Question related to alternate text
ar...@ipatientcare.com
taylor...@bah.com
Hi,
The ELR NIST test tool tests to the requirements as specified in the standards referenced in the ONC ELR certification criterion 170.314(f)(4) Inpatient setting only – transmission of reportable laboratory tests and values/results. The requirements and details can be found by looking at the standards (see documentation tab on the NIST test tool) and on the Profile Viewer.
Per the ELR IG, the Alternate Text-related fields for PID-10 (Race) and PID-22 (Ethnicity) are RE. Certain Test Cases in the ELR Test Tool require the EHR technology to demonstrate the ability to support these RE fields in case these data are available to be included in the ELR message in a production setting. For certification testing, the vendor must demonstrate that their EHR product can support them.
Though the category of the Alternate Text-related fields for PID-10 and PID-22 is listed as Changeable Data in the Message Content sheet, it would not be logical to use the same data for the Text and Alternate Text fields. The ONC testing lab likely will require different data for the Alternate Text-related fields in order for the EHR to demonstrate the ability to support the Alternate Text requirement.
Thank you for your question.
Sheryl
taylor...@bah.com
To further clarify my answer to your questions:
- PID-10.1, .2, .3, .4, .5, .6 and PID-22.1, .2, .3, .4, .5, .6 are RE in the ELR IG; therefore, for certification testing the EHR system must demonstrate the ability to support all of these fields in the ELR messages that are created
- The purpose of having Alternate fields in addition to the non-Alternate fields in PID-10 and PID-22 is to allow the message to include data representing two different coding systems, a situation that may need to be supported in a production setting; for example, PID-10.1, .2, .3 (the first triplet) could be populated with data from a standard coding system, and PID-10.4, .5, .6 (the second triplet) could be populated with data from a local coding system (if only one coding system is being used in a production setting, then only the first triplet of PID-10 and PID-22 would need to be populated in the message)
- As shown in the example test data provided for PID-10 and PID-22 in the ELR Test Cases, for certification testing the data and coding system in the first triplet (e.g., PID-10.1, .2, .3) must be different from the data and coding system in the second triplet (e.g., PID-10.4, .5, .6); however, there are instances when the example data provided in PID-10.2 (Text) and PID-10.5 (Alternate Text) are exactly the same even though two different coding systems are being used, reflecting some real-world situations
Thank you,
Sheryl
iPatientCare-Arnaz
Thanks Sheryl for your response. I get your point, but the requirement is ambiguous. On one hand it is said that ‘Alternate fields are there to support multiple coding systems in production systems and if only one coding system is used in the production setting, we need to populate only the first triplet’. On other hand, for certification they are mandating the EHR to have a Local coding system and populate the alternate text triplets. When ONC is focusing on interoperability and standard codes, why do EHRs have to maintain a local code? What use is the Local code to the receiving entity, when it does not have any standard coding system? Also, the local codes do not make sense for some of sections such as OBX.6 (Unit of Measurement) – why would someone need two coding systems for Unit of Measurement? Could you shed some light on this?
Thanks in advance.
Arnaz Bharucha
|
iPatientCare, Inc. The Jewelry Exchange Building, Opposite Woodbridge Center Mall One Woodbridge Center, Suite 812, Woodbridge, New Jersey 07095 |
taylor...@bah.com
Hi,
ONC is focused on interoperability - based on standards - and the ELR IG is a standard named in the 2014 Edition ONC ELR certification criterion. This standard specifies RE for the fields of both the first triplet and the second triplet, because the authors of the ELR IG know that some current production sites may be using both a standard code and a local code for the particular data (e.g., Race, Ethnicity, Unit of Measure, Observation, etc.). If a specific production site only uses the standard code for the data, then the EHR system at that site must be able to generate messages with the standard code. If no standard code exists for the data and the production site uses a local code (which is the case for certain lab tests), then the EHR system at that site would generate messages with said local code.
CEHRT must support present-day data exchange requirements, and the ELR IG standard is based on those requirements. The NIST ELR Test Tool tests to the requirements in the ELR specification. In order to pass certification testing, the EHR technology must be able to demonstrate that it supports these RE fields.
If you disagree with the requirements and wish to see them changed, please take your issues to ONC and the Standards Development Organization (HL7 PHER WG).
Thank you for your questions,
Sheryl
On Monday, April 14, 2014 11:42:39 AM UTC-4, iPatientCare-Arnaz wrote:
Thanks Sheryl for your response. I get your point, but the requirement is ambiguous. On one hand it is said that ‘Alternate fields are there to support multiple coding systems in production systems and if only one coding system is used in the production setting, we need to populate only the first triplet’. On other hand, for certification they are mandating the EHR to have a Local coding system and populate the alternate text triplets. When ONC is focusing on interoperability and standard codes, why do EHRs have to maintain a local code? What use is the Local code to the receiving entity, when it does not have any standard coding system? Also, the local codes do not make sense for some of sections such as OBX.6 (Unit of Measurement) – why would someone need two coding systems for Unit of Measurement? Could you shed some light on this?
Thanks in advance.
Arnaz Bharucha
iPatientCare, Inc.
The Jewelry Exchange Building, Opposite Woodbridge Center Mall
One Woodbridge Center, Suite 812, Woodbridge, New Jersey 07095
(: 732-607-2400 |7: 732-676-7667 |*: Ar...@iPatientCare.com
From: taylor...@bah.com [mailto:taylor...@bah.com]
Sent: Friday, April 11, 2014 10:12 AM
To: hl7v2-reportab...@googlegroups.com
Cc: ar...@ipatientcare.com
Subject: Re: Question related to alternate text