System roles - Payer System
- Provider System
Scenarios - Payer to Provider$davinci-ra.evaluate-measure Scenario - Actions:
- Payer calls the $davinci-ra.evaluate-measure operation on the Payer Server to evaluate a Condition Category measure by executing CQL against patient data and produce a Risk Adjustment Bundle (a MeasureReport Bundle)
- Payer POST $davinci-ra.evaluate-measure result to Payer Server
- Provider GET $davinci-ra.evaluate-measure result from Payer Server
- Preconditions:
- An example HCC — HCC189 "Amputation Status, Lower Limb/Amputation Complications" — is specified in CQL as a digital Condition Category measure that details inclusion and exclusion criteria for HCC189.
- Payer Server is pre-populated with patient data, a Risk Adjustment Model Measure resource (which references HCC 189 Library resources), the referenced Library resources (which contain the CQL libraries for HCC189), and referenced ValueSet resources.
- Success Criteria: Payer produces a Risk Adjustment Coding Gap Report Bundle with expected coding gaps information for the test patient and is received by Provider
CSV file POST Scenario - Action:
- Payer POST a CSV file containing risk adjustment data to Payer's REST server.
- Payer REST server produces Risk Adjustment Coding Gap Report Bundle and POST it to a Payer FHIR Server.
- Provider GET the Risk Adjustment Coding Gap Report Bundle from Payer Server
- Preconditions:
- A CSV file is created using the CSV header defined by the IG
- The header of the REST request contains the address of the Payer FHIR Server.
- Success Criteria: Payer successfully POST the CSV file
- Bonus Point: Payer REST Server processes the CSV file and produces Risk Adjustment Coding Gap Report Bundle based on the data in the CSV file
Scenarios - Provider to Payer$davinci-ra.resolve Scenario - Action:
- Provider calls $resolve operation to resolve coding gaps and returns Risk Adjustment Bundle with DetectedIssues
- Provider POST the Risk Adjustment Bundle to Payer FHIR Server
- Preconditions:
- Server is pre-populated with Risk Adjustment Coding Gap Reports (generated by the Payer using $report) and DetectedIssue(s) that represent the Provider's proposed modification(s)
- Success Criteria: returns a Risk Adjustment Bundle (of type document) with a Composition, associated DetectedIssue(s), and supporting evidence resources for the test patient
- Bonus Point: Payer to Provider and Provider back to Payer end to end —
- Payer calls the $report operation and returns Risk Adjustment Coding Gap Report Bundle
- Payer POST the result of $report operation to Provider
- Provider reviews the reports, creates DetectedIssue(s), and calls $resolve operation to resolve coding gaps and returns Risk Adjustment Bundle with DetectedIssues
- Provider POST Risk Adjustment Bundle to Payer
— — — Reference Implementation End Point: https://cloud.alphora.com/sandbox/r4/ra/fhir/ There are two separate instances of Risk Adjustment validator set up in Touchstone. One points to the STU1 IG and another points to the CI Build which contains the STU2 content in development. Test Scripts: https://touchstone.aegis.net/touchstone/testdefinitions - All test scripts are located in: /FHIRSandbox/DaVinci/FHIR4-0-1-RA
- The test cases for Parameters are located in: /FHIRSandbox/DaVinci/FHIR4-0-1-RA/01-RAReport/04-RA-ReportParameters
- The test cases for results are located in: /FHIRSandbox/DaVinci/FHIR4-0-1-RA/01-RAReport/05-RA-ReportResults
Test Plan (STU1) : https://confluence.hl7.org/display/DVP/%24report+Test+Plan+Template Connectathon Manager: http://conman.clinfhir.com/?event=con31 Document Testing Results in the Connectathon Manager | 
