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 $lite operation.
Inside the PlanDefinition, the definition element specifies an ActivityDefinition which is used to construct a specific resource (Task and CarePlan only for now). Along with definition, a PlanDefinition may also provide a transform element for the activity a StructureMap to do the transformation and creation of elements for CarePlan. Another element dynamicValue list can also be provided in ActivityDefinition to provide dynamic values for CarePlan using FHIRPath.
Below is a detailed description of notable properties of PlanDefinition and its usage in fhircore
PlanDefinition notable properties:
resourceType: PlanDefinitionid: unique identifier of resource, ideally UUID (Universal Unique Identifier),contained: [ ... ] : An array of resources to embed details (ActivityDefinition) about given planname: Human readable name of the PlanDefinitiontitle: Title or summary of what PlanDefinition is about. This is output to generated CarePlan as titlestatus:active,description: Detailed summary of what plan does. This is output to generated CarePlan as descriptionaction: [ ... ] : An array action elements to definecondition,definitionandtransformto be applied while generating CarePlan.
PlanDefinition action notable properties:
priority: high-priority | medium-priority | low-prioritycondition: [ ]-
kind: onlyapplicabilityis handled for now. This provides details on what aspect of CarePlan should be assessed. -
expression: The expression which runs on the context i.e. the QuestionnaireResponse, Patient, and other generated resources by QuestionnaireResponse extractionlanguage: text/FHIRPath can be handled only for nowexpression: The FHIRPath expression that runs on context resources.$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:
$thisis Patient and%resource.entry.first().resourceis Patient and(today() - 60 'months') <= $this.birthDate
-
definitionCanonical: The ActivityDefinitionidincontainedresources into this PlanDefinition prefixed by#example: #careplan-init-activitytransform: The StructureMap to run on this action definition to do the resource generation. If this is not provided onlydynamicValuecomponent of ActivityDefinition is used to modify the resources- The values available in to be used StructureMap are
definition: Current ActivityDefinitiondepends-on: The context resource QuestionnaireResponse which resulted this PlanDefintionsubject: The Patient or Group for which this Plan is runningperiod: The evaluatedexecutionPeriodfor ActivityDefinitionversion: The index of Task evaluated by ActivityDefinitiontimingor 1 by default
- The values available in to be used StructureMap are
-
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, $this.value.substring(0,10) + 'T00:00:00.00Z') "r_per_end";
}
PlanDefinition definition notable properties:
resourceType: ActivityDefinitionid: the unique id of resource into contained resource of this PlanDefinition.title: title or summary of this definitionstatus: activedescription: Detailed summary of what activity doeskind: CarePlan|Task supported for nowdynamicValue: [ ] an array of FHIRPath expression which defines the value for each property of resource of given kindpath: the name of property to set the value- example:
title|status|subject.reference|period.startetc. for CarePlan
- example:
expression: The expression for retrieveing the value from context resources i.e. the QuestionnaireResponse, Patient, and other generated resources by QuestionnaireResponse extractionlanguage: text/FHIRPath supported for nowexpression: The FHIRPath expression that runs on context resources.%rootResource: Current PlanDefinition$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 Drugdosage: The dosages applicable for thisproduct. This defines thetimingfor each dose of given product.timing: The timing for given dosesequence: 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 schedulerepeat: The repeat schedulecount: Number of Tasks to be generated. If count is defined theexecutionPeriodtiming 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 toexecutionPeriod.startdurationUnit: Duration time unit. mo | d | wk | y etc period: TheexecutionPeriod.startreference based of current task index. If count is defined theexecutionPeriodtiming 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"
}
]
},
"productCodeableConcept": {
"coding": [
{
"code": "111164008",
"display": "Poliovirus vaccine",
"system": "http://snomed.info/sct"
}
],
"text": "OPV"
},
"dosage": [
{
"sequence": 0,
"timing": {
"repeat": {
"count": 1,
"duration": 14,
"durationUnit": "d",
"period": 0,
"periodUnit": "d"
}
}
},
{
"sequence": 1,
"timing": {
"repeat": {
"count": 1,
"duration": 1825,
"durationUnit": "d",
"period": 6,
"periodUnit": "wk"
}
}
},
{
"sequence": 2,
"timing": {
"repeat": {
"count": 1,
"duration": 1825,
"durationUnit": "d",
"period": 10,
"periodUnit": "wk"
}
}
},
{
"sequence": 3,
"timing": {
"repeat": {
"count": 1,
"duration": 1825,
"durationUnit": "d",
"period": 14,
"periodUnit": "wk"
}
}
}
]
},
{
"resourceType": "ActivityDefinition",
"id": "careplan-penta-task-activity",
"title": "Child PENTA Immunization",
"description": "This is the PENTA 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": "429511000124109",
"display": "Tetanus + diphtheria + acellular pertussis vaccine",
"system": "http://snomed.info/sct"
}
],
"text": "PENTA"
},
"dosage": [
{
"sequence": 1,
"timing": {
"repeat": {
"count": 1,
"duration": 1460,
"durationUnit": "d",
"period": 6,
"periodUnit": "wk"
}
}
},
{
"sequence": 2,
"timing": {
"repeat": {
"count": 1,
"duration": 1460,
"durationUnit": "d",
"period": 10,
"periodUnit": "wk"
}
}
},
{
"sequence": 3,
"timing": {
"repeat": {
"count": 1,
"duration": 1460,
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