DTR: collecting documentation

Fill in only what is missing

A payer often needs documentation before it will approve a service. Documentation Templates and Rules, or D T R, lets the payer express what it needs so that the clinician's system can fill in what it already knows, and ask only for the rest.

What DTR is built from

D T R is built on three pieces. A FHIR Questionnaire holds the questions. C Q L, the Clinical Quality Language, holds the logic: it pulls existing information from the patient's record and decides which questions to ask. And a SMART on FHIR application shows the form inside the clinician's system.

• Questionnaire · The questions · text
• CQL · The logic and prefill · gear
• SMART app · Shown in the EHR · globe

From rules to answers

Here is how it runs. The payer writes its documentation rules as a questionnaire with C Q L logic. When the clinician needs them, the application launches inside the health record. It prepopulates answers from the patient's record using the C Q L. The clinician reviews, completes what is missing, and the result is saved as a questionnaire response, ready to go with the prior authorization request.

• Step 1 · Payer writes rules · A Questionnaire with CQL logic. · pencil
• Step 2 · App launches · Inside the clinician's system. · globe
• Step 3 · Prefill · Answers come from the record. · search
• Step 4 · Review and save · Saved as a response. · check

Standard and adaptive questionnaires

The guide defines two kinds of questionnaire. In a standard questionnaire, the payer sends the whole package up front, and the rules are in the questionnaire and its C Q L. In an adaptive questionnaire, the payer's server decides the next question as the user answers, using an operation called next question, which lets the payer's own data and logic shape the form.

Check yourself

Pause and think. What does D T R use to pull existing information from the patient's record? The answer: C Q L logic.

• CQL logic
• A paper form
• A fax
• A phone call

Keep these in mind

D T R lets a payer state its documentation needs in a form a computer can use. A questionnaire holds the questions and C Q L holds the logic. Answers are prefilled from the record where possible. And standard and adaptive questionnaires differ in who picks the questions.

• DTR lets a payer state documentation needs computably
• A Questionnaire holds the questions, CQL the logic
• Answers are prefilled from the record where possible
• Standard or adaptive: who picks questions