Date: 18 January 2023

Quarter: 3

CDS hosting CQI 

Chair:  Bryn Rhodes 

Scribe:  Howard Strasberg 

This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."

Discussion items


  • CDS Hooks (slides)
    • Project Update
    • Hook Maturity Project Update
    • DetectedIssue
    • Sandbox
Isaac Vetter 
  • Isaac provided an update on the project.  See attached slides.
  • No dedicated Connectathon track, but:
    • Clinical Reasoning track - PDDI successful with Logica (fully) and Epic (partially) sandboxes.
    • DaVinci CRD - tested systemAction with order-select t.o determine coverage
  • CDS Hooks 2.0 was published in Fall 2022 - includes override reasons, feedback service, refinements to response
  • Separate PSS for hook maturity - appointment-book (3), encounter-discharge (3), order-select (4 or 5), order-sign (5) to be balloted soon (May?).
  • EHR participation and production support timelines?  No CDS hook track this time.  PDDI tested against the Epic sandbox.  See  
  • Will payer/prior auth use cases drive CDS hooks adoption?  CRD is named in recent CMS NPRM (HL7 PAC is seeking comments).   However, prior auth is a different use case from CDS.
  • New enhancements (post-2.0)
  • CDS Hooks is being used with PAMA, PDDI, CRD and Clinical Reasoning.
  • When should CDS Hooks be balloted next and/or go normative?
  • May switch to FHIR IG format at some point
  • September normative/mixed STU ballot?  Do we have enough clients?
  • DetectedIssue - include in CDS Hooks card?
    • What is the EHR supposed to do with it?
    • Could it be an extension?
    • Structured data could help de-duplicate with existing, non-CDS Hooks interaction checking.
    • Could be a suggestion with a create action?  A system action?
    • Bryn - see also
  • CDS hooks sandbox
    • Hosted environment - need to find out where it is - no primary project person 
    • Open source project
    • Ask HL7 implementation division how they plan to maintain a CDS hooks sandbox

  • FHIRCast Project Update (slides)

  • CDS is a cosponsor 
  • Modern context synchronization
  • Balloted STU3 in May 2022
    • JIRA resolution is ongoing
    • new capability - content exchange
  • IHE is building on top of FHIRCast (imaging use case to create a diagnostic report)
  • Considering making FHIRCast a base specification that can be profiled for advanced use cases

  • WGM planning

  • Should CDS consolidate its WGM agenda to Tuesdays?  Seems reasonable.
  • Wednesdays would continue to have joint sessions with CQI.
  • CDS would host Tuesdays.
  • CQI would host Wednesdays (and/or Mondays).

  • Connectathon Reportout
    • Clinical Reasoning

  • Deferred to another quarter.

Action items

  • Ask HL7 implementation division how they plan to maintain a CDS hooks sandbox.