Da Vinci Clinical Data Exchange (CDex)
2.1.0 - STU 2.1

Da Vinci Clinical Data Exchange (CDex), published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ecdx/ and changes regularly. See the Directory of published versions

## Change Log

Page standards status: Informative

### CI Build (Anticipated Version = 3.0.0-Ballot)

- Publication Date: TBD
- URL: https://build.fhir.org/ig/HL7/davinci-ecdx/
- Based on FHIR version: 4.0.1

#### What's new in Version 3.0.0-Ballot of CDex:

The ballot addresses the following:

1. Added a new $submit-attachment parameter, a payer-assigned "administrative reference number" identifier. Used only for prior authorization solicited attachments, the payer may assign an administrative reference number in addition to the tracking control number/ACN. By using a combination of identifiers, the Payer can guarantee global uniqueness for associating attachments to the claim or prior authorization.
2. Updated the signature requirements for consistency and reliability.

   #### Changes:

Implementers submitted over two dozen trackers since the publication of 2.0.0 and 2.1.0. We have addressed them and applied the changes listed below:

Summary (Change Category) Jira Issue, Link to Updated Content

TODO:

1. ​Triaged: (Correction) Need to sort out QuestionnaireResponse Profile between US Core, CDex and DTR and SDC (Correction) FHIR-46527 See Changes Here
2. ​Triaged: Update LOINC Attachment code ValueSet (Correction) FHIR-51430 See Changes Here

Non-Substantive Changes

1. Applied: Shorten Artifact descriptions (Enhancement) FHIR-48796 See Changes Here
2. Applied: Clarify the source of Tracking Id (Clarification) FHIR-48435 See Changes Here
3. Applied: Update the section "Requesting Attachments Background" (Clarification) FHIR-48407 See Changes Here
4. Applied: Clarify Purpose of Use requirements (Clarification) FHIR-48403 See Changes Here
5. Applied: Provide guidance when sending large payloads using $submit-attachment (Clarification) FHIR-48271 See Changes Here
6. Partially Pre-Applied Use same name style for naming slices in StructureDefinitions (Correction) FHIR-50933 See Changes Here
7. Resolved - change required: Add rationale why Task supports only a single query, codes, or questionnaires (Clarification) FHIR-45981 See Changes Here
8. Applied: Clarify language the nature of the operation what acceptance/failure (Clarification) FHIR-51058 See Changes
   - OperationDefinition: Submit Attachment Operation
   - Sending Attachments
9. Applied: Remove he term "enveloping" to describe CDex signatures (Correction) FHIR-51112 See Changes Here

Substantive Changes

1. Applied: Add a new $submit-attachment parameter for administrative reference number (Enhancement) FHIR-49828 See Changes
   - Submit Attachment Operation
   - CDex Task Attachment Request Profile
   - Sending Attachments
   - Requesting Attachments Using Attachments Codes
   - Requesting Attachments Using Questionnaires
   - CDex Temporary Code System
   - CDex Parameters Example 5
   - CDex Task Example 20
   - CDex Task Example 22
   - CDex Task Example 23
   - CDex Task Example 24
   - CDex Task Example 25
   - CDex Task Example 28
   - CDex Task Example 29
2. Resolved - change required: Change Response to Post Task to 201 (Correction) FHIR-50211 See Changes Here

Breaking Changes

1. Part Applied: Update signature requirements for consistency and reliability (Enhancement) FHIR-51143 See Changes
   - Signatures
   - CDex Digital Signature Profile
   - CDEX SearchSet Bundle with Digital Signature Example
   - CDEX Document with Digital Signature Example
   - CDex Parameters Example 2
   - CDex QuestionnaireResponse Example 4
2. Applied: Limit Signature Profile to digital signatures and remove the CDex Identifier Types Value Set (Enhancement) FHIR-51146 See Changes
   - CDex Digital Signature Profile
   - CDex Signature Bundle Profile
   - CDex SDC QuestionnaireResponse Profile

### Version = 2.1.0

- Publication Date: 2025-1-15
- URL: https://hl7.org/fhir/us/davinci-cdex/STU2.1
- Based on FHIR version: 4.0.1 This STU Update of The Da Vinci Clinical Data Exchange (CDex) Implementation Guide is the fourth published version of this guide. The sponsoring HL7 International Payer/Provider Information Exchange Work Group members agreed to and voted on the resolution of the community review comments and edits to this guide.

#### What's new in Version 2.1.0 of CDex:

See the 2.1.0-snapshot version below

#### Changes:

These changes are the result of the community review of the 2.1.0-snapshot version

Status: Summary (Jira Issue) Link to Change

1. Applied: (Enhancement) Add guidance that should not bypass BR guides FHIR-48404 See Changes Here and See Changes Here
2. Applied: (Enhancement) Require adherence to Da Vinci Guiding Principles FHIR-48406 See Changes Here
3. Applied: (Enhancement) Update Figure FHIR-48384 See Changes Here
4. Applied: (Clarification) Remove conflicting guidance on Quality Measure and Risk Adjustment FHIR-48841

### Version = 2.1.0-snapshot

- Publication Date: 2024-09-11
- URL: https://hl7.org/fhir/us/davinci-cdex/STU2.1-snapshot
- Based on FHIR version: 4.0.1

This Snapshot version of The Da Vinci Clinical Data Exchange (CDex) Implementation Guide is the proposed STU update of this guide and is published for community review prior to final publication of version 2.1.0. The members of the sponsoring HL7 International Payer/Provider Information Exchange Work Group agreed to and voted on the resolution of the community comments and edits to this guide.

#### What's new in Version 2.1.0-snapshot of CDex:

1. Support for US Core 6.1.0 and US Core 7.0.0.
2. Updated guidance on Using CDex Attachments with DaVinci PAS page to align with Da Vinci PAS v 2.0.1 Guide's, Request for Additional Information page.
3. A new section on topic-based subscriptions based on the Subscription R5 Backport Implementation Guide implementation guide.
4. Updated guidance on discovery of patient ids based on FAST's Interoperable Digital Identity and Patient Matching implementation guide.
5. Version 2.0.0 Draft content about using Questionnaires with the Task-based Approach and Attachments updated to Trial Use.
6. A new design section explains the IG’s choice of exchange architecture in terms of the Approaches to Exchanging FHIR Data page.
7. Task state diagram for the CDex Task profiles.

#### Changes:

These changes are the result of the trackers listed below.

Status: Summary (Jira Issue) Link to Change

1. Applied: (Correction) Update diagram to "Provider submitted requested attachments to the Payer" FHIR-38604 See Changes Here
2. Applied: (Enhancement) Add profile for $submit-attachment Parameters resource FHIR-41336 See Changes Here
3. Applied: (Correction) Update `meta.tag.system` cardinality to 1..1 FHIR-43618 See Changes Here
4. Applied: (Clarification) Clarify when to use CDex vs PAS for attachments FHIR-44870 See Changes Here
5. Applied: (Enhancement) Include PWK01 attachment codes FHIR-44871 See Changes:
   - CDex LOINC Attachment Codes Value Set
   - CDex PWK01 Attachment Report Type Code Value Set
   - CDex Task Attachment Request Profile
   - CDex Parameters Submit Attachment Profile
   - Requesting Attachments Using Attachments Codes
6. Applied: (Enhancement) Correct X12 278 Data Element Mappings FHIR-44875 See Changes Here
7. Applied: (Clarification) Change Task.input "payer-url" to "PayerURL" to align with PAS Task FHIR-44883 See Changes Here and Here
8. Applied: (Clarification) Change Task.input "code" to "AttachmentsNeeded" to align with PAS Task FHIR-44884 See Changes Here and Here
9. Applied: (Clarification) Change Task.input "questionnaire" slice to "QuestionnaireContext" to align with PAS Task FHIR-44885 See Changes Here and Here
10. Applied: (Clarification) Fix X12 277RFAI-v6020 mapping for Line Items FHIR-45298 See Changes Here
11. Applied: (Correction) Add Business Status to Task FHIR-45299 See Changes Here
12. Applied: (Correction) Remove self referencing instantiates in CapabilityStatements FHIR-45322 See Changes:
    - Data Consumer Client CapabilityStatement
    - Data Consumer Server CapabilityStatement
    - Data Source Client CapabilityStatement
    - Data Source Server CapabilityStatement
13. Applied: (Enhancement) Update Version 2.0.0 Draft content to Trial Use FHIR-45409
14. Applied: (Enhancement) update to support topic based subscriptions FHIR-45628 See Changes:
    - Polling vs Subscriptions
    - Data Consumer Client CapabilityStatement
    - Data Source Server CapabilityStatement
    - Inline Subscription Task Scenario1 Subscription Requested
    - Inline Subscription Task Scenario1 Subscription Active
    - Inline Subscription Task Scenario1 Subscription Notification
    - CDex Capabilitystatement Inline Example
15. Applied:(Enhancement) Add design section to background page FHIR-45884 See Changes Here
16. Applied:(Enhancement) Add Task State diagram to specification FHIR-46004 See Changes:
    - Task State Machine
    - Requesting Attachments Using Attachment Codes
    - Requesting Attachments Using Questionnaires
17. Applied:(Enhancement) Change Task.input:QuestionnaireContext max from 1 to * FHIR-46093 See Changes Here and Here
18. Applied:(Enhancement) Add Task Based approach as an option for the discovery of a member’s FHIR_ID FHIR-45982 See Changes Here
19. Applied:(Enhancement) Remove FAST STU note and add guidance on using FAST's The Interoperable Digital Identity and Patient Matching guide FHIR-45985 See Changes Here and Here
20. Applied:(Enhancement) Add "Support" menu item FHIR-46349 See Changes Here
21. Applied: (Enhancement) Support both US-Core 3.1.1 and 6.1.0 FHIR-46507
22. Applied: (Enhancement) Add link to flowcharts images to downloads page FHIR-46508 See Changes Here
23. Applied: (Correction) Copy editing changes prior to comment period to ensure accuracy, clarity, and readability. FHIR-46509 For example, See Changes:
    - How To Read This Guide
    - Sensitive and Confidential Data
24. Applied: (Correction) Fix Typo and ordering in Task Data Request Profile FHIR-46294 See Changes Here
25. Applied: (Correction) Add Task.authoredOn to list of mandatory elements in the CDex Task Data Request Profile description. FHIR-46296 See Changes Here
26. Applied: (Correction) Change page statuses FHIR-46563 For example See Changes Here
27. Applied: (Enhancement) Add endpoint discovery guidance for Unsolicited Attachments FHIR-46443 See Changes Here
28. Applied: (Enhancement) Support both US-Core 3.1.1 and 6.1.0 and 7.0.0 FHIR-47303

### Version = 2.0.0

- Publication Date: 2023-01-30
- URL: http://hl7.org/fhir/us/davinci-cdex/STU2
- Based on FHIR version: 4.0.1

This STU2 version of The Da Vinci Clinical Data Exchange (CDex) Implementation Guide is the third published version of this guide and is the result of the 2022 September HL7 balloting process. The resulting resolution of the community comments and edits to this guide has been agreed to and voted on by the members of the sponsoring HL7 International Patient Care and Payer/Provider Information Exchange Work Groups.

#### What's new in Version 2.0.0 of CDex:

1. New Requesting Attachments Using Questionnaires functionality. In prior versions, CDex supported requested attachments using the request model of LOINC attachment codes, and the provider typically submitted CCDA or PDF documents in response. In this version, CDex aligns with DTR functionality and provide the ability to request attachment using Questionnaire, CQL, and QuestionnaireResponse as supported by DTR when there is no transition into/out of X12 transactions in the interactions. In addition, this approach will enable specific requests for missing data and avoid unnecessary document formats, yet still provide the ability for signature attestation if required.
2. New Task-Based transactions functionality for Using Questionnaire as Task Input. In prior versions, CDex Task Based Approach supported requests using the request model of FHIR RESTful query syntax, codes, and free-text. As a result, the provider typically returned references to FHIR Bundles. Similar to the Attachments updates, this added functionality leverages DTR and enables specific requests for missing data, avoiding unnecessary use of Bundles.
3. Improved navigation:
   - Menu Bar drop-downs for all the pages to allow faster navigation to a specific topic
   - Re-organization of FHIR Artifacts by transaction type. This version has several FHIR artifacts and dozens of examples grouped by Attachments, Task-Based Approach, and Signatures.
4. Conforming to CDex Attachments and Conforming to CDex Task Based Approach, including interactions for each role and the conformance resource and terminology that makes them unique.
5. After receiving many comments on CDex POU support, the CDex Purpose of Use Value Set now includes a hierarchy to the base "Treatment", "Payment", or "Health Care Operations" (TPO) concepts.
6. More examples, including examples of failed signature verifications, signed QuestionnaireResponse, and requesting Attachments for prior authorization using Questionnaire.

#### Changes:

These changes are the result of over 60 trackers listed below. They include the 2022 September HL7 balloting process and non-ballot issues.

##### September 2022 ballot and non-ballot comments and links to the updated content are below:

Status: Summary (Jira Issue) Link to Change

1. Applied: Correct $submit-attachment input parameter Typo. (FHIR-37956) and (FHIR-38175) See Changes Here
2. Applied: Correct claim flow diagram typo (FHIR-38060) See Changes Here
3. Applied: Added missing service line item extension to CDex Task Attachment Request Profile (FHIR-38070) See Changes Here
4. Applied: Document POU ValueSet Hierarchy to TPO (FHIR-38142) See Changes Here
5. Applied: DS4P should be evaluated before required (FHIR-38144) See Changes Here
6. Applied: Correct capitalization (FHIR-38145) See Changes Here
7. Applied: Change 277 to: “277 Request for Additional Information (RFAI)” (FHIR-38152) See Changes Here
8. Applied: Update sentence (FHIR-38153) See Changes Here
9. Applied: Correct Typo (FHIR-38154) See Changes Here
10. Applied: Modify sentence (FHIR-38155) See Changes Here
11. Applied: Change X12n 277 message to X12n 277 RFAI transaction. (FHIR-38156) See Changes Here
12. Applied: Update Data Elements table (FHIR-38172) See Changes Here and Here
13. Applied: Update Data Elements table (FHIR-38174) See Changes Here
14. Applied:Change X12n 275 message to X12n 275 transaction (FHIR-38177) See Changes Here
15. Applied:Change all documents to submitted documents (FHIR-38178) See Changes Here
16. Applied: Remove HIPAA compliance language (FHIR-38179) See Changes Here
17. Applied: Change Claim to claim or prior authorization (FHIR-38184) See Changes Here
18. Applied: Normalize term “prior authorization” (FHIR-38186) See Changes Here
19. Applied: Update Grammar (FHIR-38187) See Changes Here
20. Applied: Clarify that signature support is not required (FHIR-38188) See Changes Here and Here
21. Applied: Clarify in operation that either an OrganizationId or ProviderId is required. Allow for both Ids to be sent in request.(FHIR-38189) See Changes:[
    - Here
    - Here
    - Here
    - Here
22. Applied: Change Task service date input parameter to min = 0 and required only for claims (FHIR-38191) See Changes Here and Here
23. Applied: Clarify conformance expectations (FHIR-38192) See Changes Here and Here
24. Applied: Clarify patient account number (FHIR-38194) See Changes Here
25. Applied: Task Infrastructure Elements (FHIR-38195) See Changes Here
26. Applied: Separate solicited and unsolicited attachments workflows (FHIR-38210) See Changes Here
27. Applied: Make LOINC code display and text consistent (FHIR-38233) See Changes Here
28. Applied: Fix Typo in example (FHIR-38236)w See Changes Here
29. Applied: Clarify Attachment Scope (FHIR-38240) See Changes Here
30. Applied: Expand Attachments and Task based approach to support Questionnaires and DTR (FHIR-38241) See Changes:
    - Pages:
      - Here
      - Here
    - Conformance Artifacts:
      - Here
      - Here
      - Here
      - Here
      - Here
    - Examples:
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
      - Here
31. Applied: Clarify when human involvement needed (FHIR-38242) See Changes Here
32. Applied: Add link to PAS Guidance on pended results (FHIR-38244) See Changes Here
33. Applied: Add POU for Attachment Request as optional input parameter (FHIR-38245) See Changes Here and Here
34. Applied: Correct operation name (FHIR-38253) See Changes Here
35. Applied: Change only accepts to only accept(FHIR-38255) See Changes Here
36. Applied: Clarify use of cdex-temp code system (FHIR-38259) See Changes Here and Here
37. Applied: Clarify use of data tagging (FHIR-38286) See Changes Here
38. Applied: Updated X12 element mappings and X12 required citations (FHIR-38287) See Changes Here and Changes Here
39. Applied: Clarify how to find patient FHIR ID (FHIR-38318) See Changes Here
40. Applied: Clarify X12 Compatibility (FHIR-38326) See Changes Here
41. Applied: Add Qualifier to Signed Document Bundle (FHIR-38327) See Changes Here
42. Applied: Remove words transaction layer (FHIR-38328) See Changes Here
43. Applied: Word change analogs to fields (FHIR-38330) See Changes Here
44. Applied: Correct rendering of CCDA (FHIR-38367) See Changes Here
45. Applied: removed '*' from button bar (FHIR-38368) See Changes Here
46. Applied: Change follows to adheres to (FHIR-38576) See Changes Here
47. Applied: Revise section 'what Do Payers Do with Clinical Information?' (FHIR-38578) See Changes Here
48. Applied: Clarify when CDex is used instead of other guides (FHIR-38585) See Changes Here
49. Applied: Remove the HIE paragraph (FHIR-38588) See Changes Here
50. Applied: Create failed signature example transaction (FHIR-38596) See Changes Here
51. Applied: Clarify benefits of POU element (FHIR-38598) See Changes Here
52. Applied: change SHOULD to SHALL (FHIR-38599) See Changes Here
53. Applied: Correct Preconditions and Assumptions (FHIR-38600) See Changes Here
54. Applied: Correct Preconditions and Assumptions (FHIR-38601) See Changes Here
55. Applied: Update polling frequency guidance(FHIR-38602) See Changes Here
56. Applied: Remove trading partner agreement statement (FHIR-38603) See Changes Here
57. Applied: Clarify association comment and assign FMM levels to guide (FHIR-38605) See Changes Here
58. Applied: Clarify Profile relationship to X12 (FHIR-38612) See Changes Here
59. Applied: Change $submit-attachment's Attachment input parameter to min=1. (FHIR-38632) See Changes Here
60. Applied: Change Tracking-id.system to Must Support; and $submit-attachment TrackingId to type Identifier. (FHIR-39337) See Changes Here and Here
61. Applied: Update NPI codesystem (FHIR-39626) See Changes Here

### Version = 2.0.0-ballot

- Publication Date: 2022-08-01
- URL: http://hl7.org/fhir/us/davinci-cdex/2022Sep/
- Based on FHIR version: 4.0.1

#### Changes:

Da Vinci CDEX 2022 September Ballot. This ballot is restricted to the Draft content in the STU 1.1.0 version of CDex. The draft content includes 1) requesting and sending attachments and 2) communicating the purpose of use in Task Based Queries.

### Version = 1.1.0

- Publication Date: 2022-08-01
- URL: https://hl7.org/fhir/us/davinci-cdex/STU1.1/
- Based on FHIR version: 4.0.1

This STU1.1 version of The Da Vinci Clinical Data Exchange (CDex) Implementation Guide is the second published version of this guide and is the result of the 2022 May HL7 balloting process. The resulting resolution of the community comments and edits to the guide has been agreed to and voted on by the members of the sponsoring HL7 International Patient Care and Payer/Provider Information Exchange Work Groups.

#### What’s new in Version 1.1.0 of CDex:

- This content is DRAFT and is open for review. An Attachments section documenting how to exchange attachments for claims or prior authorization.
  - A Solicited and Unsolicited Attachments page documents the differences and similarities between solicited and unsolicited attachments workflows and the CDex transactions that can be used for each.
  - A Sending Attachments page that documents a FHIR-based approach for sending attachments for claims or prior authorization directly to a Payer.
  - A Requesting Attachments page to document a FHIR-based approach for requesting attachments for claims or prior authorization from a Provider.
  - A Using CDex Attachments with DaVinci PAS page that illustrates where in the PAS workflow the Payer could use CDEX to request attachments and the Provider could use CDEX to submit attachments.
- Signatures page sections for each transaction in CDex to provide specific guidance and rules to exchange signed data using FHIR and non-FHIR signatures.
- A Change Log page to document the changes across the versions of CDex
- More examples and example scenarios

#### Changes:

These changes are the result of almost 60 trackers listed below. They include the 2022 May HL7 balloting process, non-ballot issue, and Draft new content to meet anticipated Attachments legislation and rules.

##### May 2022 Ballot comments and links to the updated content are below::

Status: Summary (Jira Issue) Link to Change

1. Applied: Typo (FHIR-36819)
2. Applied: Typo (FHIR-36820)
3. Applied: Typo (FHIR-36821)
4. Applied: Add guidance when Signatures fail verification (FHIR-36842) See Changes:
   - Here
   - Here
   - Here
5. Applied: Add link to Example of Completed Task Request for Signed Data(FHIR-36844) See Changes Here
6. Applied: Clarification on who is signing(FHIR-36845) See Changes:
   - Here
   - Here
   - Here
   - Here
7. Applied: Clarify system level signatures (FHIR-36847) See Changes Here
8. Applied: Add example FlowSheets for each Transaction (FHIR-36854) See Changes Here
9. Applied: Typo (FHIR-36917)
10. Applied Update Figure (FHIR-36918) See Changes Here
11. Applied Clarify purpose for additional information (FHIR-36919) See Changes Here
12. Applied: Typo (FHIR-36921)
13. Applied: Typo (FHIR-36922)
14. Applied Clarify Figure 4 and associated text in 2.6.2 (FHIR-36985) See Changes:
    - Here
    - Here
15. Applied: Add non-document based attachment scenario (FHIR-36995) See Changes Here
16. Applied: Clarify association of data (FHIR-36996) See Changes Here
17. Applied: Document using CDex Attachments with DaVinci PAS (FHIR-36997) See Changes Here
18. Applied: Replace EHR with Source HIT (FHIR-36999) See Changes Here
19. Applied: Remove "preferred" approach from direct query (FHIR-37166) See Changes Here
20. Applied: Clarify H&P in diagram is object or behavior (FHIR-37225) See Changes Here
21. Applied: Clarify roles in attachments diagram(FHIR-37226) See Changes Here
22. Applied: Typo (FHIR-37227)
23. Applied: Typo (FHIR-37229)
24. Applied: Typo (FHIR-37233)
25. Applied: Clarify Figure 7 step 4 text to match the description (FHIR-37234) See Changes Here
26. Applied: Typo (FHIR-37235)
27. Applied: Rewrite introduction to Signature (FHIR-37243) See Changes Here
28. Applied: Add best practice guidance for signatures (FHIR-37246) See Changes Here
29. Applied: Remove "preferred" (FHIR-37248)
30. Applied: Use term Data Consumer consistently and Define how terms used in guide(FHIR-37250) See Changes Here
31. Applied: Re-write Signature sections(FHIR-37251) See Changes:
    - Here
    - Here
    - Here
32. Applied: Rewrite introduction to Signature (FHIR-37253) See Changes Here
33. Applied: Update Polling Guidance (FHIR-37260) See Changes Here

##### Non-Ballot Issues and links to the updated content are below::

Status: Summary (Jira Issue) Link to Change

1. Applied: Recommendation for exchanging purpose of use. (FHIR-30824) See Changes:
   - Here
   - Here
   - Here
   - Here
2. Applied Make Task.reasonReference.identifer 0…1 MS (FHIR-35151) See Changes:
   - Here
   - Various examples such as Here
   - Various example scenarios such as Here
3. Applied: Create page for change log (FHIR-36727) See Changes Here
4. Applied: Change re-associate to associate (FHIR-36733) See Changes Here
5. Applied: Fix Typo(FHIR-36736) See Changes Here
6. Applied: Clarify the relation between CDEX and HRex (FHIR-36741) See Changes Here
7. Applied: Submit Attachment AttachTo text correction (FHIR-36756) See Changes Here
8. Applied: Clarify that signature element should reference an Organization or Practitioner as signer (FHIR-36846) See Changes:
   - Here`
   - Here
9. Applied: Fix grammar(FHIR-36848) See Changes Here
10. Applied: Fix formatting Error to separate several entries(FHIR-36853) See Changes Here
11. Applied: Fix capitalization(FHIR-36896) See Changes Here
12. Applied: Adds links to operation consistently (FHIR-36897) See Changes Here
13. Applied: Rewrite digital signature functional requirements: (FHIR-36905) See Changes Here
14. Applied: Add conformance Verbs to Submit Attachment operation page (FHIR-36906) See Changes Here
15. Applied: Missing examples (FHIR-37245) See Changes Here
16. Applied: Rewrite background on section on Payers(FHIR-37252) See Changes Here
17. Applied: Clarify support for XML with signatures (FHIR-37264) See Changes:
    - Here
    - Here
    - Here
    - Here
    - Here
18. Applied: Add clarification on how to handle reads when signatures are needed (FHIR-37265) See Changes Here
19. Applied: Update $submit-attachments diagram to show 200 w/ OperationOutcome (FHIR-37271) See Changes:
    - Here
    - [Here]sending-attachments.html#scenario-1b-ccda-document-attachments-submitted-prior-to-claim)
    - Here
20. Applied: Add PayerId to $submit-attachments (FHIR-37331) See Changes Here
21. Applied: Clarify that claim's attachment submitter is same as claim submitter (FHIR-37332) See Changes:
    - Here
    - Here
22. Applied: Add "Request Attachments" content as Draft (FHIR-37563) See Changes:
    - Here
    - Here
    - Here
    - Here
    - Here
    - Here
    - Here
    - Here
    - Here
    - Here
    - Here
23. Applied: Add CCDA example and Correct PDF example (FHIR-37655) See Changes Here
24. Applied: Rewrite section on Discovery of FHIR IDs ([FHIR-37652] (https://jira.hl7.org/browse/FHIR-37652)) See Changes:
    - Here
    - Here
25. Applied: Document how implementers locate the proper identifier (FHIR-37651) See Changes Here
26. Applied: Clarify how to fetch data if can not perform a direct query. (FHIR-37649) See Changes Here

### Version = 1.1.0-ballot

- Publication Date: 2022-03-25
- Based on FHIR version : 4.0.1

#### Changes:

Da Vinci CDEX 2022 May Ballot. This ballot is restricted to the Draft content in the STU 1.0 version of CDex. The draft content includes handling of Attachments and Digital Signatures.

### Version = 1.0.0

- Publication Date: 2022-03-25
- URL: https://hl7.org/fhir/us/davinci-cdex/STU1/
- Based on FHIR version : 4.0.1

#### Changes:

This STU1 version of Da Vinci Clinical Data Exchange (CDex) Implementation Guide is the first published version of this guide and is the result of the June 2019 and January 2021 HL7 balloting process. The resulting resolution of the community comments and edits to the guide has been agreed to and voted on by the members of the sponsoring HL7 International Patient Care Work Group.

January 2021 Ballot comments and links to the updated content are below::

Status: Summary (Jira Issue) Link to Change

1. Applied: CDex documents require signature, but do not explain how used (FHIR-26855) See Changes:
   - Here
   - Here
   - Here
   - Here
2. Applied: Add reference to C-CDA on FHIR (FHIR-28158) See Change Here
3. Applied: Provide another example of a use case not covered by another Da Vinci IG (FHIR-30146) See Change Here
4. Applied: Fix link and expectations to CapabilityStatements (FHIR-30147) See Change Here
5. Applied: Failed task or task without result? (FHIR-30148) See Changes:
   - Here
   - Here
6. Applied: add item to list of benefits (FHIR-30440) See Change Here
7. Applied: Update section on What Payers Do with Clinical Information (FHIR-30442) See Change Here
8. Applied: Update text in sequence diagrams (FHIR-30445) See Change Here
9. Applied: Update Scenarios to include to support claim submission - Attachments. (FHIR-30446) See Changes:
   - Here
   - Here
10. Applied: Update definition of clinical data and added guidance on data provenance(FHIR-30489) See Changes:
    - Here
    - Here
    - Here
11. Applied: Referennce clinical safety section in HREX (FHIR-30490) See Change Here
12. Applied: Delete use of word "complete" (FHIR-30494) See Change Here
13. Applied: Explicitly reference the Da Vinci Guiding Principles in new Privacy and Security section. (FHIR-30498) See Change Here
14. Applied: Update Figure 1 (FHIR-30500) See Change Here
15. Applied: Typo. (FHIR-30812) See Change Here
16. Applied: Remove word complete. (FHIR-30813) See Change Here
17. Applied: Corrects and clarifies direct provider to provider scenario. (FHIR-30814) See Change Here
18. Applied: Updates to Provider to Provider use case(FHIR-30815) See Changes:
    - Here
    - Here
    - Here
    - Here
19. Applied: Please clarify whether any human involvement is required, and an example, as well as define the term fulfillment as it relates to attestation. (FHIR-30816) See Changes:
    - Here
    - Here
    - Here
    - Here
20. Applied: Rephrase. (FHIR-30817) See Change Here
21. Applied: Clarify how subscripition mitigates risks (FHIR-30819) See Change Here
22. Applied: Add section on termination of access to request(FHIR-30820) See Change Here
23. Applied: Update how a clients set of requests is terminated(FHIR-30821) See Change Here
24. Applied: Formalize the current scenarios (FHIR-30826) See Change Here
25. Applied: replace /Patient/$everything with /Group/$export in the bulk example (FHIR-30827) See Change Here
26. Applied: Remove empty pages (FHIR-30828)
27. Applied: Clarified formal authorization use case (FHIR-30829) See Changes:
    - Here
    - Here
28. Applied: Data Consumer Server SHOULD support Claim. (FHIR-30830) See Change Here
29. Applied: Modify CapabilityStatement Rest summary table (FHIR-30831) See Change Here
30. Applied: Add hyperlinks. (FHIR-30834) See Change Here
31. Applied: Add benefit of transition towards direct queries to Task benefits. (FHIR-30835) [See Change Here](http://hl7.org/fhir/us/davinci-cdex/STU1/task-based-approach.html
32. Appied: Update section on Authoization requirements (FHIR-30836) [See Change Here](http://hl7.org/fhir/us/davinci-cdex/STU1/task-based-approach.html
33. Applied: Typo (FHIR-30840) See Change Here
34. Applied: Typo (FHIR-30841) See Change Here
35. Applied: Typo (FHIR-30842) See Change Here
36. Applied: Updated anticipated benefits of standard (FHIR-30843) See Change Here
37. Applied: Typo (FHIR-30844) See Change Here
38. Applied: Correct Grammar (FHIR-30845) See Change Here
39. Applied: Correct Grammar (FHIR-30846) See Change Here
40. Applied: Remove unsubstantiated claims. (FHIR-30847) See Change Here
41. Applied: Remove HEDIS score claim. (FHIR-30849) See Change Here
42. Applied: Relocate paragraph. (FHIR-30850) See Change Here
43. Applied: Remove paragraph and refer to HREX security page. (FHIR-30851) See Change Here
44. Applied: Typo (FHIR-30852) See Change Here
45. Applied: Reword statement. (FHIR-30853) See Change Here
46. Applied: Typo (FHIR-30854) See Change Here
47. Applied: Typo (FHIR-30855) See Change Here
48. Applied: Typo (FHIR-30856) See Change Here
49. Applied: Typo (FHIR-30857) See Change Here
50. Applied: Updated STU-note on when authorization needed? (FHIR-30863) [See Change Here](http://hl7.org/fhir/us/davinci-cdex/STU1/task-based-approach.html#formal-authorization
51. Applied: Remove "?" or correct the section name if it is in question (FHIR-30864) See Change Here
52. Applied: Typo (FHIR-30865) See Change Here
53. Applied: Updated Purpose of Use section for Direct Query. (FHIR-30867) See Change Here
54. Applied: Updated Sensitivity and Confidentiality protection guidance. (FHIR-30868) See Change Here
55. Applied: Updated Sensitivity and Confidentiality protection guidance. (FHIR-30869) See Change Here
56. Applied: clarify when attribution is not present or non-repudiable (FHIR-30870) various changes
57. Applied: Fix sequential numbering of figures (FHIR-30935) See Change Here
58. Applied: correct last example bullet (FHIR-31050) See Change Here
59. Applied: Remove reference to HREX CommunicationRequest plus Task transaction (FHIR-31516) See Change Here
60. Applied: Clarify human involvement in Task transaction (FHIR-31886 See Change Here
61. Applied: Create privacy and security page (FHIR-31885 See Change Here
62. Applied: Clarify when HIEs are data sources (FHIR-31884)See Change Here
63. Applied: Add supplemental security guidance on audit (FHIR-31888)See Change Here
64. Applied: Add supplemental security guidance on scopes(FHIR-31887)See Change Here
65. Applied: Clarify human involvement needed(FHIR-31886)See Change Here
66. Applied: Provide guidance on finding organization and provider identifiers(FHIR-32841)See Change Here
67. Applied: Update how to represent Purpose of Use and reason in Task Based Query (FHIR-31996)See Change Here
68. Applied: Clarify the relationship between this guide and others(FHIR-32116)See Change Here
69. Applied: Added guidance on matching patients(FHIR-32840)See Change Here
70. Applied: Update to the USCDI link (FHIR-33265
71. Applied: Add guidance how to provide some work queue tags(FHIR-31890 See Change Here
72. Applied: Add push mechanism to support Attachments for Claims and Prior Auth(FHIR-33129 See Changes:
    - Here
    - Here
    - Here
73. Applied: Add figure to clarify relationship between cdex and hrex(FHIR-34559 See Change Here

### Version = 0.2.0

- Publication Date: 2020-10-23
- URL: http://hl7.org/fhir/us/davinci-cdex/2021Jan
- Based on FHIR version : 4.0.1

#### Changes:

Based on the 2019-06-20 ballot feedback, this IG has been completely re-written for this ballot. The refactoring has been sufficiently large that it is not practical/useful to enumerate a list of changes between this ballot version (0.2.0) and the 2019-06-20 ballot version (0.1.0).

### Version = 0.1.0

- Publication Date: 2019-06-18
- URL: http://hl7.org/fhir/us/davinci-cdex/2019Jun
- Based on FHIR version : 4.0.0

#### Changes:

June 2019 Ballot for Da Vinci CDex