Clinical Document Exchange Integration Guide - Outbound

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1 Clinical Document Exchange Integration Guide - Outbound Integrate your healthcare IT system with Practice Fusion s Electronic Health Record (EHR) System

2 Table of Contents 1 Introduction Integration Overview Consent Model Document Architecture Patient Identity Connectivity and File Exchange Modified XDS.b RESTful Web Services API Client HMAC Authentication Patient Identity Management Patient List Matching Criteria Based Matching Practice Fusion Outbound CCD Exchange

3 1 Introduction This guide is intended for those wishing to integrate their Accountable Care Organization (ACO), Health Information Exchange (HIE), or interoperability solution with Practice Fusion s Electronic Health Record (EHR) System. It describes Practice Fusion s integration capabilities for the generation and outbound transmission of Continuity of Care Documents (CCD), including standards supported for data transmission, patient identity management, and security. This guide assumes knowledge of Health Level 7 (HL7) standards, Integrating the Healthcare Enterprise (IHE) profiles, standard internet security protocols and modern web services. 2 Integration Overview Practice Fusion supports the automated generation and transmission of clinical documents for a defined patient population. When the medical record of a patient belonging to a partner organization is modified in Practice Fusion s EHR, Practice Fusion will generate a Continuity of Care Document (CCD) and transmit it to the partner. There are four trigger actions that will initiate CCD generation: Signing of a chart note Signing of a lab or imaging result Update to patient medications Update to patient allergies Practice Fusion will work with the partner organization to ensure documents contain the correct patient identifiers and are available for querying by the partner organization. 2 Practice Fusion Outbound CCD Exchange

4 2.1 Consent Model Practice Fusion supports an opt-out model for patient consent. By default, Practice Fusion will generate CCDs for all patients belonging to the partner organization. However, organizations will have the option to identify patients as opted out of clinical data sharing. Practice Fusion will not generate CCDs or other messaging for patients who have opted out. 2.2 Document Architecture Practice Fusion CCDs follow the architecture and schema defined by HL7 Clinical Document Architecture (CDA) standards. Practice Fusion supports two versions of the CDA standard: Consolidated-Clinical Document Architecture (C-CDA) v3.0 Healthcare Information Technology Standards Panel (HITSP) C32 CCD v Patient Identity Patient Administration (ADT) type HL7 messages are used to send patient demographic information to the partner organization. HL7 version 2.3 is used for ADT messaging. Practice Fusion sends two types of ADT messages: ADT^A28 Add a person ADT^A31 Update patient demographics ADT^A28 messages are sent when a patient is matched to the partner organization (see the Patient Identity Management section for details on patient matching). ADT^A31 messages are sent any time patient demographics are updated. 3 Practice Fusion Outbound CCD Exchange

5 Both types of ADT messages contain the following HL7 v2.3 segments: o MSH- Message Header o PID- Patient Identification 3 Connectivity and File Exchange Practice Fusion uses a modified Cross Enterprise Document Sharing (XDS.b) profile to exchange CCDs and ADT messages between organizations. This is accomplished by integrating directly with Practice Fusion s RESTful web services or by using an API client provided by Practice Fusion that runs on the partner s server and automatically makes calls to Practice Fusion s RESTful web services. Partners that do not wish to implement the XDS.b profile can still use the RESTful web services for file exchange. 3.1 Modified XDS.b In Practice Fusion s modified XDS.b profile, CCDs and HL7 ADT messages are not transmitted via Provider and Register Document Set-b transaction (ITI-41) messages as defined in the standard XDS.b profile. Instead, CCDs and ADT messages are transmitted via RESTful web service messaging. The RESTful API used to transmit CCDs and ADT messages uses HMAC security protocols to encrypt data during transmission and to authenticate the document receiver. Practice Fusion performs the Document Source actor role in the XDS.b profile, generating and transmitting CCDs to a Document Repository actor implemented by the partner organization. The partner organization completes the remaining XDS.b transactions required by the Document Registry and Document Consumer actor roles. 4 Practice Fusion Outbound CCD Exchange

6 3.2 RESTful API Implementation RESTful web services can also be used for file exchange with partner organizations who do not wish to implement the XDS.b profile. In the case of a non-xds.b implementation, the partner organization will not perform the actor roles of Document Repository, Document Registry and Document Consumer and can begin processing the CCD after the RESTful transaction is complete. 3.3 API Client Practice Fusion provides an optional.net Windows client to facilitate delivery of CCDs and ADT messages to the partner s server. The client is installed on the partner s server and retrieves CCDs and ADT messages via automated and scheduled RESTful GET calls to the Practice Fusion API. If a file or message is retrieved during a scheduled GET call, the file or message is output to a server directory specified by the partner organization. CCD files are delivered as XML documents with an.xml file extension. ADT messages will conform to the HL7 v2.3 (Pipehat) standard and have n.hl7 file extension. 3.4 HMAC Authentication Hash-based Message Authentication (HMAC) secures and encrypts all messaging between systems. Practice Fusion will generate the private and public keys required for messaging. 4 Patient Identity Management A crucial component to any Health Information Exchange (HIE) is the ability to uniquely and correctly identify the target patient population for data exchange. This problem is non-trivial, as clinical systems often use different means to identify patients. 5 Practice Fusion Outbound CCD Exchange

7 Practice Fusion can support multiple patient identification schemas, depending on the needs of the partner organization. All patient identification begins with a list of providers contracted with the organization, which Practice Fusion uses to identify active providers on the EHR platform. The scope of automated CCD generation is limited to clinical activity within one of these provider s Practice Fusion accounts. The relevant patient population can be further filtered based on patient criteria defined by the partner organization. 4.1 Patient List Matching Practice Fusion can match a relevant patient population in the EHR from a list of patients provided by the partner organization. The partner organization must restrict this list of patients to only those attributed (via a formal attribution process or based on historical encounters) to one of the known Practice Fusion providers affiliated with the partner organization. Patient matching is a continual process in the EHR. As patients are created in the Practice Fusion account of a provider affiliated with the partner organization, Practice Fusion will attempt to match this patient. Partner organizations will also be able to submit updated patient lists on regular intervals to keep all attribution up to date and ensure file exchange occurs for the most current target population. If a Practice Fusion user updates patient demographics within the EHR, the system will attempt to match against these changes. Once a patient has been matched, the patient record will generate a CCD if the appropriate triggers have been satisfied. 4.2 Criteria Based Matching Some organizations may choose to define patients for CCD exchange based on patient-specific criteria. As with patient list-based matching, criteria-based matching is limited to Practice Fusion accounts of providers affiliated with the partner organization. 6 Practice Fusion Outbound CCD Exchange

8 Partner organizations can choose to identify patients using the following attributes: Payer and/or plan Demographics Clinical criteria If a patient record meets the required criteria, CCD generation will occur for that patient as triggers are satisfied. 7 Practice Fusion Outbound CCD Exchange

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