HL7 Immunization User Group MONTHLY MEETING OCTOBER 12, 2017 2:00 - - PowerPoint PPT Presentation
HL7 Immunization User Group MONTHLY MEETING OCTOBER 12, 2017 2:00 PM ET Agenda Welcome Updates SISC Update Frequently Asked Questions Review Discussion Topic: Query and Response Query and Response Review AIRA
MONTHLY MEETING OCTOBER 12, 2017 2:00 PM ET
STANDARDS AND INTEROPERABILITY STEERING COMMITTEE (MARY WOINAROWICZ)
FREQUENTLY ASKED QUESTIONS (NATHAN BUNKER)
Question: If the ethnic group is unknown, what should be sent? Answer: PID-22 (Ethnic Group): Should be left empty when a patient declines to give their ethnic group or when the ethnic group is unknown
NK1-28 (Ethnic Group): There is no official position as to how this field is to be populated; but NK1-28 could be left empty when the next-of-kin declines to give their ethnic group or when the ethnic group is unknown
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Background: Submitter is sending product and it’s being recorded wrong
Question: According to CDC’s Product Name / CVX-MVX document they should submit as MVX as IDB instead of SKB. We suggest using NDC
Answer:
the CVX/MVX combination is not specific enough to indicate product
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Question: If the IIS is down but the interface receives a message and will process it when the IIS is up again, what is the appropriate ACK to return? Answer: The best way to communicate this back to the EHR per the HL7 standard is with the following in your ACK.
It is okay for an interface engine to queue and still process this message later but IIS should be prepared to receive this message again as the EHR may re-submit.
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Question: One receiving system is not able to process our RSPs because the lines are separated by line feeds instead of carriage returns. What is correct to return? Background:
Answer: In practical use most HL7 parsers are tolerant, so most IIS and EHRs accept both. So while the standard says CR, in practice an HL7 site should be able to accept either LF and CR.
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Question: What type of response would be appropriate for authentication errors or validating the sending facility? Answer: There are two potential responses:
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Question from EHR : Any idea if any IIS currently support or have plans to support this OBX / NTE segment pair to message “more details of interest” about partially-administered vaccines in an RSP? Answer: Release 1.5 doesn’t support this but we’ve documented the use of OBX for free text comments using the Annotation Comment LOINC code (48767-8) and the text itself in OBX-5.
this time (for partial administrations or any other sorts of messages).
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Question: When queried by the EHR for Pentacel (for example) should the IIS return CVX 120 (for Pentacel) or three individual CVX for DTaP, Hib and IPV? Answer: The IIS is responsible for storing the most specific and accurate code it can for an immunization, the IIS would
There are cases where a submitter might send the individual components, particularly in historical cases where the paper record may not indicate a Pentacel was given. So your IIS should be prepared to recognize and merge duplicates. The only time you would indicate that three components were given is if that is the best information you have received.
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QBP RESPONSES – STANDARD AND CURRENT IMPLEMENTATION
Message Type and Profile
Next implementation guide will propose changes to query
for HL7 v2.5.1
move to a new version yet
Proposed changes for query:
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Possible results from query:
shared
Does your IIS or EHR support queries?
How much do you know about HL7 queries?
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The goal of this query is to request a complete immunization history. This will support transferring a person’s immunization records from one information system to another. The response will be very similar to a VXU message in content. A complete immunization history consists of:
contraindications, history of vaccine preventable diseases
MSH – Message Header Segment
[{SFT}] – Software Segment QPD – Query Parameter Definition RCP – Response Control Parameter
# Name Usage Element Name or Value 1 MessageQueryName R Z34^Request Complete Immunization History^CDCPHINVS 2 QueryTag R Unique id assigned by sender 3 PatientList RE PID-3: Patient Identifier List 4 PatientName R PID-5: Patient Name 5 PatientMotherMaidenName RE PID-6: Mother’s maiden name 6 Patient Date of Birth RE PID-7: Patient date of birth 7 Patient Sex R PID-8: Patient Sex 8 Patient Address RE PID-11: Patient Address 9 Patient home phone RE PID-13: Patient home phone
# Name Usage Element Name or Value 10 Patient multiple birth indicator RE PID-24: Patient multiple birth indicator 11 Patient birth order RE PID-25: Patient birth order 12 Client last updated date RE PID-33: Patient last update date 13 Client last update facility RE PID-34: Patient last update facility
# Name Usag e Comments 1 Query Priority RE IZ-27: Constrain RCP-1 (Query Priority) to empty or “I”. Immediate priority is expected. 2 Quantity LimitedRequest RE This field may contain a maximum number of records that may be
contains “RD” for records. 3 Response Modality O Not described in guide 4 Executionand Delivery Time O Not described in guide 5 Modify Indicator O Not described in guide 6 Sort-by Field O Not described in guide 7 Segment inclusion O Not described in guide
Does your IIS or EHR support Z34 queries?
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The goal of this response is to return a complete immunization history in response to a request for a person’s record. This will support transferring a person’s immunization records from one information system to another. The response will be very similar to a VXU message in content.
MSH – Message Header Segment
MSA – Message Acknowledgement [ERR] – Error Segment QAK – Query Acknowledgement Segment QPD – Input Parameter Specification (echoed back)
PID – Patient Identifier Segment
# Name Usag e Comments 1 Acknowledgement Code R AA: ApplicationAccept AE: Application Error AR: Application Reject 2 Message Control ID ST Echoed back from original request, MSH-10 Message Control ID 3 Text Message X 4 Expected Sequence Number O 5 Delayed Acknowledgement Type O 6 Error Condition X
# Name Usag e Comments 1 Query Tag R Echoes back what was in QPD-2 Query Tag 2 Query Response Status RE OK – Data found, no errors NF – No data found, no errors AE – Application error AR – Application reject TM – Too many candidates found 3 Message Query Name R Echoes back what is in QPD-1 Message Query Name 4 Hit Count O Not described in guide 5 This payload O Not described in guide 6 Hits remaining O Not described in guide
The goal of this response is to return a complete list of candidate patents in response to a request for a person’s record. This will support re
member of the list. Note: This is not supported by all
prohibiting the return of patient information unless it is an exact
will never be returned. These IIS return either an exact match or no match at all.
MSH – Message Header Segment MSA – Message Acknowledgement [ERR] – Error Segment QAK – Query Acknowledgement Segment QPD – Input Parameter Specification (echoed back) { PID – Patient Identification Segment [PD1] – Patient Demographic Segment [{NK1}] – Next of Kin Segment }
Does your IIS or EHR support Z31 responses?
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The goal of this profile is to return an acknowledgment message. No demographic or immunization history will be returned. An acknowledgement is returned when one of the 3 cases occur.
This includes:
privacy reasons
list of candidates.
returned.
MSH – Message Header Segment MSA – Message Acknowledgement [ERR] – Error Segment QAK – Query Acknowledgement Segment QPD – Input Parameter Specification (echoed back)
The goal of this query is to request a evaluated immunization history and forecast of next doses due. An evaluated immunization history and forecast consists of:
decision support engine
Differences from Z44
Does your IIS or EHR support Z44 queries?
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How are IIS doing?
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Functional Standard 1.1 : The IIS provides individual immunization records accessible to authorized users at the point and time where immunization services are being delivered. Functional Standard 1.4: When the IIS receives queries from other health information systems, it can generate an automatic response in accordance with interoperability standards endorsed by CDC for message content/format and transport.
Functional Standard 3.4: The IIS can store all Core Data Elements.
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1. The IIS processes a query requesting a patient’s immunization record. 2. The IIS processes a query requesting a patient’s evaluated immunization record and forecast. 3. The IIS responds to a query for a known patient (one-to-one match). 4. The IIS responds to a query for a patient that is not in the IIS. 5. The IIS responds to a query that results in multiple possible patients. 6. The IIS responds to a query that has a significant error that cannot be accepted. 7. The IIS responds to a query for a known patient and returns known Core Data Elements. 8. The IIS responds to a query with an RSP within 5 seconds or less for 95% of the queries submitted.
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incoming message and makes appropriate decisions (e.g., de- duplicates, stores, queries, rejects, etc.) based on the information in the incoming message and previously known information already in the IIS.
final resolution, or outcome, of processing the message with a conformant HL7 message.
Test Cases
Test Outcomes
expectation(s).
which supports the local business need, policy, or law.
capability limitations, or otherwise arbitrary requirements which do not support local business need, policy, or law.
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Limitations:
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25 13 4 7 1 25 28 2 1 4 17 27 24 30 31 6 3 5 10 15 20 25 30 35 Measure 1: Imm History Capability Measure 2: Eval & Forecast Capability Measure 3: Single Patient Conformance Measure 4: Patient Not Found Conformance Measure 5: Multiple Patient Conformance Measure 6: Erroneous Query Conformance Measure 7: Core Data Returned Measure 8: Timeliness
Query and Response Measures - Aggregate Results
Fully Meets Deviates from National Standard Does Not Meet
General Recommendations
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24 27 31 19 21 25 9 10 13 1 2 3 17 19 25 20 25 28 5 10 15 20 25 30 35 Baseline 3 month 6 month
Query and Response Trends - Q3 2017
Measured Query Support Pass Average MU3 Query Support Pass Average RSP Conformance Pass Average Core Data Elements Pass Average Timeliness Pass Average
THURSDAY, NOVEMBER 9TH 2:00 PM ET / 11:00 AM PT
Web Links
http://www.hl7.org/participate/UserGroups.cfm?UserGroup=Immun ization
http://www.hl7.org/special/committees/iug/index.cfm
http://iugwiki.hl7.org/
http://www.hl7.org/documentcenter/public_temp_F760602A-1C23- BA17-0C0D326E635471F9/pressreleases/HL7_PRESS_20140402.pdf
http://www.immregistries.org/events/2014/04/10/hl7- immunization-user-group
If you have any questions or comments:
Thank you!