Which source documentation do you use to qualify your eICR fields are present during PHA Data Validation?

Hi James - in CA we have two approaches for element review, one for a new EHR vendor (full review) and one for known EHR vendors (streamlined). We use these approaches to identify what the unique challenges/issues will be with each new vendor, but with both approaches we rely on the  AIMS Validator to perform schema/schematron validation to review a good amount of the general fields found in the IG. The CDC Onboarding Team validates message structure and ensures HCOs are sending well-formed documents.

 

After the AIMS Validator, using our streamlined approach with Epic and Cerner Millennium senders we particularly review approx 30 additional elements that are critical to meeting state reporting requirements. We send all onboarding HCOs a "welcome email" which call out meds/pregnancy/social history section, which are generally sections not already mapped at their eCR interface level, as elements CDPH will review and require to see mapped via test eICR prior to pushing them into our PHA Production environment. (I can email you that welcome email if you're interested - ping me).

 

For the full review of a new EHR vendor, we check approx 95 elements including many that the AIMS Validator checks. 

 

Basically, we check to make sure that the elements important for public health reporting are mapped by the HCO/EHR, and not just the required elements to meet RCKMS processing requirements.

Hello James, 

This is Hardik from Tennessee Dept of Health and I have different question here. 

I saw your state has onboarded TheraDoc based facility.  We are onboarding them for very first time. Could you let me know the elements you were validating as part of onboarding for TheraDoc? are you using NBS for managing your eCRs?  Did you faced any issue receiving 'History of Present Illness' from them? 



Thank you!

In TN we've selected which fields in the Implementation Guide were absolutely necessary to us and focused on those. We have enough trouble getting those fields populated to worry about all the fields. 

We don't have any Cerner facilities onboarded yet. Like Hardik mentioned, we are receiving FHIR messages from TheraDocs and we haven't been able to push those to our production environment yet because of message structure and missing content issues. 

For our Epic facilities the challenging fields are: 
                               Pregnancy status - they only send that data field when it's populated. We'll get HcG lab levels, but even though the patient might be coming in for a pregnancy related problem, unless that very specific question in the chart is completed, we won't get pregnancy status. 
                               Travel History - again, it only comes if the HCP documents travel history in that specific field.
                                H&P notes: this is the narrative portion of the visit. Either we get too much (like Nursing Plans, Lactation consults, Pharmacy notes), or we only get the social workers notes. So, we have to be very specific with what note types we need. 
                                 

We don't focus on fields like the emergency contacts email address, preferred language, or the providers fax number. 1. because sometimes there's no way to consume that data in our surveillance system or 2. there is little public health benefit

                                

CA uses CliniSys (not NBS), but we do not currently parse 'History of Present Illness' due to the narrative style which can create note bloat. Challenges we've seen with TheraDoc so far is that they have not mapped pregnancy or any other Social Hx items: travel, EDD, occupation, but noted they'll work on this in concert with the eCR NOW FHIR app. We also noticed they were sending resolved problems, which we don't want. In their initial test messages they were missing Diagnosis SNOMEDS.