The process for submitting the CDex Temporary Code System POU Codes for inclusion into HL7 Terminology (THO) ACTReason CodeSystem is underway. In addition, the editors will publish a final CDex POU value set as part of an STU update.

CDex Purpose of Use Value Set Hierarchy

The current state of healthcare data exchange is typically limited to a single, well-known, and pre-established purpose-of-use (POU). The CDex Purpose of Use Value Set defines POU with a greater level of discrimination at the transaction level. These codes form a hierarchy where the child concepts have an IS-A relationship with the parents that rolls up to the [45 CFR 164.506 Treatment, Payment, and Health Care Operations (TPO)] concepts. The table and figure below illustrate this hierarchy:

* HL7 ACTReason CodeSystem
** CDex Temporary Code System Codes

Using Not OtherWise Enumerated Codes

The Not OtherWise Enumerated Codes:

• treatment-noa
• payment-noa
• operations-noa

do not define the detailed POU, and the implementer must supply an additional, alternate code. The resource fragment below shows their use:

{
    "resourceType": "Task",
...
  "input": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
                        "code": "data-query"
                    }
                ]
            },
            "valueString": "Condition?patient=cdex-example-patient&clinical-status=active,recurrance,remission"
        },
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                        "code": "purpose-of-use"
                    }
                ]
            },
            "valueCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
                        "code": "treatment-noe"
                    },
                    {
                        "system": "http://example.org/CodeSystem/POU",
                        "code": "some-other-treatment-purpose"
                    }
                ]
            }
        }
....

[Da Vinci Prior Authorization Support (PAS)]: [CDex Work Queue Value Set]: ValueSet-cdex-work-queue.html [What is Signed]: signatures.html#what-is-signed [Signatures for Task Based Requests]: task-based-approach.html#signatures [X12]: https://x12.org/ [X12 transactions]: https://x12.org/ [X12 Transaction Sets]: https://x12.org/products/transaction-sets [HEDIS]: https://en.wikipedia.org/wiki/Healthcare_Effectiveness_Data_and_Information_Set [Specification]: specification.html [$match]: http://hl7.org/fhir/R4/patient-operation-match.html [Coverage]: http://hl7.org/fhir/R4/coverage.html [FHIR RESTful Search syntax]: http://hl7.org/fhir/R4/search.html#Introduction [DocumentReference]: http://hl7.org/fhir/R4/documentreference.html [FHIR Signature]: http://hl7.org/fhir/R4/datatypes.html#signature [Bundle.signature]: http://hl7.org/fhir/R4/bundle-definitions.html#Bundle.signature [enveloped signature]: http://www.w3.org/TR/xmldsig-core/#def-SignatureEnveloped [(Verification Signature)]: http://hl7.org/fhir/R4/valueset-signature-type.html [FHIR Document]: http://hl7.org/fhir/R4/documents.html [RFC 7515]: https://tools.ietf.org/html/rfc7515 [JSON Signature rules]: http://hl7.org/fhir/R4/datatypes.html#JSON [RFC 7515: JSON Web Signature (JWS)]: https://tools.ietf.org/html/rfc7515 [Detached]: https://tools.ietf.org/html/rfc7515#appendix-F [Canonical JSON]: http://hl7.org/fhir/R4/json.html#canonical [JWS JSON Serialization]: https://datatracker.ietf.org/doc/html/rfc7515#section-3.2 [X.509 certificates]: https://www.itu.int/rec/T-REC-X.509 [RFC 7518]: https://tools.ietf.org/html/rfc7518 [RFC 7517]: https://tools.ietf.org/html/rfc7517 [RFC 8785]: https://datatracker.ietf.org/doc/rfc8785 [self-signed certificates]: https://en.wikipedia.org/wiki/Self-signed_certificate [Signed SearchSet Bundle Example]: signed-searchset-bundle-example.html [Signed Document Bundle Example]: signed-document-bundle-example.html [FHIR-36158]: https://jira.hl7.org/browse/FHIR-36158 [Solicited and Unsolicited Attachments]: solicited-unsolicited-attachments.html [Sending Attachments]: sending-attachments.html [Requesting Attachments Using Attachment Codes]: requesting-attachments-code.html [Requesting Attachments Using Questionnaires]: requesting-attachments-questionnaire.html [Using Questionnaire as Task Input]: task-based-approach.html#using-questionnaire-as-task-input [Using CDex Attachments with DaVinci PAS]: burden-reduction.html [CDex Task Attachment Request Profile]: StructureDefinition-cdex-task-attachment-request.html [LOINC attachment codes]: https://loinc.org/attachments/ [Parameters]: http://hl7.org/fhir/R4/parameters.html [CDex Patient Demographics Profile]: StructureDefinition-cdex-patient-demographics.html [CDex Claim Use Value Set]: ValueSet-cdex-claim-use.html [Prior-Auth AttachmentRequest Example]: Task-cdex-task-example20.html [Claim AttachmentRequest Example]: Task-cdex-task-example19.html [CDex Temporary Code System]: CodeSystem-cdex-temp.html [NHIN Purpose Of Use Code System]: http://hl7.org/fhir/R4/codesystem-nhin-purposeofuse.html [LOINC Document Ontology]: https://loinc.org/document-ontology/ [CDex Signature Bundle Profile]: StructureDefinition-cdex-signature-bundle.html [FHIR RESTful search]: http://hl7.org/fhir/R4/http.html#search [FHIR RESTful read]: http://hl7.org/fhir/R4/http.html#read [Change Log]: changes.html [CDex Parameters Example1]: Parameters-cdex-parameters-example1.html [CDex Parameters Example2]: Parameters-cdex-parameters-example2.html [CDex Parameters Example3]: Parameters-cdex-parameters-example3.html [CDex Parameters Example4]: Parameters-cdex-parameters-example4.html [validating profiles and resources]: http://hl7.org/fhir/R4/validation.html [ImplementationGuide]: http://hl7.org/fhir/R4/implementationguide.html [CDex ImplementationGuide Resource]: ImplementationGuide-hl7.fhir.us.davinci-cdex.html [Da Vinci DTR]: http://hl7.org/fhir/us/davinci-dtr/2.1.0-preview [Questionnaire]: http://hl7.org/fhir/R4/questionnaire.html [Smart Version 2.0.0 EHR launch flow]: https://hl7.org/fhir/smart-app-launch/app-launch.html#launch-app-ehr-launch [Using Da Vinci DTR to Complete the Questionnaire]: requesting-attachments-questionnaire.html#using-da-vinci-dtr-to-complete-the-questionnaire [Conforming to CDex Attachments]: attachments-conformance.html [Request for Additional Information]: /additionalinfo.html [SDC Questionnaire Response Profile]:http://hl7.org/fhir/uv/sdc/STU3StructureDefinition-sdc-questionnaireresponse.html [SDC Adaptive Questionnaire Response Profile]:http://hl7.org/fhir/uv/sdc/STU3StructureDefinition-sdc-questionnaireresponse-adapt.html [45 CFR 164.506 Treatment, Payment, and Health Care Operations (TPO)]: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.506 [must support]: http://hl7.org/fhir/us/davinci-hrex/STU1.1/conformance.html [DTR SMART App Launch]: requesting-attachments-questionnaire.html#dtr-smart-app-launch [Conforming to CDex Task Based Approach]: task-based-conformance.html [Signature Extension]: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature [DTR Standard Questionnaire]: http://hl7.org/fhir/us/davinci-dtr/2.1.0-previewStructureDefinition-dtr-std-questionnaire.html [signatureRequired]: http://hl7.org/fhir/StructureDefinition/questionnaire-signatureRequired [CDex Signature Profile]: StructureDefinition-cdex-signature.html [CDex SDC QuestionnaireResponse Profile]: StructureDefinition-cdex-sdc-questionnaireresponse.html [QuestionnaireResponse]: http://hl7.org/fhir/R4/questionnaireresponse.html [Topic-Based Subscriptions Framework]: http://hl7.org/fhir/2022Sep/subscriptions.html [C-CDA on FHIR Documents]: http://www.hl7.org/fhir/us/ccda/index.html [FHIR Conformance]: http://hl7.org/fhir/R4/conformance-rules.html#conflang [Must Support]: http://hl7.org/fhir/R4/profiling.html#mustsupport [modifier elements]: http://hl7.org/fhir/R4/conformance-rules.html#isModifier [CDex PractitionerRole Profile]: StructureDefinition-cdex-practitionerrole.html [CDex Task Update]: SubscriptionTopic-cdex-task-update.html [Subscription R5 Backport Implementation Guide]: http://hl7.org/fhir/uv/subscriptions-backport/STU1.1 [SubscriptionTopic]: https://hl7.org/fhir/R4B/subscriptiontopic.html [CapabilityStatement SubscriptionTopic Canonical]: http://hl7.org/fhir/uv/subscriptions-backport/STU1.1/StructureDefinition-capabilitystatement-subscriptiontopic-canonical.html [Conformance in FHIR R4]: http://hl7.org/fhir/uv/subscriptions-backport/STU1.1/conformance.html#conformance-in-fhir-r4 [R4/B Topic-Based Subscription Profile]: http://hl7.org/fhir/uv/subscriptions-backport/STU1.1/StructureDefinition-backport-subscription.html [R4 Topic-Based Subscription Notification Bundle]: http://hl7.org/fhir/uv/subscriptions-backport/STU1.1/StructureDefinition-backport-subscription-notification-r4.html [HRex Task Status ValueSet]: http://hl7.org/fhir/us/davinci-hrex/STU1.1/ValueSet-hrex-task-status.html [Task.businessStatus]: http://hl7.org/fhir/R4/task-definitions.html#Task.businessStatus [Benefits]: task-based-approach.html#benefits [Task Inputs and Outputs]: task-based-approach.html#task-inputs-and-outputs [Purpose of Use]: task-based-approach.html#purpose-of-use [Task Reason]: task-based-approach.html#task-reason [Discovery of Identifiers]: task-based-approach.html#discovery-of-identifiers [Task State Machine]: task-based-approach.html#task-state-machine [Approaches to Exchanging FHIR Data]: https://hl7.org/fhir/R5/exchanging.html [PAS Claim Response Bundle]: /StructureDefinition-profile-pas-response-bundle.html [PAS Task]: /StructureDefinition-profile-task.html [Patient Matching]: https://hl7.org/fhir/us/identity-matching/patient-matching.html [Guidance on Identity Assurance]: https://hl7.org/fhir/us/identity-matching/guidance-on-identity-assurance.html [Interoperable Digital Identity and Patient Matching]: https://hl7.org/fhir/us/identity-matching/index.html [CQL]: https://cql.hl7.org/ [Da Vinci Use Cases]: https://confluence.hl7.org/display/DVP/Da+Vinci+Use+Cases [FHIR R4 core]: http://hl7.org/fhir/R4/fhir-spec.zip [FHIR core downloads]: http://hl7.org/fhir/R4/downloads.html [validator]: https://fhir.github.io/latest-ig-validator/org.hl7.fhir.validator.jar [instructions on how to use it]: https://confluence.hl7.org/display/FHIR/Using+the+FHIR+Validator

Generated Narrative: ValueSet cdex-POU

This value set includes codes based on the following rules:

• Include these codes as defined in http://terminology.hl7.org/CodeSystem/v3-ActReason

  Code	Display	Definition
  COVERAGE	coverage under policy or program	To perform one or more operations on information for conducting activities related to coverage under a program or policy.
  CLMATTCH	claim attachment	To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.
  COVAUTH	coverage authorization	To perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.
  HQUALIMP	health quality improvement	To perform one or more operations on information used for conducting administrative activities to improve health care quality.
  HDM	healthcare delivery management	To perform one or more actions on information used for conducting administrative and contractual activities by or on behalf of organizational entities responsible for delivery of an individual's benefits in a healthcare program, health plan or insurance. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment. *Usage Note:* Examples of activities conducted under this purpose of use: provider profiling, risk adjustment, underwriting, fraud and abuse, quality improvement population health and care management. Aligns with HIPAA Operation POU minus coordination of care or other treatment related activities. Similar to the description in SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking. *Map:* Maps to ISO 14265 Classification Term "Administration of care for an individual subject of care" described as "To inform persons or processes responsible for enabling the availability of resources or funding or permissions for providing health care services to the subject of care." However, this classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.
  COC	coordination of care	To perform one or more actions on information in order to organize the provision and case management of an individual's healthcare, including: Monitoring a person's goals, needs, and preferences; acting as the communication link between two or more participants concerned with a person's health and wellness; organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person; and ensuring safe, appropriate, non-duplicative, and effective integrated care. *Usage Note:* Use when describing these functions: 1. Monitoring a person's goals, needs, and preferences. 2. Acting as the communication link between two or more participants concerned with a person's health and wellness. 3. Organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person. 4. Ensuring safe, appropriate, non-duplicative, and effective integrated care. The goal is to clearly differentiate this type of coordination of care from HIPAA Operations by specifying that these actions on information are undertaken in the provision of healthcare treatment. For similar uses of this concept, see SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking, which differentiates concepts of care coordination and case management for the provision of treatment as specifically distinct from activities related to health care delivery management and the operations of organizational entities involved in the delivery of healthcare. *Map:* Maps to ISO 14265 Classification Terms: "Support of care activities within the provider organisation for an individual subject of care" described as "To inform persons or processes enabling others to provide health care services to the subject of care." "Subject of Care Uses" described as "To inform the subject of care in support of his or her own interests."
  TREAT	treatment	To perform one or more operations on information for provision of health care.

• Include these codes as defined in http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp

  Code	Display	Definition
  care-planning	Care Planning	Request for data from payers or providers to determine how to deliver care for a particular patient, group or community.
  social-risk	Social Risk	Request for data from payers or other providers to assess of social risk, establishing coded health concerns/problems, creating patient driven goals, managing interventions, and measuring outcomes.
  payment-noe	Payment Not Otherwise Enumerated	[Existing concepts do not define a more detailed [Payment as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html). Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.
  operations-noe	Operations Not Otherwise Enumerated	Existing concepts do not define a more detailed [Healthcare Operations as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html). Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.
  treatment-noe	Treatment Not Otherwise Enumerated	Existing concepts do not define a more detailed [Treatment as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html). Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.

Generated Narrative: ValueSet

This value set contains 12 concepts