Third party integration with outside clinics

[Jeff Dawson]

I was curious if there are any other hospital system interface teams that do integration with Clinics who use their own third party EMR. Scenario could be this clinic is not affiliated with the hospital system yet sends specific lab or rad work to the hospital to perform.

We have integrated with various EMR’s to name a few Allscripts, Arpima, NextGen, Eclinical works that request to receive lab, path, rad, trans reports electronically to their own EMR. A lot of these clinics request specific filtering requirements i.e. they only want Outpatient reports if their provider is listed as the ordering, CC, referring, PCP etc. If one of their clinic providers isn’t listed on the HL7 message then it shouldn’t be sent.

What I was wondering is how other interface teams are handling this type of request. For some of our smaller clinics that have only say 10 to 30 providers we use a static Cloverleaf look table that has those providers defined. The larger clinics that have 100’s of providers in our HIS’s (Meditech) provider dictionary we have a specific clinic practice tag assigned when the provider is credentialed that associates the provider to that clinic. This Meditech provider dictionary data is stored in a table that runs on SQL server so we are able to write store procedures to download the provider dictionary a few times a day and create a sqlite provider table in Cloverleaf that can be queried.

Another issue we’ve come across is some ancillary systems don’t send all the providers on the HL7 message that a clinic may want to receive for example our Softmed Transcription interface doesn’t send a PV1 segment so we utilize stored procedures to pull all the pateint visit providers (attending, referring, consulting, admitting, family) for that patient’s visit in Meditech using the Meditech account number to enrich the Softmed report with those missing providers that a clinic may want if they are listed.

We are in the process of transitioning HIS’s from Meditech to Epic which is making our team rethink how provider filtering is done as whole and as well as by other interface teams. Some of the clinics will be transitioning to Epic however quite a few will not. If anyone has any insight or would like to share how they go about third party integration please do!

Thanks,

Topic

[Jeff Dinsmore]

We recently switched from McKesson’s Paragon to Epic.

We’ve been integrating with outside EMRs for some time and select recipients of a given result/report by provider group association – the same way you’re doing it for larger practices.

With Paragon, we’d query the DB directly to determine provider/group association.  With Epic, we’ve changed to a daily report, delivered to Cloverleaf that’s used to build a local SQLite provider DB that is queried by interface code.

We have several standard filters to suppress sending of certain classes of results/reports – such as preliminary transcription, preliminary lab results, rad, etc.

The default is, generally, to send all.  We’ll then config suppression of each class as required by a given practice.

For assembling a complete list of providers and their roles for a given encounter, it was much easier with Paragon – we’d just query the DB directly.  

With Epic, we haven’t determined a similarly elegant way to get a complete list.  

I initially understood the providers delivered in ADT messages to be a complete list at the point in time the message was generated, but I’ve recently found that to be untrue.  A provider can order a test, but is not automatically added by Epic to the “care team” associated to the encounter.  So, the ADT provider list is incomplete.  

Therefore, my current plan is to build a thread receives all ADT and orders from Epic and uses them to build a SQLite DB of providers associated to each encounter.  This DB can then be referenced by the outbound interfaces that deliver results to our external partners.

Jeff Dinsmore
Chesapeake Regional Healthcare

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