order-sign
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 | 5 - Mature |
| standardsStatus | Trial Use |
| publicationStatus | Ballot |
Workflow
The order-sign hook fires when a clinician is ready to sign one or more orders for a patient, (including orders for medications, procedures, labs and other orders).
This hook is among the last workflow events before an order is promoted out of a draft status.
The context contains all order details, such as dose, quantity, route, etc,
although the order has not yet been signed and therefore still exists in a draft status.
Use this hook when your service requires all order details, and the clinician will accept recommended changes.
This hook can also be used when an order or set of orders is being 're-signed' after revision (e.g. change to status, extending dates, or other changes allowed to signed orders within the system's workflow). In this case, the orders would typically have a status other than 'draft'. In some cases, the hook might fire with a mixture of new and revised orders.
This hook is intended to replace (deprecate) the medication-prescribe and order-review hooks.
Context
| 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 |
draftOrders |
REQUIRED | No | object | DSTU2 - FHIR Bundle of MedicationOrder, DiagnosticOrder, DeviceUseRequest, ReferralRequest, ProcedureRequest, NutritionOrder, VisionPrescription (typically with draft status) STU3 - FHIR Bundle of MedicationRequest, ReferralRequest, ProcedureRequest, NutritionOrder, VisionPrescription (typically with draft status) R4 - FHIR Bundle of DeviceRequest, MedicationRequest, NutritionOrder, ServiceRequest, VisionPrescription (typically with draft status) |
Examples
Example (R4)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 | { "context":{ "userId":"PractitionerRole/123", "patientId":"1288992", "encounterId":"89284", "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 (STU3)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 | { "context":{ "userId":"Practitioner/example", "patientId":"1288992", "encounterId":"89284", "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 (DSTU2)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 | "context":{ "userId":"Practitioner/abc", "patientId":"1288992", "encounterId":"89284", "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 | Add DeviceRequest to list of order resources for R4. |
| 1.1.0 | Updated hook to all for use in order-revision situations |