Review the Da Vinci CRD IG (hl7.org/fhir/us/davinci-crd) to understand the supported CDS Hooks (order-sign, order-select, encounter-start, encounter-discharge, appointment-book) and the prefetch template requirements for each hook.
Register the CRD service with the EHR's CDS Hooks discovery endpoint ([base]/cds-services) and configure the service to handle the appropriate hook types with the required prefetch template for patient demographics, coverage, and the ordered resource.
When a hook fires, extract the requested service (MedicationRequest, ServiceRequest, DeviceRequest, or Appointment) from the hook context, and query the payer's coverage rules engine to determine if prior authorization is required.
Return a CDS Hooks response with appropriate card types: an information card if documentation is required, a suggestion card if a covered alternative exists, an external link card for payer portal links, or a system-action card to automatically update the order.
Implement the required card attributes (summary, detail, indicator, source) and for suggestion cards include the suggested FHIR resource changes conforming to the CRD card type specifications.
Handle the case where coverage cannot be determined (e.g., no matching coverage found) by returning an informational card rather than a false-negative 'no requirements' response.
Known gotchas
CRD hooks must respond within a configurable timeout (typically 5 seconds); payer coverage rules engines that cannot respond within this window must return a graceful timeout card rather than leaving the EHR waiting indefinitely.
The prefetch template in the CRD service registration must exactly match the FHIR search and read expressions expected by the service — if the EHR does not supply prefetch data (e.g., Coverage), the service must fall back to fetching it directly using the token from the hook context.
CRD cards must not be used to automatically deny care — the IG explicitly states that CRD responses are advisory; EHRs retain clinical decision authority and must allow clinicians to proceed even if a CRD card indicates prior auth is required.
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