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To request an out-of-cycle ballot of a candidate standard/document, please complete this form.  Once completed by a sponsoring Work Group co-chair this form should be emailed to the Director of Technical Publications ( ).  Please fill in the information requested in the red-bordered areas.  For those unable to use the preferred method, a PDF version of this document can be printed and filled out by hand; please fax the completed form to headquarters (734-677-6622).  Incomplete and incorrectly completed forms will be returned to the submitter.  Questions should be directed to the Director of Technical Publications ( ).

Official Candidate Standard/ Document Name

Health Record Exchange (HRex) Implementation Guide

Clinical Data Exchange (CDex) Implementation Guide

Payer Data Exchange (PDex) Implementation Guide

Prior-Authorization Support (PAS) Implementation Guide

Name Change

Check here to indicate a name change and include the original document name below.


Standard Classification

Version 2

Version 3

CDA® and Related






(please specify)

The classification of standard to which your ballotable content belongs.  When possible, actual document names should also reflect this information.  This is most commonly needed for Version 2 and Version 3 standards development so please use "Other" for any other classification of standard and specify that standard.

Rationale Supporting Request

To ensure standards are available in order to support payors and providers in their need to meet dates in the CMS and ONC NPRMs.


Based on both the NPRMs (in particular the CMS NPRM) we are requesting changes in our HL7 IG ballot efforts for 2019.



1) The CMS NPRM has start dates for exchange of member clinical data starting 1/1/2020.

2) While we assume this date may move back, we still need to be prepared to have the IGs published as an STU in time for its use by payers and providers

3) Based on the current schedule, it is unlikely the IG will be published as an STU until Q1 of Calendar 2020.

4) We will use the input from NPRM comments as well as experience from May connectathon to produce more robust IGs.

Please provide rationale to support this Out-of-Cycle Ballot Request. This rationale will be evaluated by the TSC when considering approval of the request.

Balloting Level [1]

This is a new document.

Please check here to indicate that this is a new, previously un-balloted document.


For previously balloted documents, enter the last ballot cycle during which this document was balloted.  Example: May 2007.


(Please indicate) US Realm




For Comment Only

Standard for Trial Use

The level you expect this document to be balloted at in the requested ballot.  You will be contacted if this does not agree with our records.



The number of times the document has balloted at this level.

Examples: Normative 1 would be the first iteration of a Normative ballot; STU 3 would follow a STU 2 ballot; For Comment Only 2 would follow a For Comment Only 1 ballot.

Yes, Backwards Compatible

Not Applicable

Backwards Compatibility Status

Internally Developed

Externally Developed

Internally/Externally Developed

Requested Open Date

Open Date

July 1, 2019

Please provide a general time frame for the ballot, recognizing the need for TSC approval and a 30-day announcement preceding the ballot opening. Ballots are expected to run 30 days.

Responsible Work Groups

The co-chairs of the committees you identify will receive email copies of the ballots submitted.

Financial Management (PDex, PAS)      Approved: 2019-03-05

Patient Care (CDex)

Approved: 2019-03-11

Clinical Interoperability Council (HRex)

Approved: 2019-03-07

FMG (all)

Approved: 2019-03-06

Please list all WGs that retain or share ultimate responsibility for this document


Link to WG Meeting Minutes where this information was discussed and approved. It is important that the inclusion of this ballot document in a ballot cycle and the submission of this information has been approved by your committee.

Project Scope Statement

Yes, a Project Scope Statement for this project exists in Project Insight.  PI ID:   __________

HRex 1494

CDex 1495

PDex 1489

PAS 1490

Has a project scope statement for this item been uploaded to Project Insight?  It is only required once per release for any given ballot document. 

Document Description / Changes

The  HRex Framework Implementation Guide is a US Realm specific framework that identifies and constrains, where necessary, common FHIR artifacts (e.g. US Core Profiles, QI Core Profiles, Argonaut Profiles) for one or more FHIR releases, and interactions (Push, Pull, Request, Operations, CDS Hooks)  necessary for Da Vinci and  other implementation guides.


The CDex Implementation Guide identifies artifacts and interactions defined in the HRex Framework, along with 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).


The PDex Implementation Guide identifies artifact and interactions defined in the HRex Framework along specific along with search criteria, conformance, provenance, and other relevant requirements to support specific exchanges of clinical information between payers and providers.  This implementation guide will provide a standard for adoption by both payers and providers for the exchange of payer information regarding current and prior healthcare services received by the patient/member to more effectively manage the patients care.


The PAS Implementation Guide identifies and constrains, where necessary, existing standards to facilitate a provider’s ability, in clinical workflow, to identify the need for payer prior-authorization, assemble necessary information from the patients’ medical record, identify and supply missing information and submit it to the payer electronically. Payers should be able to respond to a number of requests for authorization in "real time" to allow the provider to move forward with treatment as soon as possible. This PSS builds on other implementation guides for the automation of coverage discovery (Coverage Requirements Discovery – CRD), definition of documentation and payer rules (Documentation Templates and Payer Rules) access to provider information (Clinical Data Exchange – CDex) and the Health Record Framework (HRex).

Please provide a description of the proposed document or the major changes to it since its last ballot.  This description will be used in both the Announcement of Ballot Pools document and other formal notices of this intent to ballot.


Provide a summary of changes of material interest (including all substantive changes) in the document since the last ballot.

Previously Balloted Information

If this document has been previously balloted, please identify the following

Yes, I have posted a Reconciliation Package to the Ballot Desktop for all previous Normative ballots of this document.

Did you post your reconciliation package for negative comment dispositions on the Ballot Desktop?  These packages are due two (2) weeks prior to the expected out-of-cycle ballot cycle opening.

Yes, I have advised negative voters of the disposition of their negative comments for each previous Normative ballot of this document.

Have you used the website or provided documentation (email correspondence for example) informing negative voters of the dispositions of their negative comments?

Yes, I have submitted negative voter Withdrawal or Retract Requests for each previous Normative ballot of this document.

Have you used the website or supplied all the proper documentation (email correspondence for example) to request withdrawal or retraction of negative votes from negative?


If there has been a name change for this document from its previous ballot, what was the previous name?

Additional Vote Recipients


In addition to the co-chairs receiving votes via email as they are submitted, supply any additional email addresses of stakeholders who should receive this information.  Please list the email addresses.


ANSI Information

The information below is required by ANSI.

Project Need

To standardize the exchanges between provider and payers and payers and payers

Briefly state the reason behind the need for this project.  This is required for all ballots.

Other Referenced standards


Does this document include text from an ISO or IEC standard?  If so, please cite those standards here

Unit of Measure



Both U.S. and Metric

Not Applicable

As required by ANSI, if measurements are introduced in this standards document, what is the measurement type from the choices available?

Consumer Product



Is this a consumer product?


Payer, providers, EHRs, HIT, government, Standards organizations,

Please identify the stakeholders.  For example, pharmaceutical, healthcare, etc.





For Office Use Only


Ballot Cycle Code


Document Code


ANSI/HL7 Designation





[1] If this is a domain with content being balloted at different levels, each level is its own ballot and should be defined by the content being balloted.