Managing Library Rules

For guidance in Library Rule management and governance, please consult Rule and Library Management.

Library Rule Evaluation in Automated Processing in the Infrastructure

For further details and to assist in understanding intended use and capabilities, please consult Example Library Resources.

Input

The Library.parameter element specifies what resources are to be made available to the Library’s rule execution as input and what is returned as output. Typically, a measurement resource - be that an Observation, QuestionnaireResponse, or Media - is provided as input as part of the evaluate operation.

It is possible to state further input for both calculation-type Library (where Library.type is logic-library) and automated processing-type Library (where Library.type is automated-processing). For the calculation-type, all input resources must be provided as part of the evaluate operation.

For automated processing type, the following can be specified as input but are not provided as they are resolved by the Library service as part of establishing facts:

Resource Type	Description
Patient	The patient for which the measurement was applied.
EpisodeOfCare	EpisodeOfCare to which the measurement is related.
CarePlan	CarePlan to which the measurement is related.
ServiceRequest	ServiceRequest referred from measurement (Observation\|QuestionnaireResponse\|Media)
PlanDefinition	PlanDefinition to which the measurement is related.
ActivityDefinition	ActivityDefinition to which the measurement is related.
Questionnaire	Questionnaire to which a measurement of type QuestionnaireResponse is a response to.

Establishing of Facts

If specified as an input parameter, the following resources are fetched and made available to an automated processing type Library rule by the Library service. In the rule, the resources can be accessed by adding the variable declaration to the when part.

Resource Type	Resolved As	Variable Declaration
Patient	Fetched as Patient referenced in `.subject` on measurement resource	`$patient : Patient()`
EpisodeOfCare	Fetched as EpisodeOfCare referenced in `.episodeOfCare` on measurement resource	`$episodeofcare : EpisodeOfCare()`
CarePlan	Fetched as CarePlan where `CarePlan.activity.reference` refers to the ServiceRequest (see resolve of ServiceRequest below)	`$careplan : CarePlan()`
ServiceRequest	Fetched as ServiceRequest referenced in `.basedOn` on measurement resource	`$ServiceRequest : ServiceRequest()`
PlanDefinition	Fetched as PlanDefinition referenced in `CarePlan.definition` (see resolve of CarePlan above)	`$plandefinition : PlanDefinition()`
ActivityDefinition	Fetched as ActivityDefinition referenced in `ServiceRequest.definition` (see resolve of ServiceRequest above)	`$activitydefinition : ActivityDefinition()`
Questionnaire	Fetched as Questionnaire referenced in `.questionnaire` on measurement resource of type QuestionnaireResponse.	`$questionnaire : Questionnaire()`

Execution of Rule and Output

For automated processing rules, there is a structure, AutomatedProcessingDTO, which lets the rule control aspects of the outcome of evaluating the rule. By adding to the structure, the rule controls if and in what number of ClinicalImpression, Task, and Communication resources are created. A special case is the property activateSelfTreatment which controls whether a check on certain ServiceRequest resources should be made, possibly leading to an update of the status of eligible ServiceRequest resources (see further details in Activation of suspended Self-treatment type ServiceRequest ).

AutomatedProcessingDTO

Property	Type	Description
ClinicalImpressions	List of `ClinicalImpressionDTO`	Each entry is an instruction to create a resource, and each entry specifies certain details.
Tasks	List of `TaskDTO`	Each entry is an instruction to create a resource, and each entry specifies certain details.
activateSelfTreatment	boolean	Set to true instructs that sibling ServiceRequests of self-treatment kind should be activated if currently suspended.

ClinicalImpressionDTO

Property	Type	Description
Code	`CodingDTO`	Used for `ClinicalImpression.code` in the created resource.
Description	String	Used for `ClinicalImpression.description` in the created resource.
CodeableConceptFindings	List of `CodingDTO`	Used for `ClinicalImpression.finding.itemCodeableConcept` in the created resource.
ObservationFindings	List of `ObservationDTO`	Used for `Observation.code` of contained Observation in `ClinicalImpression.finding.itemReference` in the created resource.
Tasks	List of `TaskDTO`	Each entry is an instruction to create a Task resource, and each entry specifies certain details. Each created Task refers to the ClinicalImpression through `Task.focus`.
FindingBasis	List of `QuestionnaireResponseFindingBasisDTO`	Used for `ClinicalImpression.ehealth-questionnaireresponse-finding-basis` in the created resource. The list contains information regarding the basis for the overall clinical impression.

TaskDTO

Property	Type	Description
Category	`CodingDTO`	Used for `Task.category` in the created resource.
Description	String	Used for `Task.description` in the created resource.
Priority	String	Used for `Task.priority` in the created resource. It must be ensured that the priority is entered in lower-case as defined for `Task.priority`.
RestrictionCategories	List of `CodingDTO`	Used for `Task.ehealth-restriction-category` in the created resource.
Communications	List of `CommunicationDTO`	Each entry is an instruction to create a Communication resource, and each entry specifies certain details. By default, the `Commnunication.topic` refers to the created Task but this may vary depending on the receiver.

QuestionnaireResponseFindingBasisDTO

Property	Type	Description
LinkId	String	Used for `ehealth-questionnaireresponse-finding-basis.linkId` in the created resource.
Finding	`CodingDTO`	Used for `ehealth-questionnaireresponse-finding-basis.finding`in created resource.
ValueString	String	One of the value elements is populated and used for `ClinicalImpression.ehealth-questionnaireresponse-finding-basis.value` in the created resource.
ValueDecimal	Double
ValueInteger	Integer
ValueBoolean	Boolean
ValueCoding	`CodingDTO`
AnswerSignificance	`AnswerSignificanceDTO`	Used for `ehealth-questionnaireresponse-finding-basis.ehealth-questionnaire-answerSignificance` in created resource.

AnswerSignificanceDTO

Property

Type

Description

Significance

CodingDTO

Used for ehealth-questionnaire-answerSignificance.significance in the created resource.

AnswerConditions

List of AnswerConditionDTO

Used for ehealth-questionnaire-answerSignificance.ehealth-answer-Condition in the created resource.

Must be a list of size 1 or 2.

AnswerConditionDTO

Property	Type	Description
Operator	String	Used for `ehealth-questionnaire-answerSignificance.ehealth-answer-Condition.operator` in the created resource.
ValueString	String	One of the value elements is populated and used for `ehealth-questionnaire-answerSignificance.ehealth-answer-Condition.value` in the created resource.
ValueDecimal	Double
ValueInteger	Integer
ValueBoolean	Boolean
ValueCoding	`CodingDTO`

CommunicationDTO

Property	Type	Description
Categories	List of `CodingDTO`	Used for `Communication.reasonCode` in the created resource.
Text	String	Used for `Communication.payload.content` in the created resource.
RestrictionCategories	List of `CodingDTO`	Used for `Communication.ehealth-restriction-category` in the created resource.

CodingDTO

Property	Type	Description
system	String	Corresponds to `Coding.system` in FHIR Coding.
code	String	Corresponds to `Coding.code` in FHIR Coding.
display	String	Corresponds to `Coding.display` in FHIR Coding.

It is the responsibility of the rule writer to ensure that a CodingDTO reflects a valid concept in a CodeSystem existing in the eHealth infrastructure and that the concept is part of the expanded ValueSet for which there is a binding to the particular resource element where it is used.

ObservationDTO

Property	Type	Description
Status	String	Used for `Observation.status` in the created resource.
Code	`CodingDTO`	Used for `Observation.code` in the created resource.
ValueString	String	One of the value elements is populated and used for `Observation.value` in the created resource.
ValueBoolean	Boolean
ValueQuantity	`QuantityDTO`

Output from automated processing

For each automated processing type Library evaluated, the returned GuidanceResponse typically contains an AutomatedProcessingDTO with instructions for further processing.

The handling is shown in the sequence diagram Automated Processing of Measurements - Handling.

Resources created

When populated by the Library in the AutomatedProcessingDTO, it results in the following resources being created. Please note that Communication resources described below are subjected to the handling described in Taking applicable CommunicationRequest into account, which further influences the number of Communication resources created and their recipient.

For every ClinicalImpressionDTO in AutomatedProcessingDTO.ClinicalImpressions:

Resource	Element	Value
ClinicalImpression	code	`ClinicalImpressionDTO.Code`
	status	`completed`
	description	`ClinicalImpressionDTO.Description`
	investigation.code	Coding with: `code` set to `271336007` `system` set to `http://snomed.info/sct` (SNOMED CT) `display` set to `Examination/signs`
	investigation.item	One version-less reference to the measurement, one versioned referenced to the measurement
	finding.itemCodeableConcept	Coding added for each `CodingDTO` in `ClinicalImpressionDTO.CodeableConceptFindings`
	finding.itemReference	For each `ObservationDTO` in `ClinicalImpressionDTO.ObservationFindings`, a reference to a contained Observation is added with the: `Observation.code` set to one corresponding to `ObservationDTO.Code` `Observation.status` set to `ObservationDTO.Status` `Observation.value` set to the one populated of `ObservationDTO.ValueString`, `ObservationDTO.ValueBoolean` or `Observation.ValueQuantity`. `ObservationDTO.episodeOfCare`set to `GuidanceResponse.episodeOfCare` `ObservationDTO.subject` set to `GuidanceResponse.subject` `ObservationDTO.performer` set to `GuidanceResponse.subject` `ObservationDTO.effective` set to current date/time `ObservationDTO.device` set to a reference to a Device representing the automated processing system `ObservationDTO.basedOn` set to reference the ServiceRequest of the measurement
	date	current date/time
	subject	Same as `GuidanceResponse.subject` (which is the same as the subject of measurement)
	episodeOfCare	Same as `GuidanceResponse.episodeOfCare` (which is the same as episodeOfCare of measurement)
	effective	Same as measurement effective (which is `Observation.effective` or `QuestionnaireResponse.authored`)
	ehealth-clinicalimpression-decisionContext	A reference to a contained Parameters with: An added `parameter` with: `name` set to `library` `value` referring to the Library from `GuidanceResponse.module.relatedArtifact.resource` An added `parameter` for each parameter named fact in GuidanceResponse.outputParameters with: `name` set to `fact` `the value` set to a reference to the parameter.value (from GuidanceResponse.outputParameters)
	ehealth-questionnaireresponse-finding-basis	For each `QuestionnaireResponseFindingBasisDTO` in `ClinicalImpressionDTO.FindingBasis`, an `ehealth-questionnaireresponse-finding-basis` is added with: `ehealth-questionnaireresponse-finding-basis.linkId` set to `QuestionnaireResponseFindingBasisDTO.LinkId` `ehealth-questionnaireresponse-finding-basis.value` set to the one populated of `QuestionnaireResponseFindingBasisDTO.ValueString`, `QuestionnaireResponseFindingBasisDTO.ValueBoolean`, `QuestionnaireResponseFindingBasisDTO.ValueInteger`, `QuestionnaireResponseFindingBasisDTO.ValueDecimcal` or `QuestionnaireResponseFindingBasisDTO.ValueCoding` `ehealth-questionnaireresponse-finding-basis.finding` set to `QuestionnaireResponseFindingBasisDTO.Finding` `ehealth-questionnaireresponse-finding-basis.ehealth-questionnaire-answerSignificance` set to `QuestionnaireResponseFindingBasisDTO.AnswerSignificanceDTO` `ehealth-questionnaire-answerSignificance.significance` set to `AnswerSignificanceDTO.Significance` `ehealth-questionnaire-answerSignificance.ehealth-answer-Condition` set to `AnswerSignificanceDTO.AnswerConditionsDTO` `ehealth-answer-Condition.operator` set to `AnswerConditionsDTO.Operator` `ehealth-answer-Condition.value` set to the one populated of `AnswerConditionsDTO.ValueBoolean` , `AnswerConditionsDTO.ValueCoding`, `AnswerConditionsDTO.ValueDecimal`, `AnswerConditionsDTO.ValueInteger` or `AnswerConditionsDTO.ValueString`
For every `TaskDTO` in the `ClinicalImpressionDTO.Tasks`
Task	ehealth-task-responsible	List of CareTeam from the CarePlan
	ehealth-restriction-category	`TaskDTO.RestrictionCategories`
	category	`TaskDTO.Category`
	status	`requested`
	intent	`plan`
	priority	`TaskDTO.Priority`
	description	`TaskDTO.Description`
	focus	The ClinicalImpression created for the current `ClinicalImpressionDTO`
	episodeOfCare	Same as `GuidanceResponse.episodeOfCare` (and `CarePlan.episodeOfCare`)
	authoredOn	current date/time
For every `CommunicationDTO` in `ClinicalImpressionDTO.Tasks.Communications`
Communication (of profile ehealth-message)	category	Coding for `message`
	status	`completed`
	reasonCode	Coding for each `CodingDTO` in `CommunicationDTO.Categories`
	payload.content	`CommunicationDTO.Text`
	ehealth-title	`CodingDTO.Display` of first `CodingDTO` in `CommunicationDTO.Categories`
	ehealth-restriction-category	Coding for each `CodingDTO` in `CommunicationDTO.RestrictionCategories`
	subject	Same as GuidanceResponse (and CarePlan)
	episodeOfCare	Same as GuidanceResponse (and CarePlan)
	topic	Reference to Task created for current `TaskDTO`
	sent	current date/time

For every TaskDTO in AutomatedProcessingDTO.Tasks:

Resource	Element	Value
Task	ehealth-task-responsible	List of CareTeam from the CarePlan
	ehealth-restriction-category	`TaskDTO.RestrictionCategories`
	category	`TaskDTO.Category`
	status	`requested`
	intent	`plan`
	priority	`TaskDTO.Priority`
	description	`TaskDTO.Description`
	focus	Reference to the measurement
	episodeOfCare	Same as `GuidanceResponse.episodeOfCare` (and `CarePlan.episodeOfCare`)
	authoredOn	current date/time
For every `CommunicationDTO` in `TaskDTO.Communications`
Communication (of profile ehealth-message)	category	Coding for `message`
	status	`completed`
	reasonCode	Coding for each `CodingDTO` in `CommunicationDTO.Categories`
	payload.content	`CommunicationDTO.Text`
	ehealth-title	`CodingDTO.Display` of first `CodingDTO` in `CommunicationDTO.Categories`
	ehealth-restriction-category	Coding for each `CodingDTO` in `CommunicationDTO.RestrictionCategories`
	subject	Same as GuidanceResponse (and CarePlan)
	episodeOfCare	Same as GuidanceResponse (and CarePlan)
	topic	Reference to Task created for current `TaskDTO`
	sent	current date/time

Taking applicable CommunicationRequest into account

When Communication resources (of ehealth-message profile) are created by automated processing, the intended receivers would typically be one or more CareTeam designated as CarePlan.careTeam on the involved CarePlan. As Communication can have at most a single CareTeam as the recipient (through Communication.ehealth-communication-recipientCareTeam), this involves duplication of the original Communication where the duplicates vary by the recipient.

The recipient(s) and duplication made for Communication created by automated processing are influenced by CommunicationRequest. By creating appropriately crafted CommunicationRequest, a Practitioner can control whether:

to suppress automated processing’s default creation of a Communication for a particular CareTeam
to duplicate Communication with the Patient as the recipient

The handling is shown in the sequence diagram Automated Processing of Measurements - Create Communications.

See https://ehealth-dk.atlassian.net/wiki/spaces/EDTW/pages/edit-v2/2415034369 on what values to use when creating CommunicationRequest.

Activation of suspended Self-treatment type ServiceRequest

When the AutomatedProcessingDTO specifies activation through the element activateSelfTreatmentset to true, automated processing performs a lookup for all sibling ServiceRequest resources which have:

ServiceRequest.status set to suspended
ServiceRequest.definition referencing an ActivityDefinition where ActivityDefinition.topic has value self-treatment.

The sibling ServiceRequest resources are those referenced fromCarePlan.activity.reference for the same CarePlan that references the ServiceRequest referenced from the measurement (be that Observation, QuestionnaireResponse or Media).

For those ServiceRequest meeting the criteria above, the ServiceRequest.status is updated to active.

Managing and Using Library Rules