DRAFT

This Da Vinci Clinical Data Exchange (CDex) Implementation Guide specifies a framework to support clinical data exchange using Direct Query, Task Based, and Attachment transaction approaches. It provides several general examples to illustrate the different approaches for exchanging clinical data, but it does not document specific scenarios or the payload for each example. We plan to identify a proposed set of high value CDex scenarios for the community to collaboratively develop detailed examples and contribute for broader use.


CDex Examples Process Overview:

Data Gathering Steps

1.    Identify the clinical/administrative scenario . e.g., Claim for Home Oxygen Therapy
2.    Get an example "form" :  from payer
3.    List the data elements from a clinical/administrative process : why, past hx, etc.

Technical Steps to Convert to a CDex Transaction

4.    Map to FHIR resources, US Core profiles and elements:  e.g to LOINC document, FHIR resource.
5.    Create the task resource
6.    Create example data
7.    Test
8.    Create Questionnaire
9.    Create CQL with Data to match
10.   Test

Sample Exchange Scenarios:

Payer to Provider:

  1. Payer requests attachments to support a claim submission.

  2. Payer requests attachments to support medical necessity or a coverage rule.

  3. Payer requests attachments to support a claims audit.

  4. Payer requests additional information for prior authorization. (See the [Da Vinci - Prior Authorization Support] for more information)

  5. Payer requests patient health record information to support a HEDIS/Stars quality program.

  6. Payer requests patient health record information to support their Risk Adjustment submissions to CMS.

  7. Payer requests patient health record information to support their member records. (Some payers create a clinical record for each of their members to facilitate data exchange with providers. Payers use this clinical record to give providers the adequate information to execute care coordination decisions.)

  8. Payers requests patient health record information to meet new regulatory requirements (e.g., promoting patient access)

Provider to Provider

  1. Referred-to provider solicits additional clinical information from referring provider to support performing the requested service.


For the above exchange scenarios, the provider then sends the requested attachments, additional clinical information, or patient health record information to the payer or to another provider. 

Proposed Scenarios for Example Development: 

Type of Clinical Exchange ScenarioExamplesCategories of InformationFHIR ArtifactsTest Data

Home Oxygen Therapy






Maternal Medicine

  • Gestational weeks and days
  • Underlying pre-existing conditions
  • Control of gestational diabetes



Post Payment Review

  • Activities of daily living (ADLs)
  • Change of therapy (COT) assessment
  • Consultation notes
  • Encounter summary
  • Pathology results



Referrals





Global Transplant 

  • Surgical reports



OASIS 



Colorectal Cancer Screening

  • Last colonscopy – 10 year lookback – include the most current report 
  • Last Fecal DNA – 3 year lookback – include the most current results
  • Last Fecal FOBT– 1 year lookback – include the results, could be in notes.
  • CT Colonoscopy (Virtual Colonoscopy) - ?? year lookback - include most current the report



Breast Cancer Screening

  • Mammography, (Any type)  - 2 year lookback – include the most current report
  • Breast Ultrasound - 2 year lookback – include the most current report



Diabetes Management 
  • 2 year lookback across all (open to discussion)
  • Glycosylated Hemoglobin (include POC) – include the most current results
  • Urine Microalbumin (include POC) – include the most current results
  • Basic Chemistry, Lipids– include the most current results
  • Retinopathy Exam– include the most current results
  • Foot Evaluation– include the most current results



Behavioral Health




References and Tools

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