DSP FHIR

DSP 1.0 in one page

The Dragon Standard Payload is a JSON envelope delivered between Dragon Copilot and partner apps. It bundles session metadata, the transcript, an optional document, and a polymorphic array of clinical resources.

Top-level envelope

FieldTypePurpose
payload_versionstringmajor.minor.revision + quality enum (Complete, Intermediate, TransientlyDegraded, PermanentlyDegraded, Failed)
prioritystringlow / medium / high
external_callback_urlurlPartner FHIR endpoint Dragon can call back to
encounterobjectPatient + Practitioner + Visit + Organization + Location
recordingsarrayAudio artifacts (status, source, template, start/end)
sessionsarrayDAX session + user + org IDs
transcriptobjectspeaker_count + turns (speaker-segmented)
documentobjectOptional unstructured narrative (e.g. referral letter)
resourcesarrayPolymorphic clinical objects (the meat of DSP)

Resource base shape

Every resource inherits the same envelope and then layers type-specific fields:

{
  "id": "condition-001",
  "context": {                          // LOINC/SNOMED coding of the content type
    "content_type": "condition",
    "display_description": "Assessment Diagnoses",
    "spoken_forms": ["encounter diagnoses"],
    "codes": [{"system":"loinc","identifier":"51847-2"}]
  },
  "provenance": [11, 15, 17],           // transcript turn indices
  "parent_reference": "enc-001",        // note: Condition uses 'parent_resource' (array); field name varies by resource
  "child_references": ["plan-001"],     // note: Condition uses 'children_resources'
  "source": { "type": "dragon_copilot", "id": "..." },
  "confidence_score": 0.94,             // DSP 1.0: currently only on orders resources
  // ...type-specific fields...
}

Content types

document_section

A narrative segment of a clinical note (e.g. HPI, A&P).

condition

Diagnoses / problems / symptoms with clinical + verification status, severity, stage.

order.medication

RxNorm drug, form, dosage, frequency, route, refills, dispense.

order.laboratory

LOINC lab + sample type + instructions.

order.imaging

Modality, body site, laterality, views, contrast.

order.procedure

CPT code, surgical team, devices, location.

order.follow_up

Return-in interval, PRN flag, approximation flag.

order.referral

Referral to specialty / provider (DSP docs exist but the dedicated page is private).

Transcript model

The transcript.turns[] array numbers speaker turns sequentially. provenance on any resource is simply a list of those indices, anchoring each extracted fact back to the spoken source. This is one of the few DSP concepts without a direct FHIR equivalent — see Gaps.

Versioning (payload_version)

Each encounter can produce multiple payloads as recordings accumulate, models refine, or users edit. Versions carry major (session ordinal), minor (coverage breadth), revision (model retry or edit; user edits start at 1000), and a quality enum. This is sidecar metadata — not resource content.

Mental model: DSP = an encounter bundle + transcript sidecar + versioning envelope. That maps almost perfectly to a FHIR Bundle with a Composition (or DocumentReference) root, plus a small extension set for the envelope.