32.0.1Table of Contents

Clinical Reasoning on Smile CDR
- Clinical Reasoning Operations per Module
Clinical Quality Language (CQL)
Quality Measures
Clinical Decision Support
Additional Implementation Guides

32.0.2Clinical Reasoning on Smile CDR

Clinical Reasoning (CR) is the ability to represent, encode, and evaluate clinical knowledge so that it can be integrated into clinical systems.

In other words, clinical reasoning is the ability to store and run business logic that is relevant to clinical settings. This may be as simple as controlling whether a particular section of an order set appears based on the conditions that a patient has, or it may be as complex as representing the care pathway for a patient with multiple conditions.

The FHIR Clinical Reasoning module specifies a foundational set of FHIR resources and associated operations that allow a FHIR repository to perform clinical reasoning on CDR stored clinical data.

Use Cases:

Prospective/Retrospective Analytics
- Quality Measures
- Gaps in Care
Clinical Decision Support
Payer/Provider Data Exchange
Prior Authorization

Smile CDR includes support for Clinical Reasoning by enabling storage of all Clinical Reasoning resources defined in FHIR CR module, which includes resources like Measure, PlanDefinition, ActivityDefinition, Questionnaire, Library, and many others.

It also enables the execution and utilization of Clinical Quality Language (CQL) Expressions to perform over a performant CQL-Engine to support operation tasks like calculating quality measures.

Smile also exposes several Clinical Reasoning operations in CDR via respective modules that allow utilization at the defined FHIR endpoint and configuration of the operations with a user interface.

32.0.3Clinical Reasoning Operations per Smile CDR Module

To activate Clinical Reasoning operations, you will require starting the respective module it resides in.

Some of these operations are open-source available and others are exclusive to CDR.

Module	Operation	CDR Exclusive	Configuration on Admin-Console
DQM	FHIR to QPP JSON $qpp-build	✓	✓
DQM	Distributed $evaluate-measure	✓	✓
DQM	$evaluate-measure		✓
DQM	Distributed $evaluate-measures	✓	✓
DQM	$evaluate-measures	✓	✓
DQM	Multi-Threaded $care-gaps	✓	✓
DQM	$care-gaps		✓
DQM	$submit-data
DQM	Evaluate $cql
DQM	Library $evaluate
DQM	$collect-data
DQM	$data-requirements
DQM	$job-analytics
Prior Auth DTR	StructureDefinition $questionnaire
Prior Auth DTR	QuestionnaireResponse $extract
Prior Auth DTR	Questionnaire $populate
Prior Auth DTR	Questionnaire $package
Prior Auth DTR	PlanDefinition $package
Prior Auth DTR	PlanDefinition $apply
Prior Auth DTR	ActivityDefinition $apply
CDS-HOOKS	PlanDefinition $apply
CDS-HOOKS	ActivityDefinition $apply

32.0.4Clinical Quality Language (CQL)

CQL module is a core dependency for Quality Improvement and many Clinical Reasoning operations used in DQM, DTR, CDS-HOOKS modules. The CQL module houses cql options and configuration, evaluation settings, and terminology retrieval settings for expression evaluations.

32.0.5Quality Measures

Getting started with Quality measures on CDR, use the following links to review documentation on operations, example data, required FHIR resources, and CDR configuration options.

32.0.6Clinical Decision Support

32.0.7Additional Implementation Guides

There are additional IGs outside the FHIR CR module that define further requirements and behavior for other Clinical Reasoning use cases. Some examples include:

32.1 Clinical Quality Language (CQL)