Level 4 (L4) is executable software running in a clinical system (either locally or via a cloud service). This includes the appropriate localization for workflow and data types, and generally involves:

Mapping of codes/ terms (value sets) to local codes/ terms

Adjustment of workflow for site-specific factors

Interpretation of computable content in the site-specific environment

Adjustment of site-specific needs/preferences (e.g. parameters, formulary services, etc.)