ISO/HL7 10781 - Electronic Health Record System Functional Model, Release 2.1
0.16.0 - CI Build
ISO/HL7 10781 - Electronic Health Record System Functional Model, Release 2.1
0.16.0 - CI Build
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| Active as of 2024-08-12 |
<Requirements xmlns="http://hl7.org/fhir">
<id value="EHRSFMR2.1-AS.8.3"/>
<meta>
<profile value="http://hl7.org/ehrs/StructureDefinition/FMFunction"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml">
<span id="description"><b>Statement <a href="https://hl7.org/fhir/versions.html#std-process" title="Normative Content" class="normative-flag">N</a>:</b> <div><p>Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.</p>
</div></span>
<span id="purpose"><b>Description <a href="https://hl7.org/fhir/versions.html#std-process" title="Informative Content" class="informative-flag">I</a>:</b> <div><p>The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering.</p>
</div></span>
<span id="requirements"><b>Criteria <a href="https://hl7.org/fhir/versions.html#std-process" title="Normative Content" class="normative-flag">N</a>:</b></span>
<table id="statements" class="grid dict">
<tr>
<td style="padding-left: 4px;">
<span>AS.8.3#01</span>
</td>
<td style="padding-left: 4px;">
<span>MAY</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>The system MAY provide the ability to extract formularies, preferred providers, and other information, from internal or external sources, that are associated with a patient's health care plan and coverage so that the provider can offer cost effective alternatives to patients.</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.3#02</span>
</td>
<td style="padding-left: 4px;">
<span>MAY</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines.</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.3#03</span>
</td>
<td style="padding-left: 4px;">
<span>MAY</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines.</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.3#04</span>
</td>
<td style="padding-left: 4px;">
<span>MAY</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>The system MAY provide the ability to render expected patient out-of- pocket cost information for medications, diagnostic testing, and procedures, from internal or external sources, that are associated with a patients health care plan and coverage.</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.3#05</span>
</td>
<td style="padding-left: 4px;">
<span>MAY</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>The system MAY provide the ability to render a notification of an alert to the provider of care where formularies, preferred provider and other information indicate the health plan requires an alternative.</p>
</div></span>
</td>
</tr>
<tr>
<td style="padding-left: 4px;">
<span>AS.8.3#06</span>
</td>
<td style="padding-left: 4px;">
<span>SHOULD</span>
</td>
<td style="padding-left: 4px;" class="requirement">
<span><div><p>The system SHOULD conform to function [[AS.9.3]] (Support Service Authorizations) to integrate support of prior authorization processes.</p>
</div></span>
</td>
</tr>
</table>
</div>
</text>
<url value="http://hl7.org/ehrs/Requirements/EHRSFMR2.1-AS.8.3"/>
<version value="0.16.0"/>
<name
value="AS_8_3_Support_Integration_of_Cost_Financial_information_into_Patient_Care"/>
<title
value="AS.8.3 Support Integration of Cost/Financial information into Patient Care (Function)"/>
<status value="active"/>
<date value="2024-08-12T10:56:01+00:00"/>
<publisher value="EHR WG"/>
<contact>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/ehr"/>
</telecom>
</contact>
<description
value="Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows."/>
<purpose
value="The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering."/>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.3-01"/>
<label value="AS.8.3#01"/>
<conformance value="MAY"/>
<conditionality value="false"/>
<requirement
value="The system MAY provide the ability to extract formularies, preferred providers, and other information, from internal or external sources, that are associated with a patient's health care plan and coverage so that the provider can offer cost effective alternatives to patients."/>
<derivedFrom value="EHR-S_FM_R1.1 S.3.2.3#1"/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.3-02"/>
<label value="AS.8.3#02"/>
<conformance value="MAY"/>
<conditionality value="false"/>
<requirement
value="The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines."/>
<derivedFrom value="EHR-S_FM_R1.1 S.3.2.3#2"/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.3-03"/>
<label value="AS.8.3#03"/>
<conformance value="MAY"/>
<conditionality value="false"/>
<requirement
value="The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines."/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.3-04"/>
<label value="AS.8.3#04"/>
<conformance value="MAY"/>
<conditionality value="false"/>
<requirement
value="The system MAY provide the ability to render expected patient out-of- pocket cost information for medications, diagnostic testing, and procedures, from internal or external sources, that are associated with a patients health care plan and coverage."/>
<derivedFrom value="EHR-S_FM_R1.1 S.3.2.3#3"/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.3-05"/>
<label value="AS.8.3#05"/>
<conformance value="MAY"/>
<conditionality value="false"/>
<requirement
value="The system MAY provide the ability to render a notification of an alert to the provider of care where formularies, preferred provider and other information indicate the health plan requires an alternative."/>
<derivedFrom value="EHR-S_FM_R1.1 S.3.2.3#4"/>
</statement>
<statement>
<extension
url="http://hl7.org/ehrs/StructureDefinition/requirements-dependent">
<valueBoolean value="false"/>
</extension>
<key value="EHRSFMR2.1-AS.8.3-06"/>
<label value="AS.8.3#06"/>
<conformance value="SHOULD"/>
<conditionality value="false"/>
<requirement
value="The system SHOULD conform to function [[AS.9.3]] (Support Service Authorizations) to integrate support of prior authorization processes."/>
<derivedFrom value="EHR-S_FM_R1.1 S.3.2.3#5"/>
</statement>
</Requirements>