Section 1c: FHIR®

HL7 FHIR® Implementation Guide: Documentation Templates and Rules (DTR), Edition 2 - 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.

 

See the specification at http://hl7.org/fhir/us/davinci-dtr/STU2

ALTERNATIVE NAMES

HL7 FHIR® Implementation Guide: Documentation Templates and Rules (DTR), Edition 2 - 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

  • Lantana Consulting Group
  • MITRE
  • Mettle Solutions
  • MCG

DEVELOPMENT BACKGROUND

The Documentation Templates and Rules (DTR) Implementation Guide (IG) specifies how payer documentation 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, procedures, or other service. When documentation requirements exist, Information will be returned and saved via system actions that define the canonical questionnaire or questionnaireResponse that DTR will use to assemble the required documentation. This IG leverages the ability of the EHR to pass context to a SMART on FHIR app (application) or native EHR DTR app to retrieve the appropriate questionnaire and utilize the defined CQL to prepopulate questions from the patient’s record via the EHR APIs. This IG specifies the interactions between the app and the payer IT system to retrieve documentation requirements, as a static questionnaire or adaptive form along with the CQL and terminology requirements as a Questionnaire bundle. In addition, the payer may, when using an adaptive form, return a unique ID to indicate that authorization requirements are satisfied. Multiple launch modes are described to support initial launch, relaunch, standalone launch, and launch from CDex. Finally, the IG provides the ability to indicate the intended use of the final questionnaireResponse package, for prior authorization, exchange with a preforming provider, support of claims documentation, or other purposes.

RELATED DOCUMENTS

HL7 FHIR® Implementation Guide: Documentation Templates and Rules (DTR), Edition 2 - US Realm

STU DOCUMENTS

HL7 FHIR® Implementation Guide: Documentation Templates and Payer Rules (DTR), Edition 2- US Realm See the standard at http://hl7.org/fhir/us/davinci-dtr/STU2. (Submit Feedback on STU)
HL7 FHIR® Implementation Guide: Documentation Templates and Payer Rules (DTR), Release 1- US Realm http://hl7.org/fhir/us/davinci-dtr/STU1/index.html Expiration Dec 2023

TOPIC

  • Decision Support

BALLOT TYPE

  • STU

STATUS DATE

2023-11-07

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