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VA Technical Reference Model v 26.1

HL7 FHIR Clinical Data Exchange (CDex)
HL7 FHIR Clinical Data Exchange (CDex) Standard or Specification

General Information

Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. More information on the proper use of the TRM can be found on the TRM Proper Use Tab/Section.

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Description: This IG provides detailed guidance that helps implementers use FHIR-based interactions to support specific exchanges of clinical data between providers and payers (or other providers). This guide documents Direct Query, Task Based and Attachments transaction approaches for requesting and sending information. Key scenarios this IG can support include:

- Requesting and sending attachments to support claims and prior authorizations
- Requesting documentation to support payer operations such as claims audits
- Gathering information for Quality programs and Risk Adjustment between payers and providers
- Exchanging clinical data between referring providers

In the context of this guide, ‘clinical data’ means any information a provider holds in a patient’s health record. The data format is not limited to FHIR resources, but includes C-CDA documents, pdfs, text files and other types of data. There may be requests for payloads of clinical records of care such as CCD Documents, clinical data sets that may be represented in a FHIRBundle (or C-CDA on FHIR Documents), and clinical data such as a specific FHIR resource.

By using the FHIR standard and implementing this guide, payers can be explicit about the data they are requesting instead of general requests, which avoids sending more information than necessary. As a result, the anticipated benefit of using FHIR is a more efficient and effective exchange of health record information in several areas, such as claims management, care coordination, risk adjustment, and quality reporting.
Technology/Standard Usage Requirements: Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). Users must ensure sensitive data is properly protected in compliance with all VA regulations. Prior to use of this technology, users should check with their supervisor, Information System Security Officer (ISSO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation.
Section 508 Information:
Decision: View Decisions
Decision Source: TRM Mgmt Group
Decision Process: One-VA TRM v25.7
Decision Date: 07/03/2025 at 03:54:06 UTC
Aliases: "HL7 FHIR® Implementation Guide: Clinical Data Exchange (CDex), Release 1 STU 2.1.0 - US Realm", "HL7 FHIR Implementation Guide: Clinical Data Exchange (CDex), R1", Da Vinci Clinical Data Exchange (CDex) - STU1 Release, Da Vinci Clinical Data Exchange, Provider to Payer Data Exchange, CDex
Introduced By: TRM Request
Standards Body: HL7
Cage Code: 3ZPX5
- The information contained on this page is accurate as of the Decision Date (07/03/2025 at 03:54:06 UTC).