Da Vinci - Documentation Templates and Rules, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.1.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-dtr/ and changes regularly. See the Directory of published versions
Page standards status: Informative |
This guide is based on the HL7 FHIR standard, the US Core 3.1.1 and 6.1 Implementation Guides, as well as the SMART on FHIR, Clinical Quality Language (CQL), and Structured Data Capture (SDC) specifications which build additional capabilities on top of FHIR. This architecture is intended to maximize the number of provider systems that conform to this guide, as well as to allow for easy growth and extensibility of system capabilities in the future.
Implementers of this specification therefore will need to understand some basic information about these specifications.
This IG uses terminology, notations, and design principles that are specific to FHIR. It's important to be familiar with some of the basic principles of FHIR as well as general guidance on how to read FHIR specifications. Readers who are unfamiliar with FHIR are encouraged to read the following prior to reading the rest of this IG.
This IG supports the R4 version of the FHIR standard.
This IG leverages and builds on the US Core 3.1.1 and 6.1 IGs defined by HL7 for sharing human EHR data in the US. Implementers need to familiarize themselves with the profiles in US Core, as well as the underlying Structured Data Capture (SDC) profiles being used.
FHIR Version: | FHIR R4 (4.0.1) |
US Core: | Release 6.1 |
Release 3.1.1 | |
Profiles: | Standard Questionnaire |
Adaptive Questionnaire | |
QuestionnaireResponse | |
Task |
Other resources may also be accessed as part of the CQL rules.
Implementers will need the knowledge of US Core 3.1.1 and 6.1 IGs to access information for pre population via CQL calls to 21st Century compliant FHIR APIs. Some of the implementations will need to support US Core requirements. (Refer to the CapabilityStatements.)
Guidance is being provided to allow DTR functionality to be invoked outside of regular EHR clinical workflows using a SMART on FHIR app or an EHR-based "Native" app to provide a consistent way of evaluating payer rules and documentation requirements across EHR implementations. As such client implementers creating a SMART App will also need to be familiar with the SMART on FHIR specification. (Payer implementers only need to be familiar with the SMART on FHIR specification if they plan to develop SMART apps for launch by CDS Hooks or other purposes.)
Clinical Quality Language (CQL) is used to query the Electronic Health Record (EHR) FHIR server to pre-populate the DTR Questionnaire and may also be used to guide which questions need to be answered. DTR Servers will need to construct Questionnaires containing CQL references and CQL libraries that perform the necessary logic. DTR clients will need to be able to execute the proved CQL.
This IG leverages several architectural to FHIR data exchange:
The choice of using REST to access and store data from the SMART app is driven by the SMART on FHIR architecture.
The choice of using operations for $next-question
for adaptive forms was made by the SDC implementation guide.
The decision tree navigation in the HRex Approaches to Exchanging Data decision tree that led to these approaches where decisions needed to be made as part of DTR are as follows:
Access to payer Questionnaire package:
Reporting of Questionnaire issues: