HL7 Immunization User Group Monthly Meeting January 9, 2020 2:00 - - PowerPoint PPT Presentation

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HL7 Immunization User Group Monthly Meeting January 9, 2020 2:00 - - PowerPoint PPT Presentation

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HL7 Immunization User Group Monthly Meeting January 9, 2020 2:00 PM ET Agenda Welcome - Which perspective do you primarily identify yourself with? Updates SISC FHIR Five on FHIR ACKs Then and Now HL7 FAQ SISC Update

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HL7 Immunization User Group

Monthly Meeting January 9, 2020 2:00 PM ET

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Agenda

  • Welcome - Which perspective do you primarily identify yourself with?
  • Updates
  • SISC
  • FHIR
  • Five on FHIR
  • ACKs Then and Now
  • HL7 FAQ
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SISC Update

Mary Woinarowicz

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FHIR Update

Nathan Bunker

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FHIR Update

  • FHIR r4 – Dec 27, 2018
  • Normative
  • Standard for Trial Use (STU)
  • FHIR r5 – Not before Jan 2021 (https://onfhir.hl7.org/)
  • Additional adjunct standards are being created:
  • FHIR – SMART App Launch
  • CDS Hooks
  • CQL
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FHIR Update

  • HL7 WGM 2019
  • Feb 2-7 – Sydney, Australia
  • May 15-22 – San Antonio, Texas
  • Sep 19-24 – Baltimore, Maryland
  • HL7 FHIR Connectathon in the US
  • Saturday and Sunday of the Conference
  • Hands on development and testing
  • Attendance increases at every meeting
  • Last meeting: 400+ attendees divided into 40 subject tracks
  • IIS community exploring participation in Public Health track
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FHIR Update

  • HL7 FHIR DevDays
  • Jun 16-18 – Cleveland, Ohio
  • Learn – Code – Share
  • Tutorials, hands-on sessions,

presentations, keynotes

  • Participants
  • Developers, data modelers,

product owners, architects, and integration engineers

https://www.devdays.com/us/event-info/

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Five on FHIR

Tracy Little

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FHIR : Fast Healthcare Interoperability Resources

  • Data exchange standard, created and maintained by the HL7
  • rganization
  • Built on the best features of the HL7 v2, HL7 v3, and CDA product

lines and leverages the latest in web standards

  • FHIR aims to simplify implementation and improve

interoperability between health care systems and users of data

  • Learn more here: https://www.hl7.org/fhir/overview.html
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ACKs Then and Now

Nathan Bunker

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Agenda

  • Quick Review of the CDC IG Release 1.5 ACK Message
  • Look at ACK responses from IIS in 2015
  • Compare to analysis of IIS in 2019
  • Provide a summary of current ACK analysis
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The ACK per CDC IG

Segmen ents

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The ACK per CDC IG – Cont’d

MSA MSA Se Segment

MSA-1 Acknowledgement Code

  • AA – Application Accept
  • AE – Application Error
  • AR – Application Reject
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The ACK per CDC IG – Cont’d

ERR S RR Segment nt

ERR-4 Severity

  • I – Information
  • W – Warning
  • E – Error
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AIRA Interop Testing Project

AC ACK A Analysis

  • Two messages were submitted to 20 IIS participating in

the AIRA Interop Testing Project.

  • AIRA first submitted a message which was accepted by

the IIS.

  • Simple, clean message
  • 3 Immunizations
  • Then AIRA removed data from one field and

resubmitted.

  • Same Simple message, one field changed from populated to

empty.

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Our Job Today

  • Pretend we are the EHR processing the ACK returned by the

IIS

  • For Each ACK Example, Ask yourself
  • What was wrong with the incoming message?
  • Did the IIS accept the message?
  • What MSA and ERR fields did you use to determine that?
  • Does the IIS expect the EHR to correct/resubmit?
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The ACKs

Example 1 e 1 of 9

MSH|^~\&||System C|TEST||20150715183728||ACK^V04^ACK_V04|7802135|P|2.5.1||||||||| MSA|AA|2778764-I.02.05504.4872|Message had been sent to queue for updates.

Field CDC IG Standard IIS Actual MSA-1 Required – AA, AE, or AR AA – Application Accept MSA-3 X – Not Supported Message had been sent to queue for updates. ERR RE No ERR Segment

  • What was wrong with the incoming message?
  • Was it accepted?
  • What fields did you use to determine that?
  • Does the IIS expect the EHR to correct/resubmit?
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The ACKs

Example 3 e 3 of 9

  • What was wrong with the incoming message?
  • Was it accepted?
  • What fields did you use to determine that?
  • Does the IIS expect the EHR to correct/resubmit?

MSH|^~\&||||XX-XXXXXX|20150723102057||ACK^V04^ACK|20150723102057|P|2.5.1 MSA|AE|4765640-I.02.05504.7451|message failed validation

Field CDC IG Standard IIS Actual MSA-1 Required – AA, AE, or AR AE MSA-3 X – Not Supported message failed validation ERR RE No ERR Segment

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The ACKs

Example 4 e 4 of 9

  • What was wrong with the incoming message?
  • Was it accepted?
  • What fields did you use to determine that?
  • Does the IIS expect the EHR to correct/resubmit?

MSH|^~\&|System A||||20150722142244||ACK^V04^ACK|2671551-I.02.05504.3847a|P|2.5.1| MSA|AA|2671551-I.02.05504.3847a| ERR|^^^1&WARNING: Missing Vaccine ID AND Text. One of these values is required. (RXA-5.1 and RXA-5.2 in HL7). Value: ID='null'. Text='null'. Coding System='null'~^^^2&WARNING: Unknown patient primary language (PID-15 in HL7). Value='eng'~^^^3&WARNING: Unknown Administered Code/Vaccine Type (RXA-5 in HL7). Value=''.| Field CDC IG Standard IIS Actual MSA-1 Required – AA, AE, or AR AA ERR-1 X – Not Supported ^^^1&WARNING: Missing Vaccine ID AND Text. One of these values is required. (RXA-5.1 and RXA-5.2 in HL7). Value: ID='null'. Text='null'. Coding System='null'~^^^2&WARNING: Unknown patient primary language (PID-15 in HL7). Value='eng'~^^^3&WARNING: Unknown Administered Code/Vaccine Type (RXA-5 in HL7). Value=''. ERR-2 RE – Error Location <Empty> ERR-3 R – HL7 Error Code <Empty> ERR-4 R – Severity of Error <Empty> ERR-5 RE – Application Error Code <Empty> ERR-8 RE – User Message <Empty>

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The ACKs

Example 6 e 6 of 9

  • What was wrong with the incoming message?
  • Was it accepted?
  • What fields did you use to determine that?
  • Does the IIS expect the EHR to correct/resubmit?

MSH|^~\&|SYSTEM G|SYSTEM G||DEFAULT2|20150722163628.296||ACK|2788163-I.02.05504.3006|P|2.5.1 MSA|AA|2788163-I.02.05504.3006|WARNING: No client financial class values specified. PV1 segment ignored. ERR||PV1^1^20|102^Data type error^HL70357 MSA|AA|2788163-I.02.05504.3006|Error: Record Rejected. You must supply at least ONE immunization identifying code. ERR||RXA^1^5|101^Required field missing^HL70357 … <cut for brevity> …

MSA|AA|2788163-I.02.05504.3006|WARNING: Inaccurate or missing observation value. No value stored. ERR||OBX^2^3^0|204^Unknown key identifier^HL70357 MSA|AA|2788163-I.02.05504.3006|WARNING: No insurance verification date sent for new administered immunization. Please verify insurance. ERR|||^^HL70357 MSA|AA|2788163-I.02.05504.3006|DED_INV_FUNDING_SRC_EMPTY ERR|||^^HL70357

Field CDC IG Standard IIS Actual MSA Segment is Required, but only 1 10 MSAs (Below is MSA and ERR of Interest) MSA-1 Required – AA, AE, or AR AA MSA-3 X – Not Supported Error: Record Rejected. You must supply at least ONE immunization identifying code. ERR-1 X – Not Supported <Empty> ERR-2 RE – Error Location RXA^1^5 ERR-3 R – HL7 Error Code 101^Required field missing^HL70357 ERR-4 R – Severity of Error <Empty> ERR-5 RE – Application Error Code <Empty> ERR-8 RE – User Message <Empty>

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The ACKs

Example 7 e 7 of 9

  • What was wrong with the incoming message?
  • Was it accepted?
  • What fields did you use to determine that?
  • Does the IIS expect the EHR to correct/resubmit?

MSH|^~\&||||NIST|20150730121603||ACK^V04^ACK|20150730KS0000074624|P|2.5.1|||||||||||9999 MSA|AE|6638200I.02.05504.68 ERR||Rxa^0^5^1|101^Required field missing^HL70357|W|||RXA-5 (AdministeredCode) : Missing required value.|RXA-5 (AdministeredCode) : Missing required value. Field CDC IG Standard IIS Actual MSA-1 Required – AA, AE, or AR AE ERR-1 X – Not Supported <Empty> ERR-2 RE – Error Location RXA^0^1^5 ERR-3 R – HL7 Error Code 101^Required field missing^HL70357 ERR-4 R – Severity of Error W ERR-5 RE – Application Error Code <Empty> ERR-7 O – Diagnostic Information RXA-5 (AdministeredCode) : Missing required value. ERR-8 RE – User Message RXA-5 (AdministeredCode) : Missing required value.

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The ACKs

Example 8 e 8 of 9

  • What was wrong with the incoming message?
  • Was it accepted?
  • What fields did you use to determine that?
  • Does the IIS expect the EHR to correct/resubmit?

MSH|^~\&|SYSTEM F|SYSTEM F||ATEST|20150722020716.727||ACK|5129720-I.02.05504.846|P|2.5.1 MSA|AE|5129720-I.02.05504.846 ERR||RXA^1^5|101^Required field missing^HL70357|E||||Record rejected. You must supply at least ONE immunization identifying code

Field CDC IG Standard IIS Actual MSA-1 Required – AA, AE, or AR AE ERR-1 X – Not Supported <Empty> ERR-2 RE – Error Location RXA^1^5 ERR-3 R – HL7 Error Code 101^Required field missing^HL70357 ERR-4 R – Severity of Error E ERR-5 RE – Application Error Code <Empty> ERR-8 RE – User Message Record rejected. You must supply at least ONE immunization identifying code

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Transport Testing 2015

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ACK Guidance

  • Approved by community in 2015
  • Provides additional guidance for

HL7 2.5.1 ACK messages

  • Required to be supported for

Assessment

  • Wide adoption by IIS since 2015
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Transport Testing 2019

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ACK Guidance

  • Severity sets expectation

for sender:

  • Sender Must Correct?
  • Sender Must Resubmit?
  • Acknowledgement Code
  • AA: If no ERR segments, or all Severities are Information (I)
  • AE: If at least one Severity is Warning (W) or Error (E)
  • AR: Only specific cases which normally do not occur
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MSA-1 Acknowledgment Code

2015 vs. 2019

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ERR-4 Severity

2015 vs. 2019

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Future of ACK Messages

  • What changes will your IIS/EHR make in 2020?
  • Are there areas you see that need more guidance?
  • What areas are working well?
  • What could be improved?
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HL7 FAQ

Tracy Little

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What data should be used to populate patient demographics in an RSP response message?

When generating an RSP message, the IIS should echo back the QPD segment received in the QBP query message. This is the patient demographic data sent by the querying system and it should be returned as it was sent. Other segments in the RSP (PID, PD1, NK1) should be populated with data from the responding system’s database. Querying systems may use this data to validate patient selection. Demographic data sent by the querying system in the QPD segment should not be used to populate the PID, PD1 or NK1 segments. The patient ID in QPD-3 should echo what was submitted in the query, but PID-3 can repeat so it can be populated with more than identifier including:

  • The querying system’s MR for the patient.
  • The IIS ID using a value of “SR” in PID-3.5
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Next Meeting

February 13, 2020 2:00 pm ET / 11:00 am PT

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More Information

  • Web Links
  • Subscribe to immunization group

http://www.hl7.org/participate/UserGroups.cfm?UserGroup=Immunization

  • Public User Group Wiki

http://www.hl7.org/special/committees/iug/index.cfm

  • Private User Group Wiki

http://iugwiki.hl7.org/

  • HL7 Press Release

http://www.hl7.org/documentcenter/public_temp_F760602A-1C23-BA17- 0C0D326E635471F9/pressreleases/HL7_PRESS_20140402.pdf

  • AIRA Press Release

http://www.immregistries.org/events/2014/04/10/hl7-immunization-user-group

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Contact Information

If you have any questions or comments:

  • Kim Salisbury-Keith Kim.SalisburyKeith@health.ri.gov
  • Nathan Bunker nbunker@immregistries.org
  • Kevin Snow ksnow@envisiontechnology.com
  • Danny Wise Danny.Wise@allscripts.com

Thank you!