Da Vinci Payer Data Exchange
2.1.0 - ballot
Da Vinci Payer Data Exchange
2.1.0 - ballot
Da Vinci Payer Data Exchange, published by HL7 International / Financial Management. 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-epdx/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org/fhir/us/davinci-pdex/CapabilityStatement/pdex-server | Version: 2.1.0 | |||
| Standards status: Trial-use | Computable Name: PdexServerCapabilityStatement | |||
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License |
||||
This Section describes the expected capabilities of the PDex Server actor which is responsible for providing responses to the queries submitted by the PDex Requestors. The complete list of FHIR profiles, RESTful operations, and search parameters supported by PDex Servers are defined. PDex Clients have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.
Raw OpenAPI-Swagger Definition file | Download
Generated Narrative: CapabilityStatement pdex-server
jsonapplication/json-patch+jsonNote to Implementers: FHIR Capabilities
Any FHIR capability may be 'allowed' by the system unless explicitly marked as 'SHALL NOT'. A few items are marked as MAY in the Implementation Guide to highlight their potential relevance to the use case.
serverThe PDex Server SHALL:
The PDex Server SHOULD:
meta.profile attribute for each instance.
- See the US Core Security Considerations section for requirements and recommendations. 2. A server SHALL reject any unauthorized requests by returning an
HTTP 401unauthorized response code.
transactioninteraction.batchinteraction.search-systeminteraction.history-systeminteraction.The summary table lists the resources that are part of this configuration, and for each resource it lists:
_include_revinclude| Resource Type | Profile | R | V-R | S | U | P | C | H-I | H-T | Searches | _include | _revinclude | Operations |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AllergyIntolerance | Supported Profiles US Core AllergyIntolerance Profile | y | y | y | y | y | patient | Provenance:target | |||||
| CarePlan | Supported Profiles US Core CarePlan Profile | y | y | y | y | y | category, date, patient, status | Provenance:target | |||||
| CareTeam | Supported Profiles US Core CareTeam Profile | y | y | y | y | y | patient, status | Provenance:target | |||||
| Condition | Supported Profiles US Core Condition Profile | y | y | y | y | y | category, clinical-status, patient, onset-date, code | Provenance:target | |||||
| Consent | Supported Profiles PDex Provider Access Consent Profile | y | y | y | y | y | y | _id, patient | Provenance:target | ||||
| Coverage | Supported Profiles HRex Coverage Profile | y | y | y | y | y | _id | Provenance:target | |||||
| Device | Supported Profiles PDex Device US Core Implantable Device Profile | y | y | y | y | y | patient, type | Provenance:target | |||||
| DiagnosticReport | Supported Profiles US Core DiagnosticReport Profile for Report and Note Exchange US Core DiagnosticReport Profile for Laboratory Results Reporting | y | y | y | y | y | y | status, patient, category, code, date | Provenance:target | ||||
| DocumentReference | Supported Profiles US Core DocumentReference Profile | y | y | y | y | y | _id, status, patient, category, type, date, period | Provenance:target | $docref | ||||
| Encounter | Supported Profiles US Core Encounter Profile | y | y | y | y | y | _id, class, date, identifier, patient, status, type | Provenance:target | |||||
| ExplanationOfBenefit | Supported Profiles PDex Prior Authorization | y | y | _id, patient, _lastUpdated, type, identifier, service-date | ExplanationOfBenefit:patient, ExplanationOfBenefit:provider, ExplanationOfBenefit:care-team, ExplanationOfBenefit:coverage, ExplanationOfBenefit:insurer, ExplanationOfBenefit:* | ||||||||
| Goal | Supported Profiles US Core Goal Profile | y | y | y | y | y | lifecycle-status, patient, target-date | Provenance:target | |||||
| Group | Supported Profiles Davinci ATR Group PDex Provider Group PDex Member Match Group | y | y | y | y | y | identifier, characteristic, Group-characteristic-value-reference | ||||||
| Immunization | Supported Profiles US Core Immunization Profile | y | y | y | y | y | patient, status, date | Provenance:target | |||||
| Location | Supported Profiles US Core Location Profile | y | y | y | y | y | name, address, address-city, address-state, address-postalcode | ||||||
| Medication | Supported Profiles US Core Medication Profile | y | y | y | y | y | |||||||
| MedicationRequest | Supported Profiles US Core MedicationRequest Profile | y | y | y | y | y | status, intent, patient, encounter, authoredon | MedicationRequest:medication | Provenance:target | ||||
| MedicationDispense | Supported Profiles PDex MedicationDispense | y | y | y | y | y | status, patient | MedicationDispense:medication | Provenance:target | ||||
| Observation | Supported Profiles US Core Pediatric BMI for Age Observation Profile US Core Pediatric Weight for Height Observation Profile US Core Pulse Oximetry Profile US Core Smoking Status Observation Profile US Core Pediatric Head Occipital Frontal Circumference Percentile Profile US Core Pediatric Weight for Height Observation Profile US Core Pulse Oximetry Profile US Core Laboratory Result Observation Profile Vital Signs Profile | y | y | y | y | y | status, category, code, date, patient | Provenance:target | |||||
| Organization | Supported Profiles US Core Organization Profile | y | y | y | y | y | name, address | ||||||
| Patient | Supported Profiles US Core Patient Profile | y | y | y | y | y | _id, birthdate, family, gender, given, identifier, name | Provenance:target | |||||
| Practitioner | Supported Profiles US Core Practitioner Profile | y | y | y | y | y | name, identifier | ||||||
| PractitionerRole | Supported Profiles US Core PractitionerRole Profile | y | y | y | y | y | specialty, practitioner | PractitionerRole:endpoint, PractitionerRole:practitioner | |||||
| Procedure | Supported Profiles US Core Procedure Profile | y | y | y | y | y | status, patient, date, code | Provenance:target | |||||
| Provenance | Supported Profiles PDex Provenance US Core Provenance Profile | y | y | y | y | y | y | ||||||
| ValueSet | $expand |
resolvessearch-type, read.vread, history-instance.history-type.resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition
| Conformance | Parameter | Type | Documentation |
|---|---|---|---|
| SHALL | patient | reference | |
| MAY | category | token | |
| MAY | clinical-status | token | |
| MAY | onset-date | date | |
| MAY | code | token |
| Conformance | Parameters | Types |
|---|---|---|
| patient+onset-date | reference+date | |
| patient+category | reference+token | |
| patient+clinical-status | reference+token | |
| patient+code | reference+token |
resolvesread, create, search-type, vread, history-instance, history-type.| Conformance | Parameter | Type | Documentation |
|---|---|---|---|
| SHALL | _id | string | |
| SHALL | patient | reference |
resolvesread, search-type, vread, history-instance, history-type.http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage
| Conformance | Parameter | Type | Documentation |
|---|---|---|---|
| SHALL | _id | string |
resolvessearch-type, read.vread, history-instance.history-type.resolvessearch-type, read.vread, history-instance.history-type.The DocumentReference.type binding SHALL support at a minimum the 5 Common Clinical Notes and may extend to the full US Core DocumentReference Type Value Set
| Conformance | Operation | Documentation |
|---|---|---|
| SHALL | $docref | A server SHALL be capable of responding to a $docref operation and capable of returning at least a reference to a generated CCD document, if available. MAY provide references to other 'on-demand' and 'stable' documents (or 'delayed/deferred assembly') that meet the query parameters as well. If a context date range is supplied the server ** SHOULD** provide references to any document that falls within the date range If no date range is supplied, then the server SHALL provide references to last or current encounter. SHOULD document what resources, if any, are returned as included resources |
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter
resolvessearch-type, read.When a Prior Authorization references another resource (e.g., Patient or Practitioner), the reference may be versioned or versionless. Payers SHALL use versioned references whenever they maintain point-in-time data (data that was effective as of the date of service or date of admission on the claim), but MAY use versionless references when they do not maintain versioned data. Clients MAY request referenced resources as part of an EOB search (by supplying the _include parameter) or directly using read or vread. Payers SHALL support both approaches, and SHALL return the same content for referenced resources in either case. “:iterate" should be used if you request to include Coverage:payor in the EOB response bundle, e.g. GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:coverage&_include:iterate=Coverage:payor.
| Conformance | Parameter | Type | Documentation |
|---|---|---|---|
| SHALL | _id | token | |
| SHALL | patient | reference | |
| SHALL | _lastUpdated | date | |
| SHALL | type | token | |
| SHALL | identifier | token | |
| SHALL | service-date | date |
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-goal
| Conformance | Parameter | Type | Documentation |
|---|---|---|---|
| SHALL | patient | reference | |
| MAY | lifecycle-status | token | |
| MAY | target-date | date |
| Conformance | Parameters | Types |
|---|---|---|
| patient+lifecycle-status | reference+token | |
| patient+target-date | reference+date |
search-type, read.vread, history-instance.history-type.| Conformance | Parameter | Type | Documentation |
|---|---|---|---|
| SHALL | identifier | token | The client SHALL provide at least a code value and MAY provide both the system and code values. The server SHALL support both. |
| SHALL | characteristic | token | A common characteristic of all members of a group. |
| SHALL | Group-characteristic-value-reference | composite | multipleAnd: It's up to the server whether the parameter may repeat in order to specify multiple values that must all be true. multipleOr: The parameter may only have one value (no comma separators). |
| Conformance | Operation | Documentation |
|---|---|---|
| SHALL | $bulk-member-match | Client will submit multi-member-match-request bundle. Server will respond with a multi-member-match-response and instantiate a Group resource conforming to the PDexMemberMatchGroup that contains a set of matched members that the Server identified. |
| SHALL | $davinci-data-export | Each DaVinci use case as part of its implementation guide can define the exportType parameter and the behavior expected. |
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-location
| Conformance | Parameter | Type | Documentation |
|---|---|---|---|
| SHALL | name | string | |
| SHALL | address | string | |
| SHOULD | address-city | string | |
| SHOULD | address-state | string | |
| SHOULD | address-postalcode | string |
resolvesread.vread, history-instance.search-type, history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication
The MedicationRequest resource can represent a medication, using an external reference to a Medication resource. If an external Medication Resource is used in a MedicationRequest, then the READ SHALL be supported.
resolvessearch-type, read.vread, history-instance.history-type.The MedicationRequest resources can represent a medication using either a code or refer to the Medication resource. When referencing Medication, the resource may be contained or an external resource. The server application MAY choose any one way or more than one method, but if an external reference to Medication is used, the server SHALL support the _include
parameter for searching this element. The client application must support all methods. For example, A server **SHALL** be capable of returning all medications for a patient using one of or both:GET /MedicationRequest?patient=[id]GET /MedicationRequest?patient=[id]&_include=MedicationRequest:medication`
| Conformance | Parameter | Type | Documentation |
|---|---|---|---|
| MAY | status | token | |
| MAY | intent | token | |
| MAY | patient | reference | |
| MAY | encounter | reference | |
| MAY | authoredon | date |
resolvessearch-type, read.vread, history-instance.history-type.The MedicationDispense resources can represent a medication using either a code or refer to the Medication resource. When referencing Medication, the resource may be contained or an external resource. The server application MAY choose any one way or more than one method, but if an external reference to Medication is used, the server SHALL support the _include
parameter for searching this element. The client application must support all methods. For example, A server **SHALL** be capable of returning all medications for a patient using one of or both:GET /MedicationDispense?patient=[id]GET /MedicationDispense?patient=[id]&_include=MedicationDispense:medication`
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/pediatric-bmi-for-age
http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-height
http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry
http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus
http://hl7.org/fhir/us/core/StructureDefinition/head-occipital-frontal-circumference-percentile
http://hl7.org/fhir/us/core/StructureDefinition/pediatric-weight-for-height
http://hl7.org/fhir/us/core/StructureDefinition/us-core-pulse-oximetry
http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab
http://hl7.org/fhir/StructureDefinition/vitalsigns
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient
| Conformance | Operation | Documentation |
|---|---|---|
| SHALL | $member-match |
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner
| Conformance | Parameter | Type | Documentation |
|---|---|---|---|
| SHALL | name | string | |
| SHALL | identifier | token |
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole
| Conformance | Parameter | Type | Documentation |
|---|---|---|---|
| SHALL | specialty | token | |
| SHALL | practitioner | reference |
resolvessearch-type, read.vread, history-instance.history-type.http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure
resolvesread.vread, history-instance.search-type, patch, history-type.If a system receives a provider in
Provenance.agent.whoas free text they must capture who sent them the information as the organization. On request they SHALL provide this organization as the source and MAY include the free text provider.
| Conformance | Operation | Documentation |
|---|---|---|
| SHOULD | $expand | A client can determine the note and report types support by a server by invoking the standard FHIR Value Set Expansion ($expand) operation defined in the FHIR R4 specification. Because servers may support different read and write formats, it also is used to determine the formats (for example, text, pdf) the server supports read and write transactions. |
IG © 2024+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pdex#2.1.0 based on FHIR 4.0.1. Generated 2024-07-26
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change