Da Vinci Risk Adjustment Implementation Guide (STU1 Ballot)
0.1.0 - STU 1 Ballot

This page is part of the Da Vinci Risk Adjustment FHIR Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Artifacts Summary

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Behavior: Capability Statements

The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.

Risk Adjustment Server Capability Statement

This profile defines the expected capabilities of a Da Vinci Risk Adjustment Server when conforming to the Da Vinci Risk Adjustment Implementation Guide for interactions between Clients and Servers. Servers are the actors receiving the request for Risk Adjustment Coding Gap Reports for patient(s) and for Risk Adjustmenet Models that are available on the Server. This CapabilityStatement resource includes the complete list of the recommended Da Vinci Risk Adjustment profiles and RESTful operations that a Risk Adjustment Server could support. Servers have the option of choosing from this list based on their local use cases and other contextual requirements.

Behavior: Operation Definitions

These are custom operations that can be supported by and/or invoked by systems conforming to this implementation guide

Report Operation

Generate a measure report

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide

Risk Adjustment Coding Gap Report Bundle Profile

The Risk Adjustment Coding Gap Report Bundle Profile describes a collection bundle returned by the report operation. This bundle is a collection of Risk Adjustment Coding Gap Reports.

Risk Adjustment Coding Gap Report Profile

This risk adjustment coding gap report profile is based on the MeasureReport to represent a risk adjustment coding gap report.

Risk Adjustment Model Measure

This risk adjustment model measure profile is based on the Measure resoure to represent a risk adjustment model and its version such as CMS-HCC version 24.

Patient Group Profile

The Patient Group Profile describes a group consisting of one or more patients.

Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide

Risk Adjustment Clinical Data Collection Deadline Extension

Risk Adjustment Clinical Data Collection Deadline Extension

Evidence Status Extension

This extension is for Evidence Status of a Condition Category coding gap, which is closed-gap, open-gap, or pending.

Risk Adjustment Evidence Status Date Extension

Risk Adjustment Evidence Status Date Extension

Group Reference Extension

This extension identifies which Condition Category gap the supporting evidence (represented by MeasureReport.group.evaluatedResource) is for.

Hierarchical Status Extension

This extension is to indicate if hierarchies were applied to a Condition Category, and if applied, whether the Condition Category is superseded.

Risk Adjustment Suspect Type Extension

Risk Adjustment Suspect Type Extension

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide

Risk Adjustment Evidence Status Value Set

Concepts for risk adjustment evidence status

Risk Adjustment Hierarchical Status Value Set

Concepts for risk adjustment hierarchical status

Risk Adjustment Suspect Type Value Set

Concepts for risk adjustment suspect type

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide

Risk Adjustment Evidence Status Code System

This is a code system for Risk Adjustment evidence status to indicate whether a Condition Category gap is open-gap, closed-gap, or pending.

Risk Adjustment Hierarchical Status Code System

This is a code system for Risk Adjustment Hierarchical Status to indicate whether hierarchies were applied to a Condition Category, and if applied, whether the Condition Category is superseded.

Risk Adjustment Suspect Type Code System

This is a code system for Risk Adjustment suspect type to indicate whether it is a suspected Condition Category (CC) gap, a historic CC gap, or an unsuspected CC. Historic, suspected, and net-new are mutually exclusive.

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like

ra-bundle01: Risk Adjustment Bundle

Example Risk Adjustment Bundle

ra-group01: Risk Adjustment Patient Group

Example Risk Adjustment Group

ra-group02: Risk Adjustment Patient Group

Example Risk Adjustment Group

ra-measurereport01: Risk Adjustment Measure Report

Example Risk Adjustment Measure Report

ra-measurereport02: Risk Adjustment Measure Report

Example Risk Adjustment Measure Report

ra-measurereport03: Risk Adjustment Measure Report for HCC V24 for Patient 02

Example Risk Adjustment Measure Report for HCC V24 for Patient 02

ra-measurereport04: Risk Adjustment Measure Report for HCC V21 for Patient 03

Example Risk Adjustment Measure Report for HCC V21 for Patient 03

ra-measurereport05: Risk Adjustment Measure Report for RxHCC V5 for Patient03

Example Risk Adjustment Measure Report for RxHCC V5 for Patient03

ra-measurereport06: Risk Adjustment Measure Report for RxHCC V5 for Patient02

Example Risk Adjustment Measure Report for RxHCC V5 for Patient02

Condition01pat03: Other artificial openings of gastrointestinal tract status

Other artificial openings of gastrointestinal tract status

Condition02pat01: Diabetes mellitus due to underlying condition with other diabetic kidney complication

Diabetes mellitus due to underlying condition with other diabetic kidney complication

Condition03pat01: Mild persistent asthma with (acute) exacerbation

Mild persistent asthma with (acute) exacerbation

Condition04pat03: Chronic obstructive pulmonary disease with (acute) exacerbation

Chronic obstructive pulmonary disease with (acute) exacerbation

Condition05pat03: Unspecified protein-calorie malnutrition

Unspecified protein-calorie malnutrition

Condition06pat03: Crohn's disease of large intestine with unspecified complicationss

Crohn’s disease of large intestine with unspecified complications

Condition07pat03: Other persistent atrial fibrillation

Other persistent atrial fibrillation

Condition08pat01: Bipolar disorder, current episode mixed, mild

Other persistent atrial fibrillation

Condition09pat01: Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis

Condition10pat01: Mild persistent asthma with (acute) exacerbation

Mild persistent asthma with (acute) exacerbation

Condition11pat01: Acute pulmonary edema

Acute pulmonary edema

Condition15pat03: Diabetes mellitus due to underlying condition with diabetic chronic kidney diseases

Diabetes mellitus due to underlying condition with diabetic chronic kidney diseases

Condition16pat03: Dependence on renal dialysis

Dependence on renal dialysis

Condition17pat01: Body mass index [BMI] 45.0-49.9, adult

Body mass index [BMI] 45.0-49.9, adult

Condition18pat01: Longstanding persistent atrial fibrillation

Longstanding persistent atrial fibrillation

Condition21pat03: Type 2 diabetes mellitus without complications

Type 2 diabetes mellitus without complications

Condition22pat03: Other acute kidney failure

Other acute kidney failure

Condition23pat03: Chronic kidney disease, stage 5

Chronic kidney disease, stage 5

Condition31pat02: Typical atrial flutter

Typical atrial flutter

Condition32pat03: Chronic pulmonary embolism

Chronic pulmonary embolism

Condition33pat01: Respiratory arrest

Respiratory arrest

Condition35pat03: Hypertension secondary to other renal disorders

Hypertension secondary to other renal disorders

Condition42pat03: Other artificial openings of gastrointestinal tract status

Other artificial openings of gastrointestinal tract status

Condition43pat01: Diabetes mellitus due to underlying condition with other diabetic kidney complication

Diabetes mellitus due to underlying condition with other diabetic kidney complicationt

Condition44pat01: Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis

Encounter on 20210714

Encounter on 2021-07-14

Encounter on 20210131

Encounter on 2021-01-31

Encounter on 20210926

Encounter on 2021-09-26

Encounter on 20211218

Encounter on 2020-12-18

Encounter on 20200303

Encounter on 2020-03-03

Encounter on 20200917

Encounter on 2020-09-17

Encounter on 20190207

Encounter on 2019-02-07

Encounter on 20170203

Encounter on 2017-02-03

Encounter on 20210327

Encounter on 2021-03-27

Encounter on 20201102

Encounter on 2020-11-02

Encounter on 20200808

Encounter on 2020-08-08

Encounter on 20210727

Encounter on 2021-07-27

Encounter on 20210823

Encounter on 2021-08-23

Encounter on 20210130

Encounter on 2021-01-30

Encounter on 20210701

Encounter on 2021-07-01

Encounter on 20210806

Encounter on 2021-08-06

Encounter on 20210212

Encounter on 2021-02-12

Encounter on 20200210

Encounter on 2020-02-10

Encounter on 20190210

Encounter on 2019-02-10

Encounter on 20170118

Encounter on 2017-01-18

Encounter on 20180721

Encounter on 2018-07-21

Observation: Creatinine Result from 20210728

Creatinine Result from 2021-07-28

Observation: PHQ9 from 20190823

PHQ9 from 2019-08-23

Trypsin [Mass/volume] in Serum or Plasma from 20170617

Trypsin [Mass/volume] in Serum or Plasma from 20170617

Organization01: ABC Payer

ABC Payer

Organization: Community Urgent Care

Community Urgent Care

Organization: GHH Outpatient Clinic

GHH Outpatient Clinic

Organization: Community HealthCenter

Community HealthCenter

Patient01: Report

Report01: Single Risk Adjustment Measure-RAModelExample01 Report for Patient01

Patient01: Eve Everywoman

Eve Everywoman

Patient02: Adam Everyman

Adam Everyman

Patient03: Nelda Nuclear

Nelda Nuclear

Practitioner: Harold Hippocrates

Harold Hippocrates

Practitioner: Patrick Pump

Patrick Pump

Practitioner: Otto Osler

Otto Osler

Risk Adjustment Model Version 24 - CMS Hierarchical Category Condition (CMS-HCC)

Example measure to represent CMS-HCC Model Version 24

Risk Adjustment Model Version 21 - CMS Hierarchical Category Condition (CMS-HCC)

Example measure to represent CMS-HCC Model Version 21

Risk Adjustment Model Version 5 - CMS Prescribing Drug Hierarchical Category Condition (CMS-HCC)

Example measure to represent CMS-RxHCC Model Version 5