Advancing Oral Health Interoperability (PSS-2779)

h2. 1. Overview

Dentistry is a distinct clinical profession. Dentists are doctors in their own right — distinct from physicians, not a subspecialty of medicine — and they refer, diagnose, document, and bill differently. Oral health needs the same modern, FHIR-native interoperability that medicine now has, but on {}dentistry's terms{}, not by forcing dentists to conduct business like physicians.

The purpose of this project is to develop new and update HL7 FHIR Implementation Guides to enable exchange or oral health information among dentists, medical providers, payers and patients.  As part of this work, the existing CCD/document-based Dental Data Exchange IG, which is not in use today, is retired in favor of a FHIR-native approach (see Objective 1). The four objectives below define the scope.

The Oral Health Interoperability Alliance (OHIA) leads this work with full support from the American Dental Association and {}Federal Electronic Health Record Modernization{}. As the multi-stakeholder implementer coalition behind the project, OHIA coordinates the organizations involved, drives the real-world Connectathon testing that has shaped the approach, and builds the cross-sector consensus — with the resulting Implementation Guides balloted through HL7 (sponsored by PIE, co-sponsored by O&O and CQI).

h2. 2. Objectives

h3. Objective 1 — Develop a new FHIR-based oral health data exchange IG

Dental Practice Management Systems ? Electronic Health Records (EHRs)

Dental Practice Management Systems ? Dental Practice Management Systems

Dental Practice Management Systems ? Health Information Exchange/Qualified Health Information Networks

*Dental Practice Management Systems ? Dental Payers"

"Dental Practice Management Systems ? Medical Payers"

Description: Develop a new HL7 FHIR Implementation Guide to facilitate standardized, secure data exchange for oral health data.

There is consensus to build a new IG and sunset the current CCD/document-based Dental Data Exchange IG ([https://build.fhir.org/ig/HL7/dental-data-exchange/]), which is not in use today. This consensus includes the {}American Dental Association (ADA){}, {}Federal Electronic Health Record Modernization (FEHRM){}, and the Oral Health Interoperability Alliance (OHIA) — whose membership includes medical payers, dental payers, clearinghouses, dental practice management system vendors, and third-party application vendors.

In HL7 Connectathons #40 and #41, multiple implementers found that more modern standards — particularly SMART on FHIR and CDS Hooks — are a better fit for the way data is now being requested and transferred than the document-based approach. A CCD/document round-trip has significant structural loss for oral health, with no native slot for dental procedure codes, tooth numbering, or periodontal data. As part of this project the existing Dental Data Exchange IG will be retired; confirmation that there are no active users has been obtained.

Scope:

• Define minimum viable product (MVP) data elements and use cases for medical-to-dental and dental-to-medical referrals (e.g., patient demographics, insurance, clinical findings, referral status).
• Leverage existing standards (CDS Hooks, SMART on FHIR, FHIR Subscriptions) for referral workflows and bidirectional data sharing.
• Address policy recommendations, best practices, and change management for implementers.
• Pilot real-world interoperability across multiple organizations including (but not limited to) payers, dentists, medical practices, and participating Health Information Exchanges (HIEs) or Qualified Health Information Networks (QHINs).
• Include key predetermination and prior authorization information.
• Ensure proper billing data is exchanged to enable proper claims submission

h3. Objective 2 — Update CARIN Blue Button guidance for dental claims

Description: Test and extend the CARIN Blue Button IG to support dental claims, encounters, and records, enabling unified patient access to dental and medical information. At minimum, dental examples are needed to support clarity; additional dental-specific fields are also required.

Scope:

• Identify gaps in the current CARIN Blue Button IG for dental-specific data.
• Collaborate with payers, clearinghouses, and patient-facing application developers to ensure comprehensive coverage.

*

• Align with CMS-9115-F and CMS-0057-F for claims and encounters.
• Support secure digital identity and patient consent.
• Ensure oral claims profile is aligned to Da Vinci prior authorization changes being made.

h3. Objective 3 — Identify and enhance referrals 

A. Referrals between Electronic Health Records and  Dental Practice Management Systems

Description: Enable a referral workflow that enables primary care practices to systematically refer to, and share data with, dentists — supporting the 2026 Physician Fee Schedule improvement activity.

Scope:

• For referrals, the intent is to define and use a specific oral health extension of the Clinical Order Workflows (COW) IG — the framework owned by co-sponsor Orders & Observations (O&O) — rather than a parallel workflow. Preference is for COW, contingent on EHR acceptance; OHIA will test the approach with clinicians and dentists to validate it. Where COW is not yet accepted, referral workflows will be developed using FHIR, CDS Hooks, and SMART on FHIR and 360x (see below)
• Define required data elements (reason for referral, referring and receiving dentist information, status, patient visibility).
• Ensure insurance coverage is included, along with notification, to streamline downstream claims submission.

h3. Objective 4 — Enable dental-to-EHR communication for dental referrals and dental clearance

Description: Develop or enhance standards to support integration between dental practice management systems and EHRs for the purpose of dental clearance, or direct referral