ATTACHMENT D Integration Broker Services

Transcription

1 This attachment provides detailed descriptions of the Integration Broker (IB) Services that will be maintained and supported according to the Service Requirements in the ITN. The IB Services detailed are: Electronic Lab Reportables Syndromic Surveillance Electronic Lab Orders-Results Electronic Prescription Ordering Lab Reporting to CDC National Provider Database Newborn Screening Billing FileMover Case Notification to CDC 1.0 Electronic Lab Reportables (ELR) Description Certain lab tests performed are reportable to the state s Department of Health as a state and federal requirement. The ELR service provides for the collection of lab test results performed in private labs and hospital labs around the state, as well as the state of Florida public labs. This collection is for a specific group of communicable diseases. The list of diseases is a combination of state and federal requirements. The information is used to predict or determine outbreaks based on the statistics of the reporting. This is probably the highest volume and most significant IB service. The data is primarily about Florida residents, however travelers are also included. The Department has agreements with three other states, and the US Virgin Islands, to trade information about their residents and the Department s. The Federal government determines acceptable format and content for the information. Reporting entities must comply with these requirements to qualify for grants and federal funding. This primary format is the standards-based HL/7, also labs that test specifically for lead send a CSV file with the same HL/7 fields. Some lab entities report the data immediately, while some send data less frequently in batches. The data is used by several program areas within the department. The integration process puts all incoming data into disease control databases where program areas can select and analyze the data information they need. This process uses all federally mandated medical code sets. There are some tests that only the CDC can do, so they too send in reportable lab test results that populate Department surveillance systems. This service is currently in a continual growth mode. Approximately 80 of the 240 hospitals send in data, and about half of the 700+ labs send in data. Although approximately one third of the facilities participate, this represents about three fourths of the overall volume that should be available. IB service personnel are regularly engaged in bringing on new partners (hospitals and private labs). This is considered a mission-critical service, which must be available 24/7. Activity and Work Effort Attention given to this service today includes: Daily monitoring of the translation process Daily monitoring the movement of files, and the adding to databases Daily reviewing of statistics and indicators to identify anomalies, such as a significant drop in records from any sender, that may indicate a problem. Troubleshooting internal issues or issues with source trading partners. 1. Electronic Lab Reportables (ELR) Page 1

2 Working at on-boarding additional hospitals and labs, working directly with their technical resources. Each new partner requires initial setup, requirements and design review, testing and reviewing, adjusting as necessary, and turning on production use. Making changes due to new tests that need to be reported, or CDC changes to format and content. Today this service uses a little more than 1 full time resource, working directly with the Division of Disease Control and Health Protection (the internal customer of the Office of IT which is the primary consumer of this specific IB service). Approximately 60% of time is operational, and 40% is bringing on new hospitals and labs as part of support and maintenance. Formats Used There are several formats that are acceptable for transmitting this data. HL Currently used by approximately 150 labs HL Currently used by approximately 240 labs CSV files with HL7-like fields Used by labs sending Lead test results Protocols Used SFTP The predominant way the reportable lab results are sent. PHINMS - Used by many of the private labs TCP/IP VPN and TCP is configured for several partners AIMS - Used by approximately 4 large lab systems Tools Used This service primarily uses Cloverleaf for HL/7 translation and other. Mirth is used to connect to PHINMS and the CDC s AIM network for file movement. Cloverleaf - Cloverleaf handles all HL7 translation and data manipulation, generating alerts when needed. Data is manipulated and then inserted into the disease control program s SQL Databases for all program areas to access. SQL triggers are used that have been coded by disease control for addition data manipulation, and results must be monitored for success. Mirth Mirth is used to connect to PHINMS and the CDC s AIM network for file movement. Other Tools: The COTS package MoveIT is used to setup SFTP locations for trading partners. FileMover (see IB Service for FileMover) is used to automate file movement. Other Although most data movement is one-directional, coming into the Department by labs and hospitals, the Department does exchange data with three other states plus the US Virgin Islands. This is primarily two-way, with other states sending us lab results for Florida residents, and the Department sending the other states lab results for their residents who were tested in the state of Florida. 1. Electronic Lab Reportables (ELR) Page 2

3 1. Electronic Lab Reportables (ELR) Page 3

4 2.0 Syndromic Surveillance Description Hospitals throughout the State of Florida report de-identified admission data, including reason for visit, for urgent care and emergency room visits. This data is processed and aggregated in the Essence Florida system. Essence is a COTS package that is hosted by an Department vendor in the vendor s data center in Jacksonville. The vendor is responsible for the health and availability of Essence. The MIRTH instance used for this is also hosted by the vendor in Jacksonville. The IB team supports the MIRTH interfaces and preparing the data for Essence. Meaningful use requires hospitals to send this data in HL format. This system provides vital information for identifying outbreaks and possible epidemics. Currently there are approximate 200+ million surveillance records a year coming through this service and into the Essence system, from 306 connected facilities. This is considered a mission-critical service, which must be available 24/7. Activity and Work Effort Attention given to this service today includes: Daily monitoring of file movement and translation processes Daily reviewing of statistics and indicators to identify anomalies, such as a significant drop in records from any sender, that may indicate a problem. Troubleshooting internal issues or issues with source trading partners. Addressing change requests related to content and formats. Regularly adding new facilities into the process. This service today requires approximately 20% of a full-time resource. Formats Used There are several formats that are acceptable for transmitting this data. HL CSV This is legacy, and only a small number of facilities use CSV files. This is being phased out. Protocols Used SFTP The predominant way the reportable lab results are sent. Tools Used Mirth Mirth is used to translate data for inserts into the Essence database. 2. Syndromic Surveillance Page 4

5 2. Syndromic Surveillance Page 5

6 3.0 Electronic Lab Orders and Results (ELO/ELR) Description Clinics in the Local Health Departments can order lab tests from the two private sector labs, Quest Diagnostics and LabCorp, and from the State of Florida Lab in Jacksonville. Users select a menu item in the DOH Certified Electronic Health Record system (called Health Management System, or HMS) to launch the Emdeon web application, and enter the order. Emdeon then sends a record in HL7 format back to the appropriate County Health Department, for recording the order in HMS. If the lab is to be handled by the State Lab (which uses Labware), the HL7 record from Emdeon is also sent to the Labware system. Labs that are targeted for Quest or LabCorp are sent to those systems by Emdeon. Results from Quest and LabCorp are returned via Emdeon, and are sent back to HMS in the County Health Departments. Results from the State Lab are returned and go to Emdeon to be recorded and to HMS in the County Health Departments. HIV-related lab orders and results are also inserted into a separate database (CTLS - Counseling, Testing, and Linkage System) for tracking purposes. CTLS also now submits lab orders to State Lab. SunQuest in Palm Beach County Clinics in Palm Beach County Health Department have an option of creating lab orders to be filled by the SunQuest laboratory system in Palm Beach County. Users launch a web application for SunQuest, and enter the order. SunQuest then sends a record in HL7 format back to the Palm Beach County Health Department, for recording the order in the HMS. Results from SunQuest are sent back to HMS in the Palm Beach County Health Department. The result is also sent to Emdeon for recording just the lab result. This service is 24/7. Activity and Work Effort Attention given to this service today includes: Daily monitoring of the translation process Daily monitoring the movement of files, and the adding to databases Troubleshooting internal issues or issues with source trading partners. Addressing change requests and HL7 version changes Today this service consumes about 60% of a full-time resource. Formats Used There are several formats that are acceptable for transmitting this data. HL HL XML CSV Protocols Used TCP/IP WebServices SFTP ODBC 3. Electronic Lab Orders and Results (ELO/ELR) Page 6

7 Tools Used Cloverleaf - Cloverleaf handles all of the movement of information. Mirth Mirth is used for translation to XML and CSV. Statistics Annual Orders to the State s Labware - approximately 423,800 Annual Orders to LabCorp/Quest - approximately 327,600 Annual Orders to Sunquest - Approximately 41, Electronic Lab Orders and Results (ELO/ELR) Page 7

8 3. Electronic Lab Orders and Results (ELO/ELR) Page 8

9 3. Electronic Lab Orders and Results (ELO/ELR) Page 9

10 4.0 Electronic Prescription Ordering (ERx) Description Clinics in the County Health Departments create prescriptions via the Emdeon application. Users select a menu item in the DOH Certified Electronic Health Record system (called Health Management System, or HMS) to launch the Emdeon web application, and enter the prescription. Emdeon then sends a record in HL7 format back to the appropriate County Health Department, for recording the prescription in the HMS. Emdeon then processes the prescription appropriately. There is no translation to or from standards based formats. This service is 24/7. Activity and Work Effort Attention given to this service today includes: Daily monitoring the movement of files. Troubleshooting internal issues or issues with Emdeon. Addressing change requests and HL7 version changes Today this service consumes about 30% of a full-time resource. Formats Used There are several formats that are acceptable for transmitting this data. HL Protocols Used TCP/IP Tools Used Cloverleaf Mirth 4. Electronic Prescription Ordering (ERx) Page 10

11 4. Electronic Prescription Ordering (ERx) Page 11

12 5.0 Electronic Lab Reporting to CDC) Description The Centers for Disease Control (CDC) requires the Department to report certain lab results that the Department receives from hospitals and labs through the electronic lab reportables service, and other labs performed by the State s Lab, to the CDC. The Department maintains a list of specific reportables to include, and the list changes at the request of the CDC. The Department currently reports Influenza lab tests fromthe Department s State Lab. The reporting is in HL7 format, and files are sent to the CDC s AIMS network. Activity and Work Effort Attention given to this service today includes: Daily monitoring of successful reporting and moving of files. Troubleshooting internal issues or issues with connecting to AIMS. Responding to changes by the CDC of what gets reported. Making changes to format and/or content. Today this service uses approximately 15% of a full-time resource. Formats Used There are several formats that are acceptable for transmitting this data. HL7 2.5 XML and CSV on older processes being phased out Protocols Used ODBC TCP/IP AIMS - AIMS CDC network. SFTP and PHINMS on older processes being phased out. Tools Used Mirth Mirth is used to connect to connect to the AIMS network and move files. Cloverleaf Used in the older processes being phased out. 5. Electronic Lab Reporting to CDC Page 12

13 5. Electronic Lab Reporting to CDC Page 13

14 6.0 National Provider Database Description ATTACHMENT D Integration Broker Services This National Provider Database (NPDB) is a federal repository for information about all medical providers in positions regulated by the state Medical Quality Assurance (MQA) program. There are two primary processes used to maintain this information. De-enrollment/Enrollment Process - Once a year, as requested by MQA, a list of all medical providers who should be removed from the NPDB as determined by the Division of MQA is transmitted to the NPDB using information extracted by MQA from their database. Once that process has been completed, a list of all new providers needing to be added to the NPDB as determined by the Division of MQA is transmitted to the NPDB. Mirth is used to convert the data to an XML format required by the NPDB. Enforcement Process - Enforcement data contains reports of legal issues pertaining to specific Florida medical providers. This information is sent from the NPDB in a process that runs every four 4 hours, every day. The information comes into DOH in XML using a Web Service. Mirth transforms the data to a format required to import it into the MQA system. The information uses an ODBC connection to insert it into the MQA database and MQA has a process to match it with the appropriate medical provider. Activity and Work Effort Attention given to this service today includes: Daily monitoring of the translation process Daily monitoring the movement of files, and the adding to databases Troubleshooting internal issues or issues with the NPDB connection. Making necessary changes as required by the NPDB or MQA. Updating Password for NPDB once every 60 days. Today this service only uses approximately 5% of a full-time resource. Formats Used There are several formats that are acceptable for transmitting this data. XML Format required by NPDB Fixed File format Required by MQA Protocols Used SFTP To move files internally. ODBC - to insert into MQA Web Service Call To push/pull data with NPDB Tools Used Mirth Mirth is used to transform data between XML and a format required by MQA. 6. National Provider Database Page 14

15 6. National Provider Database Page 15

16 7.0 Newborn Screening Description ATTACHMENT D Integration Broker Services Newborn Screening is required lab testing by the State of Florida Lab for every newborn in the state of Florida. The process has been that a blood spot is applied to a card, and additional pertinent information is written on the card, and the card is then sent overnight to the lab as an order to perform over 50 lab tests. The order is keyed into the lab system. This IB service is setup to receive electronic orders in HL7 format from hospitals and birthing centers ahead of the physical blood spots. Mirth is used to transform the HL7 order into a CSV file required by the lab system. This process is currently used by one hospital group Bay Care in Tampa, Florida. This service must be available 24/7. Activity and Work Effort Attention given to this service today includes: Daily monitoring of the translation process Daily monitoring the movement of files Troubleshooting internal issues or issues with source trading partners. Responding to change requests by the lab. This service is expected to use about 20% of a full-time resource going forward. Formats Used There are several formats that are acceptable for transmitting this data. HL CSV file with format provided by the State Lab. Protocols Used SFTP File Copy Tools Used Mirth Mirth is used to translate the HL7 input to a flat CSV file. 7. Newborn Screening Page 16

17 7. Newborn Screening Page 17

18 8.0 EDI Billing Description This service provides for electronic billing, in EDI format, of services provided by the county health departments (CHDs). This electronic billing for claims is for all 67 counties. The source claims information is in the DOH Certified Elecronic Health Record system (called Health Management System, orhms), which is in each county. HMS produces an XML file of claims data which then gets picked up by the process. Standard EDI formats are based on the Washington Publishing release of formats. Claims billing is sent to multiple payors, including several clearing houses that act as brokers for many of the payors. Acknowledgement, status, and payment records come back through the process, from the payors and to the HMS systems in the CHDs. EDI 837 claim records are sent for billing; EDI 999 acknowledgement records are returned for accept/reject; EDI 277 records may get returned these are converted to report files and to the pertinent CHD; and EDI 835 records are resulting payments records that get converted to XML and sent to the appropriate CHD for processing back into HMS. In addition to claims billing and payment processing for HMS, this service also handles State of Florida Lab billing, HMS Medicare claims billing handled a little differently, HMS Collection Agency reporting, and payment records processing for Childrens Medical Services (CMS) billing. State of Florida Lab Billing The State of Florida Lab bills for lab orders processed. The lab creates the EDI 837 itself that gets picked up by the service, and consumes the EDI 835 directly. HMS Medicare Claims Billing For HMS claims to Medicare, the service simply creates the EDI 837 records and sends them back to HMS. The CHDs then handle getting Medicare claims sent out. HMS Collection Agency Reporting For unpaid claims, HMS creates records to go to a Collection Agency. These are translated into the necessary format. The Collection Agency then sends paper reports back the the County Health Departments. CMS Billing A separate system handles the billing for Children s Medical Services (CMS), a completely different group and system within the agency. This billing goes to the Agency for Healthcare Administration. This IB service does, however, processes EDI 834 payment records for this billing, and sends a CSV file to CMS. This EDI Billing service must be available 24/7. Activity and Work Effort Much of the effort with this service is addressing the variation in the requirements of the several clearing houses and payors. Each seem to have their own uniqueness of information needed in the EDI 837 and EDI 835 record types, and change requests frequently are submitted. Attention given to this service today includes: Daily monitoring of: 8. EDI Billing Page 18

19 o the translation process o the movement of files and the EDI Track Logger database o the EDI 999 returns Daily reviewing of statistics and indicators to identify anomalies, such as a significant drop in records from any sender, that may indicate a problem. Troubleshooting internal issues or issues with source trading partners. Addressing change requests for information modifications due to payor requirements. Adding new payors, or moving to payors or clearing houses as requested by the customer. Today this service requires approximately 60 percent of a full-time resource for support and maintenance, and change requests for minor changes within the scope of support. Formats Used This service uses the following formats: EDI fomats: EDI 837 claim records are used for billing EDI 999 records are acknowledgment records returned that update EDI Track Logger EDI 277 records may get sent back to provide claims status. These get turned into report files to go to the pertinent CHD EDI 835 payment records are returned processing results XML is used for data going back and forth to the CHDs CSV is used with CMS and with Collection Agency Protocols Used SFTP Much of the file movement to/from CHDs and to/from Payors. ODBC for interacting with EDI Track Logger and State of Florida Lab system Labware AIMS - Used by approximately 4 large lab systems Tools Used o o This service primarily uses Cloverleaf. The FileMover system (see separate IB Service for FileMover) is used for much of the file routing and transmission. 8. EDI Billing Page 19

20 8. EDI Billing Page 20

21 8. EDI Billing Page 21

22 8. EDI Billing Page 22

23 8. EDI Billing Page 23

24 9.0 FileMover Description Several years ago, the need was recognized to implement an automated way to setup file movement routes and frequency driven by configuration stored in a database. FileMover was created using Cloverleaf. A.Net web frontend and SQL Server database is used to manage the file sources, destinations, and frequency. Cloverleaf moves files from one or more sources to one or more destinations without reading or modifying the file contents. The limit of transformation is the modification of filenames as requested. The bulk of the logic for this application is in a set of TCL Libraries that perform the multi-transport protocol handling for file pickup, delivery, and error checking. Files are moved from one location to another internally on the network using simple file copy. Files are moved to and from external partners through SFTP, FTPS, and SAMBA. Many of the other IB service processes depend on FileMover schedules to look for files in certain locations (internal locations and external partner locations), and deliver them to one or more other locations (internal and external). Each route has a source, destination, file location, contact information, and file naming rules. There are currently: 1834 transport routes 7231 data sources and data destinations 537 file locations 769 contacts within the File Mover interface. This must be available 24/7 to support all the other IB services. Activity and Work Effort There is daily monitoring of the health and availability of the FileMover process, and response and troubleshooting of any reported issues. New routes are setup as requested to support other processes. Today this service only uses approximately 15% of a full-time resource. Formats Used File contents are ignored by FileMover. Protocols Used SFTP SAMBA File Copy Tools Used This service uses Cloverleaf for executing scheduled file movements. 9. FileMover Page 24

25 9. FileMover Page 25

26 10.0 Case Notification to CDC Description ATTACHMENT D Integration Broker Services The National Notifiable Diseases Surveillance System (NNDSS) is a nationwide collaboration program established by the CDC that enables all levels of public health local, state, territorial, federal, and international to share notifiable disease related health information. Message mapping guides used in the NNDSS program describe the data content needed for electronic HL7 case notifications for nationally notifiable infectious diseases or conditions. The Department s Division of Disease Control and Health Protection identifies case notifications that need to be sent to the CDC, created HL7 records and stores them in files. The IB team picks up the files and transmits them to the AIMS platform where they are picked up by the CDC. This service must be available 24/7. Activity and Work Effort Daily monitoring of the movement of files. Today this service only uses approximately 5% of a full-time resource. Formats Used HL7 according to CDC Message Mapping Guides. Protocols Used PHINMS Tools Used Mirth for connecting to AIMS. 10. Case Notification to CDC Page 26

27 10. Case Notification to CDC Page 27