Comment:

FHIR resources that are intended to be persisted must be able to stand alone without any access to any referenced resources. As defined, a GuidanceResponse cannot be intepreted independently of the definition of the decision support service the call was made to. That's ok if GuidanceResponse acts like a Parameters resource which is never persisted and simply wraps the information (contraindications, recommended orders, etc.) coming back from the decision support engine. If so, this should be clarified (and it should be explained why GuidanceResponse isn't just a profile on Parameters). If not, then enough information needs to be included in GuidanceResponse that it could be passed alone to a downstream system and that system would be able to understand and act on the CDS recommendation.

Summary:

GuidanceResponse is problematic as a stand-alone resource