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RW CAREWare 4.1

Lab Import Mapping Process

Version 1.3

August 2010

Copyright © 2002-2010 Jeff Murray's Programming Shop, Inc. (jProg). All rights reserved.

The CAREWare lab import is a series of sequential steps. Each step is labeled as a status that tells the user where the lab import record stands and each needs be completed before the next step can begin. All steps need to complete before the lab can be imported into CAREWare. It is a good idea to do a manual backup before doing any mappings.

CAREWare’s internal timer will process HL7 records every five minutes, but the Process Queued Records button tells CAREWare to process the records instantly. Unless the user wants to wait five minutes for CAREWare to process records automatically, he or she should press the Process Queued Records button between the steps to ensure that the records are processed. This button only affects records that have been parsed already. The following are the basic steps for lab import.

1. Code Activation 2. Map Provider 3. Map Client 4. Client Not Found (For clients not found or does not meet threshold) 5. Map Test 6. Map Result (For qualitative results) 7. Complete

Code Activation

After Hypersend and/or the CAREWareQuestHubService are installed correctly, the application will download an HL7-formatted file to the incoming HL7 files folder. Its default location is “C:\Program Files\CAREWare\RW CAREWare Business Tier\incomingHL7Files”. CAREWare has an internal timing mechanism that will check every five minutes to see if there are any files in that folder.

When CAREWare finds file(s) in that folder, it tries to parse the file(s). The first thing it checks is whether or not the provider is activated for the MSH6 field in that particular file. If the provider has not been activated, it moves the file to the parsing errors folder and an alarm will be logged. The default location for that folder is “C:\Program Files\CAREWare\RW CAREWare Business Tier\parsingErrorHL7Files”. Files remain there until a user manually moves it. The segment should look like this.

MSH|^~\&|TST|...|JPROG|TESTABCD|

The field holding “TST” is the MSH3 field that holds the Lab ID. The field holding “TESTABCD” is the MSH6 field that holds the provider ID. jProg will need these fields to generate an activation code for the provider. Once jProg creates an activation code, the user needs to activate the activation code. To activate the activation code, the user needs to log into Central Administration and press Ctrl+R. Once the activation code has been entered, the user must move the file(s) from the parsing errors folder into the incoming folder to be processed. If an HL7 file is activated and contains no parsing errors, it is moved to the processed file folder, whose default location is “C:\Program Files\CAREWare\RW CAREWare Business Tier\processedHL7Files”. Every file that contains that same provider ID and Lab ID will automatically be parsed and will not have to be manually moved after the activation code has been activated.

Map Provider

When the HL7 files have been parsed and placed in the processed HL7 files folder, the user is ready to start mapping. The first mapping step is to map the provider. In this step, the user sets the provider, the client matching field, the data source, and the threshold. To map the provider, the user needs to be logged into the Central Administration domain. He or she will need to click on Administrative Options, then Lab Mapping Tool, and finally Map Provider.

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To map the provider, the user must select the provider from the list. Once selected, the controls will be enabled so that the user can set the provider, client, data source, and demographic threshold.

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The fields in the provider mapping screen are as follows:

MSH3 (Application ID) Tells user where the HL7 file came from. This is set by the data source and is found in the HL7 file. This value cannot be edited.

MSH6 (Provider ID) Tells user which provider the HL7 belongs to. This is set by the data source and is found in the HL7 file. This value cannot be edited.

RW CAREWare Provider This holds the list of available providers that the HL7 file should be mapped to.

Table Name This holds the table in which the matching client id is located in CAREWare. There are currently three tables in which the client id can be found. These three tables specify whether the matching client ID is the URN, Client ID, or a custom client field. If the matching client id is the client’s URN, then the user needs to select “cw_client”. If the matching client id is the Client ID, then “cw_map_client_provider” needs to be selected. If the matching client id is a custom client field created in a CAREWare custom tab, then “cw_custom_client” needs to be selected. The matching client id is agreed upon by Lab Corp/Quest and the site itself. This needs to be agreed upon before going live.

Field Name This holds the field name within the selected table name above. If “cw_client” is chosen, the user needs to type in “cln_urn”. If “cw_map_client_provider” is chosen, the user needs to type in “map_cl_client_id”. If “cw_custom_client” is chosen, then the user needs to type in the custom field name. Important note: the custom field needs to be searchable.

RW CAREWare Data Source This holds the data source the HL7 file originated from.

Client Demographic Threshold This sets the value that the client demographic information needs to match in order to be map the client. (See Client Demographic Threshold Score and Deductions)

Once all of these fields are set, the user needs to click Save to map the provider. Once mapped, the status of “Map Client” is set.

Map Client

If there is a client record within CAREWare that matches the matching client ID and meets the threshold, the status will change from Map Client to Map Test. For clients that are not found or did not meet the client demographic threshold, the status of Client Not Found is set.

Client Not Found

This step requires the user to manually map the client since the client was either not found or did not meet threshold based on the matching client id and the threshold that was set in the Map Provider step. Manual client mapping can only be done in a real time provider. To do this, the user must first be logged into the provider that the lab import is mapped to. The user may then click on Administrative Options, HL7 tools, and finally Client Mapping.

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Once this the Client Mapping button is clicked, there will be a form with all the unmapped clients. The user needs to choose a client from the list and select the Map Selected Client (F2) link.

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The user can also delete the unmapped client here if they do not wish to map that particular client. This will remove all records containing this client within the internal CAREWare HL7 table. The user can also fix the incoming data by selecting Fix Incoming Data (F7). In order for CAREWare to add a new client record, the client has to have a first name, last name, gender, and date of birth. This is the place to fix this.

For simplicity, this document will only concentrate on mapping clients with valid client demographic information. Once the Map Selected Client linked is clicked, a screen will pop up that allows the user to either map the selected client to a CAREWare client or add the client as a new client. The list on the bottom right contains clients that CAREWare believes might be a matching client. The user can select a matching client from the list and select Map Selected Client (F2) or Add New Client (F1) accordingly. The score column tells how closely the client matches.

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Once this is done, the status will change from Client Not Found to Map Test.

Map Test

This step involves mapping the HL7 results to a CAREWare Test definition. Specifically, it maps the result ID to a test definition created in CAREWare. To do this, the user needs to be in Central Administration again. To map the tests, the user must go back to the Lab Test Mapping Tool and click the Map Test Definitions and Qualitative Results button.

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The Test Definition Mapping screen allows the user to map the HL7 test ID to a CAREWare Test Definition. When the user selects a result from the list on the bottom, the RW CAREWare Test Definition (TypeName) will be enabled. The user needs to decide which CAREWare test definition matches the HL7 test. If there are no CAREWare test definitions that match the HL7 test, the user can create a new test definition by selecting the Clinical Encounter Setup button (see the "Customizing Clinical Data" quick start guide on the HRSA CAREWare website).

If there’s a matching CAREWare test definition, the user can select a matching CAREWare test definition from that list and click Save to save the mapping. If the test is a quantitative result, the status changes from “Map Test” to “Complete”. If the result is a qualitative result, the status will be changed from “Map Test” to “Map Result”. Note that, once saved, the column RW CAREWare Test Definition ID will be filled with the test definition the user has selected. This is important because it shows which test definitions have been mapped and which ones have not.

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Map Result

Once a qualitative test definition is mapped to an HL7 test, the user can select the mapped qualitative lab definition to enable the Map Qualitative Results button. That button brings up the Map Qualitative Results screen, where the user can map the HL7 qualitative result to a result defined in CAREWare. The list is populated with results associated with the test definition the user selected in the Map Test step. Once the result is mapped, the status will change from “Map Result” to “Complete”. (Congratulations, you have successfully completed the lab import process!) The user can verify that the lab was imported by checking the CAREWare client’s clinical encounters.

Administrative Alarms

Throughout the lab import process, CAREWare generates alarms when error occurs. These alarms advise the user about what is needed to complete a particular step. To access the alarms, the user should click on Acknowledge Administrative Alarms button on the Lap Test Mapping Tool screen.

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This document will concentrate on the most common of those alarms. The first alarm that a user will most likely come across is a provider not registered alarm. This alarm looks like this:

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To solve this problem, the user needs to do the Code Activation step in the mapping process.

Another alarm that a user may come across is the Client Not Found alarm. This alarm tells the user that he or she needs to map one or more clients. The alarm looks like this:

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An alarm will generate if a user tries to map a qualitative result to a quantitative result. In this case, the status of the import will be Invalid Quantitative Result. To resolve this problem, the user should correct the test definition mapping as described in the Map Test step. The user must find the test that was mapped incorrectly and map it to a correct one. The alarm will look like this:

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Client Demographic Threshold Score and Deductions

The client demographic threshold is a secondary check against data entry errors. CAREWare first tries to match the client by its comparing the ID in the incoming record to the IDs specified in the Map Provider step. If there is a match, CAREWare tries to match the client record using demographic information. The threshold determines how strict the match needs to be for matching demographic fields. The demographic fields used for matching are first name, last name, date of birth, and gender. Each client starts with a score of 100. For each misspelled letter or date, CAREWare reduces the score. The value of each reduction is based on values set by the user. To set the values, the user should go to Administrative Options and Client Matching Setup.

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Here users can choose how much to deduct for each demographic field. If a client record matches completely, then its score will remain 100. If the client record has a misspelled last name, however, the score may be deducted to 80. As long as this score exceeds the threshold, the client will be mapped to that particular client. If not, the client will fall into the queue of unmapped clients and its status will be Client Not Found. In this case, the user has to manually map the client as described in the Client Not Found step. The default value set by CAREWare for the threshold for lab imports is 75.

New HL7 features found in CAREWare 5

Domain Specific Changes

In cases where CAREWare needs to import data to different domains using Lab Corp’s HL7, a new feature is added to identify separate domains by the Provider Account value (PID 18 field). In order to use the Provider Account value, the data source needs to be from Lab Corp. The user will fill out the provider mapping as stated in the “Map Provider” section. The difference is when they choose Lab Corp. A checkbox will be visible to allow them to use the Provider Account value as the matching domain field. Once checked and saved, CAREWare will use the original MSH6 as a split identifier. Any file that contains that MSH6 will be directed to use the Provider Account field. After the records are processed again, the user will noticed sub accounts below the main account that they have just split. The user will have to create mappings for these sub accounts. Each sub account should be mapped to different domains. It is ok if two are more sub accounts are mapped to one domain. Any sub account will need a new activation code before data can be imported to client records.

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Client Specific Changes

There are a few sites that want to search across domains to see if a client matches when using HL7. The “Find clients across all domains” checkbox will do this for them. If a client is found and the client does not belong to the domain that the data is going to, this will add that client to that domain automatically.

Another feature is to delete any clients that it does not find a match for. This is primarily for sites that are unable to filter out their CAREWare clients prior to sending HL7 files for CAREWare to process. This feature should be used with caution since it will force any records that normally would go into the manual client map queue to be deleted automatically.

For any site that needs to know more details about a client before manually matching the incoming records to that client, CAREWare has added a Get Client Details link in the HL7 Client Mapping form. Once a user selects a client they want to know the details about and clicks F4 Get Client Details, the client form will be available directly from there. This should eliminate having to leave the form to do look up a client.

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Another link that was added is the Search Other. In cases where the user believes that there is a potential match but no patients or incorrect patients appear on the potential matches list. The user can do a custom search through the domain. If there are results and the user wants to use a particular patient to match, they can do so directly from the search results form.

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General Changes

The mapping tool has added a few delete methods to each of its mapping forms. The user can now delete the mappings or purge all records with a particular identifier. The mapping deletes can only be done if no records in the database is currently using it. Each stage has its own identifier to purge records. They are as follows:

1. Purge By Provider MSH3 and MSH6 (Sending ID and Receiving ID) 2. Purge By Test MSH3 and OBX 4.1 (Sending ID and Test Code) 3. Purge By Result OBX4.1 and OBX 6 (Test Code and Test Result)

Since more and more sites are now importing from multiple data sources and routing them to different domains, filters have been added to the Queue report utility. These filters will allow the user to check, reset, or purge the HL7 status by domain, data source, or both.
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