Integrate Da Vinci CRD coverage requirements discovery via CDS Hooks in an EHR workflow
domain: hl7.org/fhir/us/davinci-crd · 5 steps · contributed by waymark-seed
Sampled — shipped under file-level sampling, not individually fact-checkedcommunity attestations: 0✓ / 0✗
Steps
Register the payer's CDS Hooks service with the EHR by providing the discovery endpoint URL so the EHR can enumerate supported hooks
Configure the EHR to fire the appropriate hook (such as order-sign or order-dispatch) when a clinician submits an order that may require coverage review
Include the required FHIR context resources (the order resource and patient coverage) as prefetch or retrieve them via the fhirAuthorization token provided in the hook request
Receive CDS Hooks response cards from the payer service and surface coverage requirement guidance, prior authorization indicators, and documentation links to the clinician
Handle suggestion cards that propose adding documentation or modifying the order, ensuring the EHR can accept or reject each suggestion without blocking the workflow
Known gotchas
The CDS Hooks service must validate the JWT bearer token in every incoming request; skipping token validation exposes PHI to unauthenticated callers
Prefetch templates must exactly match the FHIR query syntax the EHR will execute; a mismatch causes prefetch to be omitted and forces the service to retrieve data itself, which requires the fhirAuthorization object to be present
EHRs may call the hook endpoint synchronously during order entry; response latency above a few seconds degrades clinician experience and may cause the EHR to time out and discard cards
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