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 Assessment Project Additional Questions / Discussion
SISC Update STANDARDS AND INTEROPERABILITY STEERING COMMITTEE (MARY WOINAROWICZ)
FAQ Update FREQUENTLY ASKED QUESTIONS (NATHAN BUNKER)
PID-22 Ethnic Group 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 ◦ usage for PID-22 is RE (required, but may be empty). 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 ◦ usage for NK1-28 is O (optional) 5
Conflicting MVX Code Background : Submitter is sending product and it’s being recorded wrong ◦ Submitter gives Flulavalquad pfree and reports as ◦ CVX 150 ◦ MVX SKB ◦ IIS records this as Fluarixquad pfree Question : According to CDC’s Product Name / CVX-MVX document they should submit as MVX as IDB instead of SKB. We suggest using NDC instead. Any suggestions? Answer : ◦ This is a tricky problem and is the first time we have seen a situation where the CVX/MVX combination is not specific enough to indicate product ◦ Using NDC will allow this product to be recorded correctly 6
ACK Handling with System Outage 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. ◦ MSA-1 = AR ◦ ERR-3= 207 ◦ ERR-4 = E 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. 7
Carriage Return 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 : ◦ HL7 requires that V2 segments (lines) are separated by carriage returns ◦ SOAP specifies that lines of text be separated by line feeds ◦ CDC SOAP standard did not address this conflict 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. 8
QBP Z44 Responses Question : What type of response would be appropriate for authentication errors or validating the sending facility? Answer : There are two potential responses: ◦ If the SOAP request is not authenticated ◦ for example, because the user id/password are wrong ◦ Throw a Security Fault and do not return any HL7 response. ◦ If the problem is in the headers ◦ for example, because they send a value in MSH-4 that is not correct ◦ Return an ACK Z33 indicating in the ERR segment which field needs to be corrected 9
Partial Administration Import Functionality 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 was developed as a replacement for the free text in RXA-9. ◦ However, we don’t know of any IIS looking to receive free text comments at this time (for partial administrations or any other sorts of messages). 10
Forecasting for Combos 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 ◦ store the single dose as it was given ◦ report this out as 120. 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. 11
Discussion Topic QBP RESPONSES – STANDARD AND CURRENT IMPLEMENTATION
Query Messages Message Type and Profile ◦ QBP ◦ Z34 – Request a Complete Immunization History ◦ Z44 – Request Evaluated Immunization History and Forecast Query Profile ◦ RSP ◦ Z32 – Response Profile – Return Complete Immunization History ◦ Z42 – Return Evaluated History and Forecast ◦ Z31 – Return a List of Candidates Profile ◦ Z33 – Return an Acknowledgement with No Person Records ◦ ACK ◦ Z23 – Return an Acknowledgement
Query Messages - Changes Next implementation guide will propose changes to query ◦ HL7 2.8.2 is being balloted in HL7 ◦ Goal of ballot is to move implementation guide into HL7 process ◦ Current regulation is still tied to the CDC Implementation Guide release 1.5 for HL7 v2.5.1 ◦ IIS are still implementing release 1.5, no plans in place for community to move to a new version yet Proposed changes for query: ◦ Query Functional Guide recommended only one type of query ◦ Distinction between the purpose of Z34 vs Z44 is not strong ◦ Having two queries complicates interfacing ◦ New guide will reduce back to only one profile 14
Query Message Responses Possible results from query: ◦ One client matches exactly the criteria sent ◦ “exact” matching determined by IIS business rules ◦ One or more clients match the criteria sent (inexact match) ◦ Also includes situation where there is more than one high-confidence match ◦ No clients match the criteria sent ◦ An exact match is found but they have requested that their data not be shared ◦ “exact” matching determined by IIS business rules ◦ There were errors or other problems
Poll Questions Does your IIS or EHR support queries? ◦ My IIS can respond to queries ◦ My IIS cannot yet respond to queries ◦ My EHR can query an IIS ◦ My EHR cannot yet query an IIS ◦ I don’t belong to an IIS or EHR How much do you know about HL7 queries? ◦ I don’t know much about them ◦ I understand them pretty well ◦ I know a lot 16
Z34 – Request a Complete Immunization History 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: ◦ demographic information about the patient ◦ a list of immunizations received ◦ a list of any patient conditions that impact ◦ immunizations ◦ allergies contraindications, history of vaccine preventable diseases
Z34 – Message Definition MSH – Message Header Segment ◦ MSH-21 – Message Profile Identifier ◦ Z34^CDCPHINVS [{SFT}] – Software Segment QPD – Query Parameter Definition RCP – Response Control Parameter
Z34-QPD – Input Parameter Specification # 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
Z34-QPD – Input Parameter Specification # 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
Z34-RCP – Response Control Parameter # Name Usag Comments e 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 returned. The first component contains the count and the second contains “RD” for records. 3 Response Modality O Not described in guide 4 Executionand Delivery O Not described in guide Time 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
Poll Questions Does your IIS or EHR support Z34 queries? ◦ My IIS can respond to Z34 queries ◦ My IIS cannot yet respond to Z34 queries ◦ My EHR can query an IIS using Z34 ◦ My EHR cannot yet query an IIS using Z34 ◦ I don’t belong to an IIS or EHR 22
Z32 – Complete Immunization History 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.
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