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 Mary Woinarowicz
FHIR Update Nathan Bunker
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
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
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/
Five on FHIR Tracy Little
FHIR : Fast Healthcare Interoperability Resources • Data exchange standard, created and maintained by the HL7 organization • 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
ACKs Then and Now Nathan Bunker
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
The ACK per CDC IG Segmen ents
The ACK per CDC IG – Cont’d MSA MSA Se Segment MSA-1 Acknowledgement Code • AA – Application Accept • AE – Application Error • AR – Application Reject
The ACK per CDC IG – Cont’d ERR S RR Segment nt ERR-4 Severity • I – Information • W – Warning • E – Error
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.
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?
The ACKs • What was wrong with the incoming message? Example 1 e 1 of 9 • Was it accepted? • What fields did you use to determine that? • Does the IIS expect the EHR to correct/resubmit? 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
The ACKs • What was wrong with the incoming message? Example 3 e 3 of 9 • 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
The ACKs • What was wrong with the incoming message? Example 4 e 4 of 9 • 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>
The ACKs • What was wrong with the incoming message? Example 6 e 6 of 9 • 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> … Field CDC IG Standard IIS Actual MSA|AA|2788163-I.02.05504.3006|WARNING: Inaccurate or missing observation value. No value stored. MSA Segment is Required, but only 1 10 MSAs (Below is MSA and ERR of Interest) ERR||OBX^2^3^0|204^Unknown key identifier^HL70357 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. MSA|AA|2788163-I.02.05504.3006|WARNING: No insurance verification date sent for new administered immunization. Please verify insurance. ERR-1 X – Not Supported <Empty> ERR|||^^HL70357 ERR-2 RE – Error Location RXA^1^5 ERR-3 R – HL7 Error Code 101^Required field missing^HL70357 MSA|AA|2788163-I.02.05504.3006|DED_INV_FUNDING_SRC_EMPTY ERR-4 R – Severity of Error <Empty> ERR-5 ERR|||^^HL70357 RE – Application Error Code <Empty> ERR-8 RE – User Message <Empty>
The ACKs • What was wrong with the incoming message? Example 7 e 7 of 9 • 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.
The ACKs • What was wrong with the incoming message? Example 8 e 8 of 9 • 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
Transport Testing 2015
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
Transport Testing 2019
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
MSA-1 Acknowledgment Code 2015 vs. 2019
ERR-4 Severity 2015 vs. 2019
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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