DRAFT
Da Vinci Guide Overlap with CDex
| Focus Area | Implementation Guide | Project Page | Transaction Scenarios | Areas of Functional Overlap with CDex |
|---|---|---|---|---|
| Member Access | Clinical Data Exchange (CDex) | Clinical Data Exchange (CDex) | Payor/Provider requests for data from Provider using Direct Queries and Task Based Transactions | N/A |
| Member Access | Health Record Exchange Framework (HRex) | Health Record Exchange Framework (HRex) | N/A | CDex based on HRex defined transactions |
| Burden Reduction | Coverage Requirements Discovery | Coverage 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 Reduction | Prior Authorization Support | Prior Authorization Support (PAS) | 1) Provider submit PA request to Payor/Intermediary using Claim/$submit operation2) 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 Reduction | Documentation 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 | None |
| Clinical Data Exchange | "Alerts: Notification (ADT) | Transitions in Care | 1) Unsolicited Provider/Intermediary to Provider/Payer/Intermediary using a $process-message operation2) Follow up queries from Payer/Provider to Provider for more information | Follow up queries from Payer/Provider to Provider for more information |
| Clinical Data Exchange | Performing Laboratory Reporting | ? | N/A | |
| Clinical Data Exchange | Health Record Exchange: Patient Data Exchange | ? | N/A | |
| Member Access | Payer 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 4) Patient request patient data from Payer | None |
| Member Access | Payer Data Exchange (PDex): Formulary | PDex Formulary | 1)Patient request formulary data from Payer | None |
| Member Access | Payer Data Exchange (PDex): Plan Network Directory | PDex Plan Net | Patient or Provider request provider directory data from Payer | None |
| Member Access | Payer - Payer Coverage Decision Exchange | Payer Coverage Decision Exchange (PCDE) | 1) Payer request patient data from Payer using task based approach 2) Payer find Member using | None (uses same technical approach) |
| Member Access | Patient Cost Transparency | ? | N/A | |
| Process Imp | Risk Based Contract Member Identification (aka: Member Attribution) | Member Attribution (ATR) List | 1) Provider request Member Attribution List Payer | Provider (consumer)requests attribution list from Provider(producer) |
| Process Imp | Risk Adjustment (was: Chronic Illness Documentation for Risk Adjustment) | Risk Adjustment | N/A | |
| Quality | Data Exchange for Quality Measures | Data Exchange for Quality Measures (DEQM/GIC) | 1) Provider request Quality Data Requirement from Payer using 2) Payer request Quality Data using 3)Provider exchanges Quality Data with Payer using either | Payer request Quality Data from Provider |
| Quality | Gaps in Care & Information | Data Exchange for Quality Measures (DEQM/GIC) | Payer/Provider/Other request GIC report using the $care-gaps operation +/- async | None |