Integration Guide for Data Originators of CCR Documents. Version 1.0

Transcription

1 Integration Guide for Data Originators of CCR Documents Version 1.0 November 11, 2010

2 Integration Guide for Data Originators of CCR Documents Revision History Date Version Description Author October 29, Draft Initial Draft J. Terrien November 11, Initial release D. Callaghan Page 2

3 Integration Guide for Data Originators of CCR Documents Table of Contents 1. ABOUT THIS IMPLEMENTATION GUIDE Purpose Audience Related Documentation SOLUTION OVERVIEW CONNECTIVITY AND SECURITY CCR REQUIREMENTS Standards CCR Object Types Supported Structures Technology Assumptions DATA REQUIREMENTS Allergy Mapping to Portlet Medication Mapping to Portlet ERROR HANDLING OTHER REQUIREMENTS APPENDIX A: SAMPLE PORTLET DISPLAY ALLERGIES APPENDIX B: SAMPLE PORTLET DISPLAY MEDICATIONS APPENDIX C: EXAMPLE CCR RESPONSE Page 3

4 Integration Guide for Data Originators of CCR Documents 1. ABOUT THIS IMPLEMENTATION GUIDE 1.1 Purpose The purpose of this document is to provide a guide to Covisint s web service interface for data originators who wish to implement real-time exchange of the ASTM Continuity of Care Record (CCR) Standard (ASTM E ). 1.2 Audience This document is intended for application developers and implementers of standards-based, interoperable healthcare information systems. Implementers will require access to the ASTM E Standard and should have knowledge of XML. 1.3 Related Documentation Covisint Guides Service Provider Master Patient Index (MPI) Transaction Specification Service Provider Patient Sync Transaction Specification Industry Documentation ASTM - Designation: E Standard Specification for Continuity of Care Record (CCR) Page 4

5 Integration Guide for Data Originators of CCR Documents 2. SOLUTION OVERVIEW The CCR service retrieves clinical data real-time from a data originator and provides it to a user at the patient s point of care. A user can access this service from a community or provider-office portal. In either case, upon receiving the user s request, Covisint exchangelink will invoke a web service to send an HTTP XML request to data originators, and expects to receive a synchronous ASTM CCR document on the web service response. Patient identity is critical for successful data retrieval. There are two different models that can be used for patient identification based on whether the environment is a health exchange community integration (Refer to MPI specification for more details) or a provider-office integration (Refer to Patient Synchronization specification for more specific details). Community integration model The community integration model is based on the existence of a community Master Patient Index (MPI). The data originator must provide a patient identity feed to the community MPI containing demographics and unique local patient identifiers. Subsequently, when Covisint exchangelink requests a CCR from the data originator, the request will contain the patient identifier that was previously supplied on the MPI patient identity feed. Provider-office integration model In the provider office integration model, the data originator is integrated with the patient identity source (e.g. office PMS) through Covisint s Patient Synchronization service. In that case the query contains the local provider s patient identifier and demographics from the office PMS, and the data originator is responsible for cross walking that identifier to its own internal patient identifier via the patient synchronization. Page 5

6 Integration Guide for Data Originators of CCR Documents 3. Connectivity and Security Covisint supports the following connectivity and security options for its CCR service: HTTPs Post, with or without basic authentication Page 6

7 Integration Guide for Data Originators of CCR Documents 4. CCR REQUIREMENTS 4.1 Standards ASTM : E Standard Specification for Continuity of Care Record (CCR) XML schema 4.2 CCR Object Types Supported Alert Type = Allergy Product/Medication Type = Medication 4.3 Structures Request HTTPs Post Parameters Source ID: Covisint Identifier Patient ID: Identifies the patient for which data is being solicited Page 7

8 Integration Guide for Data Originators of CCR Documents CCR General Structure Message structures illustrated below are defined in the ASTM CCR standard. Page 8

9 Integration Guide for Data Originators of CCR Documents Allergy (Alert Type = Allergy ) Page 9

10 Integration Guide for Data Originators of CCR Documents Medications Page 10

11 Integration Guide for Data Originators of CCR Documents 4.4 Technology Assumptions All requests will be synchronous real-time, containing a single patient inquiry. Covisint s CCR service can accept and render the ASTM CCR response for display to portal users. However, if a data originator has specific requirements for displaying the information that varies from Covisint s standard portal presentation, then custom mapping will be required. Custom mapping is outside the scope of this document. The retrieval of a CCR from a data originator (e.g. partner application) is dependent upon the application using the Covisint patient synchronization (Patient-Sync) functionality to synchronize patient records between the application and the Covisint platform, or the application providing a patient identity feed to Covisint for a community MPI. Depending on the model that applies to your application, key patient and/or practice values will be provided in the query message as follows: If your application is using the patient sync model that synchronizes patient records with provider practices, then the practice identifier and associated patient id will be contained in the request and will be used by your application to retrieve the requested artifact. Practice ID Identifier of the provider practice in the Covisint platform that maps directly to a provider practice in your application. Patient ID The Patient identifier is used in patient synchronization to create or update patient records in your application. If your organization provides a patient identity feed to Covisint s MPI services, then the request will contain the patient identifier provided by your organization on the patient identity MPI feed. Patient ID The Patient identifier used in MPI update to create or update patient records on the Covisint platform. Page 11

12 Integration Guide for Data Originators of CCR Documents 5. DATA REQUIREMENTS 5.1 Allergy Mapping to Portlet Portlet Column CCR Element Description All CCR elements begin with the root element of <CCRDocumentObjectID> Allergy Module (Portlet level) Allergy <Alert> <Text>Allergy</Text> <Agent> <Products> <Product> <Descripton> <Text>Penicillin</Text> </Description> </Product> </Product> </Products> </Agent> Identifies the Alert (Allergy/Drug Sensitivity Module of the CCR/CCD Valid content is: Allergy Adverse Reaction Ignore: Reaction Alert Reaction Severity Status <<Reaction> <Description> <Attribute>Reaction</Attribute> <Value>Hives</Value> </Description> <<Reaction> <Description> </Description> <severity> <Attribute>Severity</Attribute> <Value>Life Threatening</Value> </severity> </Reaction> <Status> <Text>Active</Text> </Status> Reaction contains the severity value Defines the <Severity> of the <Reaction> Valid values: Minimal, Mild, Moderate, Severe, Life Threatening, Critical. Valid entries: Active Prior History No Longer Active Page 12

13 Integration Guide for Data Originators of CCR Documents 5.2 Medication Mapping to Portlet The medication status values in the ASTM standard are: Active, On Hold, Prior History and No longer Active. Many e-prescribing Application Providers have custom status values which are outside the scope of this document. If this is the case, these status values need to be evaluated and mapped to the active state. Status Definition Active Active Active Medication for the patient Yes On Hold Medication is prescribed but currently on hold for No the patient Prior History Patient has taken medication for a period No No Longer Active Patient has taken medication but is no longer actively taking medication No Portlet Column CCR Element Comments All CCR elements begin with the root element of <CCRDocumentObjectID> Medication Module (Portlet level) Medication <Medication> <Text>Medication</text> <Product> <ProductName> <Text>Atenolol</Text> Valid: Medication Other values such as Immunization, Disposable, Supplies should be ignored Strength Drug Form Patient Instructions Quantity Dispensed <Strength> <Value>50</Value> <Units> <Unit>MG</Unit> </Units> </Strength> <Dose> <Value></Value> <Units> <Unit>TABS</Unit> </Units> </Dose> <Directions> <Direction> <Description> <Text>TAKE 1 TABLET DAILY.</Text> </Description> <Quantity> <Value>30.00</Value> <Units> <Unit>Tab</Unit> <Code>TABS</Code> Value & units display together Integer Page 13

14 Integration Guide for Data Originators of CCR Documents Portlet Column CCR Element Comments </Units> </Quantity> Days Supply Not available Integer Refills remaining <Refills> <Refill> <Number>12</Number> </Refill> </Refills> Integer 0-99 Fill Date Not available Format mm/dd/yyyy Prescriber Name <ActorID>Person.2ebe52df-a cbd7147cc0e</ActorID> <Text>Prescribed User</Text> Lastname, Firstname Dispensing Pharmacy Status Not available <Status> <Text>Active</Text> </Status> Used to filter entries for portlet Page 14

15 6. ERROR HANDLING This discussion outlines the most common types of errors and is not necessarily all inclusive of every error that may be encountered during processing. This section is not intended to address error reporting, resolution or any other service from an operations perspective since each client and/or data originator establishes these processes or SLAs as part of their contractual agreement with Covisint. Errors between Covisint and a data originator using the interface described in this implementation guide may fall into these areas: Data originator fails to respond: If a data originator fails to respond to the synchronous request within the configured time limit, then an exception will be returned by Covisint to the client indicating the data originator failed to respond. It is the responsibility of the client to interpret the exception and provide the end user with an appropriate informational message. The amount of time that the request will wait for a response is determined by Covisint, to ensure a consistent user experience. Transport level exception returned by data originator If a data originator returns a transport level error, (e.g. HTTPs 500) then an exception will be returned by Covisint to the client. It is the responsibility of the client to interpret the exception and provide the end user with an appropriate informational message. Application level exception returned by data originator If a data originator returns an application level error (i.e. ERROR transaction), then the error will be returned by Covisint to the client. It is the responsibility of the client to interpret the application error and provide the end user with an appropriate informational message. Non-compliant response returned by data originator If the data originator returns a response that does not comply with the expected standard interface defined in this Implementation Guide, then the response will be rejected. It will not be returned to the client. The client will instead receive a general exception error from Covisint. In all cases, the Service Level Agreement (SLA) between Covisint and the data originator will determine any operational processes for responding to errors. Responses may range from no action taken, to immediate escalation for resolution. Contact your Covisint representative for information on the available options. Rest Based (HTTP Post) Generic error response example: Start HTTP/ Internal Server Error Server: Apache-Coyote/1.1 Date: Tue, 06 Oct :16:43 GMT Content-Type: text/plain Content-Length: 174 Connection: close Page 15

16 Submitted message failed processing through the Exchange. Inbound Message ID: {tracking_id} Outbound Message ID: {tracking_id} SyncGuid: DTW114081N01-F8FN5W End Page 16

17 7. OTHER REQUIREMENTS Accuracy & Completeness When processing transaction from a data originator, Covisint does not inspect and/or translate any incoming data. Content is displayed as provided and should comply with specifications contained in this document. If there are issues with data displayed, display formats and/or associated codes, it is the responsibility of the data originator to address these content issues. If a data originator should need custom mapping, this functionality is available but is not considered part of the standard implementation activities Audit Covisint only audits that transactions happened within the Covisint environment; it does not log the content of those transactions. If a data source has other business requirements to log and audit the content of transactional flow, the data source must provide that capability. Data Retention Data that is retrieved by Covisint exchangelink using this interface is not persisted within the Covisint environment. Page 17

18 Appendix A: Sample Portlet Display Allergies Page 18

19 Appendix B: Sample Portlet Display Medications Page 19

20 Appendix C: Example CCR Response <?xml version="1.0"?> <tns1:getpatientresult> <tns1:status>success</tns1:status> <tns1:patient> <tns1:patientid> <tns1:value>afee4322-a53a ef-3e1c </tns1:value> <tns1:type>guid</tns1:type> </tns1:patientid> <tns1:patientguid>afee4322-a53a ef-3e1c </tns1:patientguid> <tns1:mrn>cookie</tns1:mrn> <tns1:licenseid>617ba90e-9a14-442d c3783bf9098</tns1:licenseid> <tns1:firstname>cookie</tns1:firstname> <tns1:lastname>monster</tns1:lastname> <tns1:middleinitial> </tns1:middleinitial> <tns1:address1>125 Oatmeal Street</tns1:Address1> <tns1:address2></tns1:address2> <tns1:city>raleigh</tns1:city> <tns1:state>nc</tns1:state> <tns1:zipcode>27615</tns1:zipcode> <tns1:phone></tns1:phone> <tns1:gender>m</tns1:gender> <tns1:dateofbirth> t00:00:00</tns1:dateofbirth> <tns1:ssn></tns1:ssn> <tns1: ></tns1: > <tns1:ccr> <ContinuityOfCareRecord xmlns:xsd=" xmlns:xsi=" xmlns="urn:astm-org:ccr"> <CCRDocumentObjectID> </CCRDocumentObjectID> <Language> <Text>English</Text> </Language> <Version>V1.0</Version> <DateTime> <Text>CCR Creation DateTime</Text> <ExactDateTime> T115955Z</ExactDateTime> </DateTime> <Patient> <ActorID>Patient.afee4322-a53a ef-3e1c </ActorID> </Patient> <From> <ActorLink> <ActorID> Person.</ActorID> Page 20

21 <Text>Provider</Text> </ActorLink> <ActorLink> <ActorID>Site</ActorID> <Text>Organization</Text> </ActorLink> <ActorLink> <Text>InformationSystem</Text> </ActorLink> </From> <To> <ActorLink> <ActorID>Patient.afee4322-a53a ef-3e1c </ActorID> <Text>Patient</Text> </ActorLink> </To> <Purpose> <Description> <Text>Patient Request</Text> </Description> </Purpose> <Body> <Problems> <Problem> <CCRDataObjectID>3da74a02-349b-4dd6-918d-34b3668cceb0</CCRDataObjectID> <DateTime> <Text>Onset</Text> <ApproximateDateTime> <Text> T00:00:00Z</Text> </ApproximateDateTime> </DateTime> <IDs> <ID>3da74a02-349b-4dd6-918d-34b3668cceb0</ID> </IDs> <Text>Diagnosis</Text> Page 21

22 <Description> <Text>STREP SORE THROAT</Text> <Code> <Value>034.0</Value> <CodingSystem>ICD9-CM</CodingSystem> </Code> </Description> <Status> <Text>Active</Text> </Status> </Problem> </Problems> <Alerts> <Alert> <CCRDataObjectID>1916d a4a fe67e83</CCRDataObjectID> <DateTime> <Text>Start Date</Text> <ExactDateTime> T00:00:00Z</ExactDateTime> </DateTime> <IDs> <ID>1916d a4a fe67e83</ID> </IDs> <Text>Allergy</Text> <Description> <Text>Dilantin - Oral</Text> </Description> <Status> <Text>Active</Text> </Status> Page 22

23 <ActorID>Person.703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ActorID> <Text>Created User</Text> <ActorID>Person.703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ActorID> <Text>Updated User</Text> <Agent> <Products> <Product> <CCRDataObjectID>PR.1916d a4a fe67e83.1</CCRDataObjectID> <Text>Medication</Text> <Description> <Text>Dilantin - Oral</Text> <Code> <Value>006636</Value> <CodingSystem>Medispan PAR ID</CodingSystem> </Code> </Description> <Product> <ProductName> <Text>Dilantin - Oral</Text> </ProductName> </Product> </Product> </Products> </Agent> <Reaction> <Description> <Text>Tachycardia</Text> </Description> </Reaction> </Alert> </Alerts> <Medications> <Medication> <CCRDataObjectID>bdfcabc0-3cb eb5d15c4922</CCRDataObjectID> Page 23

24 <DateTime> <Text>Prescription Date</Text> <ExactDateTime> T16:02:00Z</ExactDateTime> </DateTime> <DateTime> <Text>Expiration Date</Text> <ExactDateTime> T00:00:00Z</ExactDateTime> </DateTime> <IDs> <ID>bdfcabc0-3cb eb5d15c4922</ID> </IDs> <Text>Medication</Text> <Description> <Text>Ibuprofen; three times per day ; </Text> </Description> <Status> <Text>New</Text> </Status> <ActorID>Person.703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ActorID> <Text>Prescribed User</Text> <ActorID>Person.703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ActorID> <Text>Created User</Text> <Text>Source System</Text> Page 24

25 <Product> <ProductName> <Text>Ibuprofen</Text> <Code> <Value> </Value> <CodingSystem>NDC</CodingSystem> </Code> <Code> <Value>027909</Value> <CodingSystem>Medispan PAR ID</CodingSystem> </Code> <Code> <Value>R</Value> <CodingSystem>Transmission Method</CodingSystem> </Code> </ProductName> <Strength> <Value>200</Value> <Units> <Unit>MG</Unit> </Units> </Strength> <Form> <Text></Text> </Form> </Product> <Quantity> <Value>0.00</Value> <Units> <Unit></Unit> <Code>Cap</Code> </Units> </Quantity> <Directions> <Direction> <Description> <Text>three times per day</text> </Description> <Dose> <Value></Value> <Units> <Unit>Cap</Unit> </Units> </Dose> <Route> <Text>Oral</Text> </Route> <Duration> <Value>0</Value> Page 25

26 <Units> <Unit>Days</Unit> </Units> </Duration> </Direction> </Directions> <Refills> <Refill> <Number>0</Number> </Refill> </Refills> </Medication> <Medication> <CCRDataObjectID>3594f603-4d a1dc-e48fa385b57d</CCRDataObjectID> <DateTime> <Text>Prescription Date</Text> <ExactDateTime> T14:20:00Z</ExactDateTime> </DateTime> <DateTime> <Text>Expiration Date</Text> <ExactDateTime> T00:00:00Z</ExactDateTime> </DateTime> <IDs> <ID>3594f603-4d a1dc-e48fa385b57d</ID> </IDs> <Text>Medication</Text> <Description> <Text>Prevacid; once per day ; </Text> </Description> <Status> <Text>New</Text> </Status> <ActorID>Person.703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ActorID> <Text>Prescribed User</Text> Page 26

27 <ActorID>Person.703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ActorID> <Text>Created User</Text> <Text>Source System</Text> <Product> <ProductName> <Text>Prevacid</Text> <Code> <Value> </Value> <CodingSystem>NDC</CodingSystem> </Code> <Code> <Value>040382</Value> <CodingSystem>Medispan PAR ID</CodingSystem> </Code> <Code> <Value>R</Value> <CodingSystem>Transmission Method</CodingSystem> </Code> </ProductName> <Strength> <Value>15</Value> <Units> <Unit>MG</Unit> </Units> </Strength> <Form> <Text>Cap</Text> </Form> </Product> <Quantity> <Value>0.00</Value> <Units> <Unit>Cap</Unit> <Code>Caps</Code> </Units> </Quantity> <Directions> <Direction> Page 27

28 <Description> <Text>once per day</text> </Description> <Dose> <Value></Value> <Units> <Unit>Caps</Unit> </Units> </Dose> <Route> <Text>Oral</Text> </Route> <Duration> <Value>0</Value> <Units> <Unit>Days</Unit> </Units> </Duration> </Direction> </Directions> <Refills> <Refill> <Number>0</Number> </Refill> </Refills> </Medication> <Medication> <CCRDataObjectID>ce16e74f-ceea-4dd9-8e55-92b915451f35</CCRDataObjectID> <DateTime> <Text>Prescription Date</Text> <ExactDateTime> T00:00:00Z</ExactDateTime> </DateTime> <DateTime> <Text>Expiration Date</Text> <ExactDateTime> T00:00:00Z</ExactDateTime> </DateTime> <IDs> <ID>ce16e74f-ceea-4dd9-8e55-92b915451f35</ID> </IDs> <Text>Medication</Text> Page 28

29 <Description> <Text>Zithromax Z-Pak; TAKE 2 TABLETS ON DAY 1 THEN TAKE 1 TABLET A DAY FOR 4 DAYS. ; </Text> </Description> <Status> <Text>New</Text> </Status> <ActorID>Person.703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ActorID> <Text>Prescribed User</Text> <ActorID>Person.703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ActorID> <Text>Authorized User</Text> <ActorID>Person.703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ActorID> <Text>Created User</Text> <Text>Source System</Text> <Product> <ProductName> <Text>Zithromax Z-Pak</Text> <Code> <Value> </Value> <CodingSystem>NDC</CodingSystem> </Code> <Code> <Value>070227</Value> <CodingSystem>Medispan PAR ID</CodingSystem> </Code> <Code> Page 29

30 <Value>S</Value> <CodingSystem>Transmission Method</CodingSystem> </Code> </ProductName> <Strength> <Value>250</Value> <Units> <Unit>MG</Unit> </Units> </Strength> <Form> <Text>Tab</Text> </Form> </Product> <Quantity> <Value>1.00</Value> <Units> <Unit>Tab</Unit> <Code>TABS</Code> </Units> </Quantity> <Directions> <Direction> <Description> <Text>TAKE 2 TABLETS ON DAY 1 THEN TAKE 1 TABLET A DAY FOR 4 DAYS.</Text> </Description> <Dose> <Value></Value> <Units> <Unit>TABS</Unit> </Units> </Dose> <Route> <Text>Oral</Text> </Route> <Frequency> <Value>OTHER</Value> </Frequency> <Duration> <Value>5</Value> <Units> <Unit>Days</Unit> </Units> </Duration> </Direction> </Directions> <Refills> <Refill> <Number>0</Number> </Refill> </Refills> Page 30

31 </Medication> </Medications> </Body> <Actors> <ActorObjectID>Patient.afee4322-a53a ef-3e1c </ActorObjectID> <Person> <Name> <CurrentName> <Given>Cookie</Given> <Family>Monster</Family> </CurrentName> <DisplayName>CookieMonster</DisplayName> </Name> <DateOfBirth> <ApproximateDateTime> <Text>01/01/2000</Text> </ApproximateDateTime> </DateOfBirth> <Gender> <Text>Male</Text> </Gender> </Person> <IDs> <Text>Patient ID</Text> <ID></ID> <Text>ERX</Text> </IDs> <Address> <Text>Mail</Text> <Line1>125 Oatmeal Street</Line1> <City>Raleigh</City> <State>NC</State> <PostalCode>27615</PostalCode> </Address> Page 31

32 <ActorObjectID>Site</ActorObjectID> <Organization> <Name>AMA Test Site</Name> </Organization> <Address> <Text>Mail</Text> <Line1>4 AMA Way</Line1> <City>Hollywood</City> <State>CA</State> <PostalCode>90027</PostalCode> </Address> <ActorObjectID>ePrescribe</ActorObjectID> <InformationSystem> <Name>ePrescribe by Allscripts, LLC.</Name> ERX <Version>1.5.0</Version> </InformationSystem> <ActorObjectID>Medication.ce16e74f-ceea-4dd9-8e55-92b915451f35</ActorObjectID> <InformationSystem> <Name>CVS/PHARMACY #8081</Name> Pharmacy </InformationSystem> <IDs> <Text>NABP</Text> <ID> </ID> </IDs> Page 32

33 <Address> <Text>Mail</Text> <Line1>17120 KERCHEVAL AVE</Line1> <Line2></Line2> <City>GROSSE POINTE</City> <State>MI</State> <PostalCode>48230</PostalCode> </Address> <ActorObjectID> Person.703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ActorObjectID> <Person> <Name> <CurrentName> <Given>Katherine</Given> <Family>Ernhart</Family> </CurrentName> </Name> </Person> <IDs> <Text>User ID</Text> <ID>703dbf92-8a38-48b6-8af6-ccfc182a2eeb</ID> </IDs> <IDs> <Text>User Name</Text> <ID>kye_ama</ID> </IDs> <IDs> Page 33

34 <Text>User Type</Text> <ID>Provider</ID> </IDs> <Address> <Text>Mail</Text> </Address> </Actors> </ContinuityOfCareRecord></tns1:CCR> <tns1:status>active</tns1:status> </tns1:patient> Page 34