ArtifactAssessment — Assessment of an artefact

A new FHIR R5 resource. Carries an evaluation, a rating or a formal comment associated with a knowledge artefact: clinical guideline, quality measure, implementation guide, valueset. The peer review and EBM governance layer.

Purpose of the resource

A clinical guideline, a quality measure or an implementation guide are not static artefacts: they are drafted, reviewed, commented upon, voted on, approved, disapproved, ranked in evidence levels. ArtifactAssessment provides the structured format to carry all these interactions.

It enables a system (HAS, NICE, USPSTF, Cochrane, AHRQ…) to publish an independent assessment of a third-party artefact: GRADE evidence level, strong/weak recommendation, editorial comment, per-reviewer disposition. All addressable through a canonical URL for cross-site aggregation.

Key fields

JSON example

Peer review of a CKD Stage 4 guideline: GRADE B rating (moderate quality of evidence), improvement comment, disposition "agree-with-modifications".

{
  "resourceType": "ArtifactAssessment",
  "id": "guideline-review-2026",
  "url": "http://example.org/ArtifactAssessment/guideline-review-2026",
  "identifier": [{ "system": "http://example.org/reviews", "value": "REV-12345" }],
  "title": "External peer review of CKD Stage 4 management guideline",
  "citeAsMarkdown": "Smith J, Lee A. Peer review of 'CKD Stage 4 management v1.2.' 2026.",
  "date": "2026-05-16",
  "copyright": "CC-BY 4.0",
  "approvalDate": "2026-05-10",
  "lastReviewDate": "2026-05-15",
  "artifactReference": {
    "reference": "PlanDefinition/ckd-stage-4-management",
    "display": "CKD Stage 4 Management v1.2"
  },
  "content": [{
    "informationType": "rating",
    "summary": "Strong recommendation, moderate certainty evidence (GRADE).",
    "type": {
      "coding": [{
        "system": "http://terminology.hl7.org/CodeSystem/certainty-rating",
        "code": "moderate"
      }]
    },
    "classifier": [{
      "coding": [{
        "system": "http://terminology.hl7.org/CodeSystem/grade",
        "code": "B",
        "display": "Moderate quality of evidence"
      }]
    }],
    "author": { "reference": "Practitioner/dr-smith" }
  }, {
    "informationType": "comment",
    "summary": "Section 3.2 (eGFR thresholds) should reference KDIGO 2024 update.",
    "author": { "reference": "Practitioner/dr-lee" }
  }],
  "workflowStatus": "approved",
  "disposition": "agree-with-modifications"
}

Typical use cases

• IG peer review: HL7 ballot, NICE/HAS review.
• GRADE ranking: attach a certainty level to each recommendation of a PlanDefinition.
• Quality audit: editorial decision traceability for a quality measure (CMS, eCQM).
• Cochrane reviews: carry systematic review outputs in structured form.
• EBMonFHIR: the backbone of evidence-based medicine in FHIR.

Common pitfalls

• Missing artefact reference: artifactReference is 1..1. Without target, the assessment is anchorless.
• Free text instead of classifier: use classifier with a GRADE CodeSystem rather than burying the rating in summary.
• Multiple ratings without disposition: a multi-reviewer panel without disposition produces an ambiguous consensus. Define an overall disposition.
• Wrong informationType: rating ≠ comment. Putting a rating inside a free comment breaks aggregations.
• No citation: an assessment without citeAs cannot be cited in the literature.

Related resources

• PlanDefinition, Measure, ImplementationGuide, ValueSet — assessed artefacts.
• Evidence, EvidenceVariable, EvidenceReport — linked evidence.
• Citation — bibliographic base.
• Practitioner / Organization — assessment author.

See also: EvidenceReport — evidence report and Citation — bibliographic reference.