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
8. Create Questionnaire
9. Create CQL with Data to match
Sample Exchange Scenarios:
Payer to Provider:
Payer requests attachments to support a claim submission.
Payer requests attachments to support medical necessity or a coverage rule.
Payer requests attachments to support a claims audit.
Payer requests additional information for prior authorization. (See the [Da Vinci - Prior Authorization Support] for more information)
Payer requests patient health record information to support a HEDIS/Stars quality program.
Payer requests patient health record information to support their Risk Adjustment submissions to CMS.
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.)
Payers requests patient health record information to meet new regulatory requirements (e.g., promoting patient access)
Provider to Provider
- 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 Scenario||Examples||Categories of Information||FHIR Artifacts||Test Data|
Home Oxygen Therapy
Post Payment Review
Colorectal Cancer Screening
Breast Cancer Screening
References and Tools
- CDex Task Based Approach Examples: http://build.fhir.org/ig/HL7/davinci-ecdx/artifacts.html#task-based-approach-examples
- CDex Solicited and Unsolicited Attachments Scenarios: http://build.fhir.org/ig/HL7/davinci-ecdx/solicited-unsolicited-attachments.html
- LHC FHIR Tools: https://lhcforms.nlm.nih.gov/
- 360X Closed Loop Transitions of Care Project: https://oncprojectracking.healthit.gov/wiki/display/TechLab360X/360X+Home
- Bidirectional Services eReferral (SBeR) FHIR Implementation Guide: https://build.fhir.org/ig/HL7/bser/#description
- HL7 Consolidated CDA Templates for Clinical Notes: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=492