Framework Breakdown
HTI-1 Clinical EHR
45 CFR 170.315(g)(10) · USCDI v3
PASS
84
Da Vinci PDex Plan-Net
CapabilityStatement.instantiates gap · provider directory IG
PASS *
88
Da Vinci PDex Drug Formulary
IG declaration gap · formulary lookup IG
PASS *
86
Payer Patient Access (CMS-9115)
45 CFR 422.119 · member-facing API
FAIL
68
$1M per API per day exposure on Payer Patient Access · +18 pt fix path to 100 / 100 across the four frameworks. Plan-Net and Drug Formulary asterisks indicate IG declaration gaps: server passes resource-level checks but does not advertise the implementation guide in CapabilityStatement.instantiates, so procurement readers and third-party tooling miss the conformance claim.
Passing Requirements (sample, top 12 of 41)
| Req ID | Severity | Description | Regulatory Ref |
|---|
| HTI1-CAP-01 |
Critical |
Capability statement accessible |
45 CFR 170.315(g)(10) |
| HTI1-CAP-02 |
High |
FHIR version is R4 |
45 CFR 170.215(a)(1) |
| HTI1-IB-01 |
High |
Metadata reachable without auth within 10s |
45 CFR 171.301 (Information Blocking) |
| PDEX-PN-RES-01 |
High |
Practitioner resource supported with NPI identifier slice |
PDex Plan-Net IG §Practitioner |
| PDEX-PN-RES-02 |
High |
PractitionerRole resource supported with network reference |
PDex Plan-Net IG §PractitionerRole |
| PDEX-PN-RES-03 |
Medium |
Organization resource supported with payer network type |
PDex Plan-Net IG §Organization |
| PDEX-PN-RES-04 |
Medium |
Location resource supported with accessibility slice |
PDex Plan-Net IG §Location |
| PDEX-DF-RES-01 |
High |
FormularyDrug List resource supported |
PDex Drug Formulary IG §FormularyDrug |
| PDEX-DF-RES-02 |
Medium |
Coverage Plan resource supported |
PDex Drug Formulary IG §CoveragePlan |
| CMS9115-RES-01 |
Critical |
Patient resource supported (Patient Access API) |
45 CFR 422.119(b)(1) |
| CMS9115-RES-02 |
High |
ExplanationOfBenefit resource supported |
45 CFR 422.119(b)(1)(ii) |
| CMS9115-RES-03 |
Low |
USCDI v4 / US Core 7.x readiness (forward-looking) |
45 CFR 170.213 (USCDI v4) |
Failing & Gap Findings · Remediation
| Req ID | Severity | Description | Regulatory Ref |
|---|
| CMS9115-AUTH-01 |
Critical |
SMART on FHIR authorization for member-facing Patient Access not advertised
Deploy a SMART on FHIR authorization server and expose /.well-known/smart-configuration with authorization_endpoint and token_endpoint populated. Scopes must include patient/*.read, launch/patient, openid, fhirUser. Patient Access API non-conformance carries CMS enforcement exposure of up to $1M per API per day.
|
45 CFR 422.119(c)(1) |
| CMS9115-IB-01 |
High |
Bulk export ($export) not supported for member-claims history
Enable FHIR Bulk Data Access (Flat FHIR) $export on the Patient Access base. ExplanationOfBenefit, Coverage, and Patient resources must be exportable as NDJSON for downstream payer-to-payer flows under CMS-9115.
|
45 CFR 422.119(f) · Bulk Data |
| PDEX-PN-CAP-01 |
Medium |
CapabilityStatement.instantiates does not advertise Plan-Net IG
Add to CapabilityStatement.instantiates: http://hl7.org/fhir/us/davinci-pdex-plan-net/CapabilityStatement/plannet-server. Config-only change, ~4 hours. TAP re-scan included in the Corrective Action SKU. Projected score after fix: 95 / 100 composite.
|
Da Vinci PDex Plan-Net IG |
| PDEX-DF-CAP-01 |
Medium |
CapabilityStatement.instantiates does not advertise Drug Formulary IG
Add to CapabilityStatement.instantiates: http://hl7.org/fhir/us/davinci-drug-formulary/CapabilityStatement/usdf-server. Pairs with the Plan-Net fix. Both gaps close in one config push.
|
Da Vinci PDex Drug Formulary IG |