Da Vinci Clinical Data Exchange (CDex)
2.0.0-preview - CI Build United States of America flag

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-preview). 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

Version = 2.0.0-preview (CI-Build)

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 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.

Changes:

These changes are the result of over 80 trackers listed below. They include the 2022 September HL7 balloting process and non-ballot issue.

Status: Summary (Jira Issue) Link to Change

  1. Triaged: Messaging not reflected in data flow. (FHIR-30837 See Changes Here
  2. Triaged: overflowing their workflow in-basket impacting patient care (FHIR-31890 See Changes Here
  3. Triaged: Incomplete Narrative Content rendering of Submit Attachment Parameters Resource example (FHIR-36907 See Changes Here
  4. Triaged: $submit-attachment input parameter is referred to inconsistently; please correct. (FHIR-37956 See Changes Here
  5. Submitted: Solicited attachments for claim flow diagram typo (FHIR-38060 See Changes Here
  6. Triaged: Consider merging flow diagrams for solicited flow (FHIR-38061 See Changes Here
  7. Triaged: omitted service item extension to CDex Task Attachment Request Profile (FHIR-38070 See Changes Here
  8. Submitted: PoU is insufficiently exchanged in production OAuth to be dynamic (FHIR-38142 See Changes Here
  9. Submitted: DS4P should be evaluated before required (FHIR-38144 See Changes Here
  10. Submitted: capitalization (FHIR-38145 See Changes Here
  11. Submitted: at least insufficient, probably unnecessary (FHIR-38146 See Changes Here
  12. Submitted: CDEX Request Attachment 5.3 Requesting Attachments: last sentence: It is intended to be compatible with the X12n 277 and 278 response transactions. (FHIR-38152 See Changes Here
  13. Submitted: CDex Request Attachments Profile: first paragraph, last sentence (FHIR-38153 See Changes Here
  14. Submitted: CDex Request Attachments Technical Workflow: Correction first sentence (FHIR-38154 See Changes Here
  15. Submitted: CDex Request Attachment Step by Step Solicited Attachment Transaction: Modify sentence (FHIR-38155 See Changes Here
  16. Submitted: CDEX Requesting Attachments: Step by Step Solicited Attachment Transaction (FHIR-38156 See Changes Here
  17. Waiting for Input: CDex Attachment Request - 15. Tracking ID (Payer or Provider Assigned) comment (FHIR-38172 See Changes Here
  18. Pre-Applied:: CDex Attachment Request - 5.3.4.1 Data Elements for requesting attachments – Table questions/ modifications (FHIR-38173 See Changes:
  19. Pre-Applied: CDex Request Attachments -5.3.4.1 Data Elements for requesting attachments – Table questions/ modifications (FHIR-38174 See Changes Here
  20. Submitted: Typo in Solicited Attachments for a Claim diagram (FHIR-38175 See Changes Here
  21. Submitted: CDEX Requesting Attachments: Step by Step Solicited Attachment Transaction: (FHIR-38177 See Changes Here
  22. Submitted: CDEX Requesting Attachments: Step by Step Solicited Attachment Transaction: In flow chart (FHIR-38178 See Changes Here
  23. Submitted: CDEX Requesting Attachments: Verifying Patient Identity: Modification request change language (FHIR-38179 See Changes Here
  24. Submitted: CDex Requesting Attachments: Modify first and second sentence (FHIR-38184 See Changes Here
  25. Submitted: CDex Requesting Attachments: General Comment (FHIR-38186 See Changes Here
  26. Submitted: CDex Requesting Attachments: Modify sentence 2 (FHIR-38187 See Changes Here
  27. Triaged: spec should be clarified that prior auth doesn’t require signatures (FHIR-38188 See Changes Here
  28. Pre-Applied: Submit-attachment operation should require either an OrganizationId or ProviderId, Not both (FHIR-38189 See Changes:
  29. Triaged: service date should not be required for prior auth (FHIR-38191 See Changes Here
  30. Triaged: clarify conformance expectations are for prior auth attachments, not claim attachments (FHIR-38192 See Changes Here
  31. Pre-Applied: Verifying Patient Identity (FHIR-38194 See Changes Here
  32. Submitted: Task Infrastructure Elements (FHIR-38195 See Changes Here
  33. Triaged: Claim Information (FHIR-38196 See Changes Here
  34. Submitted: Incorrect URL (FHIR-38208 See Changes Here
  35. Submitted: Include Workflows (FHIR-38210 See Changes Here
  36. Submitted: Patient example missing XML and JSCON (FHIR-38230 See Changes Here
  37. Submitted: LOINC code 11504-8 display and text inconsistent (FHIR-38233 See Changes Here
  38. Submitted: Typo in example glycated hemoglobin (FHIR-38236 See Changes Here
  39. Submitted: Clarification of Attachment Scope (FHIR-38240 See Changes Here
  40. Submitted: Definition of Attachment is limited (FHIR-38241 See Changes Here
  41. Submitted: Change ““possibly”” with ““if necessary”” (FHIR-38242 See Changes Here
  42. Submitted: CDex Attachment Request appears to be missing data (FHIR-38243 See Changes Here
  43. Submitted: Unclear what transaction communicates Payer request (FHIR-38244 See Changes Here
  44. Submitted: The POU for an Attachment Request is unclear (FHIR-38245 See Changes Here
  45. Submitted: CDex Patient Demographics Profile (FHIR-38252 See Changes Here
  46. Submitted: Incorrect operation name (FHIR-38253 See Changes Here
  47. Submitted: Duplicate text (FHIR-38254 See Changes Here
  48. Submitted: small typo (FHIR-38255 See Changes Here
  49. Submitted: cdex-temp code system must not be used in implemented systems (FHIR-38259 See Changes Here
  50. Submitted: Clarify use of data tagging (FHIR-38286 See Changes Here
  51. Submitted: Reference to X12 elements and X12 required citations (FHIR-38287 See Changes Here
  52. Triaged: FHIR ID Support and Usage (FHIR-38318 See Changes Here
  53. Waiting for Input: Liability and Privacy Concerns with Digital Signature (FHIR-38320 See Changes Here
  54. Submitted: Clarification regarding reassociation being out of scope (FHIR-38322 See Changes Here
  55. Triaged: Task Reason Code (FHIR-38325 See Changes Here
  56. Triaged: X12 Compatibility (FHIR-38326 See Changes Here
  57. Triaged: Adding Qualifier to Signed Document Bundle (FHIR-38327 See Changes Here
  58. Submitted: Remove words ““transaction layer”” for conciseness (FHIR-38328 See Changes Here
  59. Submitted: Word change ““analogs”” to ““fields”” (FHIR-38330 See Changes Here
  60. Submitted: Confirm parameter naming style (FHIR-38366 See Changes Here
  61. Submitted: Improve rendered document rendering (FHIR-38367 See Changes Here
  62. Submitted: Signed should be in italics (FHIR-38368 See Changes Here
  63. Triaged: stronger language needed (FHIR-38576 See Changes Here
  64. Triaged: revise section ‘what Do Payers Do with Clinical Information?’ (FHIR-38578 See Changes Here
  65. Triaged: add supplemental guide to example scenarios (FHIR-38580 See Changes Here
  66. Triaged: CDex use case examples (FHIR-38585 See Changes Here
  67. Submitted: question related to authoring/sign off (FHIR-38588 See Changes Here
  68. Submitted: Concerned about the need for human intervention if the patient matching tech isn’t built out (FHIR-38592 See Changes Here
  69. Triaged: add limited payer access for the preconditions and assumptions (FHIR-38595 See Changes Here
  70. Triaged: does Da Vinci plan to standardize a way to communicate failed signatures? (FHIR-38596 See Changes Here
  71. Triaged: statement on purpose of use should be stronger (FHIR-38598 See Changes Here
  72. Triaged: change SHOULD to SHALL (FHIR-38599 See Changes Here
  73. Triaged: term used (FHIR-38600 See Changes Here
  74. Triaged: Would there be a claim associated with a HEDIS lab value request for quality reporting? (FHIR-38601 See Changes Here
  75. Triaged: Polling frequency (FHIR-38602 See Changes Here
  76. Triaged: trading partner agreements could be a barrier (FHIR-38603 See Changes Here
  77. Submitted: used word provider when you meant payer (FHIR-38604 See Changes Here
  78. Triaged: scope (FHIR-38605 See Changes Here
  79. Triaged: Need a new example for Signed FHIR Resource Attachments (FHIR-38609 See Changes Here
  80. Triaged: remove reference to HIPAA attachments rule (FHIR-38612 See Changes Here
  81. Waiting for Input: change SHOULD to SHALL (FHIR-38613 See Changes Here
  82. Triaged: Suspected typo in cardinality for $submit-attachment’s Attachment input parameter needs to be corrected. (FHIR-38632 See Changes Here

Version = 2.0.0-ballot

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

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.

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:
  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:
  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:
  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:
  32. Applied: Rewrite introduction to Signature (FHIR-37253) See Changes Here
  33. Applied: Update Polling Guidance (FHIR-37260) See Changes Here

Status: Summary (Jira Issue) Link to Change

  1. Applied: Recommendation for exchanging purpose of use. (FHIR-30824) See Changes:
  2. Applied Make Task.reasonReference.identifer 0…1 MS (FHIR-35151) See Changes:
  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:
  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:
  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:
  22. Applied: Add “Request Attachments” content as Draft (FHIR-37563) See Changes:
  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:
  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

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

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:
  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:
  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:
  10. Applied: Update definition of clinical data and added guidance on data provenance(FHIR-30489) See Changes:
  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:
  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:
  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:
  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
  32. Appied: Update section on Authoization requirements (FHIR-30836) See Change Here
  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
  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:
  73. Applied: Add figure to clarify relationship between cdex and hrex(FHIR-34559 See Change Here

Version = 0.2.0

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

Changes:

June 2019 Ballot for Da Vinci CDex