Guideline Appropriate Ordering (GAO)

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This profile supports communication of decision support guidance on whether or not an order is appropriate from EHR, hospital or departmental information systems,and enables receivers to validate that decision support was used to determine the appropriateness of those orders according to guidelines.


The Guideline Appropriate Ordering Profile supplies a mechanism by which EHR and departmental systems can evaluate orders to determine whether these orders conform to guidelines. The profile enables the results of the evaluation to be stored and transmitted, and the receiver of those results to verify that an order was evaluated with regard to appropriateness. Under a new US law, starting in 2017, providers ordering imaging procedures must use physician approved appropriateness guidelines to reduce unnecessary imaging in patients for whom it is not appropriate. In order to be paid for Medicare outpatient care, facilities and physicians who perform certain imaging procedures (either the technical or the clinical component) have to be able to show that decision support was used in the ordering process. The European Society of Cardiology and the European Association of Cardiovascular Imaging have also identified a need for use of appropriateness criteria in cardiovascular imaging.


The Guideline Appropriate Ordering Profile is intended to support use cases where the use of CDS to evaluate an order for appropriateness to guidelines must be demonstrated and communicated in an order. This profile is intended to address evaluation of an order at the time of order entry. It does not address the case where orders are proposed by a CDS system prior to order entry, because in these cases, the CDS system is presumed to have already ensured that those orders are appropriate, and can include the necessary information.

The focus of this profile is on ensuring that the data necessary to perform the evaluation can be communicated to a clinical decision support service. As far as the profile is concerned, the decision support service is a black box. How it works inside is out of scope. This profile does not specify the algorithms by which orders are evaluated according to guidelines, or the formats used to express clinical decision support in guidelines. There are numerous ways by which these evaluations can be performed. Implementers of a decision support service are free to use historical knowledge about the patient where available, or to interact with the EHR to query for data about a patient. This profile does not address the mechanisms by which this occurs.

Systems Affected

Actors & Transactions:

PCC GAO actor transaction.jpg


Profile Status: Trial Implementation


Guideline Appropriate Ordering (GAO) Profile

Underlying Standards:

See Also