AIRA Update on

Interoperability

STC UGM 2016

Scottsdale Arizona

June 15, 2016

Agenda

• Key Principles

• Interoperability Exercise

• Local Requirements

• Interoperability Testing Update

Key Principles of

Interoperability

Key Concepts

• Interoperability

Definition from HIMSS:

Interoperability describes the extent to which systems and devices

can exchange data, and interpret that shared data. For two

systems to be interoperable, they must be able to exchange data

and subsequently present that data such that it can be understood

by a user.

• Conformance

Definition of Conformance Testing from NIST:

Conformance testing is testing to see if an implementation meets

the requirements of a standard or specification.

Key Principles

1. Standards should not be locally interpreted

Key Principles

• Examples of local interpretations that change the

standard meaning:

– Using Administered-at Location (RXA-11.4) to indicate the facility

where the vaccination was recorded for historical immunizations

– Using Lot Number (RXA-15) to:

• Indicate flag vaccine funding source

• Store additional information, comments or details

– Not allowing Financial Eligibility Code “V01: Not VFC eligible” to

be reported for adults

Key Principles

2. Conformance to standards should be testable

IG 2.3.1 HL7 2.5 IG Release 1.5

Does your system meet these standards?

Key Principles

• Written standards and conformance testing

processes must be developed in tandem

– No normative standard should be approved without a

corresponding process to determine whether an

interface meets the standard

• AIRA is working with NIST to make this a reality– Implementation Guide Authoring Management Tool (IGAMT)

– NIST testing framework

– EHR Certification Testing

– IIS Assessment

Key Principles

3. Interoperability should be a science not an art

Photo by Cedward Brice, see https://commons.wikimedia.org/wiki/File:Mill_Ave._Bridge,_Tempe.jpg

Future

Key Principles

• Interoperability as a science is still maturing

• Various initiatives are decreasing variability:

Present

• HL7 2.3.1

• IG 2.3.1

• HL7 2.9

• IG balloted by HL7

• NIST EHR Certification

• IIS Assessment

• Implementation Guide Authoring

• Functional Standards

• HL7 2.5.1

• IG r1.5

• NIST EHR 2015

Certification

Past

Key Principles

4. Focus on interoperability not conformance

Key Principles

• These organizations are working to establish standards:

– HL7: Create standards

– CDC: Foster data exchange

– NIST: Verify systems meets the standards

• Only IIS can:

– Collect complete and accurate immunization histories

– Manage inventory and track funded vaccines

– Ensure that data quality problems are prevented or detected

early and fixed

Insuring Interoperability

• NIST certifies EHR system conformance:

– Confirms software is able to perform in a standards way

– How EHR and IIS actually operate in production is out-of-scope

• IIS must focus on interoperability

• Conformance is a tool IIS can use to help

• But a conformant interfaces can still fail to work

• And working interfaces can be non-conformant

Interoperability

Exercise

Usage: R

• Examples

– Patient Name (PID-5)

– Date/Time Start of Administration (RXA-3)

Usage: RE

• Examples:

– Patient Address (PID-11)

– Completion Status (RXA-20)

Usage: O

• Examples

– Primary Language (PID-15)

– Administered Strength (RXA-12)

Usage: X

• Example

– SSN Number Patient (PID-19)

Usage: C(a/b)

• Example:

– Birth Order (PID-25) is C(RE/O)

• RE if Multiple Birth Indicator (PID-24) is Yes.

Exercise

• Review message on Side A

– Identify as many conformance issues as you can:

• Focus on MSH, PID, and RXA segments

• OBX segments were removed for brevity, ignore this issue

• Review message on Side B

– This message meets current NIST standards for MU 2014

• Do not review it for technical issues

– Examine the message for data quality issues

• Contrast Side A and Side B

– Can conformance checking ensure high quality data?

– Can non-conformant messages transmit high quality data?

Find Problems – A

MSH|^~\&|Test EHR Application|X68||NIST Test Iz Reg|20141201082201|

|VXU^V04^VXU_V04|NIST-IZ-001.00|P|2.5.1

PID|||D26376273^^^NIST MPI^MR|D26376273|Snow^Madelynn^Ainsley|Lam^Morgan

|20070706|F||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC

|32 Prescott Street Ave^^Warwick^MA^02452^USA^L|

|^PRN^PH^^^657^4058563|||||||||2186-5^non Hispanic or Latino^CDCREC

PD1|||||||||||02^Reminder/Recall - any method^HL70215|||||A|20120701

|20120701

NK1|1|Lam^Morgan^^^^^L|MTH^Mother^HL70063

|32 Prescott Street Ave^^Warwick^MA^02452^USA^L|^PRN^PH^^^657^4058563

ORC|RE||IZ-783274^NDA|||||||I-23432^Burden^Donna^A^^^^^NIST-AA-1|

|57422^RADON^NICHOLAS^^^^^^NIST-AA-1^L

RXA|1|0|20120814|

|140^Influenza, seasonal, injectable, preservative free|0.5

|ML^MilliLiter [SI Volume Units]^UCUM|

|00^New immunization record^NIP001|7832-1^Lemon^Mike^A^^^^^NIST-AA-1

|^^^X68||||Z0860BB|20121104|CSL^CSL Behring^MVX|||CP|A

Find Problems – B

MSH|^~\&|Test EHR Application|X68||NIST Test Iz Reg|20141201082201|

|VXU^V04^VXU_V04|NIST-IZ-001.00|P|2.5.1|||AL|ER

PID|1||D26376273^^^NIST MPI^MR||Snow^Horatio^Middle^^^^L|Snow^Horatio

|20031107|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC

|455 N Galvin Pkwy^^Phoenix^AZ^85008^USA^L|

|^PRN^PH^^^657^5558563|||||||||2186-5^non Hispanic or Latino^CDCREC

PD1|||||||||||02^Reminder/Recall - any method^HL70215|||||A|20120701

|20120701

NK1|1|Snow^Horatio^Middle^^^^L|MTH^Mother^HL70063

|500 E Veterans Way^^Tempe^AZ^85287^USA^L|^PRN^PH^^^657^5558563

ORC|RE||IZ-783274^NDA|||||||I-23432^Burden^Donna^A^^^^^NIST-AA-1|

|57422^RADON^NICHOLAS^^^^^^NIST-AA-1^L

RXA|0|1|20120814|

|01^DTP^CVX|5.0

|mL^MilliLiter [SI Volume Units]^UCUM|

|00^New immunization record^NIP001|7832-1^Lemon^Mike^A^^^^^NIST-AA-1

|^^^X68||||LOTNUMUNKNOWN|20121104

|BAY^Emergent BioDefense Operations Lansing^MVX|||CP|A

Pop Quiz

1. Can the IIS accept into production a message that does

not conform to CDC or HL7 standards?

2. If a required (R) field is empty, may an IIS still process

and store the data in the rest of the message?

3. If a not supported (X) field is valued,

must the IIS reject the message

entirely?

4. Can an IIS pick and choose

what data gets accepted

and what does not?

Adapting to Local

RequirementsGuidance and Practical Advice on Aligning to the CDC

Immunization Guide

Constraint Model

• A profile constrains a standard for a particular use

HL7 2.5 IG r1.5 STC Guide IIS Guide

Pine View

Pediatrics

to State IIS

Constraining Usage

National Profile IIS Profile

R : Required R : Required

RE : Required but may be empty R : Required

RE : Required but may be empty

O : Optional R : Required

RE : Required but may be empty

O : Optional

X : Not supported

X : Not supported X : Not supported

Proper Use of Required

• Use required to ensure proper structure

• Do not move fields to required to improve data quality

• Changing an RE to R can have un-intended

consequences

• Examples of un-intended consequences when health

industry marked certain fields as required:

– Patient Name (PID-5): Not all patients have names

– Administered Amount (RXA-6): May not be known

• It is better to improve data quality by creating auxiliary

processes for assessing data quality

Local Guides

• Keep local implementation guide short

– Less than 25 pages is ideal

– Consider making a 1-2 page “delta guide” to show difference

between CDC IG and Local IIS IG

• Document how errors and warnings are messaged and

handled by the IIS

• Follow HL7 constraining rules

– R and X usage can not be changed

– RE can go to R

– O can be changed to R, RE or X

• Prepare for transition to the new NIST Immunization

Authoring Guide Management Tool

Interoperability

Testing ProjectUpdate of Progress Made

Big Picture

• Discovery Phase

– IIS Interoperability Status Check Project

• Connect to IIS test systems

• Submit a thousand VXU and QBP messages every month

– Aggregate Analysis Reporting Tool (AART)

• Collects information from all tests performed

• Create AART Report for IIS to see the results of testing

• Assessment Phase

– Measurement for Assessment and Certification Advisory Work

Group (MACAW) was convened this spring

– MACAW will lead community to set assessment measures

– Certification will build on assessment work, but certification is still

on the far horizon and details are yet to be determined

Participation

• 52 IIS Programs and 2

Vendors

• Of these

– 43 Connected

– 11 Manual Reporters

• 6 are submitting

manual tests

• 4 IIS Have Yet To

Participate

– Some of these are

migrating to new

systems

Last Updated: May 31, 2016

What Are We Today?

NIST

• AIRA Discovery testing depends on NIST resources

• Conformance of Message Format testing

– ACK format: According to

IG r1.5 and AIRA 2015

ACK Guidance

– RSP format: According to

IG r1.5

• CDC WSDL Transport

Testing

http://hl7v2-iz-testing.nist.gov/mu-immunization/

What Are We Testing?

Update (VXU/ACK)

• Accept r1.4 and r1.5

VXU updates

• ACK Conformance

• Coded Values

• Tolerance

• EHR Examples

• Performance

Query (QBP/RSP)

• Accept r1.5 QBP (Z34 &

Z44) queries

• RSP Conformance

• Forecasting Support

• Deduplication Support

• CDC WSDL Support

What do IIS Need to Do?

• Review your AART Report

– Register for access here: http://ois-pt.org/dqacm/home

– Provide feedback on improvements needed

• Join HL7 Immunization User Group

– Meetings are every 2nd Thursday at 2pm Eastern Time

– Testing updates and guidance are discussed on this monthly call

Questions?