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HL7 Immunization User Group
Monthly MeetingJanuary 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 UpdateMary Woinarowicz
FHIR UpdateNathan 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 FHIRTracy 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 NowNathan 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 IGSegments
The ACK per CDC IG – Cont’dMSA Segment
MSA-1 Acknowledgement Code• AA – Application Accept• AE – Application Error• AR – Application Reject
The ACK per CDC IG – Cont’dERR Segment
ERR-4 Severity• I – Information• W – Warning• E – Error
AIRA Interop Testing ProjectACK 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 ACKsExample 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?
The ACKsExample 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
The ACKsExample 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 ActualMSA-1 Required – AA, AE, or AR AAERR-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 ACKsExample 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 ActualMSA Segment is Required, but only 1 10 MSAs (Below is MSA and ERR of Interest)MSA-1 Required – AA, AE, or AR AAMSA-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^1^5ERR-3 R – HL7 Error Code 101^Required field missing^HL70357ERR-4 R – Severity of Error <Empty>ERR-5 RE – Application Error Code <Empty>ERR-8 RE – User Message <Empty>
The ACKsExample 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 ActualMSA-1 Required – AA, AE, or AR AE
ERR-1 X – Not Supported <Empty>ERR-2 RE – Error Location RXA^0^1^5ERR-3 R – HL7 Error Code 101^Required field missing^HL70357ERR-4 R – Severity of Error WERR-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 ACKsExample 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 ActualMSA-1 Required – AA, AE, or AR AE
ERR-1 X – Not Supported <Empty>ERR-2 RE – Error Location RXA^1^5ERR-3 R – HL7 Error Code 101^Required field missing^HL70357ERR-4 R – Severity of Error EERR-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 Code2015 vs. 2019
ERR-4 Severity2015 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?
HL7 FAQTracy Little
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
Next MeetingFebruary 13, 20202:00 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 Releasehttp://www.hl7.org/documentcenter/public_temp_F760602A-1C23-BA17-0C0D326E635471F9/pressreleases/HL7_PRESS_20140402.pdf
• AIRA Press Releasehttp://www.immregistries.org/events/2014/04/10/hl7-immunization-user-group
Contact InformationIf you have any questions or comments:
• Kim Salisbury-Keith [email protected]
• Nathan Bunker [email protected]
• Kevin Snow [email protected]
• Danny Wise [email protected]
Thank you!