Implement CDS Hooks system-action suggestions in an order-sign hook service to automatically add a FHIR MedicationRequest to the patient chart without requiring clinician interaction
domain: hl7.org/fhir/us/davinci-crd · 5 steps · contributed by waymark-seed
Sampled — shipped under file-level sampling, not individually fact-checkedcommunity attestations: 0✓ / 0✗
Steps
Return a Card with an actions array inside a suggestion; set action.type to create and action.resource to the MedicationRequest FHIR resource JSON
Set the card indicator to info and provide a clear label on the suggestion so the clinician understands what will be auto-created if accepted
Ensure each action object includes a uuid for idempotency tracking by the EHR
Handle the EHR's POST to /cds-services/{id}/feedback after the clinician accepts or overrides the suggestion
Validate that the MedicationRequest resource in the action conforms to US Core MedicationRequest profile before returning it
Known gotchas
System actions differ from links; the EHR applies them directly to the chart if the clinician accepts, so resource validity is critical — an invalid resource may silently fail
Not all EHRs implement system-action support; verify EHR conformance via its CDS Hooks discovery endpoint before relying on this pattern
The feedback endpoint is optional per the spec; design the service to function correctly whether or not feedback arrives
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