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

PDex Provenance

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When a Health Plan forwards information as a FHIR Resource it SHOULD create related Provenance record(s) to reflect the original source.

A Provenance resource SHOULD be provided with each member-related resource provided by the Health Plan's FHIR API.

This SHOULD be used to:

• identify the source of the information.
• whether the data came via a clinical record, or a claim record.

The PDex-Provenance resource is based on the US Core Provenance Profile and is documented here: StructureDefinition-pdex-provenance.html

PDex Provenance adds an extension that uses the ProvenanceSourceFrom ValueSet to the entity element. In the PDex Provenance Profile the extension is included in the Provenance.entity base element.

Provenance.recorded value SHOULD be the date/time when the data is received by the payer.

The purpose of the extension is to identify the source format that the data in the provenance.target resource is taken from.

The Pdex Provenance record SHOULD be populated with the following essential fields (Must Support or Cardinality greater than 0..*) as follows:

Table Definition

Example Provenance Records

Four examples are provided to deal with four different scenarios:

1. Payer is transmitting a bundle ExampleProvenanceTransmitter
2. Organization as source of a record ExampleProvenanceAuthor
3. Solo Practitioner as source of a record ExampleProvenanceSoloPractitioner
4. Payer as source of a record ExampleProvenancePayerSource

Payer Receives a bundle from another Payer

If the payer is storing the content of the bundle rather than retaining the bundle intact then the content received SHOULD be written to a FHIR server and the records assigned new FHIR IDs with references being re-written to maintain referential integrity.

Provenance records received need to have their target references re-written to maintain the link to the received records. If the bundle include a Transmitter Provenance record the receiving payer would re-write the target reference(s) in the Transmitter record to link to the records received in the bundle that were written to the receiving payer's FHIR server.

Example bundles showing how records are updated as they pass from Payer to Payer are shown below. In these examples we are only showing encounter records, however any US Core clinical record could be part of the transmitted bundle.

The first bundle is requested by Payer 2 from Payer 1. Payer 1 also includes a Transmitter Provenance record for the content of the bundle.

Payer 1 Bundle requested by Payer 2

When a member moves from Payer 2 to Payer 3 the bundle comprises a Patient Record from Payer 2. Encounter and Provenance records received from Payer 1. The Transmitter record from Payer 1. The Encounter record received from a Provider for the member while covered by Payer 2. A supporting Provenance record for the encounter is included. A Transmitter Provenance record is also generated by Payer 2 to cover the content of the bundle.

Payer 2 Bundle requested by Payer 3

When the member moves from Payer 2 to Payer 3 the bundle received from Payer 2 includes a Patient record written by Payer 2. The Encounter and Provenance records from Payer 1 plus the Encounter and Provenance records generated while the member was covered by Payer 2. A re-written Transmitter record is included from Payer 1 and a Transmitter record generated for the bundle by Payer 2 is also included.

Payer 3 bundle requestewd by Payer 4

Payer Converts a clinical record from a non-FHIR format

The Payer creates the Provenance record as follows:

target.reference = Reference of the converted record
recorded = Date original record was received
agent.type = Author
agent.who = US Core Organization record for the originating organization
extension.sourceFormat = "ccda" to identify that the record was transformed from a CCDA document

Payer Converts a practitioner's clinical record from a non-FHIR format

The Payer creates the Provenance record as follows:

target.reference = Reference of the converted record
recorded = Date original record was received
agent.type = Author
agent.who = US Core Practitioner record when the provider is NOT associated with an organization
extension.sourceFormat = "hl7v2" to identify that the record was transformed from a HL7 v2 message

Payer creates a clinical record from internal sources

The Payer creates the Provenance record as follows:

target.reference = Reference of the converted record
recorded = Date original record was received
agent.type = Source
agent.who = Payer's US Core Organization record
extension.sourceFormat = "custom" to identify that the record was transformed from a custom data format such as a CSV file.

The Health Plan SHALL accept and maintain Provenance information associated with information received from contributing entities. The Health Plan SHALL add Provenance record(s) as necessary to document relevant actions taken as the current custodian of the information. Provenance information SHALL be available for any information requested by an external entity as part of exchanges conformant to this implementation guide.

This guide shall define extensions to the provenance value sets as required to document the provenance of the information exchange.

Clinical Information without Provenance

The Health Plan SHOULD create a Provenance Record documenting the source of the records, the identity of the health plan and the action taken to become the custodian of the data.

The updated Provenance record SHOULD be passed on to any downstream entity that requests Provenance information for the records they request.

FHIR Resource from prior Health Plan

The Health Plan SHOULD store the Provenance information and maintain the correlation or links to the records the Provenance Record is documenting.

The Health Plan SHOULD update the Provenance records to add information covering the identity of the health plan and the action taken to become the custodian of the data.

The updated Provenance record SHOULD be passed on to any downstream entity requesting the associated records.

Claim Information from Provider

The Health Plan SHOULD create a Provenance Record documenting the source of the records, the identity of the health plan and the action taken to transform the data to FHIR Clinical Resources.

The updated Provenance record SHOULD be passed on to any downstream entity requesting the associated records.

Example Provenance Record

An example Author Provenance record appears below:

{
  "resourceType" : "Provenance",
  "id" : "1000002",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2020-07-10T16:26:23.217+00:00",
    "profile" : [
      "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-target-provenance"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">
Generated Narrative
</div>"
  },
  "extension" : [
    {
      "url" : "sourceFormat",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-pdex/ValueSet/ProvenancePayerSourceFormatVS",
            "code" : "hl7ccda"
          }
        ]
      }
    }
  ],
  "target" : [
    {
      "reference" : "encounter/2000003"
    }
  ],
  "recorded" : "2020-07-10T16:26:23.217+00:00",
  "agent" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/provenanceagenttype",
            "code" : "author"
          }
        ]
      },
      "who" : {
        "reference" : "Organization/Payer1"
      }
    }
  ]
}

Returning Provenance Records

Requesting a provenance resource is accomplished by adding the "_revinclude=Provenance:target" parameter to a search query.

For servers that support the "_revinclude" parameter this will return Provenance records in a bundle along with the resources returned by the search query.

Next Page - US Core Provenance