Da Vinci Clinical Data Exchange (CDex) Implementation Guide
0.2.0 - ballot

This page is part of the Da Vinci Clinical Documentation Exchange (v0.2.0: STU1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions


Based on balloter feedback, this IG has been completely re-written. The refactoring has been sufficiently large that it is not practical/useful to enumerate a list of changes.

This IG provides detailed guidance that helps implementers use FHIR-based interactions and resources relevant to support specific exchanges of clinical information between provider and payers (or other providers). What is unique about this guide is that is provides additional technical guidance on two FHIR transaction approaches for requesting information:

  • Direct Query
  • Task Based Approach:

The types of clinical data is not limited to FHIR resources, but includes C-CDA documents, pdfs, text files and other types of data. There may be requests for payloads of clinical records of care such as CCD Documents, clinical data sets that may be represented in a FHIR bundles, and clinical data such as a specific FHIR resource. By using the FHIR standard and implementing this guide the quality of information shared can be improved. Payers can be explicit about the data they are requesting, as opposed to general requests which often result in providers sending more information than might be necessary to make sure claims are supported. Benefits resulting from the information exchange interaction include:

  • Improve care coordination
  • Support risk adjustment
  • Ease quality management
  • Facilitate claims auditing
  • Confirm medical necessity
  • Support orders and referrals

About This Guide

This Implementation Guide is supported by the Da Vinci initiative which is a private effort to accelerate the adoption of Health Level Seven International Fast Healthcare Interoperability Resources (HL7® FHIR®) as the standard to support and integrate value-based care (VBC) data exchange across communities. Like all Da Vinci Implementation Guides, it follows the HL7 Da Vinci Guiding Principles for exchange of patient health information. The guide is based upon the prior work from the US Core and Da Vinci Health Record Exchange (HRex) Implementation Guides. Changes to this specification are managed by the sponsoring HL7 Patient Care (PC) workgroup and are incorporated as part of the standard HL7 balloting process. You can suggest changes to this specification by creating a change request tracker by clicking on the Propose a Change link at the bottom of any page.

How to read this Guide

This Guide is divided into several pages which are listed at the top of each page in the menu bar.

  • Home: The home page provides the introduction for the Da Vinci Clinical Data Exchange Project.
  • Background: This page provides the background and a summary of the Da Vinci Clinical Data Exchange Project.
  • Specification: This page provides detailed guidance on the set of FHIR transactions and the FHIR artifacts used in a general framework to support exchange of clinical information between provider and payers.
  • FHIR Artifacts: These pages provide detailed descriptions and examples for

This Implementation Guide was made possible by the thoughtful contributions of the following people and organizations:

  • The twenty-two founding Da Vinci Project member organizations.

  • Eric Haas, Health eData Inc
  • Lloyd Mckenzie, Gevity
  • Robert Dieterle, EnableCare
  • Viet Nguyen, Stratametrics
  • Jocelyn Keegan, Point of Care Partners
  • Lisa Nelson MaxMD
  • Rick Geimer Lantana Consulting Group