order-dispatch

Sep 2023 STU1 Ballot

This page defines a workflow hook for the purpose of providing clinical decision support using CDS Hooks. This is a ballot at the level of Trial Use.

Metadata Value
specificationVersion 1.0
hookVersion 1.0
hookMaturity 1 - Documented
standardsStatus Trial Use
publicationStatus Ballot

Workflow

The order-dispatch hook fires when a practitioner is selecting a candidate performer for a pre-existing order that was not tied to a specific performer. For example, selecting an imaging center to satisfy a radiology order, selecting a cardiologist to satisfy a referral, etc. This hook only occurs in situations where the order is agnostic as to who the performer should be and a separate process (which might be performed by back-office staff, a central dispatch service, or even the ordering clincian themselves at a later time) is used to select and seek action by a specific performer. It is possible that the same order might be dispatched multiple times, either because initial selected targets refuse or are otherwise unable to satisfy the order, or because the performer is only asked to perform a 'portion' of what's authorized (the first monthly lab test of a year-long set, the first dispense of a 6 month order, etc.)

This "request for fulfillment" process is typically represented in FHIR using Task. This resource allows identifying the order to be acted upon, who is being asked to act on it, the time-period in which they're expected to act, and any limitations/qualifications to 'how much' of the order should be acted on.

Decision support that may be relevant for this hook might include information related to coverage, prior-authorization and/or in-network/out-of-network evaluations with respect to the chosen performer; determination of practitioner availability or qualification; enforcement/guidance with respect to patient performer preferences; etc.

Context

Field Optionality Prefetch Token Type Description
patientId REQUIRED Yes string The FHIR Patient.id of the current patient in context
order REQUIRED Yes string The FHIR local reference for the Request resource for which fulfillment is sought E.g. ServiceRequest/123
performer REQUIRED Yes string The FHIR local reference for the Practitioner, PractitionerRole, Organization, CareTeam, etc. who is being asked to execute the order. E.g. Practitioner/456
task OPTIONAL No object DSTU2/STU3/R4 - Task instance that provides a full description of the fulfillment request - including the timing and any constraints on fulfillment

Examples

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"context":{
  "patientId" : "1288992",
  "order" : "ServiceRequest/proc002",
  "performer" : "Organization/some-performer",
  "task" : {
    "resourceType" : "Task",
    "status" : "draft",
    "intent" : "order",
    "code" : {
      "coding" : [{
        "system" : "",
        "code" : ""
      }]
    },
    "focus" : {
      "reference" : "ServiceRequest/proc002"
    },
    "for" : {
      "reference" : "Patient/1288992"
    },
    "authoredOn" : "2016-03-10T22:39:32-04:00",
    "lastModified" : "2016-03-10T22:39:32-04:00",
    "requester": {
      "reference" : "Practitioner/456"
    },
    "owner" : {
      "reference" : "Organziation/some-performer"
    }
  }
}

Change Log

Version Description
1.0 Initial Release