HL7 Immunization User Group Monthly Meeting June 13, 2019 2:00 PM - PowerPoint PPT Presentation

HL7 Immunization User Group Monthly Meeting June 13, 2019 2:00 PM ET

Agenda  Welcome  Poll: Which perspective do you primarily identify yourself with?  Updates  National Meeting Updates  SISC Update  Discussion  Common HL7 Issues and Resolutions Identified During Onboarding  We will meet in July, but August is cancelled

National Meeting Updates Tracy Little

SISC Update Heather Patrick

Common HL7 Issues and Resolutions Identified During Onboarding Kevin Snow

• What data quality issues are discoverable in the HL7 message? • What can we do with the HL7 to prevent bad data in… without rejecting good data?

Patient – Identifiers (MR, SS, etc.) • Identifiers with placeholder text or in the wrong format PID|1||87542982^^^MyEHR^MR~5555555555555^^^MA^MCD~222445555SS^^^SS^SSA| • Alternate identifiers with mismatched identifier type • A PI or MR type ID that looks like an SS or MA. PID|1||200224455^^^MyEHR^MR~43259986543^^^MA^MCD~200224455^^^SS^SSA|

Patient – Identifiers (MR, SS, etc.) Identify: • Alternate identifiers with suspicious formats such as 111111111 or 123456789 • Identifiers with invalid values such as NONE • Identifiers with mismatched identifier type codes such as a MA or SS being sent as an MR • Ask the vendor and provider: Which identifiers are required to be entered in the EHR? Resolve: • Implement business rules during message processing to flag invalid ID formats

Patient – Name (Last, First, and Middle) • Placeholder text in name fields. This may be more prevalent in responsible person name fields. • Patient: Tracy None Little PID|1||87542982^^^MyEHR^MR||LITTLE^TRACY^NONE^^^^L|… • Also applies to Responsible Person names: Tracy Carole None NK1|1||NONE^TRACY^^^^^L|MTH^MOTHER^HL70063|… NK1|1||MOTHER^TRACY^^^^^L|MTH^MOTHER^HL70063|… • Placeholder text when patient does not yet have a legal name. • Baby Boy Little PID|1||87542456^^^MyEHR^MR||LITTLE^BABY^BOY^^^^|…

Patient – Name (Last, First, and Middle) Identify • Suspect values such as ‘None’ or ‘Test’ ‘Mother’ or ‘Blank’ • Ask the vendor and provider: What naming convention is used for baby names? Resolve • Implement business rules to prevent suspected bad data from importing. • Patient first or last name is ‘baby’ or ‘none’ • Patient first or last name contains a numerical value

Patient – Mothers Maiden Name • Placeholder text in mother’s maiden name (last) field PID|1||87542982^^^MyEHR^MR||LITTLE^TRACY^^^^^L|UNKNOWN^^^^^^M|… • Placeholder text in mother’s maiden name (first, middle) field PID|1||87542982^^^MyEHR^MR||LITTLE^TRACY^^^^^L|SMITH^UNKNOWN^UNK NOWN^^^^M|…

Patient – Mothers Maiden Name Identify • Similar to patient name issues; is placeholder text being sent? • Ask the vendor and provider: Is the EHR requiring a full name when the HL7 IG is only asking for the maiden last name? Resolve • Clarify submission requirements (not all CDC Endorsed Data Elements are required per the HL7 IG) to ensure that providers are not required to enter something even if unknown.

Patient - Address • Invalid data in patient address PID|1||432155^^^dcs^MR||Brickowski^Emmett^^^^^L|Brickowski^Sally^^^ ^^M |20110411|M|||9684 Duplo Drive^^8005551212^WI^54000^^L||… • Placeholder text in patient address PID|1||432155^^^dcs^MR||Brickowski^Emmett^^^^^L|Brickowski^Sally^^^ ^^M |20110411|M|||ADDRESS UNKNOWN^^Madison^WI^54000^^L||…

Patient - Address Identify • Street address of ‘none’ ‘blank’ ‘n/a’ ‘temp’ or ‘unknown’ • Street address is empty or contains invalid data Resolve • If your IIS requires a patient address is sent, ensure that EHRs and providers know the repercussions of sending placeholder text. • Have a plan for providers when they want to report immunizations, but no viable address for the patient.

Patient – Race/Ethnicity • Invalid (or old) codes for patient race or patient ethnicity PID|1||432155^^^dcs^MR||Patient^Johnny^New^^^^L|Lastname^Sally^^^^^ M |20110411|M||I^American Indian or Alaska Native^HL70005|123 Any St^^Somewhere^WI^54000^^L||… • Incorrect codes for patient race or patient ethnicity PID|1||432155^^^dcs^MR||Patient^Johnny^New^^^^L|Lastname^Sally^^^^^ M |20110411|M||1002-5^Native American^HL70005|123 Any St^^Somewhere^WI^54000^^L||||||||||||N^not Hispanic or Latino^HL70189|…

Patient – Race/Ethnicity Identify • Correct code sets are being used • Correct mapping of race to PID-10 and ethnicity to PID-22. • Ask the vendor and provider: Which code sets are set up to send in the EHR? Ensure that your IIS is validating the code during processing. Resolve • Communicate correct code sets to vendors • Implement business rules that do not permit invalid codes to be imported

Vaccination – Administration Date • Administration Date is illogical RXA|0|1|20220113||48^HIB PRP-T^CVX|0.5|mL^^UCUM||00^New admin^NIP001|… • Administration Date is unlikely PID|1||432155^^^dcs^MR||Patient^Johnny^New^^^^L|Lastname^Sally^^ ^^^M |20110411|… ORC|… RXA|0|1|20120113||165^HPV9^CVX|0.5|mL^^UCUM||00^New admin^NIP001|^Sticker^Nurse^^^^^^^^^^^^^^^^^^RN|^^^DCS_DC||||32k 2a|20130309|PMC^sanofi^MVX|||CP|A

Vaccination – Administration Date Identify • Find illogical or improbably dates in IIS data. • Administration date is in the future or too far in the past. • Administration date is on a suspicious date such as January 1 or there are spikes of historical doses every month on the 1 st or 15 th . • Ask the vendor and provider: How are historical immunizations entered when the exact month or day is unknown? Resolve • Implement business rules to ensure that immunizations with a date prior to the patient’s date of birth are rejected. • Advise providers on how to manage historical immunizations when the month/day is unknown.

Vaccination – Administered Code (CVX, NDC) • Administered doses reported with the unspecified CVX code RXA|0|1|20190113||137^HPV Unspecified^CVX|0.5|mL^^UCUM||00^New admin^NIP001|… • Administered doses with mismatched CVX and NDC codes RXA|0|1|20190113||48^HIB PRP- T^CVX~ 00006409301^HepB^NDC |0.5|mL^^UCUM||00^New admin^NIP001|…

Vaccination – Administered Code (CVX, NDC) Identify • Unspecified vaccine codes sent with a dose marked as administered (RXA-9 is 00) • Mismatched CVX and NDC codes in the same RXA segment Resolve • Implement business rules to validate NDC to CVX • Follow up with the vendor and provider to ensure that CVX codes are current in EHR.

Vaccination – Lot Number • Extra characters appended to lot numbers to identify stock (private/public) RXA|0|1|20120113||165^HPV9^CVX|0.5|mL^^UCUM||00^New admin^NIP001|^Sticker^Nurse^^^^^^^^^^^^^^^^^^RN|^^^MAIN ST CLINIC||||32k2a-PRIVATE|20130309|PMC^sanofi^MVX|||CP|A • Placeholder text in lot number field RXA|0|1|20120113||165^HPV9^CVX|0.5|mL^^UCUM||00^New admin^NIP001|^Sticker^Nurse^^^^^^^^^^^^^^^^^^RN|^^^MAIN ST CLINIC||||2222222|20130309|PMC^sanofi^MVX|||CP|A

Vaccination – Lot Number Identify • Extra characters in the lot number field, such as ‘VFC’ or ‘private’ • Monitor during ongoing submission for issues with inventory deduction • Ask vendor and provider: Are lot numbers manually typed into the patient record or selected from a drop down? • Resolve • Send an acknowledgment to the provider. • Consider business rules that review the format of lot numbers, looking for patterns or suspicious characters. • Prevent or reduce occurrence of this issue by not allowing manual entry of lot numbers to the EHR.

Vaccination – Route/Site • Including Site but not Route RXR| |RT^Right Thigh^HL70163 • Using the correct codes RXR|IM^Intramuscular^HL70162|RT^Right Thigh^HL70163

Vaccination – Route/Site Identify • Missing site or route data • Use of older code sets Resolve • Follow up with vendor and provider to ensure that code sets are correct in EHR

What are some of your favorite ways to use HL7 to identify incoming data quality issues?

Next Meeting July 11, 2019 2:00 pm ET / 11:00 am PT

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

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!