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PlanDefinitions

A PlanDefinition is a pre-defined group of actions to be taken in particular circumstances, often including conditional elements, options, and other decision points. The resource is flexible enough to be used to represent a variety of workflows, as well as clinical decision support and quality improvement assets, including order sets, protocols, and decision support rules.

It can be used to define an end to end activities that will be used to generate both a CarePlan and related Tasks for a Patient or Group. The CarePlan can include one or more activities to carry on across the lifecycle of Patient care. The PlanDefinition is usually associated to address a specific workflow e.g. ANC, PNC, Child Vaccination, Household Visits, etc.

The pre-defined set of actions, are often conditional and based on certain decision points (triggers and conditions). Each action defines an activity to be performed often in terms of an ActivityDefinition (via definition and/or transform).

For defining whether the specific action should be taken, the condition element can be used to provide an expression that evaluates to true or false to indicate the applicability of the action to the specific context.

Applying a PlanDefinition for a specific context/subject yields a CarePlan and Task resources representing the actions that should be performed for given beneficiary. This is done via the $apply or $lite operation.

Inside the PlanDefinition, the definition element specifies an ActivityDefinition which is used to construct a specific resource (Task and CarePlan only for now). Along with definition, a PlanDefinition may also provide a transform element for the activity a StructureMap to do the transformation and creation of elements for CarePlan. Another element dynamicValue list can also be provided in ActivityDefinition to provide dynamic values for CarePlan using FHIRPath.

Below is a detailed description of notable properties of PlanDefinition and its usage in fhircore

PlanDefinition notable properties:​

  • resourceType: PlanDefinition
  • id: unique identifier of resource, ideally UUID (Universal Unique Identifier),
  • contained: [ ... ] : An array of resources to embed details (ActivityDefinition) about given plan
  • name: Human readable name of the PlanDefinition
  • title: Title or summary of what PlanDefinition is about. This is output to generated CarePlan as title
  • status: active,
  • description: Detailed summary of what plan does. This is output to generated CarePlan as description
  • action: [ ... ] : An array action elements to define condition, definition and transform to be applied while generating CarePlan.

PlanDefinition action notable properties:​

  • priority: high-priority | medium-priority | low-priority
  • condition: [ ]

    • kind: only applicability is handled for now. This provides details on what aspect of CarePlan should be assessed.

    • expression: The expression which runs on the context i.e. the QuestionnaireResponse, Patient, and other generated resources by QuestionnaireResponse extraction

      • language: text/FHIRPath can be handled only for now
      • expression: The FHIRPath expression that runs on context resources.
        • $this : Patient or Group on which PlanDefinition is applied
        • %resource.entry : The Bundle which was generated as a result of extraction of QuestionnaireResponse. QuestionnaireResponse which resulted into this CarePlan generation is also available into this Bundle
        • example: $this is Patient and %resource.entry.first().resource is Patient and (today() - 60 'months') <= $this.birthDate

    • definitionCanonical: The ActivityDefinition id in contained resources into this PlanDefinition prefixed by #

      • example : #careplan-init-activity
      • transform: The StructureMap to run on this action definition to do the resource generation. If this is not provided only dynamicValue component of ActivityDefinition is used to modify the resources
        • The values available in to be used StructureMap are
          • definition: Current ActivityDefinition
          • depends-on: The context resource QuestionnaireResponse which resulted this PlanDefintion
          • subject : The Patient or Group for which this Plan is running
          • period: The evaluated executionPeriod for ActivityDefinition
          • version: The index of Task evaluated by ActivityDefinition timing or 1 by default

Example StrcutureMap to Extract Tasks​

Below is an example of a StructureMap to extract Refferal Tasks

map "http://hl7.org/fhir/StructureMap/ab62f8e8-e6d8-4ffb-b460-64b23e89b370" = 'eCBIS Pregnancy Referral'

uses "http://hl7.org/fhir/StructureDefinition/Parameters" as source
uses "http://hl7.org/fhir/StructureDefinition/CarePlan" as target

group pregnancyReferral(source src : Parameters, target tgt: CarePlan) {
src -> evaluate(src, $this.parameter.where(name='subject').resource) as subject,
    evaluate(src, $this.parameter.where(name='definition').resource) as definition,
    evaluate(subject, today()) as dueDate
    then ExtractTasks(dueDate, subject, tgt) "r_careplan";
}

group ExtractTasks(
source dueDate: DateType,
source subject : Patient,
target careplan: CarePlan){

subject -> dueDate as start,
        evaluate(subject, today() + '1 \'months\''.toQuantity()) as end,
        create('Period') as period,
        careplan.contained = create('Task') as task then {

subject then ExtractPeriod(start, end, period) "r_task_period_extr";

subject -> task.id = uuid(),
        task.identifier = create('Identifier') as iden, iden.value = uuid(), iden.use = 'official',
        task.status = 'ready',
        task.intent = 'plan',
        task.executionPeriod = period,
        task.priority = 'routine',
        task.description = 'Pregnancy Referral Task',
        task.for = create('Reference') as ref, ref.reference = evaluate(subject, $this.id.replaceMatches('/_history/.*', '')),
        // should refer to plandefinition since referral has no careplan
        task.basedOn = create('Reference') as ref, ref.reference = evaluate(careplan, $this.instantiatesCanonical.first()),
        task.authoredOn = evaluate(subject, now()),
        task.requester = evaluate(subject, $this.generalPractitioner.first()),
        task.owner = evaluate(subject, $this.generalPractitioner.first()) "r_task_data";

// pregnancy referral referral form
subject -> task.reasonReference = create('Reference') as ref, ref.reference = 'Questionnaire/c309abfa-7536-4c60-baea-cf631201f79e' "r_task_reason_ref";
} "r_cp_acti_outcome";
}

group ExtractPeriod(source start: DateType, source end: DateType, target period: Period) {
start -> period.start = create('dateTime') as dt,
      dt.value = evaluate(start, $this.value.substring(0,10) + 'T00:00:00.00Z') "r_per_start";

end -> period.end = create('dateTime') as dt,
    dt.value = evaluate(end, $this.value.substring(0,10) + 'T00:00:00.00Z') "r_per_end";
}

PlanDefinition definition notable properties:​

  • resourceType: ActivityDefinition
  • id: the unique id of resource into contained resource of this PlanDefinition.
  • title: title or summary of this definition
  • status: active
  • description: Detailed summary of what activity does
  • kind: CarePlan|Task supported for now
  • dynamicValue: [ ] an array of FHIRPath expression which defines the value for each property of resource of given kind
    • path: the name of property to set the value
      • example: title | status | subject.reference | period.start etc. for CarePlan
    • expression: The expression for retrieveing the value from context resources i.e. the QuestionnaireResponse, Patient, and other generated resources by QuestionnaireResponse extraction
      • language: text/FHIRPath supported for now
      • expression: The FHIRPath expression that runs on context resources.
        • %rootResource : Current PlanDefinition
        • $this : Patient or Group on which Plan is running
        • %resource.entry : The Bundle which was generated as a result of extraction of QuestionnaireResponse. QuestionnaireResponse which resulted into this CarePlan generation is also available into this Bundle
        • example:
          • %rootResource.id.replaceMatches('/_history/.*', '')
          • $this.generalPractitioner.first()
          • %resource.entry.where(resource is QuestionnaireResponse).resource.descendants().where(linkId='lmp').answer.value
  • code : CodeableConcept for standard code for this activity.
  • productCodeableConcept: The CodeableConcept for product for which current activity is running. For Medication or Immunization this is helpful to run ActivityDefinition for specific type of Drug
  • dosage: The dosages applicable for this product. This defines the timing for each dose of given product.
    • timing: The timing for given dose
    • sequence : The sequence of dose
  • timing: If dosage is define this can not be use. This is an alternate way of defining timing for Task. The timing can define a complete schedule
    • repeat: The repeat schedule
      • count: Number of Tasks to be generated. If count is defined the executionPeriod timing reference is Careplan.period.start. Otherwise if missing the reference of this timing is today duration: The duration of Task to be active for with reference to executionPeriod.start durationUnit: Duration time unit. mo | d | wk | y etc period: The executionPeriod.start reference based of current task index. If count is defined the executionPeriod timing reference is Careplan.period.start. Otherwise if missing the reference of this timing is today periodUnit: Period time unit. mo | d | wk | y etc:

Example ANC PlanDefinition that generates all Tasks at once​

  {
    "resourceType": "PlanDefinition",
    "id": "132157",
    "meta": {
      "versionId": "1",
      "lastUpdated": "2022-06-20T22:30:39.217+00:00"
    },
    "contained": [
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-init-activity",
        "title": "ANC Register Handler Activity",
        "status": "active",
        "description": "This action will assess careplan on registration to init careplan",
        "kind": "CarePlan",
        "dynamicValue": [
          {
            "path": "title",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%rootResource.title"
            }
          },
          {
            "path": "description",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%rootResource.description"
            }
          },
          {
            "path": "instantiatesCanonical",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%rootResource.id.replaceMatches('/_history/.*', '')"
            }
          },
          {
            "path": "status",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'active'"
            }
          },
          {
            "path": "intent",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'plan'"
            }
          },
          {
            "path": "created",
            "expression": {
              "language": "text/fhirpath",
              "expression": "now()"
            }
          },
          {
            "path": "subject",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.subject"
            }
          },
          {
            "path": "author",
            "expression": {
              "language": "text/fhirpath",
              "expression": "$this.generalPractitioner.first()"
            }
          },
          {
            "path": "period.start",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.descendants().where(linkId='245679f2-6172-456e-8ff3-425f5cea3243').answer.value"
            }
          },
          {
            "path": "period.end",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.descendants().where(linkId='245679f2-6172-456e-8ff3-425f5cea3243').answer.value + 9 'months'"
            }
          },
          {
            "path": "activity.detail.kind",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'Task'"
            }
          },
          {
            "path": "activity.detail.status",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'in-progress'"
            }
          },
          {
            "path": "activity.detail.description",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'This action will assess careplan on registration to init careplan'"
            }
          },
          {
            "path": "activity.detail.performer",
            "expression": {
              "language": "text/fhirpath",
              "expression": "$this.generalPractitioner.first()"
            }
          }
        ]
      },
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-task-activity",
        "title": "ANC Visits Plan",
        "status": "active",
        "description": "This action will performed every month for a pregnant woman",
        "kind": "Task",
        "timingTiming": {
          "repeat": {
            "count": 8,
            "duration": 1,
            "durationUnit": "mo",
            "period": 1,
            "periodUnit": "mo"
          }
        }
      },
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-end-activity",
        "title": "Careplan completion Activity",
        "status": "active",
        "description": "This action will assess careplan every time a followup happens on a task generated by plan to mark it complete",
        "kind": "CarePlan",
        "dynamicValue": [
          {
            "path": "status",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'completed'"
            }
          }
        ]
      },
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-referral-activity",
        "title": "ANC Referral Handler Activity",
        "status": "active",
        "description": "This action will assess careplan and generate referral task every time a followup happens on a task generated by plan",
        "kind": "Task"
      }
    ],
    "name": "ANC Follow Up Plan",
    "title": "ANC Follow Up Plan",
    "status": "active",
    "description": "This defines the schedule of care for pregnant women",
    "action": [
      {
        "prefix": "1",
        "priority": "routine",
        "condition": [
          {
            "kind": "applicability",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.where(questionnaire = 'Questionnaire/132152').exists()"
            }
          }
        ],
        "definitionCanonical": "#careplan-init-activity"
      },
      {
        "prefix": "1",
        "priority": "routine",
        "condition": [
          {
            "kind": "applicability",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.where(questionnaire = 'Questionnaire/132152').exists()"
            }
          }
        ],
        "definitionCanonical": "#careplan-task-activity",
        "transform": "http://hl7.org/fhir/StructureMap/132156"
      },
      {
        "prefix": "1",
        "priority": "routine",
        "condition": [
          {
            "kind": "applicability",
            "expression": {
              "language": "text/fhirpath",
              "expression": "$this is Patient and %resource.entry.first().where(resource is QuestionnaireResponse).resource.questionnaire = 'Questionnaire/132170'"
            }
          }
        ],
        "definitionCanonical": "#careplan-end-activity"
      },
      {
        "prefix": "1",
        "priority": "routine",
        "condition": [
          {
            "kind": "applicability",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.first().where(resource is QuestionnaireResponse).resource.descendants().where((linkId='1b625d5c-d0bc-44d5-8eed-3efc37c51f84' or linkId='9b486fa3-5323-47db-c8eb-f725fb50e8d6') and answer.value.code='yes').exists()"
            }
          }
        ],
        "definitionCanonical": "#careplan-referral-activity",
        "transform": "http://hl7.org/fhir/StructureMap/528a8603-2e43-4a2e-a33d-1ec2563ffd3e"
      }
    ]
  }

ANC PlanDefinition generating Tasks on demand​

  {
    "resourceType": "PlanDefinition",
    "id": "132157",
    "meta": {
      "versionId": "1",
      "lastUpdated": "2022-06-20T22:30:39.217+00:00"
    },
    "contained": [
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-init-activity",
        "title": "ANC Register Handler Activity",
        "status": "active",
        "description": "This action will assess careplan on registration to init careplan",
        "kind": "CarePlan",
        "dynamicValue": [
          {
            "path": "title",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%rootResource.title"
            }
          },
          {
            "path": "description",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%rootResource.description"
            }
          },
          {
            "path": "instantiatesCanonical",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%rootResource.id.replaceMatches('/_history/.*', '')"
            }
          },
          {
            "path": "status",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'active'"
            }
          },
          {
            "path": "intent",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'plan'"
            }
          },
          {
            "path": "created",
            "expression": {
              "language": "text/fhirpath",
              "expression": "now()"
            }
          },
          {
            "path": "subject",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.subject"
            }
          },
          {
            "path": "author",
            "expression": {
              "language": "text/fhirpath",
              "expression": "$this.generalPractitioner.first()"
            }
          },
          {
            "path": "period.start",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.descendants().where(linkId='245679f2-6172-456e-8ff3-425f5cea3243').answer.value"
            }
          },
          {
            "path": "period.end",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.descendants().where(linkId='245679f2-6172-456e-8ff3-425f5cea3243').answer.value + 9 'months'"
            }
          },
          {
            "path": "activity.detail.kind",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'Task'"
            }
          },
          {
            "path": "activity.detail.status",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'in-progress'"
            }
          },
          {
            "path": "activity.detail.description",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'This action will assess careplan on registration to init careplan'"
            }
          },
          {
            "path": "activity.detail.performer",
            "expression": {
              "language": "text/fhirpath",
              "expression": "$this.generalPractitioner.first()"
            }
          }
        ]
      },
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-task-activity",
        "title": "ANC Visits Plan",
        "status": "active",
        "description": "This action will performed every month for a pregnant woman",
        "kind": "Task",
        "timingTiming": {
          "repeat": {
            "duration": 1,
            "durationUnit": "mo",
            "period": 1,
            "periodUnit": "mo"
          }
        }
      },
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-end-activity",
        "title": "Careplan completion Activity",
        "status": "active",
        "description": "This action will assess careplan every time a followup happens on a task generated by plan to mark it complete",
        "kind": "CarePlan",
        "dynamicValue": [
          {
            "path": "status",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'completed'"
            }
          }
        ]
      },
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-referral-activity",
        "title": "ANC Referral Handler Activity",
        "status": "active",
        "description": "This action will assess careplan and generate referral task every time a followup happens on a task generated by plan",
        "kind": "Task"
      }
    ],
    "name": "ANC Follow Up Plan",
    "title": "ANC Follow Up Plan",
    "description": "This defines the schedule of care for pregnant women",
    "action": [
      {
        "prefix": "1",
        "priority": "routine",
        "condition": [
          {
            "kind": "applicability",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.where(questionnaire = 'Questionnaire/132152').exists()"
            }
          }
        ],
        "definitionCanonical": "#careplan-init-activity"
      },
      {
        "prefix": "1",
        "priority": "routine",
        "condition": [
          {
            "kind": "applicability",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.where(questionnaire = 'Questionnaire/132152').exists()"
            }
          }
        ],
        "definitionCanonical": "#careplan-task-activity",
        "transform": "http://hl7.org/fhir/StructureMap/132156"
      },
      {
        "prefix": "1",
        "priority": "routine",
        "condition": [
          {
            "kind": "applicability",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.questionnaire = 'Questionnaire/132170'"
            }
          }
        ],
        "definitionCanonical": "#careplan-end-activity"
      },
      {
        "prefix": "1",
        "priority": "routine",
        "condition": [
          {
            "kind": "applicability",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%resource.entry.where(resource is QuestionnaireResponse).resource.descendants().where((linkId='1b625d5c-d0bc-44d5-8eed-3efc37c51f84' or linkId='9b486fa3-5323-47db-c8eb-f725fb50e8d6') and answer.value.code='yes').exists()"
            }
          }
        ],
        "definitionCanonical": "#careplan-referral-activity",
        "transform": "http://hl7.org/fhir/StructureMap/528a8603-2e43-4a2e-a33d-1ec2563ffd3e"
      }
    ]
  }

Child Immunization schedule PlanDefinition​

  {
    "resourceType": "PlanDefinition",
    "id": "e994ab6f-30a5-4450-9a90-691c8199f379",
    "contained": [
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-init-activity",
        "title": "ANC Register Handler Activity",
        "status": "active",
        "description": "This action will assess careplan on registration to init careplan",
        "kind": "CarePlan",
        "dynamicValue": [
          {
            "path": "title",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%rootResource.title"
            }
          },
          {
            "path": "description",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%rootResource.description"
            }
          },
          {
            "path": "instantiatesCanonical",
            "expression": {
              "language": "text/fhirpath",
              "expression": "%rootResource.id.replaceMatches('/_history/.*', '')"
            }
          },
          {
            "path": "status",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'active'"
            }
          },
          {
            "path": "intent",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'plan'"
            }
          },
          {
            "path": "created",
            "expression": {
              "language": "text/fhirpath",
              "expression": "now()"
            }
          },
          {
            "path": "subject.reference",
            "expression": {
              "language": "text/fhirpath",
              "expression": "$this.id.replaceMatches('/_history/.*', '')"
            }
          },
          {
            "path": "author",
            "expression": {
              "language": "text/fhirpath",
              "expression": "$this.generalPractitioner.first()"
            }
          },
          {
            "path": "period.start",
            "expression": {
              "language": "text/fhirpath",
              "expression": "$this.birthDate"
            }
          },
          {
            "path": "period.end",
            "expression": {
              "language": "text/fhirpath",
              "expression": "$this.birthDate + 4017 'days'"
            }
          },
          {
            "path": "activity.detail.kind",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'Task'"
            }
          },
          {
            "path": "activity.detail.status",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'in-progress'"
            }
          },
          {
            "path": "activity.detail.description",
            "expression": {
              "language": "text/fhirpath",
              "expression": "'This action will assess careplan on registration to init careplan'"
            }
          },
          {
            "path": "activity.detail.performer",
            "expression": {
              "language": "text/fhirpath",
              "expression": "$this.generalPractitioner.first()"
            }
          }
        ]
      },
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-bcg-task-activity",
        "title": "Child BCG Immunization",
        "description": "This is the BCG scheduled immunization.",
        "status": "active",
        "kind": "Task",
        "code": {
          "coding": [
            {
              "code": "33879002",
              "display": "Administration of vaccine to produce active immunity (procedure)",
              "system": "http://snomed.info/sct"
            }
          ]
        },
        "productCodeableConcept": {
          "coding": [
            {
              "code": "42284007",
              "display": "BCG vaccination",
              "system": "http://snomed.info/sct"
            }
          ],
          "text": "BCG"
        },
        "dosage": [
          {
            "timing": {
              "repeat": {
                "count": 1,
                "duration": 1825,
                "durationUnit": "d",
                "period": 0,
                "periodUnit": "d"
              }
            }
          }
        ]
      },
      {
        "resourceType": "ActivityDefinition",
        "id": "careplan-opv-task-activity",
        "title": "Child OPV Immunization",
        "description": "This is the OPV scheduled immunization.",
        "status": "active",
        "kind": "Task",
        "code": {
          "coding": [
            {
              "code": "33879002",
              "display": "Administration of vaccine to produce active immunity (procedure)",
              "system": "http://snomed.info/sct"
            }
          ]
        },
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