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

After careful evaluation, the HRex 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 exchange of provider originated data or Clinical Data exchange (CDex) is sponsored by Patient Care. The overall HRex Framework described in the PSS is planned to be sponsored by CIC as a US Realm specific framework that defines common elements and interactions necessary for the other implementation guides.

The following depicts the relationship of the multiple Da Vinci use cases developed during 2018 and planned for 2019.  Many of these will use the HRex Framework as their basis for defining the use of specific FHIR artifacts.

The scope of the HRex Framework project is to defined combinations of exchange methods (push, pull, subscribe, CDS Hooks, …), specific payloads (Documents, Bundles, and Individual Resources), search criteria, conformance, provenance, and other relevant requirements to support specific exchanges of clinical information between: 1) providers, 2) a provider and a payer, 3) a payer and providers, and/or a provider and any third party involved in value based care (e.g. a quality management organization). 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. The specific use case driven implementation guides will inherit the HRex Framework to avoid defining the same exchanges, profiles, constraints in multiple guides with slightly differed variations.

This project will reference, where possible, the prior work from Argonaut, US Core and QI Core effort for FHIR R4. The following diagram depicts the anticipated scope of the eHRx Framework IG.

The ultimate goal is to provide a framework from which specific implementation guides can be developed with reduces effort and potential conflicting definitions to support the exchange of provider and payer data on specific patients/members or groups of patients/members to reduce provider and payer burden, and improve patient care using technology that supports FHIR R4 release of the FHIR standard. The project will address patient consent where appropriate. 

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.

Project Scope was modified to focus on R4 only and not on DSTU2 or STU3 (approved by sponsoring WG March 2020

3.b. Project Need

Providers and Payers need to exchange information regarding prior and current 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. To satisfy this need, a number of specific implementation guides will need to be created, each of which will span multiple version of FHIR (DSTU2, STU3, R4,...) and multiple methods of exchange. To avoid defining the same profiles and exchanges multiple times, we propose to create a US Realm focused Framework Implementation guide for use by Da Vinci and other FHIR standards development efforts to defined the appropriate use of the exchange methods, specific FHIR resources, profiles, values sets, etc. once and allow them to be reference by each of the specific implementation guides. This implementation guide will provide a standard framework for inclusion in multiple use case specific implementation guides focused on the exchange of provider and payer originated information to improve patient care and reduce provider and payer burden.