Da Vinci Clinical Data Exchange (CDex)
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Da Vinci Clinical Data Exchange (CDex), published by HL7 International - Patient Care Work Group. This is not an authorized publication; it is the continuous build for version 2.0.0). This version is based on the current content of https://github.com/HL7/davinci-ecdx/ and changes regularly. See the Directory of published versions

ValueSet: CDex Purpose of Use Value Set

Official URL: http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-POU Version: 2.0.0
Standards status: Draft Maturity Level: 1 Computable Name: CDexPOUCodes

Copyright/Legal: Used by permission of HL7 International all rights reserved Creative Commons License

The set of purpose of use codes for the requested data (the output of the task). This code set is composed of FHIR core Purpose of Use security labels and additional codes defined by this Guide.

References

This Value Set is draft content. The process for submitting the CDex Temporary Code System POU Codes for inclusion into HL7 Terminology (THO) ACTReason CodeSystem is underway. In addition, the editors will publish a final CDex POU value set as part of an STU update.

CDex Purpose of Use Value Set Hierarchy

The current state of healthcare data exchange is typically limited to a single, well-known and pre-established purpose-of-use (POU). The CDex Purpose of Use Value Set defines POU with a greater level of discrimination at the transaction level. These codes form a hierarchy where the child concepts have an IS-A relationship with the parents that rolls up to the 45 CFR 164.506 Treatment, Payment, and Health Care Operations (TPO) concepts. The table and figure below illustrate this hierarchy:

TPO HL7 ACTReason POU TPO Codes CDEX POU Codes
T TREAT TREAT*
T   treatment-noa**
P   payment-noa**
O   operations-noa**
P HPAYMT COVERAGE*
P HPAYMT CLMATTCH*
P HPAYMT COVAUTH*
O HOPERAT HQUALIMP*
O HOPERAT HDM*
T TREAT COC*
T   care-planning**
O   care-planning**
T   social-risk**
O   social-risk**

* HL7 ACTReason CodeSystem
** CDex Temporary Code System Codes

CDex Purpose of Use Value Set Heirarchy
POU-rollup.svg

Legend
POU-rollup-legend.svg

Using Not OtherWise Enumerated Codes

The Not OtherWise Enumerated Codes:

  • treatment-noa
  • payment-noa
  • operations-noa

do not define the detailed POU, and the implementer must supply an additional, alternate code. The resource fragment below shows their use:

{
    "resourceType": "Task",
...
  "input": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
                        "code": "data-query"
                    }
                ]
            },
            "valueString": "Condition?patient=cdex-example-patient&clinical-status=active,recurrance,remission"
        },
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                        "code": "purpose-of-use"
                    }
                ]
            },
            "valueCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                        "code": "treatment-noe"
                    },
                    {
                        "system": "http://example.org/CodeSystem/POU",
                        "code": "some-other-treatment-purpose"
                    }
                ]
            }
        }
....

Logical Definition (CLD)

This value set includes codes based on the following rules:

  • Include these codes as defined in http://terminology.hl7.org/CodeSystem/v3-ActReason
    CodeDisplayDefinition
    COVERAGEcoverage under policy or programTo perform one or more operations on information for conducting activities related to coverage under a program or policy.
    CLMATTCHclaim attachmentTo perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.
    COVAUTHcoverage authorizationTo perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.
    HQUALIMPhealth quality improvementTo perform one or more operations on information used for conducting administrative activities to improve health care quality.
    HDMhealthcare delivery managementTo perform one or more actions on information used for conducting administrative and contractual activities by or on behalf of organizational entities responsible for delivery of an individual's benefits in a healthcare program, health plan or insurance. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment.

    *Usage Note:* Examples of activities conducted under this purpose of use: provider profiling, risk adjustment, underwriting, fraud and abuse, quality improvement population health and care management. Aligns with HIPAA Operation POU minus coordination of care or other treatment related activities. Similar to the description in SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking.

    *Map:* Maps to ISO 14265 Classification Term "Administration of care for an individual subject of care" described as "To inform persons or processes responsible for enabling the availability of resources or funding or permissions for providing health care services to the subject of care."

    However, this classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.
    COCcoordination of careTo perform one or more actions on information in order to organize the provision and case management of an individual’s healthcare, including: Monitoring a person's goals, needs, and preferences; acting as the communication link between two or more participants concerned with a person's health and wellness; organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person; and ensuring safe, appropriate, non-duplicative, and effective integrated care.

    *Usage Note:* Use when describing these functions: 1. Monitoring a person’s goals, needs, and preferences. 2. Acting as the communication link between two or more participants concerned with a person's health and wellness. 3. Organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person. 4. Ensuring safe, appropriate, non-duplicative, and effective integrated care.

    The goal is to clearly differentiate this type of coordination of care from HIPAA Operations by specifying that these actions on information are undertaken in the provision of healthcare treatment.

    For similar uses of this concept, see SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking, which differentiates concepts of care coordination and case management for the provision of treatment as specifically distinct from activities related to health care delivery management and the operations of organizational entities involved in the delivery of healthcare.

    *Map:* Maps to ISO 14265 Classification Terms: "Support of care activities within the provider organisation for an individual subject of care" described as "To inform persons or processes enabling others to provide health care services to the subject of care." "Subject of Care Uses" described as "To inform the subject of care in support of his or her own interests."
    TREATtreatmentTo perform one or more operations on information for provision of health care.
  • Include these codes as defined in http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
    CodeDisplayDefinition
    care-planningCare PlanningRequest for data from payers or providers to determine how to deliver care for a particular patient, group or community.
    social-riskSocial RiskRequest for data from payers or other providers to assess of social risk, establishing coded health concerns/problems, creating patient driven goals, managing interventions, and measuring outcomes.
    payment-noePayment Not Otherwise Enumerated[Existing concepts do not define a more detailed [Payment as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html). Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.
    operations-noeOperations Not Otherwise EnumeratedExisting concepts do not define a more detailed [Healthcare Operations as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html). Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.
    treatment-noeTreatment Not Otherwise EnumeratedExisting concepts do not define a more detailed [Treatment as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html). Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.

 

Expansion

This value set contains 12 concepts

CodeSystemDisplayDefinition
  COVERAGEhttp://terminology.hl7.org/CodeSystem/v3-ActReasoncoverage under policy or program

To perform one or more operations on information for conducting activities related to coverage under a program or policy.

  CLMATTCHhttp://terminology.hl7.org/CodeSystem/v3-ActReasonclaim attachment

To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.

  COVAUTHhttp://terminology.hl7.org/CodeSystem/v3-ActReasoncoverage authorization

To perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.

  HQUALIMPhttp://terminology.hl7.org/CodeSystem/v3-ActReasonhealth quality improvement

To perform one or more operations on information used for conducting administrative activities to improve health care quality.

  HDMhttp://terminology.hl7.org/CodeSystem/v3-ActReasonhealthcare delivery management

To perform one or more actions on information used for conducting administrative and contractual activities by or on behalf of organizational entities responsible for delivery of an individual's benefits in a healthcare program, health plan or insurance. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment.

Usage Note: Examples of activities conducted under this purpose of use: provider profiling, risk adjustment, underwriting, fraud and abuse, quality improvement population health and care management. Aligns with HIPAA Operation POU minus coordination of care or other treatment related activities. Similar to the description in SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking.

Map: Maps to ISO 14265 Classification Term "Administration of care for an individual subject of care" described as "To inform persons or processes responsible for enabling the availability of resources or funding or permissions for providing health care services to the subject of care."

However, this classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.

  COChttp://terminology.hl7.org/CodeSystem/v3-ActReasoncoordination of care

To perform one or more actions on information in order to organize the provision and case management of an individual’s healthcare, including: Monitoring a person's goals, needs, and preferences; acting as the communication link between two or more participants concerned with a person's health and wellness; organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person; and ensuring safe, appropriate, non-duplicative, and effective integrated care.

Usage Note: Use when describing these functions: 1. Monitoring a person’s goals, needs, and preferences. 2. Acting as the communication link between two or more participants concerned with a person's health and wellness. 3. Organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person. 4. Ensuring safe, appropriate, non-duplicative, and effective integrated care.

The goal is to clearly differentiate this type of coordination of care from HIPAA Operations by specifying that these actions on information are undertaken in the provision of healthcare treatment.

For similar uses of this concept, see SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking, which differentiates concepts of care coordination and case management for the provision of treatment as specifically distinct from activities related to health care delivery management and the operations of organizational entities involved in the delivery of healthcare.

Map: Maps to ISO 14265 Classification Terms: "Support of care activities within the provider organisation for an individual subject of care" described as "To inform persons or processes enabling others to provide health care services to the subject of care." "Subject of Care Uses" described as "To inform the subject of care in support of his or her own interests."

  TREAThttp://terminology.hl7.org/CodeSystem/v3-ActReasontreatment

To perform one or more operations on information for provision of health care.

  care-planninghttp://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-tempCare Planning

Request for data from payers or providers to determine how to deliver care for a particular patient, group or community.

  social-riskhttp://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-tempSocial Risk

Request for data from payers or other providers to assess of social risk, establishing coded health concerns/problems, creating patient driven goals, managing interventions, and measuring outcomes.

  payment-noehttp://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-tempPayment Not Otherwise Enumerated

[Existing concepts do not define a more detailed Payment as defined by HIPAA. Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.

  operations-noehttp://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-tempOperations Not Otherwise Enumerated

Existing concepts do not define a more detailed Healthcare Operations as defined by HIPAA. Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.

  treatment-noehttp://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-tempTreatment Not Otherwise Enumerated

Existing concepts do not define a more detailed Treatment as defined by HIPAA. Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.


Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code