HL7 File Processing

1. HL7 File Processing Introduction and FAQ

2. Table of Contents • Introduction • HL7 File Validation Process • Email Notifications • HL7 Reports • Common Error/Warning Messages • Frequently Asked Questions

3. HL7 File Processing Introduction

4. Review of Accomplishments So far in the HL7 on-boarding process, your organization has accomplished the following: Steps Completed Purpose Introduced the process and received high-level explanation of what is required to move forward with Stage 2 Meaningful Use. Added to ImmTrac (1st time registrants), or updated site agreement in the system so that an import code and FTP credentials could be requested. Provided a six-character code that will be used as an identifier and must be included in the name of all HL7 files submitted. Required for the secure folders from which HL7 files will be submitted or results received. • Held a discovery call • Completed registration/renewal process • Obtained an Import Code • Received FTP credentials and completed setup configuration for the Core FTP Client.

5. Test File Submission The next step will be to submit test files to the FTP Folder. You will be asked to submit multiple test files during this stage: • First test file: • should contain one message with one RXA segment. • Must pass through the pre-validation process and be free of errors before another file is requested. • May contain warnings and still pass pre-validation • Subsequent test files • should contain the number of messages that is characteristic for your organization to send on a weekly basis. • May contain test or live data • At least two error-free files containing live data are required before gaining approval for Live status • May contain warnings and still pass. You will work with the Interop HL7 File Processing Team, who will review the files and help answer any questions you have.

6. Pre-LIVE Status Training Considerations • Is the staff familiar with the EHR already or do they need to be trained? • Who will review the results of each HL7 file submitted? • How will messages with errors get fixed? • How will they get resubmitted in the next weekly batch? Is the EHR set up to support this? • Who will the staff go to for questions? What kind of support can they expect? • Who will call the EHR vendor as questions/issues arise?Do they know their main point of contact at the EHR vendor site? • Is the site aware of the schedule date for when HL7 files will be submitted to the state? • Are there any technical considerations on the IT Services/Vendor side that would prevent them from being promoted to live status?

7. Live File Submission Once you complete the testing and your file submissions are approved, your status in the system will be set to “Live” • Only live data should be sent once the status has been set to “Live” • You may now resubmit any test files containing live data for processing and importation into ImmTrac, provided this information has not yet been submitted to ImmTrac • You will be expected to submit live data on a weekly basis • After live files have been processed, feedback report files for all files submitted will be available in your DQA Reports folder for 90 days up to a 300 file maximum. • Staff will need to be properly trained on any new processes put in place.

8. Naming HL7 Files Your HL7 immunization file must be prefixed with the import code we assigned to your organization during your registration and on-boarding process.  If your file is not prefixed with your assigned import code, it cannot be processed by the validation engine.  We will email the primary contact on file if this occurs.  You will need to correct the file name and resubmit it. The import code, if possible, should be followed by the two digit calendar year and the Julian Date, which is the three-digit day on the Julian Calendar (see: http://www.fs.fed.us/fire/partners/fepp/juliandate.htm). For example, if Provider ‘MYFILE’ is submitting a file on February 20, 2012, the file should be named MYFILE12051.HL7

9. HL7 File Processing HL7 File Validation Process

10. HL7 Validation Process • All HL7 files will be put through a 2-stage validation process to validate the data prior to ImmTrac importation. • Stage 1: DQA • The DQA is a validation tool that is used to check the formatting and measure the data quality in a HL7 file. • DQA will go through the messages in your HL7 file and provide feedback on the completeness and quality of the data submitted. • An HL7 message must pass DQA validation without errors before it can be submitted to ImmTrac. • Stage 2: ImmTrac • ImmTrac has its own set of validations that it performs.  While DQA validates the file for formatting and data quality, ImmTrac validates the patient level data in the file. • ImmTrac may ultimately be unable to import data that successfully made it through DQA validation.

11. Examples of DQA and ImmTrac Validation • DQA validates CDC-level information • HL7 format • Expired Vaccinations • Mismatched manufacturers and vaccination products • ImmTrac validates patient level information • Consent on file • Patient record match • Patient data match

12. FTP File Share Structure ---- Your FTP Share Server will contain the following folders ----

13. HL7 Validation Process Flow

14. High-Level Validation Process It may be helpful to look at the file validation process as four discrete steps: • Submission • Pre-Processing • Error Notification (if applicable) • ImmTrac Processing and Importation Each of these steps are detailed on the following slides

15. HL7 File Submissions

16. HL7 File Pre-Processing

17. HL7 Error Notification (if applicable)

18. ImmTrac Processing & Importation

19. HL7 File Processing Email Notifications

20. Email notifications during the HL7 file submission process The following is a list of emails that Providers could potentially receive during the HL7 file submission process. Each of the bulleted items are detailed in the slides that follow: • Email Acknowledgement of File Receipt • Email Notification of Fatal Errors • Email Notification of File Errors • Error notifications are received only if the submitted HL7 file contained errors. • If your file contains no errors, the only email you will receive will be the acknowledgement. • While we do not recommend it, you may unsubscribe from the automatic notifications.

21. Email Acknowledgement of File Receipt When our processing system discovers your submitted HL7 file, we will automatically send an email acknowledgement to your facility’s primary ImmTrac contact on file.  If your organization submits immunizations for multiple sites in a single file, we will only send the acknowledgement to the ImmTrac contact on record for the parent facility on record. 

22. Email Notification of Fatal Errors Notification of Fatal Errors are emailed error messages that Providers receive upon submission of an erroneous HL7 file. The reason for the fatal error is clearly stated in the email. These files cannot be processed until the error is fixed.  Errors received upon submission are generally for HL7 files that: • Were submitted with an invalid file name.  • Were already submitted on a previous date.  • Contained an invalid file type extension. • Submitted files may only be of type .HL7, .TXT (IHQ files only), or .IMP (AFFIRM files only).  Providers are urged to correct the file extension and resubmit.

23. Email Notification of File Errors If we detect any errors in your HL7 immunization file during DQA validation, we will send an email to your facility’s primary ImmTrac contact.  The email will tell you how many errors and warnings were noted in your file.  We will allow your error-free HL7 messages to be submitted to ImmTrac but messages with errors cannot be submitted to ImmTrac.  This error notification in conjunction with our new feedback reports will allow you to correct the errors we discovered and submit them in a future file. 

24. HL7 File Processing HL7 reports

25. Feedback Report Files Every time you submit an HL7 immunization file to ImmTrac, we will generate four detailed feedback report files for you.  These report files are generated automatically when you file is pre-processed for submission to ImmTrac.  These report files will be placed in your DQA-REPORT folder on our secure FTP server.  Please note that these report files will not be emailed to you- they contain protected data and must be downloaded from our secure FTP server just as you download the return notification files from ImmTrac now. The four feedback reports are listed below and will be detailed in the HL7 Reports section of this slide deck: • Summary Report • Acknowledgement File • Log File • Error File

26. Download your Feedback Report Files Within 90 Days Your feedback report files will be kept in your DQA-REPORT folder on our secure FTP server for 90 days.  After 90 days they will be deleted due to regulatory requirements. There is a 300 file limit for the FTP folder. This limitation is combined for all Provider folders on the FTP server.

27. What will I see after the validation process is complete? Four Generated Files will appear in your DQA Report Folder after processing is complete. Each of these will be detailed on the following slides. Acknowledgement File Error File Summary Report Log File

28. Error File • Lists specific warnings and errors found in the segments of all messages • If there were no errors this file will be empty • For troubleshooting assistance, refer to the Common Error/Warning Messages section of this document

29. Log File • Detailed information about each message received • Includes detailed errors and warnings

30. Acknowledgement File • A list of HL7 acknowledgements for each received message • States whether messages were accepted or rejected (A) • Errors will be marked with an |e| and warnings with a |w| in the 5th column. In this example, only warnings were received (B)

31. Summary Report • Gives a high level analysis of a file’s data quality • Quantifiably measures the DQA submission in three areas: • Completeness-Are all required and recommended fields being sent as expected? • Quality-Are there errors or warnings in the received data? • Timeliness-Are reports of vaccination administration being received on time per CDC guidelines? • A user guide for the DQA Summary Report can be found here: http://openimmunizationsoftware.org/dataQuality/dqaReport.html

32. ImmTrac Return Notification Files ImmTrac will continue to produce return notification files that will be placed in your RECEIVE folder. Notification files let you know that the patient for which the immunization was received: • was matched in the registry • had a consent on file to accept immunization data, and • was imported into ImmTrac.

33. HL7 File Processing Common Error/Warning messages

34. Error #1: Vaccination Product • Error: • + Vaccination product is invalid • Description: • The vaccination product was recognized by DQA but was not accepted for submittal. • This error was received in a test file where an arbitrary manufacturer was listed as the maker of the immunization product. DQA will mark a message as an error if the manufacturer and lot number do not match the immunization product. • Resolution: • Update the manufacturer/lot information listed for the immunization product.

35. Error #2: Vaccination Admin Code • Error: • + Vaccination admin code is invalid, Vaccination CPT Code = '90646' • Description: • The Vaccination Admin code was recognized by DQA but was not accepted for submittal. • This error was received in a test file where CPT Code 90646 was submitted for a patient immunization that was administered 2012. CPT 90646 links to CVX Code 46, which CDC rendered inactive on 5/28/10. DQA is set to error out any immunization administered after the vaccination became inactive. • Resolution: • If the shot is historical, change the date to when the vaccination was administered. Otherwise, use the current active code for the product(A list of cvx codes in our system is embedded in the FAQ section of this document).

36. Error #3: Vaccination Facility ID Error: +Vaccination facility id is invalid Description: RXA-11 does not include the PFS number of the site that administered the vaccination. This is a required field for all newly administered vaccinations. Resolution: Add the PFS number for RXA-11 (see blue text below). Refer to 3.5 RXA: Pharmacy/Treatment Administration Segment Definition of the Implementation Guide for more information. RXA|0|1|20120518|20021214|48^Hib^CVX|0.5|ML||00^Administered^NIP0001||^^^1234567890^^^^^3131 Briarpark Dr., Ste 108^^Dallas^TX^77042^US||||I2110SY||SKB^GlaxoSmithKline^MVX||||A|

37. Error #4: Vaccination Information Source Error: +Vaccination information source is missing Description: ImmTrac is following the NCIRD’s guidelines by using this field to indicate whether the immunization being reported was administered (new) or came from other records (historical). It is not specified in the RXA segment whether this is a new or an historical immunization record. Resolution: In RXA-9 (see blue text below), add the administration notes to indicate a new or historical immunization. • New immunization: |00^New Immunization Record^NCIRD001| • Historical immunization: |01^Historical Information^NCIRD001| RXA|0|999|20060817091022|20060817091022|20^DTaP^CVX|999||| 00^New Immunization Record^NCIRD001| 1008765^^^^^^^^TX^^^^MD| ^^^1234567890^^^^^321 MedicalDr.^Suite 325^Austin^TX^78756^US|||| X-1234||MSD^MERCK^MVX|<CR> RXA|0|999|20040908|20040908|08^HepB^CVX^90744^HepB^C4|999||| 01^Historical information^NCIRD001|<CR>

38. Error #5: MSH Sending Facility Error: + HL7 MSH sending facility is invalid Description: In the Message Header Segment (MSH), the PFS number for the Provider sending the HL7 message is not included. Resolution: In MSH-4, (see blue text below), add 10 digit PFS number for the Parent Provider. Refer to Section 3.1 MSH: Message Header Segment Definition in the Implementation Guide for more information. MSH|^~\&|ABC|1023456789|TxImmTrac|TxDSHS|20120518205126||VXU^V04^VXU_V04|TEST 000|P|2.5.1

39. Error #6: Missing RXA Segment Error: + HL7 RXA segment is missing, in repeat #4 Description: A test document including three RXA segments got a message about the 4th RXA segment missing. We discovered that the sender submitted the file with the ORC segment, which is not required, but if it is sent it must be followed by an RXA segment. The ORC came after the 3rd RXA segment, and therefore DQA expected to find a 4th RXA segment after it. It didn’t, so this error was received. Resolution: If including the ORC segment, ensure that it appears before the RXA, not after. ORC|RE||197023^DCS|||||||^Clerk^Myron|||||||DCS^Metro Clinic| RXA|0|999|20060903|20060903|20^DTaP^CVX|999|

40. HL7 File Processing Frequently Asked Questions (FAQS)

41. How will I know if there are any errors found in my submitted file? • Once DQA has completed validating your file, you will receive an automated email message only if there were errors. • If there are errors, the email will inform you of the number of errors and warnings found and direct you to your DQA folder on our secure FTP server. • Based on the feedback received, you may choose to fix the errors/warnings and resubmit only the messages that had errors. Do not resubmit the entire file, as this will result in duplicate immunization messages being submitted to ImmTrac.

42. What is the best way to manage who receives the email notifications coming out of DQA? The default is for the ImmTrac contact to be in receipt of the acknowledgement and error notification emails. Anyone can be added to this list, but if there are more than two, or if the audience is expected to change often, it may be helpful to set up a generic email list address on your end so that you can move people in and out of that generic email list as needed.

43. I received a fatal error email on my file, but when I went to the DQA Reports folder to review the reports, the folder was empty. Why? Reports are placed in the DQA reports folder only after the file is processed. When a file receives a fatal error, the system is prevented from processing the file at all. Therefore, the DQA Reports folder will be empty when a fatal error was found on a file .

44. How can I know when a code becomes inactive? I’m having trouble determining which codes are valid and which are not. • The CDC has an email alert that you can sign up for to be notified of updates to the CVX codes. You may sign up here: http://www2a.cdc.gov/vaccines/iis/iisstandards/vaccines.asp?rpt=cvx • In addition, the CVX/CPT codes and their status in our system is embedded below. It lists the date that the vaccination code became inactive, and indicates codes Texas does not accept.

45. I tried to submit a file to the FTP server, but got this error message: 452 Quota Exceeded: 90 files; 1096397 bytes MYFILE12188b.HL7 – 0 bytes transferred PASV 227 Entering Passive Mode(159,84,129,40,19,144) LIST Connect socket #1992 to 160.84.126,50, port4556… • Once the 300 file limit is reached you will have met your quota and will not be able to do anything else until you reduce (delete or move files off their subfolders) the number below 300. • The Accepted and DQA-Report folders are read only, so the only way to delete files in these folders is to contact the DSHS Security Coordinator.

46. Not all of our Historical Immunizations will have a date for when they were administered, but the date is required. How do we report these? If a vaccination date is unavailable, do not send those records. Since the date(s) of immunization are not known, the age appropriate vaccination schedule should be utilized since the individual would be considered as “susceptible”.

47. Who should I go to for Information? We hope that all of these changes demonstrate that we are serious about making things better and more efficient for you.  The ImmTrac Interoperability Team is ready to assist you.