue a different, non-recommended treatment or approach (e.g., holistic medicine). |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | patient-refuses | Patient refuses/declines (no context given)* | The patient has simply refused the recommendation without providing an explicit, detailed reason. |  |
1 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | not-convenient-feasible | Recommendation is not convenient or feasible | Practical barriers related to cost, logistics, technology, or patient capability prevent the action. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | inadequate-support | Patient has inadequate caregiver/social support | The patient lacks the necessary assistance from family or caregivers to comply with the action. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | service-not-available | Treatment or service is not practically available | The required service, medication, or equipment is not accessible, either geographically or logistically. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | implementation-challenges | Recommended action cannot be implemented due to technology/challenges | Technical issues, system downtime, or complexity of the EHR/device prevent the action from being recorded or performed. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | too-costly-uncovered | Recommended action is too costly or not covered by insurance | Financial burden is a barrier, either due to the cost of the service or lack of insurance coverage. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | recipient-does-not-understand | Recipient does not understand the recommended action or know how to perform the recommended action | The recipient (patient or clinician) lacks the necessary health literacy or procedural knowledge to execute the action. |  |
2 | `http://terminology.hl7.org/CodeSystem/non-adherence-reason-codes` | comorbidity-disability | Patient has co-morbidity or disability that hinders them from completing recommended action | An unrelated or co-existing physical/mental condition (e.g., severe arthritis, dementia) makes the action impossible for the patient. |  |

Description of the above table(s).