Atrius India Core FHIR Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Cds Clinical Reasoning

CDS and clinical reasoning artifacts

How Library, Measure, and PlanDefinition resources are authored in this IG and published to the knowledge repository (KR) for CDS Hooks $apply.

See also: repository docs docs/authoring-plan.md, docs/activity-definition-catalog-authoring.md, and docs/clinical-reasoning-stack.md.

Artifact roles

Libraries use the ig-loader pattern (JSON stub → translate → embedded ELM). Measures and PlanDefinitions are FSH Instances with Usage: #example.

Directory layout (measure bundles)

Clinical reasoning artifacts are grouped by measure slug (cms165 for the pilot) under input/fsh/clinical-reasoning/. All CQL libraries live flat in input/cql/.

input/
├── fsh/clinical-reasoning/
│   └── measures/cms165/
│       ├── measure.fsh
│       ├── plandefinition.fsh
│       └── activities/          ← ActivityDefinition instances
├── cql/
│   ├── {Name}.cql               ← all libraries (AtriusCommon, AtriusCMS165…, AtriusERChestPain…)
│   ├── atriusin-modelinfo-0.1.0.xml   (CQL translation; also embedded in Library/AtriusIn-ModelInfo)
│   ├── FHIRHelpers-4.4.0.cql
│   └── reference/               ← optional reference CQL/modelinfo
└── resources/
    ├── Library-*.json           ← flat Library stubs (IG Publisher + SUSHI)
    └── modelinfo/

For a new measure or pathway, copy the measures/cms165/ or pathways/er-chest-pain/ folder pattern under fsh/, add CQL as input/cql/{LibraryName}.cql, add a flat input/resources/Library-{Name}.json stub, then register artifacts in sushi-config.yaml.

CDSHooksServicePlanDefinition (required elements)

Profile: CDSHooksServicePlanDefinition

Full hook / service / prefetch authoring plan: repository docs/cds-hooks-service-authoring.md (FHIR Clinical Reasoning §14.5.2 mapping).

Type: clinical-protocol / order-set / eca-rule / workflow-definition as appropriate (see docs/cds-hooks-service-authoring.md §3.1.1). Exemplars: HF + ER chest pain (clinical-protocol), sepsis (order-set), critical-labs / surgical gate (eca-rule), surgical checklist phases (workflow-definition).

Prefetch: Use Atrius India Core profile URLs in action.input.profile (not generic QI-Core). Author only types the Library retrieves. Discovery must not silently widen to a full chart pack (see authoring plan Phase 1).

Pilot: CMS165

Canonical base: https://atrius.in/fhir/r4/atrius-in/

Build and publish

# 1. Libraries: translate CQL → ELM
./scripts/generate-modelinfo.sh   # after profile changes
./scripts/translate-cql.sh

# 2. Full IG (FSH → Measure + PlanDefinition in output/)
# sushi && ./_build.sh   # or publisher -ig .

# 3. KR import (8079)
./scripts/import-atrius-kr-libraries.py --clinical-reasoning

# 4. Regenerate CDS manifest from KR PlanDefinitions (atrius-hfs repo)
python3 scripts/generate-cds-hooks-manifest.py --from-plandefinition \
  --kr-base-url http://127.0.0.1:8079 \
  --output manifests/cds-services-kr-ecqm.json

# 5. Sidecar cache flush after KR update
curl -s -X POST http://127.0.0.1:8088/v1/admin/cache/libraries/clear \
  -H "Authorization: Bearer $SIDECAR_ADMIN_TOKEN"

Synthesized vs authored PlanDefinitions

Replace synthesized twins per measure when authored PlanDefinitions pass smoke and /ready probes.