No mechanism in eScription for account/encounter moves?

[Jim Beall]

Has anyone done an ADT interface with Nuance eScription?  The vendor is telling us they have no way of doing account/encounter moves (moving an encounter from one valid patient to another valid patient).  Our HIS (STAR) generates either an A36 or a Z44/A44 when this happens but the people we’re working with from Nuance say they don’t accept either transaction.  Is this true and, if it is, how are you working around it?  Thanks!

Topic

[Jeff Dinsmore]

That’s interesting to hear. We’re just starting an integration with eScription and certainly need the ability to move an account/encounter to a different person.

Here’s an excerpt from their ADT spec.

Trigger Events

Here are the types of HL7 ADT messages that eScription typically receives.

A01 Admit/visit notification

A02 Transfer a patient

A03 Discharge/end visit

A04 Register a patient

A05 Pre-admit a patient

A06 Change an outpatient to an inpatient

A07 Change an inpatient to an outpatient

A08 Update patient information

A11 Cancel Admit

A12 Cancel Transfer

A13 Cancel Discharge

A14 Pending admit for a patient

A17 Swap patient beds

A18 Merge patient information

A24 Link patient info

A28 Add person information

A31 Update person information

A34 Merge patient information

Jeff Dinsmore
Chesapeake Regional Healthcare

[Jim Beall]

Yep; that’s what I have too.  Do you know who your technical/integration resource will be?

[Carol Gross]

Has anyone investigated whether it would be acceptable to use the A36 or Z44 message to create an A11 Cancel Admit for the erroneous patient record, followed by either an A01 or an A08 to create the account number on the correct patient record?

Carol Gross

Sr. Data Analyst

Oklahoma State University Medical Center

[Jim Beall]

eScription doesn’t physically remove encounters when it receives an A11.  It treats them more like A08s, which I think is a bit odd.  If it wasn’t for that your suggestion would probably work.

[Chris Williams]

We’ve been using eScription for several years. We currently integrate it with Epic. The list of message types that they “receive” is not necessarily a list of messages that they act upon. Basically for ADTs we’re limited to sending them only A08 and A11 messages.

When designing the integration you need to be aware that eScription will ACK all messsages with AA. They do not send AR or AE. Messages that they encounter that would normally be errored back to the engine are ACKed back with AA and then dropped into the bit bucket.

[Jim Beall]

We got more information back from Nuance on this.  eScription now says that A08s will update MRN number.  Apparently encounter/account number is the only key to patient data in their system; they must not have anything like an MPI.  So you’d need to either create an A08 from whatever message your HIS sends out (which won’t work for us because the A36 STAR generates has no PV1) or trigger A08s from your HIS after the accounts have transfered.

[Jeff Dinsmore]

From the spec, it looks like PV1 is optional and, according to the excerpt below, they’ll be looking for encounter in PID:18.

Note: One of either PID:18 or PV1:19 is used to store the account number representing the patient visit.  eScription prefers that PID.18 be used.

Quote:

Jeff Dinsmore
Chesapeake Regional Healthcare

[Author]

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