Clinical workflows on FHIR involve integration with EHRs at five specific points. Getting these integrations right shapes clinician adoption.
Point 1: Chart open / patient-view. Clinician opens a patient. CDS Hooks patient-view fires; third-party CDS returns cards with alerts, reminders.
Point 2: Order entry / order-select. Clinician picks an order. order-select hook fires; CDS returns alternatives, drug interactions, formulary matches.
Point 3: Order signing / order-sign. Clinician signs order. order-sign hook fires; last chance for CDS interception.
Point 4: Charting / SDC-based documentation. Clinician completes structured SDC Questionnaire; results extracted to Observation resources.
Point 5: Task assignment / referral. Task resource assigned to another clinician or team; tracked to completion.
Integration surface
| Point | FHIR primitive | Delivery |
|---|---|---|
| patient-view | CDS Hooks | HTTP POST to CDS service |
| order-select | CDS Hooks | HTTP POST |
| order-sign | CDS Hooks | HTTP POST |
| SDC documentation | Questionnaire + $extract | SMART-launched or embedded |
| Task | REST + Subscription | REST POST + notification |
Adoption metrics that matter
1. Card action rate — percentage of CDS cards clinicians act on. 2. Alert override rate — how often clinicians proceed despite warnings. 3. Task completion time — median time from assignment to completion. 4. SDC form completion rate — percentage of assigned forms completed.
Common workflow mistakes
1. Over-firing CDS Hooks → alert fatigue. 2. Slow CDS response → EHR times out. 3. Task without owner → drops. 4. Forms outside workflow → adoption fails. 5. Missing role-based scoping → wrong information shown.
Design principles
1. Right information, right time, right person. 2. Minimal interruption to workflow. 3. Clear action to take (not just information). 4. Track adoption; iterate on card content. 5. Under-fire; add cards when clinicians request.
Clinical workflow integration on FHIR delivers real value when executed thoughtfully. The five integration points above cover essentially every clinician-facing workflow.
