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Change History

Page standards status: Informative

This page describes the primary releases of the specification and summarizes the content for each:

Release 2.2.0-ballot

Breaking changes:

• FHIR-50276 - Moved codes out of the temporary code system to their permanent home (correction) TODO
• FHIR-49897 - Clarify that CRD must not be called in 'patient pay' situations (if system is aware) (clarification) link
• FHIR-49909 - Added expectations for handling unexpected content (clarification) link
• FHIR-49128 - Clarified (and loosened) conformance language for prefetch syntax (clarification) link link
• FHIR-50102 - Make explicit that Coverage Information system actions are prohibited from making changes other than adding or updating the coverage-information extension (clarification) link
• FHIR-49830 - Clarify that the requirement to provide access to DTR for clinicians is required for patient forms, not just clinical forms (correction) link
• FHIR-50492, FHIR-50494, FHIR-50495, FHIR-50496 - Updated CommunicationRequest.reasonReference, DeviceRequest.reasonReference, ServiceRequest.reasonReference, Encounter.diagnosis to force most references (other than Observation) to refer to US Core profiles, and added guidance that US Core Observation profiles should be used when possible. (correction) multiple profiles
• FHIR-50318 - Added expectation to put coverage-expectation extension on ServiceRequest for appointments based on ServiceRequest (clarification) link

• FHIR-51045 - Relaxed Location.address to be optional, added guidance expecting propagation of address to fine-grained components (correction, enhancement) link

• Coverage Information Extension
  • FHIR-49950 - Set expectations about coverage-information extension being used in subsequent CRD, DTR and PAS calls to serve as a linking mechanism (clarification) link
  • FHIR-49637 - Defined explicit coverage-information.reason codes for 'no-member-found' and 'no-active-coverage', and required their use (enhancement) link, link
  • FHIR-49754 - Moved detail-code code from 'reason' to 'info-needed' element (correction) link
  • FHIR-49792 - Add coverage-information.detail.category, categorize the standard detail.code values, and advise on expectation to display certain categories to clinical staff (enhancement) link
  • FHIR-51413 - Remove the auth-out-network-only code from coverage-information.detail and add auth-out-network to coverage-information.reason. Also added guidance on when to send multiple coverage information repetitions vs. a single 'conditional' repetition stating the rules. (correction, clarification) link
  • FHIR-49827 - Update crd-ci-q4 contraint on coverage-information to say 'noauth' and 'not-covered' in addition to 'satisfied' as reasons why you can't have a doc purpose of with-pa (correction) link
  • FHIR-49829 - Added crd-ci-q8 to enforce that if doc-purpose is present with a value other than 'conditional', doc-reason must be present (correction) link

Substative changes

• FHIR-50051 - Updated specification to point to current version of CDS Hooks spec and individual hooks (correction) - throughout the spec
• FHIR-49742 - Change logical model token 0..1 to 1..1, made expectation to provide a token 'SHALL' instead of 'will' (correction) link
• FHIR-51420 - Allow coverage-information ids to be unique for the same coverage within a request resource. (correction) link
• FHIR-50009 - Relaxed expectations from SHALL to SHOULD for CRD response types other than coverage-information (correction) link
• FHIR-49983 - Added new 'BillingOptions' extension and allow its use on all Request resources. (enhancement) link, many profiles
• FHIR-49813 - Allow PractitionerRole as an Encounter.participant (enhancement) link
• FHIR-51470, FHIR-51488 - Removed expectations and constraints for inclusion of medical record numbers in the Patient profile (correction) link
• FHIR-49794 - In Questionnaire task, prohibit Task.focus and require input[questionnaire] (correction) link
• FHIR-50269 - Remove 'after completion' input from Questionnaire Task (correction) link
• FHIR-49894 - Added more language around when to use doc-needed vs. info-needed, added example of both, made clear that if info-needed of OTH, one of the reasons need to indicate what type of information is needed (clarification) link
• FHIR-49801 - Update appointment prefetch to include ServiceRequest (correction) link

Non-substantive changes:

• FHIR-49689 - Corrected change log hyperlink in menu (correction) all pages
• FHIR-48553 - Improved language in first intro paragraph (clarification) link
• FHIR-49753 - Provided recommendations for when CRD discovery should be called (clarification) link
• FHIR-49833 - Reframed warnings about the _include search mechanism to reflect the fact that it is no longer used in prefetch. (correction) link
• FHIR-49003 - Removed language implying that Task could be a focal request when submitting a CRD request or have coverage-information and provided clearer information about the purpose of CommunicationRequest (correction, clarification) - section no longer exists to link to
• FHIR-49731 - Corrected prefetch syntax to be CDS Hooks-conformant (correction) link
• FHIR-48771 - Clarified prefetch references (clarification) link, link
• FHIR-49196 - Clarified that _include may not be supported when using non-prefetch queries. (clarification) link
• FHIR-48797 - Clarified rules on multiple coverages (clarification) link
• FHIR-49805 - Added CommunicationRequest and VisionPrescription to prefetch and non-prefetch queries (correction) link, link, link, , link
• FHIR-49835 - Removed the "additional hook resources" section of the deviations page (because in the referenced version of the CDS Hooks, it's no longer a deviation). (correction) Nothing to link to anymore
• FHIR-49762 - Added VisionPrescription to the list of supported 'Request' resources for order-select and order-dispatch. (They were already in the technical list, just not the HTML.) (correction) link link
• FHIR-49085 - In diagram, corrected "Payer CDA System" to "Payer CDS System" (correction) link
• FHIR-50006 - Added additional examples for non-provided/insufficient information that is not considered an error (clarification) link
• FHIR-48625 - Added guidance on best CRD service available practices (clarification) link
• FHIR-49799 - Corrected appointment profiles to not be abstract (correction) link, link
• FHIR-50206 - Removed patient as an allowed type of Coverage payer (correction) link
• FHIR-49795 - Dropped Questionnaire Task reason value set and require inclusion of text (correction) link
• FHIR-50225 - Added an introduction to the coverage-information extension providing a detailed overview and ensured all elements had proper descriptions (clarification) link
• FHIR-48773 - Clarified where coverage-information.coverage must exist (clarification) link
• FHIR-49711 - Fixed short description for 'info-needed' component of coverage-information extension (correction) link
• FHIR-49791 - Fixed odd content in logical model instances (correction) all logical model files and fragments
• FHIR-49153, FHIR-51036, FHIR-49094 - Corrected names and descriptions of CDS Hooks request and response examples (correction) link
• FHIR-49800 - Fixed bad brackets in CDS Hooks Service Response (correction) link
• FHIR-51187 - Added links to examples zip files on the downloads page (clarification) link
• FHIR-49041 - Added CommunicationRequest examples (clarification) link, link
• FHIR-50814, FHIR-45672 - Added formal models for CDS Hooks components and improved validation of examples (clarification, correction) - many new models and links from various pages

In addition, there have been various miscellaneous non-substantive improvements to formatting, spelling, grammar, etc.

Release 2.1.0

• FHIR-47329, FHIR-48622 - Added support for USCDI v4 (US Core 7.0.0) and clarify language about what multi-US-Core release implementation means
• FHIR-48352 - Set mustSupport expectations for practitioner, practitionerRole and organization for multi-target relationships
• FHIR-48430 - Set clearer expectations for handling failure states
• FHIR-48559 - Make ability to bypass CRD services that are running too long a 'SHALL'
• FHIR-48560 - Make clear that clients need to constrain scopes provided to what's needed
• FHIR-48722 - Collapse the 2 Encounter profiles (USCDI 1, USCDI 3+4) into one

Release 2.1.0-preview

Significant Coverage Information changes:

• FHIR-46088 - Set MS expectations (and general expectations too)
• FHIR-46460 - Remove 'response' element
• FHIR-46089 - Tightened invariants around info-needed
• FHIR-44410 - Add support for policy links and information as qualifiers
• FHIR-45440 - Added new configuration option for 'wanting information' ServiceRequest and one not
• FHIR-44909 - Added support for additional information from patient

Significant other changes:

• FHIR-46440, FHIR-46603 - Set expectations for endpoints and endpoint discovery
• FHIR-45551 - Removed the CRD Practitioner profile (use HRex instead)
• FHIR-46254 - Define a Task profile for order-dispatch hook
• FHIR-44891 - Clarified expectations for mandatory hook support
• FHIR-46006 - Added PractitionerRole to Appointment profile
• FHIR-44527 - Corrected contexts for order-dispatch
• FHIR-46120, FHIR-43435 - Made Location.type MS and require it to be present in the hierarchy
• FHIR-46383 - Prohibit use of CRD to point to portal launch
• FHIR-43182 - Add expiration date to Coverage-Information
• FHIR-45295 - Relax expections on Request statuses to not have to be 'draft'
• FHIR-44388 - Split Appointment profile into two - one pointing to
• FHIR-45230 - Relaxed 'reason' constraints in profiles to align with US Core
• FHIR-46793 - Set expectations for CRD clients to query data when possible

A variety of minor corrections and clarifications to wording and examples.

Release 2.0.1

Corrected the embedded JSON examples to be technically correct and in line with other rules in the specification

Release 2.0.0

A number of additional changes and enhancements. Key differences are:

• Renamed the 'Annotate' card to Coverage Information and made it a system action rather than a card
• Removed the Unsolicited determination card type
• Added system action as an optional feature of the form completion and update coverage information cards
• Removed guidance on deferring card actions (as it's no longer terribly relevant for CRD and SMART now defines a mechanism)
• Added additional properties to the coverage-information extension including the ability to specify questionnaires and draft responses for DTR, authorized billing codes, dependencies on other orders, and other details.
• Removed support for 'de-identified' invocation of CRD
• Corrected ServiceRequest.location to be 0..1 instead of 1..1
• Dropped expectation for coverage information to be conveyed as part of orders
• Changed language to make clear that CRD does not provide prior authorizations
• Tightened general conformance expectations
• A few additional corrections and numerous clarifications and refinements

Release 1.1.0

Added a number of enhancements and some changes to approach. Key differences are:

• Clarified that CRD results can be returned to non-clinical users
• Highlighted the challenges of CRD data coming in a different form and set of codes than payers have traditionally dealt with
• Explicit expectations with respect to performance and accuracy of CRD Servers
• Expectations around client ability to flag sensitive orders
• Specified a starter set of codes for configuration options and mandated the appearance of those codes in cards in a new topic element
• Made support for a minimal set of configuration options mandatory
• Added an extension to link cards to requests
• Introduced the new order-dispatch hook
• Added the Annotate and Unsolicited Determination card types
• Revamped how Prefetch handles retrieving a patient's coverage information
• Provided explicit guidance around deferring card actions
• Added a section on registering DTR apps with CRD
• Updated to support CRD 2.0, which included changes to the 'topic' element within cards
• Added support for system actions and made their use mandatory for updates to orders and coverage
• Added a definition of mustSupport for this guide
• Acknowledged that CRD clients can be made up of multiple systems
• Removed constraint prohibiting [ServiceRequest.doNotPerform])(StructureDefinition-profile-servicerequest.html#profile)
• Added guidance on enabling a CRD server
• Added guidance on CRD access tokens
• Clarified expectations about controlling hook invocation
• Provided guidance on external references
• Corrected cardType codes to use the IG temporary code system, as it is likely that long-term these codes won't all live as part of the IG
• Added CapabilityStatements describing CRD client and CRD Server responsibilities

As well there were various other adjustments to specification language, profiles, and examples to align with these changes and to correct minor typos or improve wording.

Release 1.0.0

Initial release of the CRD specification.