To execute end-to-end testing across high-volume and high-priority clinical services, ONC and CMS have anchored the initiative around the HL7 FHIR Da Vinci Burden Reduction implementation guides, utilizing dedicated testing infrastructure operated by federal and private-sector partners.
The technical workflow evaluates three sequential interoperability specifications across simulated clinical encounters. First, Coverage Requirements Discovery (CRD) enables a provider’s EHR to query a payer’s system in real time at the point of order entry to determine whether a proposed service or procedure requires prior authorization. Second, Documentation Templates and Rules (DTR) pulls payer-specific clinical documentation requirements directly into the clinical workflow, allowing automated extraction of structured data from the patient’s chart without manual data entry. Third, Prior Authorization Support (PAS) packages the clinical evidence into a standardized FHIR payload and transmits it electronically to the health plan for automated adjudication and immediate status tracking.
To manage recruitment, participant matching, and technical execution, ONC and CMS engaged the MITRE-led Health Federally Funded Research and Development Center alongside conformity assessment organization Drummond Group. Drummond Group will host the testing sprints on FHIRplace, a virtual interoperability testing environment that allows EHR vendors, payers, and intermediaries to simulate real-world transactional traffic across connected endpoints.
Executive leadership at ONC emphasized that publishing technical standards is insufficient unless payers and health IT developers validate how those standards perform under live clinical conditions. , National Coordinator for Health IT, stated that while federal regulations and industry standards have established essential groundwork for electronic prior authorization, advancing the next phase of implementation testing with CMS is vital to accelerating industry progress in the near term.
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