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Add CDS Hooks #707

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111 changes: 111 additions & 0 deletions content/cds_hooks.md
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---
title: CDS Hooks
layout: cds_hooks
---

# CDS Hooks #
------------------------------------------------------------------------
<%= beta_tag(resource: false) %>
* TOC
{:toc}

## General ##

### Introduction ###
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@fpivonka fpivonka Aug 2, 2021

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Should we have a note at the end of the introduction to mention CDS Hooks is dependent on specific software releases and then point to our reference pages? I don't want to put the actual releases on our reference page since we've had to change them frequently. I know 3rd party developers won't have access to those reference pages but clients will. Thoughts?

EDIT: after talking in scrum I think we'll disregard this and not make a note on fhir.cerner.com about releases. We'll probably also need to wait to push fhir.cerner.com changes until we have the packages available in c1941 and p1941

The CDS Hooks (Clinical Decision Support Hooks) workflow defines a specification for external CDS Service developers to send notification cards to an electronic health record (EHR). These cards are triggered based on conditions such as the opening of a patient chart of a specified demographic(age, gender, etc.) or when a order is selected. These cards can contain information, a suggestion for the user, or a link to launch a SMART app (See [SMART](./smart) for more information).
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### Authorization Model ###
1. Cerner must validate and register every CDS service.
2. Each client decides whether they want to allow a CDS Service on a domain-by-domain basis.
3. Each client decides which users and roles can access the CDS Service.

### Supported Hooks ###
Currently, Cerner supports the following CDS Hooks:

- [Patient View](https://cds-hooks.org/hooks/patient-view/)
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I think we might need to specify which version we support as well

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## CDS Service Registration ##
In order to submit a service to be registered, the following information should be provided:

Name | Required | Description | Example
-------------|--------------|-------------|--------
hook | Yes | The hook this service should be invoked on. See [Supported Hooks](#supported-hooks). | patient-view
title | Yes | The human-friendly name of this service. | Severe Condition Alerter
fhir server | Yes | The FHIR server that the service queries. | https://fhir-ehr.cerner.com/r4/ec2458f2-1e24-41c8-b71b-0e701af7583d
service url | Yes | The url for the service that the CDS server will call to get the service card response. | https://company.myservice.com
description | No | Further information about the service. | Sends alerts for patients above age 65 who may have a severe condition.
owner email | No | Required when scopes are provided. The email address of the owner of the service. | john.smith@company.com
tenants | No | A list of tenants where the service is enabled. | C1941 - ec2458f2-1e24-41c8-b71b-0e701af7583d, A1234 - as1558f2-1e24-44c8-b71b-0e701af787f3d
fhir scopes | No | A list of the FHIR scopes required for any FHIR calls this CDS service makes. | patient/Patient.read, patient/Encounter.read, patient/Observations.read
allowed links | No | A list of all links allowed in the response. Any links not in this list will be removed. | https://www.google.com, https://www.cerner.com
smart apps | No | A list of launch urls for any SMART applications that may be linked to in CDS service responses. | https://www.myapp.com, https://www.otherapp.org

For more information on CDS Service attributes see the Discovery Response section [here](https://cds-hooks.hl7.org/1.0/#response).

## CDS Service Workflow ##
When the condition in the EHR is met, the CDS Hooks Server will make a GET request to the provided service url. The service should returns an array of cards formatted according to the [CDS Service HTTP Response specification](https://cds-hooks.hl7.org/1.0/#http-response).
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### Service Authorization ###
When Cerner's CDS Hooks server calls a service, authorization will be accomplished with a JWT token.

1. The JWT issuer `iss` will be ```https://cds-hooks.cerner.com```. Make sure this is whitelisted as a trusted CDS Client.
2. The JWT signature should be verified by calling the Cerner Authorization well-known endpoint: ```https://authorization.cerner.com/jwk``` to get the list of JKUs and confirm the token JKU is present.


For more information on CDS Authorization best practices, see [this page](https://cds-hooks.org/best-practices/#jwt).

### Example Response from a CDS Service ###

{
"cards": [
{
"summary": "A summary of the card.",
"detail": "Additional card detail.",
"indicator": "info",
"source": {
"label": "Company",
"url": "https://company.com",
"icon": "https://company.com/company-logo.png"
},
"links": [
{
"label": "Webpage",
"url": "https://webpage.com",
"type": "absolute"
}
]
},
{
"summary": "A summary of the card.",
"detail": "Additional card detail. See https://webpage.com.",
"indicator": "critical",
"source": {
"label": "External"
},
"links": [
{
"label": "Webpage In Detail",
"url": "https://webpage.com",
"type": "absolute"
},
{
"label": "Smart App",
"url": "https://smart.cerner.com/smart/eb2384f8-839e-4c6e-8b29-18e71db1a034/apps/a77a3d9a-28fe-48te-a96a-2ff09bed599a",
"type": "smart"
},
]
}
]
}

### SMART Apps ###
Some CDS services return SMART app link cards. For information on registering a SMART app, see [this page](./smart).

_Note: Each client decides whether they want a SMART app to run on a domain-by-domain basis. An app link card will only work correctly in a domain in which the corresponding SMART app is enabled._

## Additional Resources ##

- [CDS Hooks Specification](https://cds-hooks.org/)
- [Cerner Millennium FHIR API Documentation](http://fhir.cerner.com/millennium/r4/)
- [Cerner Authorization Documentation](http://fhir.cerner.com/authorization/)
- [Cerner FHIR Developers Google Group](https://groups.google.com/forum/#!forum/cerner-fhir-developers)
14 changes: 14 additions & 0 deletions layouts/cds_hooks.html
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<%= render '/head.*' %>

<body class="<%= @item[:version].to_s %>_api">
<%= render '/header.*' %>

<div id="wrapper">
<div class="content">
<%= yield %>
</div>
</div><!-- #wrapper -->

<%= render '/footer.*' %>
</body>
</html>
1 change: 1 addition & 0 deletions layouts/header.html
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Expand Up @@ -19,6 +19,7 @@
<li><a href="/soarian/dstu2/">Soarian</a></li>
<li><a href="/authorization">Authorization</a></li>
<li><a href="/smart">SMART</a></li>
<li><a href="/cds_hooks" class="nav-dstu2-api">CDS Hooks</a></li>
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</ul>

</div><!-- /.header-wrapper -->
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7 changes: 4 additions & 3 deletions lib/resources.rb
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Expand Up @@ -145,12 +145,13 @@ def disclaimer

# Public: Helper method to create a tag to denote if a resource/action is still under development.
#
# @param action [boolean] flag to denote if a resource action is under development. Defaults to false.
# @param action [boolean] flag to denote if a resource action or feature is under development. Defaults to false.
# @param known_issues [Array<String>] an array of known issues for the resource/action.
#
# @return [String] an HTML div for beta tag.
def beta_tag(action: false, known_issues: nil)
beta = "<div class=\"beta-tag\"><p>This Resource#{' Action' if action} is still under development.</p>"
def beta_tag(resource: true, action: false, known_issues: nil)
beta = "<div class=\"beta-tag\"><p>This#{resource ? ' Resource' : ' feature'}"
beta += "#{' Action' if action} is still under development.</p>"

if known_issues
beta += '<p>Known Issues:</p><ul>'
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44 changes: 39 additions & 5 deletions spec/lib/resources_spec.rb
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Expand Up @@ -661,7 +661,9 @@
end

context 'when parameters are passed in' do
subject(:beta_tag_parameters) { Cerner::Resources::Helpers.beta_tag(action: action, known_issues: issues) }
subject(:beta_tag_parameters) do
Cerner::Resources::Helpers.beta_tag(resource: resource, action: action, known_issues: issues)
end
let(:issues) { %w[hi hello] }
let(:beta_tag_div) do
'<div class="beta-tag"></div>This Resource is still under development.<p>Known Issues:</p><ul><li>hi</li>'\
Expand All @@ -677,8 +679,23 @@
'<div class="beta-tag"><p>This Resource is still under development.</p></div>'
end

it 'returns the beta_tag div for a Resource' do
expect(beta_tag_parameters).to eq(beta_tag_div)
context 'when resource is false' do
let(:resource) { false }
let(:beta_tag_div) do
'<div class="beta-tag"><p>This feature is still under development.</p></div>'
end

it 'returns the beta_tag div for a feature' do
expect(beta_tag_parameters).to eq(beta_tag_div)
end
end

context 'when resource is true' do
let(:resource) { true }

it 'returns the beta_tag div for a Resource' do
expect(beta_tag_parameters).to eq(beta_tag_div)
end
end
end

Expand All @@ -688,14 +705,31 @@
'<li>hi</li><li>hello</li></ul></div>'
end

it 'returns the beta_tag div for a Resource with known issues' do
expect(beta_tag_parameters).to eq(beta_tag_div)
context 'when resource is false' do
let(:resource) { false }
let(:beta_tag_div) do
'<div class="beta-tag"><p>This feature is still under development.</p><p>Known Issues:</p><ul>'\
'<li>hi</li><li>hello</li></ul></div>'
end

it 'returns the beta_tag div for a feature with known issues' do
expect(beta_tag_parameters).to eq(beta_tag_div)
end
end

context 'when resource is true' do
let(:resource) { true }

it 'returns the beta_tag div for a Resource with known issues' do
expect(beta_tag_parameters).to eq(beta_tag_div)
end
end
end
end

context 'when action is true' do
let(:action) { true }
let(:resource) { true }

context 'when known issues are not present' do
let(:issues) { nil }
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