Da Vinci - Coverage Requirements Discovery
2.2.1 - STU 2.2

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 2.2.1 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

Instance of logical model CRD CDSHooks Response (Logical Definition)

## Binary: Example CRD Response with: Order Replacement, Order supplement, Form Completion, Coverage Update, SMART launch

    {
      "cards" : [
        {
          "extension" : {
            "davinci-crd.associated-resource" : [
              {
                "reference" : "MedicationRequest/2222"
              }
            ]
          },
          "uuid" : "urn:uuid:a1c2d18b-bc29-4ce9-be70-f6c26e1d78d8",
          "summary" : "Replace order with covered generic?",
          "indicator" : "info",
          "source" : {
            "label" : "Centers for Medicare & Medicaid Services",
            "url" : "https://example.org/cms",
            "topic" : {
              "system" : "http://terminology.hl7.org/CodeSystem/cdshooks-card-type",
              "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",
                    "id" : "1",
                    "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"
                      }
                    }
                  }
                }
              ]
            }
          ],
          "selectionBehavior" : "any"
        },
        {
          "extension" : {
            "davinci-crd.associated-resource" : [
              {
                "reference" : "MedicationRequest/1111"
              }
            ]
          },
          "uuid" : "urn: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://example.org/cms",
            "topic" : {
              "system" : "http://terminology.hl7.org/CodeSystem/cdshooks-card-type",
              "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",
                    "id" : "1",
                    "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",
                          "system" : "http://unitsofmeasure.org",
                          "code" : "mo"
                        },
                        "frequency" : 1,
                        "period" : 1,
                        "periodUnit" : "mo"
                      }
                    },
                    "authoredOn" : "2019-02-15",
                    "requester" : {
                      "reference" : "http://example.org/fhir/PractitionerRole/987",
                      "display" : "Dr. Jones"
                    }
                  }
                }
              ]
            }
          ],
          "selectionBehavior" : "any"
        },
        {
          "extension" : {
            "davinci-crd.associated-resource" : [
              {
                "reference" : "MedicationRequest/2222"
              }
            ]
          },
          "uuid" : "urn: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://example.org/cms",
            "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" : [
                {
                  "extension" : {
                    "davinci-crd.if-none-exist" : [
                      "url=http://example.org/Questionnaire/XYZ&version=2"
                    ]
                  },
                  "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",
                    "id" : "1",
                    "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"
                      }
                    ]
                  }
                },
                {
                  "type" : "create",
                  "description" : "Add 'Complete ABC form' to the task list",
                  "resource" : {
                    "resourceType" : "Task",
                    "id" : "1",
                    "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",
                    "requester" : {
                      "reference" : "http://example.org/fhir/Practitioner/987"
                    },
                    "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"
                            }
                          ]
                        }
                      }
                    ]
                  }
                }
              ]
            }
          ],
          "selectionBehavior" : "any"
        },
        {
          "uuid" : "urn:uuid:5561ec1e-78c5-48aa-8fc0-037c476452bf",
          "summary" : "Patient coverage information is incomplete",
          "indicator" : "info",
          "source" : {
            "label" : "Some Payer",
            "url" : "https://example.org",
            "icon" : "https://example.org/img/icon-100px.png",
            "topic" : {
              "system" : "http://terminology.hl7.org/CodeSystem/cdshooks-card-type",
              "code" : "insurance",
              "display" : "Insurance"
            }
          },
          "suggestions" : [
            {
              "label" : "Update coverage information to be current",
              "uuid" : "urn: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"
                    },
                    "relationship" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                          "code" : "self"
                        }
                      ]
                    },
                    "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"
                      }
                    ]
                  }
                }
              ]
            }
          ],
          "selectionBehavior" : "any"
        },
        {
          "extension" : {
            "davinci-crd.associated-resource" : [
              {
                "reference" : "MedicationRequest/2222"
              }
            ]
          },
          "uuid" : "urn:uuid:353cd963-2ecd-46f9-958b-ed7d2bbf6e01",
          "summary" : "Launch opioid XYZ-assessment",
          "indicator" : "info",
          "source" : {
            "label" : "Some Payer",
            "url" : "https://example.org",
            "icon" : "https://example.org/img/icon-100px.png",
            "topic" : {
              "system" : "http://terminology.hl7.org/CodeSystem/cdshooks-card-type",
              "code" : "guideline",
              "display" : "Guideline"
            }
          },
          "links" : [
            {
              "label" : "Opioid XYZ-assessment",
              "url" : "https://example.org/opioid-assessment",
              "type" : "smart",
              "appContext" : "{\"payerXYZQNum\":\"205f471f-f408-45d4-9213-0eedf95f417f\"}"
            }
          ]
        }
      ]
    }