Da Vinci HL7 FHIR

Da Vinci Guide Overlap with CDex

Focus AreaImplementation GuideProject PageTransaction ScenariosAreas of Functional Overlap with CDex
Member AccessClinical Data Exchange (CDex)Clinical Data Exchange (CDex)Payor/Provider requests for data from Provider using Direct Queries and Task Based TransactionsN/A
Member AccessHealth Record Exchange Framework (HRex)Health Record Exchange Framework (HRex)N/ACDex based on HRex defined transactions
Burden ReductionCoverage Requirements DiscoveryCoverage Requirements Discovery (CRD)1) Provider request Coverage Requirements from Payor
2) Payor request additional Patient Data from Provider
Payor query provider systems for additional patient information For CDS Services that want the full patient resource, they can fetch it as needed from the FHIR server instead using a CDS prefetch (for example if CDS hook client refused prefetch request)
Burden ReductionPrior Authorization SupportPrior Authorization Support (PAS)1) Provider submit PA request to Payor/Intermediary using Claim/$submit operation
2) Provider poll/subscribe progress on PA
3) Payor/Intermediary request Provider to supplement PA with additional required information
Payer requests additional information for prior authorization see http://hl7.org/fhir/us/davinci-pas/usecases.html#submit-additional-information
Burden ReductionDocumentation Templates and Payer Rules (DTR)Documentation Templates and Payer Rules (DTR)

1)Smart App/"DTR process" fetches and prepopulates Questionnaire

2) Human intervention

3) "DTR process" saves QuestionnaireResponse to EHR

4) Provider creates Task on EHR

Clinical Data Exchange"Alerts: Notification (ADT)Transitions in Care1) Unsolicited Provider/Intermediary to Provider/Payer/Intermediary using a $process-message operation
2) Follow up queries from Payer/Provider to Provider for more information
Follow up queries from Payer/Provider to Provider for more information
Clinical Data ExchangePerforming Laboratory Reporting
Clinical Data ExchangeHealth Record Exchange: Patient Data Exchange
Member AccessPayer Data Exchange (PDex)Payer Data Exchange (PDex)

1) Provider request medical history from Payer

2) Payer request patient data from Payer

3) Payer find Member using $member-match operation

4) Patient request patient data from Payer

Member AccessPayer Data Exchange (PDex): FormularyPDex Formulary1)Patient request formulary data from PayerNone
Member AccessPayer Data Exchange (PDex): Plan Network DirectoryPDex Plan NetPatient or Provider request provider directory data from PayerNone
Member AccessPayer - Payer Coverage Decision ExchangePayer Coverage Decision Exchange (PCDE)

1) Payer request patient data from Payer using task based approach

2) Payer find Member using $member-match operation

None (uses same technical approach)
Member AccessPatient Cost Transparency
Process ImpRisk Based Contract Member Identification (aka: Member Attribution)Member Attribution (ATR) List1) Provider request Member Attribution List PayerProvider (consumer)requests attribution list from Provider(producer)
Process ImpRisk Adjustment (was: Chronic Illness Documentation for Risk Adjustment)Risk Adjustment
QualityData Exchange for Quality MeasuresData Exchange for Quality Measures (DEQM/GIC)

1) Provider request Quality Data Requirement from Payer using $data-requirements operation

2) Payer request Quality Data using $submit-data operation

3)Provider exchanges Quality Data with Payer using either $collect-data, a direct POST, or a transaction Bundle

Payer request Quality Data from Provider
QualityGaps in Care & InformationData Exchange for Quality Measures (DEQM/GIC)Payer/Provider/Other request GIC report using the $care-gaps operation +/- asyncNone
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