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

## Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

### CDex Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.

Data Consumer Client CapabilityStatement | This CapabilityStatement describes the expected capabilities of a Da Vinci CDex Data Consumer in Client mode when requesting clinical data from the Data Source during clinical data exchange. The capabilities include one or more of the following interactions: Requesting and Fetching Clinical Data using a FHIR RESTful query Requesting and Fetching Clinical Data using a Task-based query including: Polling or Subscribing for Task update notifications Requesting Attachments Requesting Attachments Using Attachments Codes Requesting Attachments Using Questionnaires
Data Consumer Server CapabilityStatement | This CapabilityStatement describes the expected capabilities of a Da Vinci CDex Data Consumer in Server mode when responding to a Data Source or one of its proxies during clinical data exchange. The capabilities include one or more of the following interactions: Responding to a query for authorization information represented by a CommunicationRequest or ServiceRequest Responding to the `$submit-attachment` operation.
Data Source Client CapabilityStatement | This CapabilityStatement describes the expected capabilities of a Da Vinci CDex Data Source in Client mode during clinical data exchange with a Data Consumer. The capabilities include one or more of the following interactions: Post the `$submit-attachment` operation to a Data Consumer endpoint. Launch Da Vinci DTR. Query for Authorization information represented by a CommunicationRequest or ServiceRequest. Post a subscription notification to a Data Consumer endpoint updating the status of a task.
Data Source Server CapabilityStatement | This CapabilityStatement describes the expected capabilities of a Da Vinci CDex Data Source in Server mode when responding to a Data Consumer during clinical data exchange. The capabilities include one or more of the following interactions: Responding to a FHIR RestFul Query for Clinical Data Responding to a Task-based query request for clinical data including: Polling or Subscription requests for Task update notifications Responding to Requesting Attachments Using Attachments Codes Requesting Attachments Using Questionnaires

### Attachments Profiles

Profiles Associated with CDex Attachments Transactions

CDex Task Attachment Request Profile | Payers use this Task based profile to request additional documentation ("attachments") for claims or prior authorizations. It constrains the Task resource to minimal necessary data elements needed to request attachments and respond in a way that is compatible with existing X12 277 RFAI and 278 response transactions to allow for association and requests for (typically PDF and CCDA) documents using LOINC and X12 standard codes. It also supports requests for more detailed missing data using Questionnaire, CQL, and QuestionnaireResponse, as supported by Da Vinci Documentation Templates and Rules (DTR).
CDex PractitionerRole Profile | This Profile is defined as a contained resource within the CDex Task Attachment Request Profile. It is referenced by `Task.owner` to communicate the provider ID as a unique organization/location identifier (e.g., Type 2 NPI), or unique provider identifier (e.g., Type 1 NPI), or both. It constrains the following elements to be must support (min=0).: A default resource ID of "practitionerrole" A `practitioner.identifier` An `organization.identifier` At least a practitioner identifier or organization identifier SHALL be present.
CDex Patient Demographics Profile | This Profile is defined as a contained resource within the CDex Task Attachment Request Profile or CDex Task Data Request Profile. It is referenced when additional patient demographic data is communicated for a clinical data request (such as verifying patient identity for HIPAA compliance regulations). It constrains the following elements to be mandatory (min=1): A default resource ID of "patient" A member ID identifier slice A patient's name and the following element to be must support (min=0): A patient account number identifier slice A date of birth
CDex Parameters Submit Attachment Profile | The Parameters profile for Da Vinci Submit Attachment Operation

### Attachments Operations

Operations Associated with CDex Attachments Transactions

Submit Attachment Operation | Providers use this operation to submit solicited and unsolicited attachments or additional information for claims or prior authorization. The $submit-attachment operation accepts the clinical/administrative attachments and the information required to associate them with the claim or prior authorization and returns an HTTP response. For unsolicited attachments, the Provider invokes this operation before, concurrently, or after the claim or pre-authorization transaction. For solicited attachments, the Provider invokes it when responding to a Payer request for attachments or additional information. Any HTTP endpoint can use $submit-attachment, not just FHIR RESTful server endpoints. Implementers of CDex's Unsolicited Attachments SHOULD support the Endpoint Discovery Strategy defined in the Da Vinci HRex specification to allow discovery of the endpoint for this operation. For Solicited Attachments, the $submit-attachment endpoint is supplied in the CDex Task Attachment Request Profile

### Attachments Terminology

ValueSets Associated with CDex Attachments Transactions

CDex Claim Use Value Set | The purpose of a Claim resource and the reason for attachments. It includes the codes "preauthorization" and "claim".
CDex LOINC Attachment Codes Value Set | This value set includes LOINC terms that can be sent by a payer as part of an HL7 attachment request for additional information. It has been curated by the HL7 Payer/Provider Information Exchange (PIE) Work Group. More information about using LOINC in HIPAA attachments and the source of this value set can be found at LOINC Attachments.
CDex PWK01 Attachment Report Type Code Value Set | In addition to using LOINC attachment codes, a payer may request for additional information from the provider to support a prior authorization request using X12's PWK01 Attachment Report Type Code. Note that the PWK01 codes will not be published in due to X12 IP restrictions.

### Attachments Examples

Examples Associated with CDex Attachments Transactions (see also "Signature Examples" below)

CDex Task Example 19 | Claim Attachment Request Example: Claim Attachment Request sent by payer to a provider requesting a signed Progress note (H&P) note
CDex Task Example 20 | Prior-Auth Attachment Request Example: Prior Authorization Attachment Request with a POU of "coverage authorization" sent by payer to a provider requesting a signed History and physical (H&P) note.
CDex Task Example 22 | Request Additional Data using a Questionnaire: Prior Authorization Attachment Request with a POU of "coverage authorization" sent by payer to a provider requesting a data request questionnaire be completed.
CDex Task Example 23 | Request Additional Data using an Adaptive Questionnaire: Prior Authorization Attachment Request with a POU of "coverage authorization" sent by payer to a provider requesting an adaptive questionnaire be completed.
CDex Task Example 24 | Completed Request for Additional Data using a Questionnaire: Completed Task for CDex Task Example 22. This example has a status of "completed" and a "lastModified" date of 6/17/2022. The "reasonCode" is "request additional data" and the "output" is a QuestionnaireResponse.
CDex Task Example 25 | Completed Request for Additional Data Using an Adaptive Questionnaire: Completed Task for CDex Task Example 23. This example has a status of "completed" and a "lastModified" date of 6/17/2022. The "reasonCode" is "request additional data" and the "output" is a QuestionnaireResponse.
CDex Task Example 28 | Request Additional Data Requiring a Verification Signature Using a Questionnaire: Prior Authorization Attachment Request with a POU of "coverage authorization" and Signature required sent by payer to a provider requesting a data request questionnaire be completed and signed.
CDex Task Example 29 | Completed Request for Additional Data Requiring a Verification Signature Using a Questionnaire: Completed Prior Authorization Attachment Request (CDex Task Example 28) with a status of "completed" and output referencing the digitally signed QuestionnaireResponse.
CDex Parameters Example 1 | CCDA Attachment Example: Parameters Resource example showing how it is used to submit attachments using the `$submit-attachment` operation. It contains a CCDA attachment and the necessary information needed to associate them to the claim.
CDex Parameters Example 3 | PDF Attachment Example: Parameters Resource example showing how it is used to submit attachments using the `$submit-attachment` operation. It contains a PDF attachment and the necessary information needed to associate them to the claim.
CDex Parameters Example 4 | Laboratory Results Attachment Example: Parameters Resource example showing how it is used to submit multiple attachments using the `$submit-attachment` operation. It contains 3 Hemoglobin A1c results as attachments and the necessary information needed to associate them to the claim.
CDex Parameters Example 5 | Completed QuestionnaireResponse Attachment Example: Parameters Resource example showing how it is used to submit a solicited attachment using the `$submit-attachment` operation for a prior authorization. The attachment parameter payload is a QuestionnaireResponse completed using DTR in response to a Questionnaire sent in the Attachments request.

### Task Based Approach Profiles

Profiles Associated with CDex Task Based Approach Transactions

CDex Task Data Request Profile | This Task profile is used to solicit information from a system. The Data Consumer uses it when direct query transactions are not an option, and the transaction may require human intervention. It represents both the data request and the returned "data request". Data requests are supplied as codes, free-text, or FHIR Restful queries. It can also support requests for more detailed missing data using Questionnaire, CQL, and QuestionnaireResponse as supported by Da Vinci DTR.

### Task Based Approach Terminology

ValueSets Associated with CDex Task Based Approach Transactions

CDex Work Queue Value Set | The set work queue tags that the provider may use in their workflow to process requests. This code set is composed of codes defined by this Guide.
CDex Data Request Task Code Value Set | Codes used to identify the type of data request. It includes the codes “data-request-query”, “data-request-code”, and “data-request-questionnaire”.

### Task Based Approach Examples

Examples Associated with CDex Task Based Approach Transactions

CDex Task Example 1 | Query String Request for Condition: Task to seek a patient's active conditions using the CDex Profile query input. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 2 | Completed Query String Request for Condition: Completed Task to seek a patient active conditions using the CDex Profile query input. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 3 | Completed Query String Request for Condition with Contained Output: Completed Task to seek a patient active conditions using the CDex Profile query input and using a contained resource for the output data. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 4 | Free Text Request for Condition: Task to seek a patient active conditions using free text in the CDex Profile code input. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 5 | Completed Free Text Request for Condition: Completed Task to seek a patient active conditions using free text for the input in the CDex Profile code input. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 6 | Coded Request for Progress note: Task to seek a patient's latest Progress notes using the CDex Profile code input. This example illustrates the use of FHIR resource references to the various actors.
CDex Task Example 7 | Completed Coded Request for Progress note - PDF: Completed Task to seek a patient''''s latest Progress notes using the CDex Profile code input. This example illustrates the use of FHIR resource references to the various actors. The output data is a contained DocumentReference with an inline base64 encoded PDF document.
CDex Task Example 8 | Completed Coded RequestOperative note -CCDA: Completed Task to seek a patient's Operative notes using the CDex Profile code input. This example illustrates the use of FHIR resource references to the various actors. The output data is a contained DocumentReference with an inline base64 encoded CCDA document.
CDex Task Example 9 | Failed Coded Request for A1C Results: Task to seek a patient's HbA1c test results using the CDex Profile query input with a failed status. This example illustrates the use of FHIR resource references to the various actors.
CDex Task Example 10 | Coded Request for A1C Results: Task to seek a patient's HbA1c test results using the CDex Profile query input. This example illustrates the use of FHIR resource references to the various actors.
CDex Task Example 11 | Query String Request for Condition with Authorization: In this provider to provider request, a Task is used to request a patient active conditions using the CDex Profile query input. A reference to a formal authorization is provided. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 12 | Completed Query String Request for Condition with Authorization: In this completed provider to provider request, a Task is used to request a patient active conditions using the CDex Profile query input. A reference to a formal authorization is provided. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 13 | Free Text Request for Condition with Provenance: Task to seek a patient active conditions and its provenance using free text in the CDex Profile code input. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 14 | Completed Free Text Request for Condition with Provenance: Completed Task to seek a patient active conditions and its provenance using free text in the CDex Profile code input. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 15 | Query String Request for Condition with Provenance: Task to seek a patient active conditions and its provenance using query string in the CDex Profile query input. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 16 | Completed Query String Request for Condition with Provenance: Completed Task to seek a patient active conditions their provenance using the CDex Profile query input. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 17 | Query String Request for Signed Condition Data: Task to seek a patient active conditions using the CDex Profile query input and using the signature input to indicate a signature is required. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 18 | Completed Query String Request for Signed Condition Data: Completed Task to seek a signed patient active conditions. This example illustrates the use of business identifiers (instead of pointing to a FHIR resource) to references the various actors.
CDex Task Example 21 | Coded Request for Surgical Operation Note: Task to seek a patient's latest operative notes using the CDex Profile code input. This example illustrates the use of FHIR resource references to the various actors.
CDex Task Example 26 | Data Request Using a Questionnaire: Task to seek reason for home oxygen therapy using the CDex Profile questionnaire input. This example illustrates the use of Questionnaire to request data from a data source
CDex Task Example 27 | Completed Data Request Using a Questionnaire: Completed Task for CDex Task Example 26. This example has a status of "completed" and a "lastModified" date of 6/19/2022. The "output" is a QuestionnaireResponse.Task to seek reason for home oxygen therapy.
CDex Task Example 30 | Data Request Requiring a Verification Signature Using Questionnaire: Task to seek reason for home oxygen therapy using the CDex Profile questionnaire input. This example illustrates the use of Questionnaire to request data from a data source and requires a digitally signed QuestionnaireResponse.
CDex Task Example 31 | Completed Data Request Requiring a Verification Signature Using Questionnaire: Completed Task (CDex Task Example 30) with a status of "completed" and output referencing the digitally signed QuestionnaireResponse.

### Direct Query Examples

Examples Associated with CDex Direct Query (FHIR RESTful search) Approach Transactions

Direct Query for Patient's Active Conditions | Bundle example used in direct query transactions scenario 1 and in task based transactions - for example, scenario 1a.
Direct Query Response Including Provenance | Bundle example used in the direct query scenario that includes the corresponding Provenance records. Payer Seeks Insured Person/Patient Active Conditions from Provider to support a claims audit.
Direct Query for Patient's Progress Notes | Bundle example used in direct query scenario 3. Payer Seeks Insured Person/Patient Progress Notes from Provider to support a claim submission.
Direct Query for Patient's HbA1c Test Results | Bundle example used in direct query scenario 2. Payer Seeks Insured Person/Patient HbA1c Test Results from Provider

### Questionnaire Examples

Questionnaire examples used in both CDex Attachments and Task Based Approach Transaction (see also "Signature Examples" below)

CDex Questionnaire Example1 | This example is a simple data request Questionnaire used in the Task Based and Attachments transactions. It is adapted from the Da Vinci DTR IG.
CDex QuestionnaireResponse Example1 | This Questionnaire Response example demonstrates the response to a CDEX Data Query or Attachments that uses a Questionnaire to request the data. It is adapted from the Da Vinci DTR IG.
CDex QuestionnaireResponse Example2 | This Questionnaire Response example demonstrates the response to a CDEX Data Query or Attachments that uses a Questionnaire to request the data. The Questionnaire is an adaptive questionnaire and the resulting QuestionnaireResponse contains the generated Questionnaire instance. This example is adapted from the Da Vinci DTR IG. For more information about adaptive questionnaires in FHIR see the SDC Implementation Guide.

### Signature Profiles

Profiles Associated with CDex Signatures

CDex Digital Signature Profile | This Signature DataType profile enforces the various elements of digital signatures documented in Digital Signature Rules and Guidance For CDEX Bundle and QuestionnaireResponse.
CDex Signature Bundle Profile | This Bundle profile supports the signatures as documented in the CDex guide. It adds the following mandatory (min=1) constraint: A `Bundle.signature` element using: The CDex Digital Signature Profile for digital signatures The base Signature datatype for other electronic signatures (picture, etc)
CDex SDC QuestionnaireResponse Profile | This profile is derived from the US Core QuestionnaireResponse Profile profile and enforces the various elements of signature documented in the CDex guide. It adds the following constraints: The signature extensions use using: The CDex Digital Signature Profile for digital signatures The base Signature datatype for other electronic signatures (picture, etc)

### Signature Terminology

ValueSets Associated with CDex Signatures

CDex Identifier Types Value Set | Identifier types for providers and organizations. It includes the codes “TAX” and “NPI”.

### Signature Examples

Examples Associated with CDex Signatures

CDEX SearchSet Bundle with Digital Signature Example | Digital signature example showing how it is used to sign a search set Bundle . The CDEX use case would be a response to a Direct Query where a digital signature was required.
CDEX Document with Digital Signature Example | Digital signature example showing how it is used to sign a FHIR Document. The CDEX use case would be the target resource in response to a Task-based request where a digital signature was required. If no signature was required, the response would typically be in the form of an individual resource.
CDEX Document with Electronic Signature Example | Electronic signature example showing how an image file can be used to sign a document Bundle. The CDEX use case would be the target resource in response to a Task-based request where an electronic signature was required. If no signature was required, the response would typically be in the form of an individual resource.
CDex Parameters Example 2 | Signed FHIR Document Attachment Example: Parameters Resource example showing how it is used to submit attachments using the `$submit-attachment` operation. It contains a Signed FHIR Document attachment and the necessary information needed to associate it to a claim.
CDex Questionnaire Example2 | This example is a simple data request Questionnaire used in the Task Based and Attachments transactions. It indicates that a verification signature is needed when completing the QuestionnaireResponse. It is adapted from the Da Vinci DTR IG.
CDex QuestionnaireResponse Example3 | This Questionnaire Response example demonstrates the response to a CDEX Data Query or Attachments that uses a Questionnaire to request the data when an electronic verification signature is required. It is adapted from the Da Vinci DTR IG. The electronic signature is an image file in the QuestionnaireResponse signature extension. This example is adapted from the Da Vinci DTR IG.
CDex QuestionnaireResponse Example4 | This Questionnaire Response example demonstrates the response to a CDEX Data Query or Attachments that uses a Questionnaire to request the data and an electronic digital Verification signature is required. It is adapted from the Da Vinci DTR IG. The digital signature is a JSON FHIR Signature in the QuestionnaireResponse signature extension. This example is adapted from the Da Vinci DTR IG.

### Common Terminology

ValueSets and CodeSystems used in both CDex Attachments and Task Based Approach Transactions

CDex Purpose of Use Value Set | The set of purpose of use (POU) codes for requesting data. This code set is composed of FHIR core Purpose of Use security labels and additional codes defined by this Guide.
CDex Temporary Code System | Codes temporarily defined as part of the CDex implementation guide. These will eventually migrate into an officially maintained terminology (likely HL7's UTG code systems).

### Inline Examples

These examples are used in the inline example scenarios throughout the guide. They are listed here so the implementation guide's publication tooling can validate them against the CDex profile definitions. Since they are used to illustrate "over-the-wire" transactions, the rendered narrative and id elements are often absent.

CDex Inline Task Example 1 | Task example used to create inline scenarios for example tasked-based transactions based in scenarios 1a, 1c and 4.
CDex Inline Task Example 4 | Task example used to create example task based transactions using free text inputs
CDex Task Inline Example 6 | Task example used to create inline task based scenario for progress note exam notes as PDF
CDex Inline Task Example 21 | Task example used to create inline task based scenarios for surgical notes as ccda documents
CDex Inline Task Example 10 | Task example used to create inline task based scenarios for and example unsuccessful task based transaction
CDex Inline Task Example 11 | Task example used to create inline scenarios for task based transaction with a formal authorization.
CDex Inline Task Example 13 | Task example used to create inline requests for provenance using task based transaction
CDex Inline Task Example 15 | Task example used to create inline requests for provenance using task based transaction
CDex Inline Task Example 17 | Task example used to create inline scenarios for a signed task based transaction
CDex Inline Task Example 19 | Task example used to create inline scenarios for the requesting attachments using codes transaction
CDex Inline Task Example 22 | Task example used to create inline requesting attachments using questionnaire transaction
CDex Inline Task Example 26 | Task example used to create inline task based scenarios using questionnaire as task input
Inline Subscription Task Scenario1 Subscription Requested | Subscription example used to create inline scenarios for the example task based transaction using subscription
Inline Subscription Task Scenario1 Subscription Active | Subscription example used to create inline scenarios for the example task based transaction using subscription
Inline Subscription Task Scenario1 Subscription Notification | Notification Bundle example used to create inline scenarios for the example task based transaction using subscription
CDex Bundle Inline Example 858p | Bundle example used to create inline requests for provenance using task based transaction
CDex Condition Inline Example 858 | Condition example used to create inline scenarios for this guide
CDex Provenance Inline Example 858 | Provenance example used to create inline scenarios for this guide
Inline CDex Task Inline Communicationrequest Example 1 | CommunicationRequest example used to create inline scenarios for this guide.
CDex Questionnaireresponse Inline Example 1 | QuestionnaireResponse example example used to create inline task based scenarios using questionnaire as task input
CDex Inline OperationOutcome Example 1 | OperationOutcome example used to create inline scenarios for this guide
cdex-capabilitystatement-inline-example | R4 example of a CapabilityStatement advertising support for CDex Task Update topic-based subscription