Da Vinci Clinical Data Exchange (CDex)
1.1.0 - STU1.1 US

This page is part of the Da Vinci Clinical Documentation Exchange (v1.1.0: STU1.1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

ValueSet: CDex Purpose of Use Value Set

Official URL: http://hl7.org/fhir/us/davinci-cdex/ValueSet/cdex-POU Version: 1.1.0
Draft as of 2021-10-26 Computable Name: CDexPOUCodes

Copyright/Legal: Used by permission of HL7 International all rights reserved Creative Commons License

The set of purpose of use codes for the requested data (the output of the task). This code set is composed of FHIR core Purpose of Use security labels and additional codes defined by this Guide.

References

The following page is DRAFT. It has not yet undergone HL7 balloting.

Logical Definition (CLD)

This value set includes codes based on the following rules:

  • Include these codes as defined in http://terminology.hl7.org/CodeSystem/v3-ActReason
    CodeDisplayDefinition
    COVERAGEcoverage under policy or programTo perform one or more operations on information for conducting activities related to coverage under a program or policy.
    CLMATTCHclaim attachmentTo 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.
    COVAUTHcoverage authorizationTo perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.
    HQUALIMPhealth quality improvementTo perform one or more operations on information used for conducting administrative activities to improve health care quality.
    HDMhealthcare delivery managementTo 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.
    COCcoordination of careTo 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."
    TREATtreatmentTo 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
    CodeDisplayDefinition
    care-planningCare PlanningRequest for data from payers or providers to determine how to deliver care for a particular patient, group or community.
    social-riskSocial RiskRequest 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-nosPayment Not Otherwise Specified[Healthcare Payment as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html) and isn't defined further to ascertain a more detailed Purpose of Use concept.
    operations-nosOperations Not Otherwise Specified[Healthcare Operations as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html) and isn't defined further to ascertain a more detailed Purpose of Use concept.

 

Expansion

This value set contains 11 concepts

CodeSystemDisplayDefinition
  COVERAGEhttp://terminology.hl7.org/CodeSystem/v3-ActReasoncoverage under policy or programTo perform one or more operations on information for conducting activities related to coverage under a program or policy.
  CLMATTCHhttp://terminology.hl7.org/CodeSystem/v3-ActReasonclaim attachmentTo 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.
  COVAUTHhttp://terminology.hl7.org/CodeSystem/v3-ActReasoncoverage authorizationTo perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.
  HQUALIMPhttp://terminology.hl7.org/CodeSystem/v3-ActReasonhealth quality improvementTo perform one or more operations on information used for conducting administrative activities to improve health care quality.
  HDMhttp://terminology.hl7.org/CodeSystem/v3-ActReasonhealthcare delivery managementTo 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.
  COChttp://terminology.hl7.org/CodeSystem/v3-ActReasoncoordination of careTo 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."
  TREAThttp://terminology.hl7.org/CodeSystem/v3-ActReasontreatmentTo perform one or more operations on information for provision of health care.
  care-planninghttp://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-tempCare PlanningRequest for data from payers or providers to determine how to deliver care for a particular patient, group or community.
  social-riskhttp://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-tempSocial RiskRequest 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-noshttp://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-tempPayment Not Otherwise Specified[Healthcare Payment as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html) and isn't defined further to ascertain a more detailed Purpose of Use concept.
  operations-noshttp://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-tempOperations Not Otherwise Specified[Healthcare Operations as defined by HIPAA](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html) and isn't defined further to ascertain a more detailed Purpose of Use concept.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code