The purpose of this document is to outline how CAREWare imports immunization records through the HL7 feed interface.   Currently the design is for a results-only interface.  This document focuses on items that are required for immunization import through HL7.  These key items include the addition of new indexes to the CAREWare interface, CAREWare immunization fields, the HL7-designated segment that holds the immunization record, and the parsing of the segment for processing.  

There are new indexes on the interface that activate the immunization imports.  These indexes will be labeled “IMM_Map_Provider”, “IMM_Map_Client”, and “IMM_Process_Records.  The “IMM_Map_Provider” index allows CAREWare to choose in which provider to look for the patient record where the data should go. The “IMM_Map_Client” index allows CAREWare to choose which CAREWare patient to link the data to.  The “IMM_Process_Records” index processes all mappings to translate the incoming record to the patient record in CAREWare.

CAREWare has seven fields that make up an immunization record. Five of these fields are mandatory and two are optional.

Table 1.0 - CAREWare Immunization Fields  

How CAREWare processes an HL7 message 

Once the HL7 indexes are set to active, CAREWare attempts to parse the incoming HL7 message into document stubs for processing.  It is important to activate all three indexes for a particular import in order to get the data imported.  CAREWare determines whether the message is a valid import record by looking at the MSH 9 for the message type and MSH 9.1 for the trigger event.  If the message type and trigger event match a message type and trigger event pair from a pre-defined list of possible importable messages, CAREWare parses the incoming file.  The MSH specifications can be found in table 1.1.   During parsing, CAREWare sets the primary provider and client values based on the settings the user has set.

CAREWare will also split the messages into multiple document stubs if more than one PID segment exists in the message.  The PID specifications can be found in table 1.2.  CAREWare splits multiple RXA segments into individual document stubs as well. See Table 1.3 for RXA segment specifications. This is done so that it a single record for an individual client is processed independently.  Once the document stubs are created, they will have a starting status of “Map Provider.”

Map Provider Index

This index is used to match the provider ID (MSH 5) to a domain in CAREWare.  CAREWare creates a mapping record if none exists and deletes the messages if the mappings are incomplete or the activation code is not entered.  If a mapping is complete and an activation code is entered for the domain, CAREWare proceeds to update the status to Map Client.  The Lab Test Mapping Tool’s Map Provider form lists out all provider mappings.  The Lab Test Mapping Tool can only be accessed in the Central Administration domain.  It is located in the Administrative Options Menu in the upper right hand corner.  The Map Provider records indicate whether they are active or inactive.  Active means that an activation code has already been registered by CAREWare.  There are no field mappings for this index.  The activation code will be generated by jProg and will be sent out when the site sends a request for one.  The site must know the value in MSH 5 in order for jProg to create the activation code. 

Map Client Index

This index processes client matching using the matching criteria set in the provider mappings.  If the patient record matches the HL7 value and meets the threshold, then it will be updated to Process Records.  If it doesn’t match or does not meet the threshold, the HL7 document stub will be deleted.  

Process Records Index 

Once CAREWare extracts the data necessary for an import, it then attempts to import this data as the patient record.  For immunizations, the designated segment that holds the immunization record is the RXA segment.  See Table 1.3 for specifications.

Before the incoming record can be imported as a patient record, CAREWare has to do a lookup.  The purpose of the lookup is to determine if there’s an existing immunization record already present in CAREWare for a particular patient.  This lookup is based on the immunization date, immunization definition, the patient, and the domain in which the patient resides.  If there is a record that matches the date and definition already in CAREWare, it updates the record with the incoming data regardless of the message type, trigger event, or action code.  If it does not find a record, it treats it as a new record unless the action code is a delete action.  If a delete action is set and there’s an immunization record found during lookup, the CAREWare record will be deleted.

Table 1.1 - MSH Specifications for HL7 socket interface 

Table 1.2 - PID Specifications for HL7 Socket Interface 

Table 1.3 RXA - CAREWare Field