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order-select

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
Hook maturity 4 - Documented
standardsStatus Trial Use
publicationStatus Ballot

Workflow

The order-select hook fires when a clinician selects one or more orders to place for a patient, (including orders for medications, procedures, labs and other orders). If supported by the CDS Client, this hook may also be invoked each time the clinician selects a detail regarding the order. This hook is among the first workflow events for an order entering a draft status. The context of this hook may include defaulted order details as it first occurs immediately upon the clinician selecting the order from the order catalogue of the CPOE, or upon her manual selection of order details (e.g. dose, quantity, route, etc). CDS services should expect some of the order information to not yet be specified. Additionally, the context may include previously selected orders that are not yet signed from the same ordering session. The order-select hook occurs after the clinician selects the order and before signing.

This hook is intended to replace (deprecate) the medication-prescribe hook.

Context

Decision support should focus on the 'selected' orders - those that are newly selected or actively being authored. The non-selected orders are included in the context to provide context and to allow decision support to take into account other pending actions that might not yet be stored in the system (and therefore not queryable). The context of this hook distinguishes between the list of unsigned orders from the clinician's ordering session, and the one or more orders just added to this list. The selections field contains a list of ids of these newly selected orders; the draftOrders Bundle contains an entry for all unsigned orders from this session, including newly selected orders.

Field Optionality Prefetch Token Type Description
userId REQUIRED Yes string The id of the current user.
For this hook, the user is expected to be of type Practitioner or PractitionerRole.
For example, PractitionerRole/123 or Practitioner/abc.
patientId REQUIRED Yes string The FHIR Patient.id of the current patient in context
encounterId OPTIONAL Yes string The FHIR Encounter.id of the current encounter in context
selections REQUIRED No array The FHIR id of the newly selected order(s).
The selections field references FHIR resources in the draftOrders Bundle. For example, MedicationRequest/103.
draftOrders REQUIRED No object DSTU2 - FHIR Bundle of MedicationOrder, DiagnosticOrder, DeviceUseRequest, ReferralRequest, ProcedureRequest, NutritionOrder, VisionPrescription with draft status
STU3 - FHIR Bundle of MedicationRequest, ReferralRequest, ProcedureRequest, NutritionOrder, VisionPrescription with draft status
R4 - FHIR Bundle of DeviceRequest, MedicationRequest, NutritionOrder, ServiceRequest, VisionPrescription with draft status

Examples

Example (R4)

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{
   "context":{
      "userId":"PractitionerRole/123",
      "patientId":"1288992",
      "encounterId":"89284",
      "selections": [ "NutritionOrder/pureeddiet-simple", "MedicationRequest/smart-MedicationRequest-103" ],
      "draftOrders":{
         "resourceType":"Bundle",
         "entry":[
            {
               "resource":{
                  "resourceType":"NutritionOrder",
                  "id":"pureeddiet-simple",
                  "identifier":[
                     {
                        "system":"http://goodhealthhospital.org/nutrition-requests",
                        "value":"123"
                     }
                  ],
                  "status":"draft",
                  "patient":{
                     "reference":"Patient/1288992"
                  },
                  "dateTime":"2014-09-17",
                  "orderer":{
                     "reference":"Practitioner/example",
                     "display":"Dr Adam Careful"
                  },
                  "oralDiet":{
                     "type":[
                        {
                           "coding":[
                              {
                                 "system":"http://snomed.info/sct",
                                 "code":"226211001",
                                 "display":"Pureed diet"
                              },
                              {
                                 "system":"http://goodhealthhospital.org/diet-type-codes",
                                 "code":"1010",
                                 "display":"Pureed diet"
                              }
                           ],
                           "text":"Pureed diet"
                        }
                     ],
                     "schedule":[
                        {
                           "repeat":{
                              "boundsPeriod":{
                                 "start":"2015-02-10"
                              },
                              "frequency":3,
                              "period":1,
                              "periodUnit":"d"
                           }
                        }
                     ],
                     "texture":[
                        {
                           "modifier":{
                              "coding":[
                                 {
                                    "system":"http://snomed.info/sct",
                                    "code":"228055009",
                                    "display":"Liquidized food"
                                 }
                              ],
                              "text":"Pureed"
                           }
                        }
                     ],
                     "fluidConsistencyType":[
                        {
                           "coding":[
                              {
                                 "system":"http://snomed.info/sct",
                                 "code":"439021000124105",
                                 "display":"Dietary liquid consistency - nectar thick liquid"
                              }
                           ],
                           "text":"Nectar thick liquids"
                        }
                     ]
                  },
                  "supplement":[
                     {
                        "type":{
                           "coding":[
                              {
                                 "system":"http://snomed.info/sct",
                                 "code":"442971000124100",
                                 "display":"Adult high energy formula"
                              },
                              {
                                 "system":"http://goodhealthhospital.org/supplement-type-codes",
                                 "code":"1040",
                                 "display":"Adult high energy pudding"
                              }
                           ],
                           "text":"Adult high energy pudding"
                        },
                        "productName":"Ensure Pudding 4 oz container",
                        "instruction":"Ensure Pudding at breakfast, lunch, supper"
                     }
                  ]
               }
            },
            {
               "resource":{
                  "resourceType":"MedicationRequest",
                  "id":"smart-MedicationRequest-103",
                  "meta":{
                     "lastUpdated":"2018-04-30T13:25:40.845-04:00"
                  },
                  "text":{
                     "status":"generated",
                     "div":"<div xmlns=\"http://www.w3.org/1999/xhtml\">Amoxicillin 120 MG/ML / clavulanate potassium 8.58 MG/ML Oral Suspension (rxnorm: 617993)</div>"
                  },
                  "status":"draft",
                  "intent":"order",
                  "medicationCodeableConcept":{
                     "coding":[
                        {
                           "system":"http://www.nlm.nih.gov/research/umls/rxnorm",
                           "code":"617993",
                           "display":"Amoxicillin 120 MG/ML / clavulanate potassium 8.58 MG/ML Oral Suspension"
                        }
                     ],
                     "text":"Amoxicillin 120 MG/ML / clavulanate potassium 8.58 MG/ML Oral Suspension"
                  },
                  "subject":{
                     "reference":"Patient/1288992"
                  },
                  "dosageInstruction":[
                     {
                        "text":"5 mL bid x 10 days",
                        "timing":{
                           "repeat":{
                              "boundsPeriod":{
                                 "start":"2005-01-04"
                              },
                              "frequency":2,
                              "period":1,
                              "periodUnit":"d"
                           }
                        },
                        "doseAndRate":{
                           "doseQuantity":{
                              "value":5,
                              "unit":"mL",
                              "system":"http://unitsofmeasure.org",
                              "code":"mL"
                           }
                        }
                     }
                  ],
                  "dispenseRequest":{
                     "numberOfRepeatsAllowed":1,
                     "quantity":{
                        "value":1,
                        "unit":"mL",
                        "system":"http://unitsofmeasure.org",
                        "code":"mL"
                     },
                     "expectedSupplyDuration":{
                        "value":10,
                        "unit":"days",
                        "system":"http://unitsofmeasure.org",
                        "code":"d"
                     }
                  }
               }
            }
         ]
      }
   }
}

Example (STU3)

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{
   "context":{
      "userId":"Practitioner/example",
      "patientId":"1288992",
      "encounterId":"89284",
      "selections": [ "NutritionOrder/pureeddiet-simple", "MedicationRequest/smart-MedicationRequest-103" ],
      "draftOrders":{
         "resourceType":"Bundle",
         "entry":[
            {
               "resource":{
                  "resourceType":"NutritionOrder",
                  "id":"pureeddiet-simple",
                  "identifier":[
                     {
                        "system":"http://goodhealthhospital.org/nutrition-requests",
                        "value":"123"
                     }
                  ],
                  "status":"draft",
                  "patient":{
                     "reference":"Patient/1288992"
                  },
                  "dateTime":"2014-09-17",
                  "orderer":{
                     "reference":"Practitioner/example",
                     "display":"Dr Adam Careful"
                  },
                  "oralDiet":{
                     "type":[
                        {
                           "coding":[
                              {
                                 "system":"http://snomed.info/sct",
                                 "code":"226211001",
                                 "display":"Pureed diet"
                              },
                              {
                                 "system":"http://goodhealthhospital.org/diet-type-codes",
                                 "code":"1010",
                                 "display":"Pureed diet"
                              }
                           ],
                           "text":"Pureed diet"
                        }
                     ],
                     "schedule":[
                        {
                           "repeat":{
                              "boundsPeriod":{
                                 "start":"2015-02-10"
                              },
                              "frequency":3,
                              "period":1,
                              "periodUnit":"d"
                           }
                        }
                     ],
                     "texture":[
                        {
                           "modifier":{
                              "coding":[
                                 {
                                    "system":"http://snomed.info/sct",
                                    "code":"228055009",
                                    "display":"Liquidized food"
                                 }
                              ],
                              "text":"Pureed"
                           }
                        }
                     ],
                     "fluidConsistencyType":[
                        {
                           "coding":[
                              {
                                 "system":"http://snomed.info/sct",
                                 "code":"439021000124105",
                                 "display":"Dietary liquid consistency - nectar thick liquid"
                              }
                           ],
                           "text":"Nectar thick liquids"
                        }
                     ]
                  },
                  "supplement":[
                     {
                        "type":{
                           "coding":[
                              {
                                 "system":"http://snomed.info/sct",
                                 "code":"442971000124100",
                                 "display":"Adult high energy formula"
                              },
                              {
                                 "system":"http://goodhealthhospital.org/supplement-type-codes",
                                 "code":"1040",
                                 "display":"Adult high energy pudding"
                              }
                           ],
                           "text":"Adult high energy pudding"
                        },
                        "productName":"Ensure Pudding 4 oz container",
                        "instruction":"Ensure Pudding at breakfast, lunch, supper"
                     }
                  ]
               }
            },
            {
               "resource":{
                  "resourceType":"MedicationRequest",
                  "id":"smart-MedicationRequest-103",
                  "meta":{
                     "lastUpdated":"2018-04-30T13:25:40.845-04:00"
                  },
                  "text":{
                     "status":"generated",
                     "div":"<div xmlns=\"http://www.w3.org/1999/xhtml\">Amoxicillin 120 MG/ML / clavulanate potassium 8.58 MG/ML Oral Suspension (rxnorm: 617993)</div>"
                  },
                  "status":"draft",
                  "intent":"order",
                  "medicationCodeableConcept":{
                     "coding":[
                        {
                           "system":"http://www.nlm.nih.gov/research/umls/rxnorm",
                           "code":"617993",
                           "display":"Amoxicillin 120 MG/ML / clavulanate potassium 8.58 MG/ML Oral Suspension"
                        }
                     ],
                     "text":"Amoxicillin 120 MG/ML / clavulanate potassium 8.58 MG/ML Oral Suspension"
                  },
                  "subject":{
                     "reference":"Patient/1288992"
                  },
                  "dosageInstruction":[
                     {
                        "text":"5 mL bid x 10 days",
                        "timing":{
                           "repeat":{
                              "boundsPeriod":{
                                 "start":"2005-01-04"
                              },
                              "frequency":2,
                              "period":1,
                              "periodUnit":"d"
                           }
                        },
                        "doseQuantity":{
                           "value":5,
                           "unit":"mL",
                           "system":"http://unitsofmeasure.org",
                           "code":"mL"
                        }
                     }
                  ],
                  "dispenseRequest":{
                     "numberOfRepeatsAllowed":1,
                     "quantity":{
                        "value":1,
                        "unit":"mL",
                        "system":"http://unitsofmeasure.org",
                        "code":"mL"
                     },
                     "expectedSupplyDuration":{
                        "value":10,
                        "unit":"days",
                        "system":"http://unitsofmeasure.org",
                        "code":"d"
                     }
                  }
               }
            }
         ]
      }
   }
}

Example (DSTU2)

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"context":{
  "userId":"Practitioner/example",
  "patientId":"1288992",
  "encounterId":"89284",
  "selections":[ "NutritionOrder/nest-patient-1-NUTR1", "MedicationOrder/smart-MedicationOrder-103" ],
  "draftOrders":{
    "resourceType":"Bundle",
    "entry":[
      {
        "resource":{
          "resourceType":"NutritionOrder",
          "id":"nest-patient-1-NUTR1",
          "patient":{
            "reference":"Patient/1288992"
          },
          "orderer":{
            "display":"Dr Adam Careful"
          },
          "identifier":[
            {
              "system":"http://goodhealthhospital.org/nutrition-orders",
              "value":"123"
            }
          ],
          "dateTime":"2014-09-17",
          "status":"draft",
          "oralDiet":{
            "type":[
              {
                "coding":[
                  {
                    "system":"http://snomed.info/sct",
                    "code":"435801000124108",
                    "display":"Texture modified diet"
                  },
                  {
                    "system":"http://goodhealthhospital.org/diet-type-codes",
                    "code":"1010",
                    "display":"Texture modified diet"
                  }
                ],
                "text":"Texture modified diet"
              }
            ],
            "schedule":[
              {
                "repeat":{
                  "boundsPeriod":{
                    "start":"2015-02-10"
                  },
                  "frequency":3,
                  "period":1,
                  "periodUnits":"d"
                }
              }
            ],
            "texture":[
              {
                "modifier":{
                  "coding":[
                    {
                      "system":"http://snomed.info/sct",
                      "code":"228049004",
                      "display":"Chopped food"
                    }
                  ],
                  "text":"Regular, Chopped Meat"
                },
                "foodType":{
                  "coding":[
                    {
                      "system":"http://snomed.info/sct",
                      "code":"22836000",
                      "display":"Vegetable"
                    }
                  ],
                  "text":"Regular, Chopped Meat"
                }
              }
            ]
          }
        }
      },
      {
        "resource":{
          "resourceType":"MedicationOrder",
          "id":"smart-MedicationOrder-103",
          "status":"draft",
          "patient":{
            "reference":"Patient/1288992"
          },
          "medicationCodeableConcept":{
            "coding":[
              {
                "system":"http://www.nlm.nih.gov/research/umls/rxnorm",
                "code":"617993",
                "display":"Amoxicillin 120 MG/ML / clavulanate potassium 8.58 MG/ML Oral Suspension"
              }
            ],
            "text":"Amoxicillin 120 MG/ML / clavulanate potassium 8.58 MG/ML Oral Suspension"
          },
          "dosageInstruction":[
            {
              "text":"5 mL bid x 10 days",
              "timing":{
                "repeat":{
                  "boundsPeriod":{
                    "start":"2005-01-04"
                  },
                  "frequency":2,
                  "period":1,
                  "periodUnits":"d"
                }
              },
              "doseQuantity":{
                "value":5,
                "unit":"mL",
                "system":"http://unitsofmeasure.org",
                "code":"mL"
              }
            }
          ],
          "dispenseRequest":{
            "numberOfRepeatsAllowed":1,
            "quantity":{
              "value":1,
              "unit":"mL",
              "system":"http://unitsofmeasure.org",
              "code":"mL"
            },
            "expectedSupplyDuration":{
              "value":10,
              "unit":"days",
              "system":"http://unitsofmeasure.org",
              "code":"d"
            }
          }
        }
      }
    ]
  }
}

Change Log

Version Description
1.0 Initial Release
1.0.1 Small documentation correction
1.0.2 Add DeviceRequest to list of order resources for R4.