Case 1a - Alex - no PHQ-9
Alex is a 46 year old female patient who has a diagnosis of major depression with no PHQ-9. The source system has a weight and height value for Alex.
The source system would send the following FHIR resource to RAPIDS:
{
"hookInstance": "d1577c69-dfbe-44ad-ba6d-3e05e953b2ea",
"fhirServer": "https://example.org/fhir",
"hook": "patient-view",
"context": {
"patientId": "Patient/urn:emr:telus:chr:HSCN3212:2462",
"userId": "Practitioner/urn:emr:telus:chr:HSCN3212:practitioner:22"
},
"prefetch": {
"patient": {
"resource": {
"resourceType": "Bundle",
"type": "transaction",
"entry": [
{
"request": {
"method": "POST",
"url": "Patient"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Patient/urn:emr:telus:chr:HSCN3212:2462",
"resource": {
"resourceType": "Patient",
"id": "urn:emr:telus:chr:HSCN3212:2462",
"meta": {
"lastUpdated": "2022-04-10T03:48:33.708+00:00"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient 2462 Female</div>"
},
"identifier": [
{
"system": "urn:emr:telus:chr:HSCN3212",
"value": "2462"
}
],
"active": true,
"gender": "female",
"deceasedBoolean": "false",
"managingOrganization": [
{
"reference": "RPSOrganization/urn:emr:telus:chr:HSCN3212"
}
]
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11222",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11222",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>Body weight Measured at 185lbs on 2022-03-28 for patient 2462</b></div>"
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital Signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "3141-9",
"display": "Body weight Measured"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "2022-03-28",
"valueQuantity": {
"value": 83.9,
"unit": "Kg"
}
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11223",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11223",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>Body Height Measured at 170.2cm on 2022-03-28 for patient 2462</b></div>"
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital Signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height Measured"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "2022-03-28",
"valueQuantity": {
"value": 170.2,
"unit": "cm"
}
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11224",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11224",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>Patient 2462 is 46 years old on 2022-03-28</b></div>"
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "social-history",
"display": "Social History"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "21612-7",
"display": "Age Reported"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "2022-03-28",
"valueInteger": 46
}
},
{
"request": {
"method": "POST",
"url": "Condition"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:condition:123",
"resource": {
"resourceType": "Condition",
"id": "urn:emr:telus:chr:HSCN3212:2462:condition:123",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Major Depressive Disorder</div>"
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "problem-list-item",
"display": "Problem List Item"
},
{
"system": "http://snomed.info/sct",
"code": "439401001",
"display": "Diagnosis"
}
]
}
],
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/icd-9-cm",
"code": "296.22",
"display": "Major depressive disorder, single episode"
}
],
"text": "Major depressive disorder, single episode"
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
}
}
}
]
}
}
}
}
In this case RAPIDS would respond, requesting a PHQ-9 and would send the Questionnaire resource to the source system:
{
"cards": [
{
"uuid": "781e08d7-5598-47b7-b1a9-72c19875682e",
"summary": "Please Complete a PHQ-9",
"source": {
"label": "TELUS RAPIDS CDS",
"url": "http://telus.rapids.com/"
},
"indicator": "info",
"suggestions": [
{
"label": "None of the supporting scales for diagnosis MDD have been provided. Please provide the following scales: PHQ-9",
"actions": [
{
"type": "create",
"description": "PHQ-9 Questionnaire",
"resource": {
"resourceType": "Questionnaire",
"id": "questionnaire-example-PHQ9",
"contained": [
{
"resourceType": "ValueSet",
"id": "RPSPHQ9",
"name": "RPSPHQ9",
"status": "draft",
"description": "The answer list for questions in the PHQ9 Questionnaire.",
"immutable": true,
"compose": {
"include": [
{
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/CSPHQ9",
"concept": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"code": "Not-at-all",
"display": "Not at all"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"code": "Several-days",
"display": "Several days"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"code": "More than half the days",
"display": "More than half the days"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"code": "Nearly every day",
"display": "Nearly every day"
}
]
}
]
}
}
],
"name": "RAPIDS PHQ9",
"title": "Patient Health Questionnaire 9 Item Scale",
"status": "final",
"experimental": false,
"subjectType": [
"Patient"
],
"item": [
{
"linkId": "GQ",
"code": [
{
"system": "http://loinc.org",
"code": "44249-1"
}
],
"type": "group",
"required": true,
"item": [
{
"linkId": "GQH",
"text": "Over the last 2 weeks, how often have you been bothered by any of the following problems? (Use “X” to indicate your answer)",
"type": "display"
},
{
"linkId": "GQ1",
"code": [
{
"system": "http://loinc.org",
"code": "44250-9"
}
],
"prefix": "1.",
"text": "Little interest or pleasure in doing things,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ2",
"code": [
{
"system": "http://loinc.org",
"code": "44255-8"
}
],
"prefix": "2.",
"text": "Feeling down, depressed, or hopeless,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ3",
"code": [
{
"system": "http://loinc.org",
"code": "44259-0"
}
],
"prefix": "3.",
"text": "Trouble falling or staying asleep, or sleeping too much",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ4",
"code": [
{
"system": "http://loinc.org",
"code": "44254-1"
}
],
"prefix": "4.",
"text": "Feeling tired or having little energy,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ5",
"code": [
{
"system": "http://loinc.org",
"code": "44251-7"
}
],
"prefix": "5.",
"text": "Poor appetite or overeating,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ6",
"code": [
{
"system": "http://loinc.org",
"code": "44258-2"
}
],
"prefix": "6.",
"text": "Feeling bad about yourself - or that you are a failure or have let yourself or your family down,",
"type": "choice",
"required": true,
"repeats": false
},
{
"linkId": "GQ7",
"code": [
{
"system": "http://loinc.org",
"code": "44252-5"
}
],
"prefix": "7.",
"text": "Trouble concentrating on things, such as reading the newspaper or watching television,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ8",
"code": [
{
"system": "http://loinc.org",
"code": "44253-3"
}
],
"prefix": "8.",
"text": "Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ9",
"code": [
{
"system": "http://loinc.org",
"code": "44260-8"
}
],
"prefix": "9.",
"text": "Thoughts that you would be better off dead, or of hurting yourself",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ10",
"code": [
{
"system": "http://loinc.org",
"code": "44261-6"
}
],
"prefix": "9.",
"text": "Thoughts that you would be better off dead, or of hurting yourself",
"type": "quantity",
"required": true,
"repeats": false
}
]
}
]
}
}
]
}
]
}
]
}
Case 1b - Alex - outdated PHQ-9
Alex is a 46 year old female patient who has a diagnosis of major depression. The source system has a weight and height value for Alex. The source system also has a PHQ-9 value of 15 dated March 1, 2022 (greater than one month old).
The source system would send the following FHIR resource to RAPIDS:
{
"hookInstance": "1f18d6c8-1fce-405d-a88c-e46f98c70945",
"fhirServer": "https://example.org/fhir",
"hook": "patient-view",
"context": {
"patientId": "Patient/urn:emr:telus:chr:HSCN3212:2462",
"userId": "Practitioner/urn:emr:telus:chr:HSCN3212:practitioner:22"
},
"prefetch": {
"patient": {
"resource": {
"resourceType": "Bundle",
"type": "transaction",
"entry": [
{
"request": {
"method": "POST",
"url": "Patient"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Patient/urn:emr:telus:chr:HSCN3212:2462",
"resource": {
"resourceType": "Patient",
"id": "urn:emr:telus:chr:HSCN3212:2462",
"meta": {
"lastUpdated": "2022-04-10T03:48:33.708+00:00"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient 2462 Female</div>"
},
"identifier": [
{
"system": "urn:emr:telus:chr:HSCN3212",
"value": "2462"
}
],
"active": true,
"gender": "female",
"deceasedBoolean": "false",
"managingOrganization": [
{
"reference": "RPSOrganization/urn:emr:telus:chr:HSCN3212"
}
]
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11222",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11222",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>Body weight Measured at 185lbs on 2022-03-28 for patient 2462</b></div>"
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital Signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "3141-9",
"display": "Body weight Measured"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "2022-03-28",
"valueQuantity": {
"value": 83.9,
"unit": "Kg"
}
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11223",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11223",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>Body Height Measured at 170.2cm on 2022-03-28 for patient 2462</b></div>"
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital Signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height Measured"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "2022-03-28",
"valueQuantity": {
"value": 170.2,
"unit": "cm"
}
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11224",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11224",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>Patient 2462 is 46 years old on 2022-03-28</b></div>"
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "social-history",
"display": "Social History"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "21612-7",
"display": "Age Reported"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "2022-03-28",
"valueInteger": 46
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11225",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11225",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient 2462 has a caluculated PHQ-9 score of 15 as recorded on 2022-03-01</div>"
},
"status": "final",
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
},
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "44261-6",
"display": "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "2022-03-01",
"valueQuantity": {
"value": 15,
"unit": "score"
}
}
},
{
"request": {
"method": "POST",
"url": "Condition"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:condition:123",
"resource": {
"resourceType": "Condition",
"id": "urn:emr:telus:chr:HSCN3212:2462:condition:123",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Major Depressive Disorder</div>"
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "problem-list-item",
"display": "Problem List Item"
},
{
"system": "http://snomed.info/sct",
"code": "439401001",
"display": "Diagnosis"
}
]
}
],
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/icd-9-cm",
"code": "296.22",
"display": "Major depressive disorder, single episode"
}
],
"text": "Major depressive disorder, single episode"
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
}
}
}
]
}
}
}
}
In this case RAPIDS would respond:
```javascript
{
"cards": [
{
"uuid": "781e08d7-5598-47b7-b1a9-72c19875682e",
"summary": "Please Complete a PHQ-9",
"source": {
"label": "TELUS RAPIDS CDS",
"url": "http://telus.rapids.com/"
},
"indicator": "info",
"suggestions": [
{
"label": "Scale PHQ-9 is not valid since it is greater than one month old. Please provide an updated PHQ-9.",
"actions": [
{
"type": "create",
"description": "PHQ-9 Questionnaire",
"resource": {
"resourceType": "Questionnaire",
"id": "questionnaire-example-PHQ9",
"contained": [
{
"resourceType": "ValueSet",
"id": "RPSPHQ9",
"name": "RPSPHQ9",
"status": "draft",
"description": "The answer list for questions in the PHQ9 Questionnaire.",
"immutable": true,
"compose": {
"include": [
{
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/CSPHQ9",
"concept": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"code": "Not-at-all",
"display": "Not at all"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"code": "Several-days",
"display": "Several days"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"code": "More than half the days",
"display": "More than half the days"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"code": "Nearly every day",
"display": "Nearly every day"
}
]
}
]
}
}
],
"name": "RAPIDS PHQ9",
"title": "Patient Health Questionnaire 9 Item Scale",
"status": "final",
"experimental": false,
"subjectType": [
"Patient"
],
"item": [
{
"linkId": "GQ",
"code": [
{
"system": "http://loinc.org",
"code": "44249-1"
}
],
"type": "group",
"required": true,
"item": [
{
"linkId": "GQH",
"text": "Over the last 2 weeks, how often have you been bothered by any of the following problems? (Use “X” to indicate your answer)",
"type": "display"
},
{
"linkId": "GQ1",
"code": [
{
"system": "http://loinc.org",
"code": "44250-9"
}
],
"prefix": "1.",
"text": "Little interest or pleasure in doing things,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ2",
"code": [
{
"system": "http://loinc.org",
"code": "44255-8"
}
],
"prefix": "2.",
"text": "Feeling down, depressed, or hopeless,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ3",
"code": [
{
"system": "http://loinc.org",
"code": "44259-0"
}
],
"prefix": "3.",
"text": "Trouble falling or staying asleep, or sleeping too much",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ4",
"code": [
{
"system": "http://loinc.org",
"code": "44254-1"
}
],
"prefix": "4.",
"text": "Feeling tired or having little energy,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ5",
"code": [
{
"system": "http://loinc.org",
"code": "44251-7"
}
],
"prefix": "5.",
"text": "Poor appetite or overeating,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ6",
"code": [
{
"system": "http://loinc.org",
"code": "44258-2"
}
],
"prefix": "6.",
"text": "Feeling bad about yourself - or that you are a failure or have let yourself or your family down,",
"type": "choice",
"required": true,
"repeats": false
},
{
"linkId": "GQ7",
"code": [
{
"system": "http://loinc.org",
"code": "44252-5"
}
],
"prefix": "7.",
"text": "Trouble concentrating on things, such as reading the newspaper or watching television,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ8",
"code": [
{
"system": "http://loinc.org",
"code": "44253-3"
}
],
"prefix": "8.",
"text": "Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual,",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ9",
"code": [
{
"system": "http://loinc.org",
"code": "44260-8"
}
],
"prefix": "9.",
"text": "Thoughts that you would be better off dead, or of hurting yourself",
"type": "choice",
"answerValueSet": "#RPSPHQ9",
"required": true,
"repeats": false
},
{
"linkId": "GQ10",
"code": [
{
"system": "http://loinc.org",
"code": "44261-6"
}
],
"prefix": "9.",
"text": "Thoughts that you would be better off dead, or of hurting yourself",
"type": "quantity",
"required": true,
"repeats": false
}
]
}
]
}
}
]
}
]
}
]
}
Case 1c - Alex - diagnosis and medication suggestion
Alex is a 46 year old female patient who has a diagnosis of generalized anxiety disorder with no GAD-7. The source system has a weight and height value for Alex. The source system also has a PHQ-9 value of 15 dated today.
The source system would send the following FHIR resource to RAPIDS:
{
"hookInstance": "1f18d6c8-1fce-405d-a88c-e46f98c70945",
"fhirServer": "https://example.org/fhir",
"hook": "patient-view",
"context": {
"patientId": "Patient/urn:emr:telus:chr:HSCN3212:2462",
"userId": "Practitioner/urn:emr:telus:chr:HSCN3212:practitioner:22"
},
"prefetch": {
"patient": {
"resource": {
"resourceType": "Bundle",
"type": "transaction",
"entry": [
{
"request": {
"method": "POST",
"url": "Patient"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Patient/urn:emr:telus:chr:HSCN3212:2462",
"resource": {
"resourceType": "Patient",
"id": "urn:emr:telus:chr:HSCN3212:2462",
"meta": {
"lastUpdated": "2022-04-10T03:48:33.708+00:00"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient 2462 Female</div>"
},
"identifier": [
{
"system": "urn:emr:telus:chr:HSCN3212",
"value": "2462"
}
],
"active": true,
"gender": "female",
"deceasedBoolean": "false",
"managingOrganization": [
{
"reference": "RPSOrganization/urn:emr:telus:chr:HSCN3212"
}
]
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11222",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11222",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>Body weight Measured at 185lbs on 2022-03-28 for patient 2462</b></div>"
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital Signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "3141-9",
"display": "Body weight Measured"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "2022-03-28",
"valueQuantity": {
"value": 83.9,
"unit": "Kg"
}
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11223",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11223",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>Body Height Measured at 170.2cm on 2022-03-28 for patient 2462</b></div>"
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "vital-signs",
"display": "Vital Signs"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body Height Measured"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "2022-03-28",
"valueQuantity": {
"value": 170.2,
"unit": "cm"
}
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11224",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11224",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>Patient 2462 is 46 years old on 2022-03-28</b></div>"
},
"status": "final",
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "social-history",
"display": "Social History"
}
]
}
],
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "21612-7",
"display": "Age Reported"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "2022-03-28",
"valueInteger": 46
}
},
{
"request": {
"method": "POST",
"url": "Observation"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:observation:11225",
"resource": {
"resourceType": "Observation",
"id": "urn:emr:telus:chr:HSCN3212:2462:observation:11225",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient 2462 has a caluculated PHQ-9 score of 15 as recorded on today</div>"
},
"status": "final",
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/observation-category",
"code": "survey",
"display": "survey"
}
]
},
"code": {
"coding": [
{
"system": "http://loinc.org",
"code": "44261-6",
"display": "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]"
}
]
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"effectiveDateTime": "today placeholder",
"valueQuantity": {
"value": 12,
"unit": "score"
}
}
},
{
"request": {
"method": "POST",
"url": "Condition"
},
"fullUrl": "http://telus.com/rapids/StructureDefinition/Observation/urn:emr:telus:chr:HSCN3212:2462:condition:123",
"resource": {
"resourceType": "Condition",
"id": "urn:emr:telus:chr:HSCN3212:2462:condition:123",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Major Depressive Disorder</div>"
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "confirmed"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "problem-list-item",
"display": "Problem List Item"
},
{
"system": "http://snomed.info/sct",
"code": "439401001",
"display": "Diagnosis"
}
]
}
],
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/icd-9-cm",
"code": "296.22",
"display": "Major depressive disorder, single episode"
}
],
"text": "Major depressive disorder, single episode"
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
}
}
}
]
}
}
}
}
In this case RAPIDS would respond:
{
"cards": [
{
"uuid": "781e08d7-5598-47b7-b1a9-72c19875682e",
"summary": "A score of 15 on PHQ-9 supports a diagnosis of MDD: Moderate to severe depression. For MDD it is important to screen for the following: Anxious distress, BP disorders, insomnia.",
"source": {
"label": "TELUS RAPIDS CDS",
"url": "http://telus.rapids.com/"
},
"indicator": "info",
"suggestions": [
{
"label": "The given diagnosis is MDD with no specifiers",
"actions": [
{
"type": "create",
"description": "MDD Diagnosis",
"resource": {
"resourceType": "Condition",
"id": "urn:emr:telus:chr:HSCN3212:2462:condition:123",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Major Depressive Disorder</div>"
},
"clinicalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
"code": "active"
}
]
},
"verificationStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
"code": "provisional"
}
]
},
"category": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/condition-category",
"code": "problem-list-item",
"display": "Problem List Item"
},
{
"system": "http://snomed.info/sct",
"code": "439401001",
"display": "Diagnosis"
}
]
}
],
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/icd-9-cm",
"code": "296.22",
"display": "Major depressive disorder, single episode"
}
],
"text": "Major depressive disorder, single episode"
},
"subject": {
"reference": "Patient/urn:emr:telus:chr:HSCN3212:2462"
},
"recordedDate": "2022-04-01"
}
}
]
},
{
"label": "Consider initiating treatment with a preferred first-choice antidepressant: bupropion xl, desvenlafaxine, duloxetine, escitalopram, levomilnacipran, mirtazapine, sertraline, vilazodone, vortioxetine",
"actions": [
{
"type": "create",
"description": "Create a presciption for bupropion xl",
"resource": {
"resourceType": "Medication",
"id": "telus:rapids:medication:bupropionxl",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Medication bupropionxl 150mg Extended Release Tablet</div>"
},
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/NamingSystem/ca-hc-din",
"code": "02275090",
"display": "WELLBUTRIN XL 150MG EXTENDED RELEASE TABLETS"
}
]
},
"form": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/medication-form-codes",
"code": "420627008",
"display": "Tablet (Extended-Release)"
}
]
},
"ingredient": [
{
"item": {
"concept": {
"coding": [
{
"system": "https://health-products.canada.ca/dpd-bdpp",
"code": "bupropion hydrochloride",
"display": "bupropion hydrochloride"
}
]
}
},
"strengthRatio": {
"numerator": {
"value": 150,
"system": "http://unitsofmeasure.org",
"code": "mg"
},
"denominator": {
"value": 1,
"system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code": "TAB"
}
}
}
]
}
}
]
}
]
}
]
}