HL7.FHIR.US.DAVINCI-DTR\Retrieval of Payer Resources

This page is part of the Documentation Templates and Rules (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Retrieval of Payer Resources

Authentication of SMART on FHIR application to payer API
Questionnaire
CQL Rules

The DTR process will need to retrieve resources from a payer IT system to operate properly. This application will need to obtain a FHIR Questionnaire and associated Clinical Quality Language (CQL) logic files in order to execute. The information needed to obtain the required resources will be provided as escaped JSON in the appContext property of the Clinical Decision Support (CDS) Hooks Card Link object, as described in Section 4.2.1. That object will have the following properties:

Field	Optionality	Type	Description
filePath	OPTIONAL	string	The base URL used to retrieve the questionnaire and related CQL resources. If left blank the app should use a default base URL.
template	REQUIRED	string	The canonical URL of the Questionnaire for the DTR process to use for execution.
request	REQUIRED	string	A copy of the draft request resource for which documentation requirements are being gathered.

The request resource created during the CRD workflow should be saved to the EHR FHIR server for retrieval by the DTR process, if possible. This might, for example, be the ServiceRequest resource that is sent in the CDS hook to the CRD server. Additionally, a tight integration between the CRD service and the DTR process should enable the DTR process to access FHIR resources received by the CRD service that are not available from the EHR’s FHIR server.

This IG will support the HRex Decision point - REST searchable? when using RESTful endpoints to get payer resources (e.g., CQL rules and templates).

Authentication of SMART on FHIR application to payer API

Payers SHALL require the DTR process to authenticate in order to retrieve resources when PHI is exchanged, and MAY required authentication in other situations. In the case that authentication is required, the following JSON structure SHALL be populated by the payer system. This JSON is based on the structure for FHIR Authorization in CDS Hooks.

Field	Optionality	Type	Description
access_token	REQUIRED	string	The OAuth 2 access token that provides access to the payer FHIR server.
token_type	REQUIRED	string	Fixed value: `Bearer`.
expires_in	REQUIRED	integer	The lifetime of the access token in seconds.
scope	REQUIRED	string	Fixed value: `user/Questionnaire.read user/Library.read`.
subject	REQUIRED	string	The OAuth 2.0 client identifier of the DTR process, as registered with the payer’s authorization server.

Questionnaire

The DTR process SHALL use the URL provided in the template property of the appContext to retrieve a Questionnaire resource. The payer SHALL provide this as a FHIR resource, such that the DTR process will be executing a FHIR read interaction on the payer’s server. The returned Questionnaire resource SHALL conform to the CQF-Questionnaire Profile and MAY conform to Structured Data Capture (SDC) Advanced Rendering Profile.

The Questionnaire SHALL have a cqf-library extension property specified. That property SHALL provide the location of one or more CQL libraries needed to execute the payer rules.

CQL Rules

The DTR process SHALL use the URL provided in the cqf-library extension to retrieve the CQL necessary to execute the payer rules. Metadata about the rules will be represented as a FHIR Library resource. The payer SHALL provide this as a FHIR resource, such that the DTR process will be executing a FHIR read interaction on the payer’s server.