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The Clinical Data exchange (CDex) is part of the larger Da Vinci use case for Health Record exchange (HRex).

After careful evaluation, the eHRx project was decomposed into four independent efforts (and tied to 4 separate PSSs). The exchange of Quality Measures was included in the existing work on the Data Exchange for Quality Measures (DEQM) that is sponsored by the CQI workgroup. The exchange of Payer Data (PDex) is sponsored by Financial Management. The overall HRex Framework is planned to be sponsored by the Clinical Interoperability Council (CIC) and we looking to a combination of Structured Documents, Patient Care and Attachments to sponsor the work on e Clinical Data exchange (CDex).

The scope of the CDex project is to defined combinations of exchange methods (push, pull, subscribe, …), specific payloads (Documents, Bundles, and Individual Resources), search criteria, conformance, provenance, and other relevant requirements to support specific exchanges of clinical information between provider and other providers and/or payers. The goal is to identify, document and constrain very specific patterns of exchange so that providers and payers can reliably exchange information for patient care (including coordination of care), risk adjustment, quality reporting, identifying that requested services are necessary and appropriate (e.g. should be covered by the payer) and other uses that may be documented as part of this effort. Clinical data payloads will include C-CDA, C-CDA on FHIR, compositions, bundles, specific resources, and bulk data exchange. This list is intended to be illustrative and not prescriptive. The project will address patient consent where appropriate. 

This project will reference, where possible the "standards" defined by the Health Record exchange (HRex) Framework Implementation Guide which in turn will utilize prior work from Argonaut, US Core and QI Core effort for FHIR DSTU2, STU3, and R4. The following diagram depicts the anticipated scope of the HRex Framework IG.

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The ultimate goal is to support the exchange of provider data on specific patients/members for better patient care with other providers and payers using technology that support FHIR DSTU2, STU3, and R4 releases release of the FHIR standard.

The project team plans to work with existing FHIR artifacts where possible. If changes are necessary, the project team will work with the responsible Work Group to review and implement (via tracker items or new PSS) any necessary enhancements to base FHIR resources, extensions, and/or profiles.

Updated to R4 only

3.b. Project Need

Providers and Payers need access to provider information regarding current and prior healthcare services planned for or received by the patient/member to more effectively manage the patients care. Currently, no FHIR implementation guides exist to standardize the method of exchange (push, pull, triggers, subscription, etc.) and the formal representation (e.g. Documents, Bundles, Profiles and Vocabulary) for the range of exchanges between providers and providers or providers and payers of current and emerging interest to the involved parties. This implementation guide will provide a standard for adoption by both payers and providers for the exchange of provider originated information.


If you checked New Product Definition or New Product Family, please define below:

For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?


5. Project Intent (check all that apply)