Da Vinci - Coverage Requirements Discovery
2.1.0-preview - STU 2 United States of America flag

Da Vinci - Coverage Requirements Discovery, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-crd/ and changes regularly. See the Directory of published versions

Binary: Example CRD Service Response - Coverage Information

    
{
  "cards": [
    {
      "extension": {
        "davinci-crd.associated-resource": [
          "MedicationRequest/2222"
        ]
      },
      "uuid": "a1c2d18b-bc29-4ce9-be70-f6c26e1d78d8",
      "summary": "Replace order with covered generic?",
      "indicator": "info",
      "source": {
        "label": "Centers for Medicare & Medicaid Services",
        "url": "https://cms.gov",
        "topic": {
          "system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
          "code": "therapy-alternatives-req",
          "display": "Required Therapy Alternatives"
        }
      },
      "suggestions": [
        {
          "label": "Change to lower price name brand (selected name brand not covered)",
          "actions": [
            {
              "type": "delete",
              "description": "Remove name-brand prescription",
              "resourceId": [
                "MedicationRequest/2222"
              ]
            },
            {
              "type": "create",
              "description": "Add lower-cost alternative",
              "resource": {
                "resourceType": "MedicationRequest",
                "status": "draft",
                "intent": "original-order",
                "medicationCodeableConcept": {
                  "coding": [
                    {
                      "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
                      "code": "1790533",
                      "display": "Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza]"
                    }
                  ]
                },
                "subject": {
                  "reference": "http://example.org/someEHR/fhir/Patient/123"
                },
                "encounter": {
                  "reference": "http://example.org/someEHR/fhir/Encounter/987"
                },
                "authoredOn": "2015-11-01",
                "requester": {
                  "reference": "http://example.org/someEHR/fhir/PractitionerRole/123"
                },
                "dosageInstruction": [
                  {
                    "text": "1 10mg tablet, every 12 hours",
                    "timing": {
                      "repeat": {
                        "boundsPeriod": {
                          "start": "2015-11-01",
                          "end": "2015-11-15"
                        },
                        "frequency": 1,
                        "period": 12,
                        "periodUnit": "h"
                      }
                    },
                    "doseAndRate": [
                      {
                        "doseQuantity": {
                          "value": 1,
                          "unit": "Tablet",
                          "system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
                          "code": "TAB"
                        }
                      }
                    ]
                  }
                ],
                "dispenseRequest": {
                  "numberOfRepeatsAllowed": 0,
                  "quantity": {
                    "value": 28,
                    "unit": "Tablet",
                    "system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
                    "code": "TAB"
                  }
                }
              }
            }
          ]
        }
      ]
    },
    {
      "extension": {
        "davinci-crd.associated-resource": [
          "MedicationRequest/1111"
        ]
      },
      "uuid": "9cda1f90-48ce-4b1e-abc7-970c65c4bab9",
      "summary": "Liver testing recommended",
      "detail": "Administration of Diclofenac should be accompanied by SGPT monitoring due to potential toxicity",
      "indicator": "info",
      "source": {
        "label": "Centers for Medicare & Medicaid Services",
        "url": "https://cms.gov",
        "topic": {
          "system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
          "code": "clinical-reminder",
          "display": "Clinical Reminder"
        }
      },
      "suggestions": [
        {
          "label": "Add monthly AST test for 1st 3 months",
          "actions": [
            {
              "type": "create",
              "description": "Add order for AST test",
              "resource": {
                "resourceType": "ServiceRequest",
                "status": "draft",
                "intent": "original-order",
                "category": [
                  {
                    "coding": [
                      {
                        "system": "http://snomed.info/sct",
                        "code": "108252007",
                        "display": "Laboratory procedure"
                      }
                    ]
                  }
                ],
                "code": {
                  "coding": [
                    {
                      "system": "http://www.ama-assn.org/go/cpt",
                      "code": "80076",
                      "display": "Hepatic function panel"
                    }
                  ]
                },
                "subject": {
                  "reference": "http://example.org/fhir/Patient/123",
                  "display": "Jane Smith"
                },
                "encounter": {
                  "reference": "http://example.org/fhir/Encounter/ABC"
                },
                "occurrenceTiming": {
                  "repeat": {
                    "boundsDuration": {
                      "value": 3,
                      "unit": "months",
                      "code": "mo",
                      "system": "http://unitsofmeasure.org"
                    },
                    "frequency": 1,
                    "period": 1,
                    "periodUnit": "mo"
                  }
                },
                "authoredOn": "2019-02-15",
                "requester": {
                  "reference": "http://example.org/fhir/PractitionerRole/987",
                  "display": "Dr. Jones"
                }
              }
            }
          ]
        }
      ]
    },
    {
      "extension": {
        "davinci-crd.associated-resource": [
          "MedicationRequest/2222"
        ]
      },
      "uuid": "ba18576a-1905-4e2c-b5fd-cf04171dc291",
      "summary": "Complete Opiod Use form",
      "detail": "Form ABC is required to attest to appropriate opiod usage",
      "indicator": "info",
      "source": {
        "label": "Centers for Medicare & Medicaid Services",
        "url": "https://cms.gov",
        "topic": {
          "system": "http://example.org/fhir/CodeSystem/SomeCodes",
          "code": "123",
          "display": "Regulatory Requirement"
        }
      },
      "suggestions": [
        {
          "label": "Add 'completion of the ABC form' to your task list (possibly for reassignment)",
          "actions": [
            {
              "type": "create",
              "description": "Add version 2 of the XYZ form to the clinical system's repository (if it doesn't already exist)",
              "resource": {
                "resourceType": "Questionnaire",
                "url": "http://example.org/Questionnaire/XYZ",
                "version": "2",
                "status": "active",
                "item": [
                  {
                    "linkId": "1",
                    "text": "Has the patient previously tried non-opioid therapy and been unsuccessful?",
                    "type": "boolean"
                  }
                ]
              },
              "extension": {
                "davinci-crd.if-none-exist": "url=http://example.org/Questionnaire/XYZ&version=2"
              }
            },
            {
              "type": "create",
              "description": "Add 'Complete ABC form' to the task list",
              "resource": {
                "resourceType": "Task",
                "basedOn": [
                  {
                    "reference": "http://example.org/fhir/Appointment/27"
                  }
                ],
                "status": "ready",
                "intent": "order",
                "code": {
                  "coding": [
                    {
                      "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
                      "code": "complete-questionnaire"
                    }
                  ]
                },
                "description": "Complete XYZ form for local retention",
                "for": {
                  "reference": "http://example.org/fhir/Patient/123"
                },
                "authoredOn": "2018-08-09",
                "input": [
                  {
                    "type": {
                      "text": "questionnaire"
                    },
                    "valueCanonical": "http://example.org/Questionnaire/XYZ|2"
                  },
                  {
                    "type": {
                      "text": "afterCompletion"
                    },
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://example.org/fhir/CodeSystem/SomeCodes",
                          "code": "987",
                          "display": "Local Use"
                        }
                      ]
                    }
                  }
                ]
              }
            }
          ]
        }
      ]
    },
    {
      "uuid": "5561ec1e-78c5-48aa-8fc0-037c476452bf",
      "summary": "Patient coverage information is incomplete",
      "indicator": "info",
      "source": {
        "label": "Some Payer",
        "url": "https://example.com",
        "icon": "https://example.com/img/icon-100px.png",
        "topic": {
          "system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
          "code": "insurance",
          "display": "Insurance"
        }
      },
      "suggestions": [
        {
          "label": "Update coverage information to be current",
          "uuid": "1207df9d-9ff6-4042-985b-b8dec21038c2",
          "actions": [
            {
              "type": "update",
              "description": "Update current coverage record",
              "resource": {
                "resourceType": "Coverage",
                "id": "1234",
                "status": "active",
                "subscriberId": "192837",
                "beneficiary": {
                  "reference": "http://example.org/fhir/Patient/123" 
                },
                "period": {
                  "start": "2023-01-01",
                  "end": "2023-11-30"
                },
                "payor": [
                  {
                    "reference": "http://example.org/fhir/Organization/ABC"
                  }
                ],
                "class": [
                  {
                    "type": {
                      "coding": [
                        {
                          "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                          "code": "group"
                        }
                      ]
                    },
                    "value": "A1"
                  }
                ]
              }
            }
          ]
        }
      ]
    },
    {
      "extension": {
        "davinci-crd.associated-resource": [
          "MedicationRequest/2222"
        ]
      },
      "uuid": "353cd963-2ecd-46f9-958b-ed7d2bbf6e01",
      "summary": "Launch opioid XYZ-assessment",
      "indicator": "info",
      "source": {
        "label": "Some Payer",
        "url": "https://example.com",
        "icon": "https://example.com/img/icon-100px.png",
        "topic": {
          "system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
          "code": "guideline",
          "display": "Guideline"
        }
      },
      "links": [
        {
          "label": "Opioid XYZ-assessment",
          "url": "https://example.org/opioid-assessment",
          "type": "smart",
          "appContext": "{\"payerXYZQNum\":\"205f471f-f408-45d4-9213-0eedf95f417f\"}"
        }
      ]
    }
  ]
}