krames on-demand integration using...

Krames On-Demand Integration using HL7

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Krames On-Demand Integration Using HL7

Technical Documentation

April, 2011


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Table of Contents Table of Contents .................................................................................................................................................................... 2

Krames On-Demand (KOD) HL7 Interfaces ........................................................................................................................ 3 Types of HL7 Interfaces ................................................................................................................................................... 3 KOD HL7 Interface Solutions ........................................................................................................................................... 3 ADT Interface Implementation Tasks .............................................................................................................................. 4 Results Interface Implementation Tasks ......................................................................................................................... 5

KOD Interface Requirements .............................................................................................................................................. 6 Hardware Requirements .................................................................................................................................................. 6 Software Requirements ................................................................................................................................................... 6

Implementation Notes ......................................................................................................................................................... 7 Hospital Information ........................................................................................................................................................ 7 Client Contact Information ............................................................................................................................................... 7 Integration Information ..................................................................................................................................................... 7 Configuration Information ................................................................................................................................................ 8 Client Setup Questions .................................................................................................................................................... 8 ADT and Results Interface Project Plans ......................................................................................................................... 8

HL7 Message Specification ................................................................................................................................................ 9 Trigger Events .................................................................................................................................................................. 9 Patient (ADT) Trigger Events Table .................................................................................................................................. 9 KOD Actions .................................................................................................................................................................. 10 Education Results Trigger Event Table ......................................................................................................................... 11 HL7 Segment Layouts ................................................................................................................................................... 12 MSH Segment ................................................................................................................................................................ 12 MSA Segment ................................................................................................................................................................ 13 NTE Segment ................................................................................................................................................................. 13 ADT Segments ............................................................................................................................................................... 13 EVN Segment ................................................................................................................................................................. 13 PID Segment .................................................................................................................................................................. 14 PV1 Segment ................................................................................................................................................................. 15 Other ADT Segments ..................................................................................................................................................... 16 Observation/Unsolicited Results Segment .................................................................................................................... 16 OBR Segment ................................................................................................................................................................ 16 OBX Segment ................................................................................................................................................................ 18 HL7 Message Specifications ......................................................................................................................................... 18 Patient Data (ADT) ......................................................................................................................................................... 18 Education Results (ORU) ............................................................................................................................................... 20

Appendix A ........................................................................................................................................................................ 21 Results Message............................................................................................................................................................ 21 Sample Formatted Results Message ............................................................................................................................ 21 Sample HL7 Results Message ....................................................................................................................................... 21

Appendix B ........................................................................................................................................................................ 22


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Krames On-Demand (KOD) HL7 Interfaces

The purpose of the Krames On-Demand HL7 interfaces is to share patient information and education encounters between KOD and the Electronic Medical Record (EMR) systems. Using HL7 messaging standards, our HL7 interfaces communicate directly with a hospital’s interface engine to coordinate and exchange messages between KOD and the EMR.

Types of HL7 Interfaces

KOD supports two interfaces to exchange messages with the EMR:

ADT Interface – The Admissions, Discharge and Transfer (ADT) allows KOD to receive patient demographic and registration information from the EMR. Patient demographic information includes name, patient and visit identification number, date of birth, sex and address and the registration information includes admission and discharge dates/times, status and unit.

Results Interface – The Results Interface sends patient education transaction data such as patient, date/time, educator, education topics, notes and assessments from KOD to the EMR.

KOD HL7 Interface Solutions

A hospital client must provide an HL7 compliant interface engine so our ADT and Results interfaces can share information with the EMR. The primary reason for an interface engine is manage the exchange of patient data between KOD and the EMR. In managing the exchange of information, the interface engine usually manage the mapping, routing, translation and modification of messages. In addition, the interface engine is may be instrumental in guaranteeing message delivery, managing message queues, and providing message statuses. In addition to a HL7 compliant interface engine, the hospital will need to provide the following to install and operate the KOD HL7 interfaces:

Interface Server or PC – The KOD HL7 interfaces will need to be installed on a shared or standalone server or PC. Usually, 1 PC or server is required. The application is designed to operate as an executable or service. During implementation, the executable is applied to the test environment and the service is used in production. This allows clients to use only 1 PC and server to test the application and cutover into production. If the client wants to use only the application as a service in both test and production then two PCs or two servers will be required. Clients cannot run two services with the same name on the same PC or server.

SQL Database License – A database will collect transaction data to be stored in tables on the PC or server running SQL standard edition.

TCP/IP – This networking protocol is required to transfer data between KOD interfaces and the EMR.

Figures 1 and 2 illustrate the fundamental systems and configurations required to integrate the KOD interfaces with an EMR.


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ADT Interface Implementation Tasks

This diagram illustrates the basic topology deployed to enable the ADT interface to send patient demographic information from the EMR to KOD. In addition, the diagram lists some of the configurations required to send patient information to KOD. Elements to be configured include:

HL7 Interface Engine – A client must have an interface engine to exchange messages with the ADT interface.

Port Number – Krames ADT interface needs a port to listen for ADT messages being sent from the EMR system.

IP Address – This information is needed for the SQL server so transaction data can be collected and stored.

Firewall – The firewall will need to support an SSL connection.

Figure 1: ADT Interface


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Results Interface Implementation Tasks

The Results Interface transfers patient education encounters from KOD to the EMR system. The basic configurations required include:

HL7 Interface Engine – A client must have an interface engine to exchange messages with the Results interface.

Port Number – This is the port where KOD will send its outgoing messages.

IP Address – The IP address is where KOD will send its outgoing messages.

Firewall – The firewall will need to support an SSL connection

Figure 2: Results Interface


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KOD Interface Requirements This section outlines the hardware and software required to implement the ADT and Results interfaces in a hospital network. When each of the requirements has been met, the ADT and Results interfaces can be implemented.

Hardware Requirements

Since the interface can run on a server or PC, the systems must meet the following hardware requirements:

Pentium III processor with 256 MB RAM or better -- Expect less than 1000 message per day.

Pentium 4 with 500 MB RAM or better -- Expect more that 1000 messages per day.

Disk Space (Application) – 2 MB to store interface software

Disk Space (Storage) – 10 GB to store log files The disk space required to store log files is dependent on the number of messages sent through the interfaces, number of days messages are retained, and how frequently the logs are backed up. It is recommended that clients start with 10 GB and adjust disk space to an optimal size over a 3 month period – in accordance with transaction log backup practices.

Software Requirements

The client must support the following software to implement the HL7 interfaces:

SQL Server License – SQL standard edition version 2000 or better

Microsoft .NET Framework 1.1.4322

Operating Systems – Windows 2000, Windows 98, Windows ME, Windows NT or Windows XP

HTTPS – Setup a secure connection through a firewall The main purpose of the SQL server is to temporarily store incoming and outgoing messages, and maintain detailed logs of interface activities. Messages will be purged every 20 days – except for undelivered messages. Undelivered messages will remain in the queue until delivered. Krames does not recommend the type of SQL license a client should purchase because of the different ways SQL may be used. The basic information that Krames can provide is that KOD interfaces will make up to 5 simultaneous connections to the SQL server and support multiple users.


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Implementation Notes This section provides a summary of our implementation process. The summary includes elements from our pre-installation form and tasks from our project plan. There is specific configuration information requested in the pre-installation form – it is intended to facilitate the implementation by ensuring configuration details are determined prior to initiating the project. In addition, specific project tasks are provided to outline the steps to implement the ADT and Results interfaces.

Hospital Information The following hospital information is required:

Address Phone Number Fax Number Alternate Phone Number Website URL:

Client Contact Information These are the resources that are required to implement the interface and the contact information needed:

Project Manager - Email Address: - Phone Number - Alternate Phone Number:

Interface Engineer - Email Address: - Phone Number - Alternate Phone Number:

SQL Server Administrator - Email Address: - Phone Number - Alternate Phone Number:

Network Administrator - Email Address: - Phone Number - Alternate Phone Number:

Integration Information The types of KOD interfaces requested, EMR system used, and hospital interface engine are requested in this section:

Interface(s) Requested - ADT - Results

Hospital Electronic Medical Record (EMR) System - Name/Brand - Version

Hospital Interface Engine - Name/Brand - Version


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Configuration Information Specific system configuration parameters are required:

What port number should the Krames interface listen to for ADT messages from the EMR system/interface engine? What IP address and port number should be used for sending outgoing messages from the Krames interface to the Results interface? What is the name and IP address of the SQL server the Krames interface will send information? What is the System Administrator (SA) password for the SQL server?

Client Setup Questions General questions to prepare the implementation plan:

Is your EMR system currently prepared to send ADT messages? Is your EMR system currently prepared to receive Results messages? If you are using an interface engine, is it currently prepared to send ADT messages? If you are using an interface engine, is it currently prepared to receive Results messages? Are there any limitations on the number of characters that can be received on any line in the Results message? Where in the ADT messages will the Medical Record Number be located? Where in the ADT messages will the Account/Visit ID be located? Provide a sample ADT message for us to review.

ADT and Results Interface Project Plans

ADT Interface Results InterfaceVPN Access

Apply for VPN Access Receive VPN Access Determine Connectivity Process (VPN) Test VPN Access

Timeline Develop Timeline Conference Call to discuss Timeline

Configuration and Optimization Testing Confirm Correct Host Computer Config

Install Krames Interface Engine - Configure Customer Account Info - Send Frequency - Web Service Information Configure Outbound ADT feed from EMR Configure Customer Interface Engine

Verify Connectivity - KOD Interface PC Address - Interface Engine Address - Connection Port Number Test External Network Connectivity Open Port for SSL Connection HL7 Mapping Receive Test Messages from Customer

Testing Customer Integration Contact Krames Integration Contact

Interface Adjustments

Configuration and Optimization Testing Test VPN Access Confirm Correct Host Computer Config

Configure Krames Interface Engine - Configure Customer Account Info - Polling Frequency - Web Service Information

Configure Customer Interface Engine - Transaction Tables - Mapping Tables - Identify Business Rules - Results HL7 Data Specifications

Verify Connectivity - KOD Interface PC Address - Interface Engine Address - Connection Port Number Test External Network Connectivity HL7 Mapping Send Test Messages to Customer

Testing Customer Integration Contact Krames Integration Contact

Interface Adjustments


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HL7 Message Specification This section describes the HL7 Event Codes, Messages and Segments that will be supported in the ADT Universal Interface to Krames On-Demand (KOD). This unit also describes how the KOD interface will process each event.

Trigger Events The following tables represent all the HL7 trigger events that are either accepted or sent by the KOD

interface engine:

Patient (ADT) Trigger Events Table


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KOD Actions The following is a summary of the KOD Actions listed above for the ADT trigger events: Add Pt./Update – This function will add the patient and the encounter if they do not exist and

will mark them as active. If a matching patient or encounter is found, they will be updated and marked as active. Update/No Status Change – This function will update the patient and the encounter if they exist - but the status will not be change. Mark Pt. Inactive – This function will update the patient and encounter if they exist and mark them as inactive. Not supported – The preference is that these transactions will not be received, however, if they are received, no action will be taken.


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Education Results Trigger Event Table

Other Trigger Events


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HL7 Segment Layouts Control Segments

MSH Segment The MSH segment defines the intent, source, destination, and some specifics of the syntax of

a message.


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MSA Segment

The MSA segment contains information sent while acknowledging another message.

NTE Segment The NTE segment is defined here for convenience only. It is commonly used for sending notes

and comments, but is not used by the Krames On-Demand interface.

ADT Segments

EVN Segment The EVN segments communicate the “event trigger” information to the receiving application.

The supported ADT events were described previously thereby making this segment optional.


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PID Segment The PID segment is used by all applications as the primary means of communicating patient

identification information. This segment contains permanent patient identifying and demographic information that, for the most part, is not likely to change frequently. In addition, this segment supports subcomponents.


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PV1 Segment

The PV1 segments provide visit or encounter specific information. In addition, this segment supports subcomponents.


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Other ADT Segments All other ADT segments as defined in the HL7 2.5 standard and prior may be sent, but the

data content will not be populated in the Krames On-Demand system.

Observation/Unsolicited Results Segment

OBR Segment In the reporting of clinical data, the OBR serves as the report header. It identifies the

observation set represented by the following atomic observations. It includes the relevant ordering information when that applies. It contains many of the attributes that usually apply to all of the included observations.


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OBX Segment

HL7 Message Specifications

Patient Data (ADT) The ADT message must include MSH, EVN, PID and PV1 segments and they are required by the KOD application. All others will be ignored. PV1 is only required because it is required by the HL7 standard but will not be evaluated by the KOD application.

Medical Record # Social Security # (not required) Last Name First Name Middle Name ( not required) Date of Birth Sex (M/F)

ADT message (only the segments in gray are required, see the table below for the required fields).


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The length of the observation field is variable, depending upon value type. See OBX-2 value type.


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Education Results (ORU) The ORU message must include MSH, PID, and OBR segments. All others will be ignored.

Date and time of education Identification of the patient receiving the education Identification of educator that delivered the education A reference ID to the actual education offered and recorded by the KOD application ORU message (only segments in gray are required, see the table below for the required fields).


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Appendix A

Results Message

Sample Formatted Results Message

Sample HL7 Results Message


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Appendix B HL7 Integration: Sample Client Information Form The form below is the information that will be requested from clients prior to integration.

Hospital Information

Hospital/Medical Center Name: Address:

Phone:

Fax:

Alternate:

Website:

KRAMES Contact Information:

Project Manager: Becky McGuigan Email: [email protected]

Phone Number: (267) 685-2534

Alternate: 1 (800) 203-7902

Sales Representative: Email @krames.com

Client Services Rep: Email: @krames.com

Client Contact Information:

Project Manager:

Email:

Phone Number:

Alternate:

Interface Engineer:

Email:

Phone Number:

Alternate:


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SQL Server Admin:

Email:

Phone Number:

Alternate:

Network Admin:

Email:

Phone Number:

Alternate:

Integration Information:

Interfaces Requested: ADT Results

Hospital EMR (Electronic Medical Record) System: Name: Version: Other:

Hospital Interface Engine (if applicable): Name: Version: Other:

N/A (Not Applicable):

Configuration Information:

Directed Toward the Network Admin: What is the name and/or IP address of the system on which the KIE will be installed?

System Name: IP Address: What is the Username and password for the KIE system?

Username: Password:

Directed Toward the Network Admin: Provide method and login information for Network access. Attach .pcf file if applicable, provide VPN URL, etc.

Username: Password:


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Directed Toward the Interface Engineer: What port number should the KRAMES Interface Engine (KIE) listen to for ADT messages from the local EMR System/Interface Engine?

Port Number:

What IP address and port number should be used for sending outgoing messages FROM the KIE to the local Results feed interface?

IP Address: Port Number:

Directed Toward the SQL Admin: What is the name and/or IP address of the SQL Server the KIE will be talking to? (SQL server and KIE can be located on the same machine)

Sever Name: IP Address: Located on the KIE

What is the SA password for the SQL server? (this can be provided anytime prior to the install and can be changed immediately following the install)

SA Password:


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Client Setup Questions:

General HL7 Questions: Is your EMR system currently prepared to send ADT messages?

Yes

No

If Not Please Explain:

Is your EMR system currently prepared to receive Results messages?

Yes

No


If you are using an Interface Engine, is it currently prepared to send ADT messages?

Yes

No

N/A


If you are using an Interface Engine, is it currently prepared to receive Results messages?

Yes

No

N/A


Are there any limitations on the number of characters that can be received on any line in a Results message?

Yes

No

If Yes Please Enter Limitation Number:

Where in ADT messages will the Medical Record # be located?

Where in ADT messages will the Account/Visit ID be located?

Please insert a sample ADT messages (from your test region or live messages that have been "depersonalized") for us to review and QA in our internal test region? This insures that issues are identified and prevented as early as possible in the process.


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Please Insert Any Comments, Questions or Concerns in the Box Below.

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