Evaluate Response
The GuidanceResponse is the synchronous response generated by the Clinical Decision Support System (CDSS). It is returned by the CDSS in response to the EMS’s ServiceDefinition.$evaluate
operation.
It carries the status of the response, any warnings or messages returned by the service, as well as the output data of the module and the result in the form of any suggested actions to be performed.
View the CDS implementation guidance for a GuidanceResponse.
Result interaction
Any triage interaction undertaken by a user needs to end by providing an appropriate recommendation as to what action to perform next. To facilitate the above user outcomes each ServiceDefinition
should in turn end in either:
- Care advice,
- A referral to a service, or
- Redirection to a more appropriate
ServiceDefinition
based on the responses entered by the user
For example, a user might initially answer questions related to a ServiceDefinition
for a rash. If their responses suggested potential meningitis, the system should have the ability to switch to a ServiceDefinition
relating to meningitis so that an appropriate triage can be completed.
A ServiceDefinition
may need to be capable of redirecting to multiple other ServiceDefinitions
. For example, dependent on what answers are provided a ServiceDefinition
relating to headache might need to redirect to ServiceDefinitions
such as migraine, head injury or stroke.
Given that a ServiceDefinition
may redirect to other appropriate ServiceDefinitions
there is potential for:
- A circular user journey, i.e. the user being asked questions that have already been answered earlier in the journey
- An unintended loop within the system, where
ServiceDefinitions
directly or indirectly redirect to each other
The possibility of this occurring will be based on the CDSS triage logic. Deploying organisations should configure their solution to prevent being directed back to a previous ServiceDefinition
unintentionally.
It is recommended that testing is undertaken to ensure a given solution can prevent unintentional looping.
Request Headers
The following HTTP request headers are supported for this interaction:
Header | Value | Conformance |
---|---|---|
Accept |
The Accept header indicates the format of the response the client is able to understand, this will be one of the following application/fhir+json or application/fhir+xml . See the RESTful API Content types section. |
MAY |
Authorization |
The Authorization header MUST carry a base64url encoded JSON web token. See the RESTful API Security section. |
MAY |
Key Aspects of the Return GuidanceResponse Interaction
Key aspects of this interaction which are of particular significance to implementers are noted below:
Outcome of the Triage Journey
This is carried in the result
element of the GuidanceResponse
. The outcome of the triage journey is displayed to the user by the EMS.
There are three main outcomes for a triage journey and these are outlined below:-
1. Triage referral
A recommendation as to where the patient should go next; the result
element in GuidanceResponse
MUST be populated with a RequestGroup
resource which will reference a ReferralRequest
.
The details of the referral carried in the ReferralRequest
may be displayed to the user by the EMS.
This referral may be also used to drive a directory search within the EMS to locate a specific provider, location or service for a patient.
View CDS implementation guidance for a ReferralRequest
2. Care Advice
Care advice for the patient (or third party) on actions that can be performed now to either assist the patient, or to assist the triage process.
- More than one piece of care advice may be appropriate for a given triage, for example in a scenario where a patient has multiple injuries requiring care
- The result element in
GuidanceResponse
MUST be populated with a RequestGroup resource which will reference at least one CarePlan, and may optionally reference a ReferralRequest - Any care advice carried in the one or more CarePlan resources MUST be displayed to the user by the EMS.
View CDS implementation guidance for a CarePlan
3. Redirection of the Service Definition
A recommendation to redirect to a different ServiceDefinition
; the result
element in GuidanceResponse
SHOULD NOT be populated. Additionally, the GuidanceResponse.dataRequirement element will be used to carry a description of the data required by the EMS to enable it to select the new ServiceDefinition
as directed by the CDSS.
View CDS implementation guidance for a GuidanceResponse
The final result or outcome of a triage journey will be available only when the GuidanceResponse.status
is set to ‘success’.
Status of the returned GuidanceResponse
The status of the GuidanceResponse
is a trigger for the Encounter Management System (EMS). It MUST contain one of the following values:
Code | Display | Definition |
---|---|---|
success |
Success | The request was processed successfully |
data-requested |
Data Requested | The request was processed successfully, but more data may result in a more complete evaluation |
data-required |
Data Required | The request was processed, but more data is required to complete the evaluation |
Status of success
This means that the result is ready and no further Questionnaires
are posted in the GuidanceResponse
.
The CDSS has all information possible for the ServiceDefinition
to which the GuidanceResponse
is responding and has provided a result.
If the CDSS is recommending a referral to another service, the GuidanceResponse.result
element will reference a RequestGroup
which will in turn reference a ReferralRequest
with a status
of active. This referral may be accompanied by care advice (not self-care) and/or information about a procedure which the recommended service is expected to provide.
If the CDSS is recommending care advice for a patient, the result
element will reference a RequestGroup
which will reference a CarePlan
with a status
of active.
Alternatively, the result
element will be null and the GuidanceResponse.dataRequirement
element will be used to carry a description of the data required by the EMS to enable it to select the new ServiceDefinition
as directed by the CDSS.
The table below gives additional information relating to outcome scenarios when the status
element of the GuidanceResponse
is set to ‘success’:
Result | Status of the GuidanceResponse | Resource(s) referenced from GuidanceResponse | Additional information |
---|---|---|---|
The CDSS has completed successfully with a recommendation of what service the patient should use next. | success | GuidanceResponse references RequestGroup which in turn references ReferralRequest to carry the information pertinent to the recommended referral. |
The ReferralRequest will have a status of 'active'. |
The CDSS has completed successfully with a recommendation of what service the patient should use next and there is a known procedure which the referring service is intended to perform. | success | GuidanceResponse references RequestGroup which references ReferralRequest which in turn references ProcedureRequest . |
The ReferralRequest and the ProcedureRequest will have a status of 'active'. |
The CDSS has completed successfully with a recommendation regarding what service the patient should use next and also some care advice (not self-care) for the patient. | success | GuidanceResponse references RequestGroup which references ReferralRequest which in turn references one or more CarePlans . |
The ReferralRequest and the CarePlan will have a status of 'active'. |
The CDSS has completed successfully with some recommended care advice (self-care) for the patient. | success | GuidanceResponse references RequestGroup which references a CarePlan . |
The CarePlan will have a status of 'active'. |
The CDSS has completed successfully and has re-directed the user to a new ServiceDefinition . |
success | GuidanceResponse.result is null and the GuidanceResponse.dataRequirement element will be used to carry a description of the data required by the EMS to enable it to select the new ServiceDefinition . |
Status of data-requested
This means that the CDSS has sufficient information to render a result, but additional information will provide a better result. There are additional Questionnaire
resources in the GuidanceResponse
which SHOULD be answered.
The result
element in GuidanceResponse
MUST be populated with a RequestGroup
resource.
If the CDSS is recommending an interim or initial recommendation relating to a referral to another service, the RequestGroup
will reference a ReferralRequest
in draft status.
Care advice may additionally be given alongside this interim referral recommendation. If the CDSS is additionally recommending care advice (not self-care), the ReferralRequest
will also reference a CarePlan
in draft status.
If the CDSS is recommending an interim or initial recommendation relating to care advice for the patient (self-care), the RequestGroup
will reference a CarePlan
in draft status.
The dataRequirement
element in GuidanceResponse
MUST be populated with at least one Questionnaire
.
The table below gives additional information relating to outcome scenarios when the status
element of the GuidanceResponse
is set to ‘data-requested’:
Result | Status of the GuidanceResponse | Resource(s) referenced from GuidanceResponse | Additional information |
---|---|---|---|
The CDSS has sufficient information to recommend a referral, but additional information will provide a better result. | data-requested | GuidanceResponse references RequestGroup which in turn references ReferralRequest to carry the information pertinent to the recommended referral. |
The ReferralRequest will have a status of 'draft' updating to 'active' when the finalised score is available. When the result is final, the GuidanceResponse.status SHOULD be 'success' as above. |
The CDSS has sufficient information to make a recommendation regarding what service the patient should use next and there is also a recommendation relating to a care plan (not self-care). | data-requested | GuidanceResponse references RequestGroup which references ReferralRequest which in turn references CarePlan . |
The ReferralRequest and the CarePlan will have a status of 'draft' updating to 'active' when the finalised score is available. When the result is final, the GuidanceResponse.status SHOULD be 'success' as above. |
Status of data-required
This means that the CDSS has insufficient information to render an outcome. There are additional Questionnaire(s)
in the GuidanceResponse
which MUST be answered.
The result
element in GuidanceResponse
MAY be populated with a RequestGroup
, for example referencing one or more CarePlans
or one ReferralRequest
.
The CDSS can make a referral during the triage journey, and also wish to continue the triage process. This is referred to as an inline referral, and is commonly done for Ambulance Despatch.
This can be represented by setting GuidanceResponse.status
to ‘data-required’, but populating the result
element with a ReferralRequest
resource with a status
of ‘active’. Care advice can be given with this inline referral (not self-care).
The CDSS can also recommend inline care advice (self care).
The dataRequirement
element in GuidanceResponse
MUST be populated with at least one Questionnaire
.
The table below gives additional information relating to outcome scenarios when the status
element of the GuidanceResponse
is set to ‘data-required’:
Result | Status of the GuidanceResponse | Resource(s) referenced from GuidanceResponse | Additional information |
---|---|---|---|
The CDSS is requesting additional information from the EMS using a Questionnaire resource. |
data-required | A GuidanceResponse is returned which references one or more Questionnaires . |
|
The CDSS is making an inline referral. | data-required | GuidanceResponse references RequestGroup which references ReferralRequest . |
The ReferralRequest will have a status of 'active'. |
The CDSS is making an inline referral with care advice (not self-care). | data-required | GuidanceResponse references RequestGroup which references ReferralRequest which in turn references CarePlan . |
The ReferralRequest and the CarePlan will have a status of 'active'. |
The CDSS is giving inline care advice (self-care). | data-required | GuidanceResponse references RequestGroup which references a CarePlan . |
The CarePlan will have a status of 'active'. |
OutputParameters of the returned GuidanceResponse
As users input answers to triage questions, the EMS will relay them to the CDSS within the QuestionnaireResponse
element.
In response the CDSS will generate assertions, which will be captured in the GuidanceResponse.outputParameters
element. Within this element, the CDSS MUST also return the QuestionnaireResponse
resources originally populated by the EMS. Not all QuestionnaireResponses
will generate assertions, but any QuestionnaireResponse
which can generate an assertion MUST generate an assertion.