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

Persisting Results

When the Documentation Templates and Rules (DTR) application has collected all of the necessary information, it must save the results of the data collection to the patient record. This implementation guide describes two methods for saving the collected information: a text block in the Electronic Health Record (EHR) System and a QuestionnaireResponse.

Text Block

Many EHR Systems do not currently support writing a QuestionnaireResponse into a FHIR server. However, The US Core Implementation Guide (IG) now includes a DocumentReference Profile, which allows clients, like the DTR application, to write notes into the EHR System’s FHIR server. The following section describes how the QuestionnaireResponse that is generated through the processes described in Section 4.4.3 and Section 4.4.4 can be transformed into text such that it may be saved as a note in the EHR system.

QuestionnaireResponse transformation process

The information that is collected (via the Questionnaire interaction with the user) SHOULD be written to the EHR via the available FHIR API if possible. The results of the questionnaireResponse SHALL be saved as the FHIR resource and/or as a human readable format that is supported by the EHR.

The DTR application SHOULD support transforming a DTR-QuestionnaireResponse resource into a Portable Document Format (PDF) representation. DTR applications SHOULD ensure that the document indicates whether data was entered by the provider in reponse to the questionnaire or retrieved from the EHR directly.

The DTR application SHOULD store this information in the EHR - either as a DocumentReference resource conforming to the US Core profile or in another EHR-appropriate form. The generated PDF SHOULD be recorded in DocumentReference.content.attachment.data. DocumentReference.content.attachment.contentType SHOULD be application/pdf

Note to ballot comments

This is an area the project is explicitly seeking comments on. Please provide any details on constraints that should be applied to the document generation process.

Interaction with EHR

EHR systems that conform to US Core STU3 allow for the creation of DocumentationReference resources through a FHIR API. As such, the DTR application should use the typical FHIR create interaction to write the documentation into the EHR.


The DTR application creates a QuestionnaireResponse resource through the course of normal operation. This resource may be saved to the patient record in the EHR system of the healthcare provider if it is supported. It may also be transmitted to the Payer IT system.

Interaction with Payer API

The Payer IT system should support the FHIR create interaction to allow the DTR application to send the QuestionnaireResponse resource to the payer. The FHIR endpoint for the payer may require authentication. If it is required, it SHALL follow the procedures described in Section 4.4.1 - Authentication of SMART on FHIR application to payer API.