Da Vinci Risk Adjustment Implementation Guide
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## 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 Remediation Client Capability Statement | This profile defines the expected capabilities of a Da Vinci Risk Adjustment Remediation Client when conforming to the Da Vinci Risk Adjustment Implementation Guide for interactions between Remediation Clients and Remediation Servers. Clients are the actors making the request for remediating Risk Adjustment coding gaps for Risk Adjustment Coding Gap Reports of patient(s) that are available on the Server.
Risk Adjustment Remediation Server Capability Statement | This profile defines the expected capabilities of a Da Vinci Risk Adjustment Remediation 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 gaps remediation for Risk Adjustment Coding Gap Reports of patients that are available on the Server.
Risk Adjustment Reporting Client Capability Statement | This profile defines the expected capabilities of a Da Vinci Risk Adjustment Reporting Client when conforming to the Da Vinci Risk Adjustment Implementation Guide for interactions between Reporting Clients and Reporting Servers. Clients are the actors making 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 Reporting Client could support. Clients have the option of choosing from this list based on their local use cases and other contextual requirements.
Risk Adjustment Reporting Server Capability Statement | This profile defines the expected capabilities of a Da Vinci Risk Adjustment Reporting Server when conforming to the Da Vinci Risk Adjustment Implementation Guide for interactions between Reporting Clients and Reporting 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 Reporting 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.

Evaluate Measure | The ra.evaluate-measure operation is used to evaluate Digital Condition Category and obtain the results.

### Structures: Resource Profiles

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

Risk Adjustment Clinical Evaluation Evidence Task | This Task profile is used to support the risk adjustment coding gap remediation process.
Risk Adjustment Coding Gap Report Bundle | The Risk Adjustment Coding Gap Report Bundle Profile describes a collection bundle returned by the $ra.evaluate-measure operation. This bundle is a collection of Risk Adjustment Coding Gap Reports.
Risk Adjustment Coding Gap MeasureReport | This 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 | The Patient Group Profile describes a group consisting of one or more patients.
Risk Adjustment SearchSet Bundle | A SearchSet Bundle with entries that include resources for risk adjustment coding gap clinical evaluation evidence and the fullUrl of the resource.

### Structures: Extension Definitions

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

Annotation | Annotation
Risk Adjustment Clinical Data Collection Deadline | Risk Adjustment Clinical Data Collection Deadline
Confidence Scale | Confidence scale for a Condition Category (CC) coding gap.
Evidence Status | Evidence status of a Condition Category (CC) coding gap, which is closed-gap, open-gap, or pending.
Risk Adjustment Evidence Status Date | Risk adjustment evidence status date
Group Reference | This extension identifies which Condition Category (CC) gap the supporting evidence (represented by `MeasureReport.group.evaluatedResource`) is for.
Hierarchical Status | This extension is to indicate if hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded.
Risk Adjustment Suspect Type | Risk adjustment suspect type

### Terminology: Value Sets

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

Coding Gap Annotation | Coded annotation for a coding gap
Coding Gap Task Reason ValueSet | Risk adjustment clinical evaluation evidence task reason
Coding Gap Task Status ValueSet | Task status codes for use to support risk adjustment coding gap reconciliation
Confidence Scale Value Set | This describes confidence scale of a risk adjustment coding gap.
Risk Adjustment Evidence Status ValueSet | Concepts for risk adjustment evidence status
Risk Adjustment Hierarchical Status ValueSet | Risk adjustment hierarchical status
Sample CMS Hierarchical Condition Category | This is a sample of the concepts that can be found in the CMS Hierarchical Condition Categories (CMS-HCC) code system version 24. The source of the codes included in this example was published at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2020.pdf. The CMS-HCC model uses more than 9,000 ICD-10-CM codes, which are mapped to condition categories (CCs) that predict costs well. The condition categories (CCs) are based on diagnoses clinically related to one another and with similar predicted cost implications. Hierarchies are imposed on the Condition Categories (CCs) to capture the most costly diagnoses. Hierarchy logic is imposed on certain Condition Categories (CCs) to account for different hierarchical costs, thus, the term Hierarchical Condition Category, or HCC.
Risk Adjustment Suspect Type ValueSet | Risk adjustment suspect type

### Terminology: Code Systems

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

Coding Gap Annotation CodeSystem | Coded annotation for coding gap
Coding Gap Task Reason CodeSystem | Risk adjustment clinical evaluation evidence task reason
Risk Adjustment Evidence Status CodeSystem | Indicates whether a coding gap is an open-gap, invalid-gap, closed-gap, or pending.
Risk Adjustment Hierarchical Status CodeSystem | Indicate whether hierarchies were applied to a Condition Category (CC), and if applied, whether the Condition Category (CC) is superseded.
Risk Adjustment Suspect Type CodeSystem | Risk Adjustment suspect type indicates whether it is a suspected Condition Category (CC) gap, a historic Condition Category (CC) gap, or an unsuspected Condition Category (CC). Historic, suspected, and net-new are mutually exclusive.
Task Label CodeSystem | Label of task input or output.

### 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-searchsetbundle01pat01: SearchSet Bundle Pat1 MeasureReport01 group003 | Example Risk Adjustment SearchSet Bundle with clinical evaluation evidence for Patient01 Eve Everywoman MeasureReport01 group003 HCC 59: Major Depressive, Bipolar, and Paranoid Disorders
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-measurereport01-with-annotation: Risk Adjustment Measure Report with Annotation | Example Risk Adjustment Measure Report with Annotations
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: Chronic obstructive pulmonary disease with (acute) exacerbation | Chronic obstructive pulmonary disease 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: Long term (current) use of insulin | Long term (current) use of insulin
Condition11pat01: Acute pulmonary edema | Acute pulmonary edema
Condition12pat01: Manic episode, unspecified | Manic episode, unspecified (clinical evaluation evidence)
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
ConditionR01pat01: Cystic fibrosis with other intestinal manifestations | Cystic fibrosis with other intestinal manifestations
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: Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
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 complication
Condition44pat01: Allergic bronchopulmonary aspergillosis | Allergic bronchopulmonary aspergillosis
Documentreference01pat01: Outpatient Note | Outpatient Note
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
Encounter on 2021-10-15 | Encounter on 2021-10-15 (clinical evaluation evidence)
Observation: Trypsin [Mass/volume] in Serum or Plasma result from 20190617 | Trypsin [Mass/volume] in Serum or Plasma result from 2019-06-17
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 2017-06-17
Organization01: ABC Payer | ABC Payer
Organization: Community Urgent Care | Community Urgent Care
Organization: GHH Outpatient Clinic | GHH Outpatient Clinic
Organization: Community HealthCenter | Community HealthCenter
Organization: Risk Adjustment Author | Risk Adjustment Author
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
Task: Clinical Evaluation Task | Task for Patient01 Eve Everywoman MeasureReport01 group003 HCC 59: Major Depressive, Bipolar, and Paranoid Disorders
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