HL7 FHIR® Implementation Guide: Documentation Templates and Rules (DTR), Edition 2.2 - 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/2.2.0

ALTERNATIVE NAMES

HL7 FHIR® Implementation Guide: Documentation Templates and Rules (DTR), Edition 2.2 - US Realm may also go by the following names or acronyms:

BENEFITS

• Enables reduction of provider burden because of reduced manual data entry.
• Provides a mechanism for payers to express their documentation requirements computably in a way that allows clinicians and other EHR users to navigate and quickly specify the needed information in a context-specific way.
• Allows rules to be written in a way that supports automatically extracting existing EHR information for review and/or confirmation and adjusting the information prompted for based on what data is already known or entered, minimizing impact on provider time, while expediting subsequent payer interactions.

IMPLEMENTATIONS/CASE STUDIES

• Lantana Consulting Group
• MITRE

DEVELOPMENT BACKGROUND

This specification was created as part of the Da Vinci project with significant participation from the U.S. Payer community as well as several EHR software vendors.

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 2.2 - US Realm

STU DOCUMENTS

	HL7 FHIR® Implementation Guide: Documentation Templates and Rules (DTR), Edition 2.2 - US Realm See the standard at '>http://hl7.org/fhir/us/davinci-dtr/2.2.0'>.	(Submit Feedback on STU)
	HL7 FHIR® Implementation Guide: Documentation Templates and Rules (DTR), Edition 2.1 - US Realm See the standard at http://hl7.org/fhir/us/davinci-dtr/STU2.1.	Expiration May 2026
	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

2026-03-26

RESPONSIBLE WORK GROUP

PRODUCT TYPE

• Implementation Guide

STAKEHOLDERS

• EHR, PHR Vendors
• Healthcare Institutions
• Payors

FAMILY

• FHIR

CURRENT STATE

• Active

REALM

• US Realm