11.3 Reusable Components These data elements represent reusable sets of data that are can be used in any combination across a CDS Knowledge Artifact. 11.3.1 Actions In order to support basic functionality for Actions within the first iteration of the standard, only Notifications and Orders will be supported initially. However, the Action constructs themselves should be built in such a way that they support extension to different action types (such as Fire Event, or Inference) in future iterations. In addition, the Actions should support the ability to capture complex actions, in the same way that Order Sets can capture multiple actions as a group. Section Name & Description # Data Elements Data Element Descriptions Cardinality Additional Notes Name: Action (Multiple) Description: This is the consequence of a positive evaluation of the clinical scenario expression. It includes a structured action that can be enacted by the user. 1 Action mode Action mode describes whether a new action sentence is being added, an existing action sentence is being refined, or an existing or contemplated action sentence should be discontinued. Single 2 Supporting Evidence See supporting evidence component. Multiple 3 Supporting Reference See supporting reference component. Multiple 4 Urgency An indicator of the urgency with which the action must be executed. Single 5 Action Sentence See Action Sentence defined Single 6 Action Text A textual description of the action to be performed. formattable (tabs, spaces, etc.). Single It is permissible for the Action Sentence to be empty, and for the Action Text to constitute the action.
Such an unstructured action cannot be processed by the target system, but it can be displayed to the user who interprets it and takes the desired action. Name: Action Sentence Description: A structured description of the care action that the CDS artifacts recommend to be executed, i.e., the output of the CDS. The data elements contain the action class with the necessary parameters specified (e.g., dose of medication) Example: Perform a liver function test panel after 30 days 7 Clinical Data Mapping The Action Sentence includes (a) clinical actions (see Clinical Data Mapping) and (b) system actions (e.g., invoking another CDS artifact; that are not included in the clinical data mapping). The clinical actions include: Substance Event– Includes medications, vaccinations, gases, blood products and other activities that fit the same output activity structure, including hydration and feeding) Procedure– Includes surgical procedures, nursing and other allied health activities and procedures Single Some of the data elements listed at left may be simply more specific instances of other elements, or combinations of several other elements. For example, Diagnostic Test is a Procedure that may produce an Observation. Nutrition can be a Procedure (feeding the patient), Education, Substance Administration (which is the superclass of Medication), or a Goal. We keep the Output Action Classes as simple and generic as possible, consistent with supporting all the different types of activities that we need to perform. All classes should support coding the action with codes from standard terminologies. Action classes will provide the attributes necessary to provide a structured, detailed description of
Encounter– Including proposed encounter, referral, and admission discharge Observation– Includes documentation, diagnosis, assessment evaluation Diagnostic Test Education Goal Supply Message The non-clinical actions include: Invoking another rule Making an inference Storing a record in a database The lists are illustrative and not comprehensive the recommended action. For example, the substance administration will contain attributes for dose, frequency, and route of administration, etc. Action sentences may implicitly or explicitly include denoting automatic execution and destinations. These will be determined during harmonization. Actions may also require responses. Actions may be synchronous or asynchronous. Table . Reusable Components - Actions 11.3.2 Supporting Evidence Section Name & Description # Data Elements Data Element Descriptions Cardinality Additional Notes
Name: Person (Multiple) Description: This is a person who is being evaluated by CDS, including at least the patient as the primary focus. May also include relatives, public health contacts, or other persons with clinical relationship to the patient. This section focuses on the individual person; the expression language would communicate the criteria for the persons to be selected within the specifications of the artifact. 1 Type A type of person that is referenced by the knowledge artifact, e.g., Patient, Relative. Multiple Persons for CDS purposes fall into two major groups: those who are subjects of clinical evaluation, and everyone else. The persons who are subjects of clinical evaluation include: patients, relatives for purposes of family history/genetic evaluation, public health "contacts", etc. The "other" persons are not clinically evaluated, and don't need the same depth of data elements. Therefore depending on the person type the level of data elements required will vary. 2 States of residence of evaluated persons that can be used to determine applicability of CDS artifact Multiple 3 Zip code Zip codes of residence of the evaluated person that can be used to determine applicability of CDS artifact Multiple Address data should be modeled in a way to account for international addresses. 4 Birth date/time Specific or ranges of birth dates and times of evaluated persons that can be used to determine the applicability of a CDS artifact Multiple 5 Gender One or more gender categories of evaluated persons that can be Multiple Will need a coding scheme
11 Resuscitation Status Indicator of the resuscitation preferences of a patient. For example, comfort care only, full code/full care. Used to determine applicability of CDS artifact or action. Single Name: Insurance Information (Multiple) Description: Insurance information for the person who is evaluated by CDS. 12 Type Category of insurer referenced by the knowledge artifact, e.g. Medicare, Medicaid, HSA, Private. Single Standard lists? 13 Insurer/Carrier Specific insurer referenced by the knowledge artifact. Single This field will be addressed during implementation. Name: Provider (Multiple) Description: This section describes a care Provide. 14 Specialty An area of medical practice in a provider has been trained, e.g., neurology, cardiology. Multiple Name: Facility (Multiple) Description: Location information on an entity that is providing services that can be used to determine applicability of CDS artifact. 15 State States for the locations of entities providing services that can be used to determine applicability of CDS artifact Single 16 Zip code Zip codes for the locations of entities providing services that can be used to determine applicability of CDS artifact Single
applicability of a CDS artifact or to define actions to be taken. For example, proposed, ordered, administered, dispensed, undelivered. . 61 Lot Number Lot number of the referenced substance. Single 62 Approach body site The body site where that the substance will be administered. Can be used to determine the applicability of a CDS artifact or to define actions to be taken Multiple 63 Target body site The body site that the substance will or test. Can be used to determine the applicability of a CDS artifact or to define actions to be taken Multiple 64 Delivery method The manner by the substance is delivered. Can be used to determine the applicability of a CDS artifact or to define actions to be taken Single 65 Delivery route The method for delivering the substance, e.g., oral, injection. Can be used to determine the applicability of a CDS artifact or to define actions to be taken. Can be used to determine the applicability of a CDS artifact or to define actions to be taken Single
Description: Expressions are used to unambiguously define the logic for any aspect of an artifact requiring computation of some kind to be performed. For example, Boolean expressions, Value Set operations, Formulas, and conditions. 2 Computable Expression This is a computable expression of operations on input elements and the value to be returned. For example, the expression may define Boolean logic to be applied and the resulting value indicating whether or not a particular action should be performed, or it may be a formula resulting in an arbitrary value used by some other expression. Single In general, the expression will return a value of some type, and may have any number of arguments, including zero, which are themselves expressions. 3 Expression Name The name of the expression, allowing it to be referenced by other expressions within the artifact Single 4 Expression Description Human readable description of the expression. Single Name: Parameter 5 Parameter Name Descriptive name of the parameter. Single
Description: Parameters specify additional information that will be available to an artifact or expression during evaluation. For more information refer to the Expression Reference data element defined below. 6 Parameter Value The value of the parameter to be used in the expression. Multiple 7 Parameter Type The form of the parameter to be used in the expression. For example, the threshold for A1c evaluations, it might be set at 6 months. Single Name: Value Description: Atomic, or scalar values such as numbers, dates, and strings 8 Atomic or Scalar Value A specific value used within the expression. E.g. 6.5 or “99082” Single Not specifying a value is valid. Name: Request Description: A request for clinical data of some specific type, and optionally for a specific set of codes and/or a date range. 9 Request Type The type of the data requested. The request type specifies the type of information the request will return, based on the data elements specified in the Clinical Data section. Single 10 Request Criteria Criteria limiting the data being requested. See the Request Criterion data element for details. Multiple
The data element names are repeated 16D Arithmetic Arithmetic operations. For example, +, -, /, *, div, mod, ceiling, floor, power, log 16E String Manipulation String manipulation operations. For example, Concat, Substring, IndexOf Single 16 F Date Manipulation Date manipulation operators should include granularity specifications, allowing date manipulation to be performed at any level of precision, day, month, year, hour, minute, second. For example, DateDiff, DateAdd, DatePart. Single 16G Date Selection Date selection operators. For example, Now, Today, Range, RangeWithin, Date, Time. Single 16H Aggregate Aggregate operations. For example, Min, Max, Sum, Avg, First, Last. Single 16I Set Operations Operations performed on sets of data. For example, Subset, Proper Subset, Superset, Proper Superset, Union, Intersection, Difference, Complement Multiple
evaluation of the condition. 7B A time interval The time interval before or after the anchor event (e.g., +7 days or days) Single 7C Anchor event The event whose time is the fixed point against which the time interval provides the offset Single 8 Periodic-Time Event Event defined by as occurring at specific intervals 8A Setting The clinical care setting (e.g., primary care clinic, home, nursing home) where the event takes place Multiple 8B Period description A definition of the periodicity at event trigger should be generated. Example: 12AM every Sunday. Most likely will involve a start time, a repeating frequency or interval, and duration. Single See, for example, HL7 data-type definition for precise definition. Name: Data Definition Patient and other clinical data required to evaluate if and how the rule and its actions apply to this patient. 9 Clinical Data Mapping See Clinical Data Mapping component. Multiple Name: Condition 10 Logical expression This is a computable expression of the input elements specifying when/whether the output should be enacted. Single Equivalent to the logic slot in Arden or the left hand side (when) of a rule
Should contain Boolean, set, mathematical (at least arithmetic), and temporal operators. Value set operations Name: Action 11 See Actions component. See Actions component. Multiple Name: Supporting Evidence 12 See Supporting Evidence component. See Supporting Evidence component. Multiple Name: Supporting Reference 13 See Supporting Reference component. See Supporting Reference component. Multiple Name: Implementation Extensions Description: For storing metadata. 14 List See component. Single A list of which allows for extensible section metadata, to support application-specific needs. ITEMS FOR CONSIDERATION IN FUTURE VERSIONS Name: Response Recommendations 15 These are data elements related to user acknowledgment, overrides, “snoozing” of reminders
of expressions for the artifact. . Name: Implementation Extensions Description: For storing metadata. 6 Attribute-Value List See Attribute-Value component. Single A list of items which allows for extensible section metadata, to support application-specific needs. Name: Order Set Section (Multiple) Description: An order set is composed of a number of sections that group together order items and/or other sections. A section can contain multiple sections. 7 Title A descriptive heading for the set of orders in that section. E.g., Medications, Diagnostic Single 8 Order Sub Section Repeating Set Section elements. Multiple 9 Order elements Specific order and related data Included in the order sub-section Multiple 10 Sequence Indicator Information indicating the placement of this order set section within the order set or the containing section Single 11 Supporting Evidence See Supporting Evidence component. Multiple Optional, you can include this at the artifact, section or element level. 12 Supporting Reference See Supporting Evidence component. Multiple
18 Supporting Reference See Supporting Reference component. 19 Action (Order Sentence ) See Actions component. Single 20 Clinical Data Mapping See Clinical Data Mapping component. Single 21 Expression See Expression component. An expression to determine the applicability this action. Optional, can be included at the artifact, section or element level. 22 Clinical Optionally defines a set of appropriate venues for the item. Multiple are two approaches to modeling venue relevant order sets, one is to have order sets be where an order set only contains order items relevant for the venue. The other is to allow the order set items to indicate relevant venues. Because the majority of elements in an order set will be common to all venues, the latter approach is more manageable because it prevents duplication of the common elements if the order set is required to be venue specific. 23 Pre-selection Status A code that indicates the extent to use of the order set is, optional, recommended, required: not changeable, required:changeable with reason Single An optional element is unselected by default and may be selected. A recommended order element is selected by default, and may be unselected. Required:not changeable is selected by default, and may not be unselected.
Section Name & Description # Data Elements Data Element Descriptions Cardinality Additional Notes Name: Metadata 1 See metadata See metadata. Single Name: Applicability 2 See Expression component See Expression component. This element describes the clinical conditions in which this documentation template is applicable Single Unlike the elements in the metadata, this element can be used within the clinical setting to identify templates that are applicable to the patient. Name: Implementation Extensions Description: For storing metadata. 3 Attribute-Value List See Attribute-Value component. Single A list of items which allows for extensible section metadata, to support application-specific needs. Name: Documentation Section Description: The document template is composed of a number of sections that organize the concepts 4 Title A descriptive title for the section Single Examples of Sections: History of present illness, Physical Exam, Review of Systems 5 Subsection Subsections of the documentation template Multiple GI System Review, Respiratory System Review 6 Documentation Concept The clinical concept being documented. Multiple E.g., Blood pressure, History of chest pain 7 Section Cardinality Indicator of whether one or multiple instances of this section Single
For all items Formula (Expression) Computation that should be used to derived an item from other data. Single The formula for computing the value is written as an Expression. For all items Constraint Expression An expression that specifies an arbitrary constraint on the possible values of the documentation concept Single The constraint is written as an Expression. 20 Display Order The display sequence within the section in which this item is presented Single 21 Concept Visibility An expression that constrain the display of a concept. Display the concept only if the expression evaluates to true. Single For example, show items about pregnancy history only for women patients; show concepts based on responses to previous concepts 22 Subconcept A subconcept is a modifier or a qualifier of the documentation concept. They have the same structure as the documentation concept. Multiple Example: severity, duration, quality, location, and timing are all subconcepts to the documentation concept of chest pain. 23 Related Concept Codes Coded term (s) to describe related concepts. The codes can be used to find templates that might be Multiple Example: In a documentation template for chest pain, if user documents that the patient has shortness of breath; the related
Name: Documentation Concept (Action) Description: A documentation concept is a single concept that is being recorded about the patient [Even though this is described here, a documentation concept will be modeled as an Action] Documentation Concept Rendered Text Text associated with the documentation concept that is used to generate the sentence Single Often includes context identifying the concept being documented: ‘Symptoms include’. Response Item Rendered Text Text associated with the response item Single, per item identical to display label, but may spell out abbreviations or include articles or other additional text. 25c Meta Tags The meta tags will be used to drive functionality for gender, plural, articles, etc. Single, per item Name: Documentation 26 Documentation Template Reference Information Information that allows the user to identify and locate a Multiple
Template Reference (Multiple) Description: Please note, to preserve data integrity, this field will reference another CDS Artifact, but it would not be rendered or displayed in the artifact itself documentation template that is being referenced LinkName A descriptive name of the documentation template referenced Single LinkText A short description of the documentation template referenced from the link Single URL The hyperlink to access the documentation template reference Single Table . Documentation Templates Data Elements