Smile CDR v2024.08.PRE
On this page:

23.0.1Table of Contents


23.0.2Clinical 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.

23.0.3Clinical 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.

ModuleOperationCDR ExclusiveConfiguration on Admin-Console
DQMFHIR to QPP JSON $qpp-build
DQMDistributed $evaluate-measure
DQMDistributed $evaluate-measures
DQMMulti-Threaded $care-gaps
DQMEvaluate $cql
DQMLibrary $evaluate
Prior Auth DTRStructureDefinition $questionnaire
Prior Auth DTRQuestionnaireResponse $extract
Prior Auth DTRQuestionnaire $populate
Prior Auth DTRQuestionnaire $package
Prior Auth DTRPlanDefinition $package
Prior Auth DTRPlanDefinition $apply
Prior Auth DTRActivityDefinition $apply
CDS-HOOKSPlanDefinition $apply
CDS-HOOKSActivityDefinition $apply

23.0.4Clinical 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.

23.0.5Quality 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.

23.0.6Clinical Decision Support


23.0.7Additional 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: