Result Interaction

The GuidanceResponse is the primary message 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.

Request Headers

The following HTTP request headers are supported for this interaction:

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.

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.

• In the case of advice which is not self-care, the result element in GuidanceResponse MUST be populated with a RequestGroup resource which will reference a ReferralRequest. The RequestGroup will also reference one or more CarePlans.
• In the case of advice to the patient relating to self-care, the result element in GuidanceResponse MUST be populated with a RequestGroup resource which will reference a CarePlan.
  Note that care advice can also be given at any point during a triage journey (even without a referral request). In this case, the result element MUST be populated with a RequestGroup which will reference a CarePlan.

Any care advice carried in a CarePlan 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:

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’:

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’:

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’:

OutputParameters of the returned GuidanceResponse

The GuidanceResponse.outputParameters element carries assertions (resulting from the EMS’s responses to received questions) sent to the EMS by the CDSS. It also carries the QuestionnaireResponse resources created by the EMS, from user input. Where the data carried in outputParameters can be interpreted by a system, it SHOULD be published as an assertion, typically by populating an Observation resource. This is done by the CDSS when it receives responses to received questions from the EMS.

If the information can only be interpreted by a human, it SHOULD be maintained as a QuestionnaireResponse only. The logical ID of either or both of these resources can be returned to the EMS by the CDSS for persistence and these IDs are carried as a reference in this element throughout the triage journey.

GuidanceResponse: Implementation Guidance

View CDS implementation guidance for a GuidanceResponse.