Da Vinci - Documentation Templates and Rules 0.2.0 - STU Ballot

Da Vinci - Documentation Templates and Rules, HL7 Clinical Decision Support Work Group - CI build for vesion 0.2.0). This version is based on the current content of https://github.com/HL7/davinci-dtr/ and changes regularly. See the Directory of published versions

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The Documentation Templates and Rules (DTR) Implementation Guide (IG) specifies how payer rules can be executed in a provider context to ensure that documentation requirements are met. The IG is a companion to the Coverage Requirements Discovery (CRD) IG, which uses Clinical Decision Support (CDS) Hooks to query payers to determine if there are documentation requirements for a proposed medication, procedure or other service. When those requirements exist, CDS Hooks Cards will be returned with information about the requirements. This IG leverages the ability of CDS Hooks to link to a Substitutable Medical Applications, Reusable Technologies (SMART) on FHIR app to launch and execute payer rules. The IG specifies how to maintain the transaction state as the workflow transitions from CDS Hooks to a SMART on FHIR app. It describes the interactions between the SMART on FHIR app and the payer IT system to retrieve documentation requirements, in the form of CQL and a FHIR Questionnaire resource.

Both DTR and CRD are being balloted and will be published as “standards for trial use”. As such, both are expected to evolve based on implementer experience. FHIR’s approach to standards development is to release specifications that we deem “implementation-ready” for use in the real world and adapt based on feedback. Given that both specifications are at the same level of maturity, their interdependence is not problematic. The dependence relationship does mean that DTR will not be able to be locked down as a normative specification until CRD has also reached the same maturity.

This IG leverages Clinical Quality Language (CQL) to allow payers to inspect a patient’s record for the necessary information related to the required documentation for a proposed item. The IG details the use of a payer provided Questionnaire resource and results from CQL execution to generate a QuestionnaireResponse resource containing the necessary information. This IG also provides methods for sending that information to the payer or for persistance in the provider’s Electronic Health Record (EHR) system.

Although not detailed in this IG it may be possible to achieve the same level of integration with a native EHR application instead of the SMART on FHIR app. The same payer sourced FHIR Questionnaire and CQL could be consumed by the native EHR application. The interface for exchanging data would need to be developed further in a method that achieves the same level of interoperability that the SMART on FHIR app achieves.

Content and Organization

The implementation guide is organized into the following sections:

  • Use Case Provides examples of how this specification can be used by provider and payer organizations.
  • Underlying Technologies Describes the underlying technologies this specification builds upon.
  • Specification Provides the technical conformance details for the specification.
  • Resources Introduces and provides links to the FHIR profiles.
  • Credits Identifies the individuals and organizations involved in developing this implementation guide.