CoverageRequirementsDiscovery 0.1.0 - STU1 Ballot 1 (for FHIR 3.5.0)

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v0.1.0: STU 1 Ballot 1) based on FHIR v3.5.0. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Background and Use Cases

Underlying technologies

This guide is based on the HL7 FHIR standard, as well as the CDS Hooks and SMART on FHIR standards, which build additional capabilities on top of FHIR. This architecture is intended to maximize the number of clinical systems that conform to this guide as well as to allow for easy growth and extensibility of system capabilities in the future.

Implementers of this specification therefore need to understand some basic information about these specifications

FHIR

This implementation guide uses terminology, notations and design principles that are specific to FHIR. Before reading this implementation guide, it’s important to be familiar with some of the basic principles of FHIR as well as general guidance on how to read FHIR specifications. Readers who are unfamiliar with FHIR are encouraged to read (or at least skim) the following prior to reading the rest of this implementation guide.

This implementation guide builds on two different versions of FHIR - STU3 and R4. The former is intended to support the versions of systems now being moved into production by EHR vendors. The latter is intended to ensure the implementation guide is aligned with the current direction of the FHIR standard. Initial implementation will likely focus on STU3, but both payer and clinical systems will likely eventually need to support both.

Implementers should also familiarize themselves with the FHIR resources used within the guide:

STU3 R4
Appointment
Coverage
CommunicationRequest
Device
DeviceRequest
Encounter
Location
Organization
Medication
MedicationRequest
NutritionOrder
Patient
Practitioner
PractitionerRole
ProcedureRequest
Questionnaire
ReferralRequest
SupplyRequest
Task
VisionPrescription 		Appointment
Coverage
CommunicationRequest
Device
DeviceRequest
Encounter
Location
Organization
Medication
MedicationRequest
NutritionOrder
Patient
Practitioner
PractitionerRole
Questionnaire
ServiceRequest
SupplyRequest
Task

CDS Hooks

The bulk of the functionality of this specification is implemented using CDS Hooks. The Hooks specification is small. Implementers should read and be familiar with all of it.

SMART on FHIR

Client systems conformant to this implementation guide will also have to serve as a SMART on FHIR client to allow coverage discovery functionality to be invoked outside of regular clinical workflows. As such client implementers will also need to be familiar with the SMART on FHIR specification. It is also relatively short. Because the SMART on FHIR app will interact with payer systems through the CDS Hooks interface, payer implementers only need to be familiar with the SMART on FHIR specification if they plan to develop SMART apps for launch by CDS Hooks or for other purposes.

Use cases and process flow

TODO