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Section 1c: FHIR®

HL7 FHIR® Implementation Guide: Documentation Templates and Payer Rules (DTR), Release 1- US Realm

DESCRIPTION

The Documentation Templates and Rules (DTR) Implementation Guide (IG) specifies how payer rules can be executed in a provider context to ensure that documentation requirements are met.

ALTERNATIVE NAMES

HL7 FHIR® Implementation Guide: Documentation Templates and Payer Rules (DTR), Release 1- US Realm may also go by the following names or acronyms:

"HL7 FHIR® IG: Documentation Templates and Payer Rules (DTR), R1", Documentation Templates and Rules, DTR

BENEFITS

  • Enables reduction of provider burden because of reduced manual data entry.

IMPLEMENTATIONS/CASE STUDIES

  • MITRE,
  • Mettle Solutions
  • MCG

DEVELOPMENT BACKGROUND

The Documentation Templates and Rules (DTR) Implementation Guide (IG) specifies how payer rules can be executed in a provider context to ensure that documentation requirements are met. In turn provider burden will be reduced because of reduced manual data entry. This IG is a companion to the Coverage Requirements Discovery (CRD) IG, which uses Clinical Decision Support (CDS) Hooks to query payers to determine if there are documentation requirements for a proposed item, certain medications, procedure or other service. When those requirements exist, CDS cards will be returned with information about the requirements. This IG leverages the ability of CDS Hooks to link to a SMART on FHIR app (application) or native EHR app to launch and execute payer rules. This IG specifies how to maintain the transaction state as the workflow transitions from CDS Hooks to the app. It describes the interactions between the app and the payer IT system to retrieve documentation requirements, in the form of CQL and a FHIR Questionnaire resource.

RELATED DOCUMENTS

HL7 FHIR® Implementation Guide: Documentation Templates and Payer Rules (DTR), Release 1- US Realm

STU DOCUMENTS

HL7 FHIR® Implementation Guide: Documentation Templates and Payer Rules (DTR), Release 1- US Realm http://hl7.org/fhir/us/davinci-dtr/STU1/index.html (Submit Feedback on STU)

TOPIC

  • Decision Support

BALLOT TYPE

  • STU

STATUS DATE

2020-12-23

RESPONSIBLE WORK GROUP

Clinical Decision Support

PRODUCT TYPE

  • Implementation Guide

STAKEHOLDERS

  • EHR, PHR Vendors
  • Healthcare Institutions
  • Payors

FAMILY

  • FHIR

CURRENT STATE

  • Active

REALM

  • US Realm