recommendation obligatory (#12)

- use of "Recommendation" as the base profile for a recommendation is now obligatory (as opposed to using only RecommendationPlan profile instances). Recommendation is a collection of individual RecommendationPlan resources, which in turn define the different pieces of a single recommendation.
-

input/fsh/examples/covid-dexamethason/bundle.fsh

@@ -9,6 +9,9 @@ Description: "COVID19 Intensive Care Treatment Guideline (Bundle)."
 * entry[guidelineCitation][+]
   * resource = COVID19IntensiveCareTreatmentGuidelineCitation
   * insert canonical-full-url(example/guidelines/covid19-intensive-care-treatment/guideline-citation)
+* entry[recommendation][+]
+  * resource = COVID19DexamethasoneApplication
+  * insert canonical-full-url(example/guidelines/covid19-intensive-care-treatment/dexamethasone/recommendation)
 * entry[recommendationPlan][+]
   * resource = COVID19VentilatedPatientsDexamethasoneApplicationPlan
   * insert canonical-full-url(example/guidelines/covid19-intensive-care-treatment/dexamethasone/recommendation-plan-ventilated-patients)

input/fsh/examples/covid-dexamethason/recommendations/recommendation_05_intervention.fsh

@@ -1,6 +1,37 @@
 /*********************/
 /* Intervention Plan */
 /*********************/
+Instance: COVID19DexamethasoneApplication
+InstanceOf: recommendation
+Usage: #example
+Title: "Dexamethasone Application"
+Description: "Application of Dexamethasone for ventilated patients only"
+* name = "Dexamethasone_Application"
+* title = "Dexamethasone Application"
+* version = "4.0"
+* date = "2021-12-12"
+* status = #active
+* description = "Application of Dexamethasone for ventilated patients only"
+* insert canonical-url(example/covid19-dexamethasone-recommendation)
+* experimental = true
+* publisher = "CPGonEBMonFHIR"
+* subjectCanonical = Canonical(PopulationCOVID19Ventilated)
+* action[+]
+  * title = "Dexamethasone Application"
+  * code = $cs-common-process#guideline-based-care
+  * description = "Application of Dexamethasone: 6 mg once per day for 10 days p.o. or i.v. for ventilated COVID-19 patients"
+  * definitionCanonical = Canonical(COVID19VentilatedPatientsDexamethasoneApplicationPlan)
+  * selectionBehavior = #exactly-one
+* action[+]
+  * title = "No Dexamethasone Application"
+  * code = $cs-common-process#guideline-based-care
+  * description = "No Dexamethasone Application for non-ventilated COVID-19 patients"
+  * definitionCanonical = Canonical(COVID19NonVentilatedPatientsDexamethasoneApplicationPlan)
+  * selectionBehavior = #exactly-one
+* relatedArtifact[recommendationJustification].resourceReference = Reference(DexamethasoneRecommendationJustification)
+* relatedArtifact[recommendationCitation].resourceReference = Reference(DexamethasoneRecommendationCitation)
+* relatedArtifact[guidelineCitation].resourceReference = Reference(COVID19IntensiveCareTreatmentGuidelineCitation)
+
 Instance: COVID19VentilatedPatientsDexamethasoneApplicationPlan
 InstanceOf: recommendation-plan
 Usage: #example
@@ -22,9 +53,6 @@ Description: "Application of Dexamethasone: 6 mg once per day for 10 days p.o. o
 * action[drugAdministration][+]
   * definitionCanonical = Canonical(DexamethasoneApplicationActionIntravenous)
   * selectionBehavior = #exactly-one
-* relatedArtifact[recommendationJustification].resourceReference = Reference(DexamethasoneRecommendationJustification)
-* relatedArtifact[recommendationCitation].resourceReference = Reference(DexamethasoneRecommendationCitation)
-* relatedArtifact[guidelineCitation].resourceReference = Reference(COVID19IntensiveCareTreatmentGuidelineCitation)
 
 Instance: COVID19NonVentilatedPatientsDexamethasoneApplicationPlan
 InstanceOf: recommendation-plan
@@ -44,9 +72,6 @@ Description: "No application of Dexamethasone for non-ventilated COVID-19 patien
 * action[drugAdministration][+]
   * definitionCanonical = Canonical(NoDexamethasoneApplication)
   * selectionBehavior = #exactly-one
-* relatedArtifact[recommendationJustification].resourceReference = Reference(DexamethasoneRecommendationJustification)
-* relatedArtifact[recommendationCitation].resourceReference = Reference(DexamethasoneRecommendationCitation)
-* relatedArtifact[guidelineCitation].resourceReference = Reference(COVID19IntensiveCareTreatmentGuidelineCitation)
 
 Instance: DexamethasoneRecommendationCitation
 InstanceOf: recommendation-citation

input/fsh/guideline-recommendation/p-recommendation.fsh

@@ -24,6 +24,15 @@ InstanceOf: recommendation
 Usage: #example
 Title: "recommendation"
 Description: "Recommendation"
+* name = "Recommendation"
+* title = "Recommendation"
+* version = "1.0"
+* date = "2022-02-14"
+* status = #active
+* description = "Example Recommendation"
+* insert canonical-url(example/recommendation-plan/example-recommendation)
+* experimental = true
+* publisher = "CPGonEBMonFHIR"
 * action[+]
   * title = "example recommendation"
   * code = $cs-common-process#guideline-based-care
@@ -36,15 +45,6 @@ Description: "Recommendation"
   * description = "Example recommendation"
   * definitionCanonical = Canonical(ExampleRecommendationPlan)
   * selectionBehavior = #all
-* name = "Recommendation"
-* title = "Recommendation"
-* version = "1.0"
-* date = "2022-02-14"
-* status = #active
-* description = "Example Recommendation"
-* insert canonical-url(example/recommendation-plan/example-recommendation)
-* experimental = true
-* publisher = "CPGonEBMonFHIR"
 * relatedArtifact[recommendationJustification].resourceReference = Reference(ExampleRecommendationJustification)
 * relatedArtifact[recommendationCitation].resourceReference = Reference(ExampleRecommendationCitation)
 * relatedArtifact[guidelineCitation].resourceReference = Reference(ExampleGuidelineCitation)

input/fsh/guideline/p-guideline.fsh

@@ -45,7 +45,7 @@ Description: "Representation of an evidence-based clinical practice guideline."
   * title 1..1 MS
   * code 1..1 MS
   * code = $cs-ceosys#guideline-recommendation "Clinical practice guideline recommendation"
-  * focus only Reference(RecommendationPlan)
+  * focus only Reference(Recommendation)
 
 Instance: GuidelineExample
 InstanceOf: guideline
@@ -67,4 +67,4 @@ Description: "Example of a guideline resource."
   * text
     * status = #generated
     * div = "<div xmlns=\"http://www.w3.org/1999/xhtml\">This is an example guideline recommendation.</div>"
-  * focus = Reference(ExampleRecommendationPlan)
+  * focus = Reference(ExampleRecommendation)

input/fsh/intervention/p-recommendation-plan.fsh

@@ -75,7 +75,6 @@ Description: "Definition of an activity that is part of an intervention in the c
         * system 1.. MS
         * code 1.. MS
     * detail[x] 1..1 MS
-* insert recommendation-related-artifacts
 
 Invariant: goal-must-be-linked
 Description: "The goal linked by goalId is not defined"
@@ -126,6 +125,3 @@ Description: "An active recommendation plan."
     * measure = $loinc#48066-5 "Fibrin D-dimer DDU [Mass/volume] in Platelet poor plasma"
     * detailRange
       * high = 250 'ng/mL'
-* relatedArtifact[recommendationJustification].resourceReference = Reference(ExampleRecommendationJustification)
-* relatedArtifact[recommendationCitation].resourceReference = Reference(ExampleRecommendationCitation)
-* relatedArtifact[guidelineCitation].resourceReference = Reference(ExampleGuidelineCitation)

input/fsh/p-guideline-bundle.fsh

@@ -16,6 +16,7 @@ Description: "Collection of all resources that represent a single clinical pract
 * entry contains
   guideline 1..1 MS
   and guidelineCitation 0..1 MS
+  and recommendation 1..* MS
   and recommendationPlan 1..* MS
   and recommendationAction 1..* MS
   and PICOEvidenceVariable 1..* MS // includes RecommendationEligibilityCriteria, StudyEligibilityCriteria, and Outcome
@@ -25,50 +26,33 @@ Description: "Collection of all resources that represent a single clinical pract
   and studyCitation 0..* MS
   and recommendationCitation 0..* MS
   and netEffect 0..* MS
-* entry[guideline]
+* entry
   * resource 1.. MS
-  * resource only Guideline
   * fullUrl 1..1 MS
+* entry[guideline]
+  * resource only Guideline
 * entry[guidelineCitation]
-  * resource 1.. MS
   * resource only GuidelineCitation
-  * fullUrl 1..1 MS
+* entry[recommendation]
+  * resource only Recommendation
 * entry[recommendationPlan]
-  * resource 1.. MS
   * resource only RecommendationPlan
-  * fullUrl 1..1 MS
 * entry[recommendationAction]
-  * resource 1.. MS
   * resource only RecommendationAction
-  * fullUrl 1..1 MS
 * entry[PICOEvidenceVariable]
-  * resource 1.. MS
   * resource only PICOEvidenceVariable
-  * fullUrl 1..1 MS
 * entry[recommendationJustification]
-  * resource 1.. MS
   * resource only RecommendationJustification
-  * fullUrl 1..1 MS
 * entry[certaintyOfEvidenceRating]
-  * resource 1.. MS
   * resource only CertaintyOfEvidenceRating
-  * fullUrl 1..1 MS
 * entry[outcomeEvidence]
-  * resource 1.. MS
   * resource only OutcomeEvidence
-  * fullUrl 1..1 MS
 * entry[studyCitation]
-  * resource 1.. MS
   * resource only StudyCitation
-  * fullUrl 1..1 MS
 * entry[recommendationCitation]
-  * resource 1.. MS
   * resource only RecommendationCitation
-  * fullUrl 1..1 MS
 * entry[netEffect]
-  * resource 1.. MS
   * resource only NetEffectEstimate
-  * fullUrl 1..1 MS
 
 Invariant: bdl-1
 Description: "First element of Bundle must be an Composition."
@@ -86,6 +70,9 @@ Description: "Example of a clinical practice guideline representation bundle."
 * entry[guidelineCitation][+]
   * resource = ExampleGuidelineCitation
   * insert canonical-full-url(example/guidelines/guideline-example/citation)
+* entry[recommendation][+]
+  * resource = ExampleRecommendation
+  * insert canonical-full-url(example/guidelines/guideline-example/recommendation)
 * entry[recommendationPlan][+]
   * resource = ExampleRecommendationPlan
   * insert canonical-full-url(example/guidelines/guideline-example/recommendation-plan)