Recently, Galen’s technical consultants took part in a large state Health Information Exchange’s, HIE migration from Axolotl HIE to the Orion HIE platform.

Often times, connecting a participant to an HIE means compromising between two sets of standards to find a maintainable medium.  Having a flexible, driven team of passionate consultants committed to the long-term success of a project can be the difference between a successful and an unsuccessful endeavor.  These are some of the challenges faced throughout the HIE migration that were overcome with our technical experience and dynamic solutions.

Normalizing Converted Data With Minimal Background Information

When migrating from one HIE vendor to another, it is imperative to backload historical data to perpetuate the data repository built up over years on the legacy system.

Decisions are often made in healthcare IT to overcome limitations of a system.  These choices can cause unforeseen downstream issues, especially when migrating to an HIE with a different set of specifications and standards.  In many situations, decisions made in the past aren’t well tracked and the reasoning for handling the data isn’t easily discernable.  Over long periods of time, these issues become magnified, especially when they involve multiple data sources.  As issues are discovered, adjustments are made to mappings and resolutions are developed on the fly, though the documentation around these decisions is sometimes inadequate and difficult to follow.

Galen’s team of interface analysts is uniquely equipped to identify patterns in data sets and develop solutions to overcome the transition to a new HIE.  With our extensive interface knowledge and experienced team of healthcare IT professionals, Galen can provide a deep understanding into how data is changing over time, discern the specific reasoning behind why decisions were made, and determine how best to move forward with the information and tools that are available.

Managing Reused Patient Identifiers

HIE systems require that patient identifiers (e.g. MRNs) be unique.  That is to say, each patient identifier that comes into an HIE from a particular facility should be distinct to a patient, and should never be reused on another patient.

There are instances where this isn’t the case in HIT, for example, reference labs will sometimes recycle patient identifiers used in previous years.  In order to retain the uniqueness, identifiers need to be intelligently manipulated.  Galen’s interface analysts have experience dealing with this situation and can help partners develop customized solutions to overcome this challenge.

Managing Reused Message Control Identifiers

Some interface engines also require that each HL7 message have a unique message identifier in the MSH-10 field.  If an HL7 comes in with the same message ID as one that was previously processed by the system, the interface engine knows to reject that message (typically, this would be a repeat message).  Some participants do not or cannot send a unique MSH-10.  In these cases, Galen’s analysts have collaborated with partners to develop creative solutions to circumvent these limitations when converting data from legacy systems.

Managing Order Codes with Multiple Descriptions

Order codes should be unique to the order description they align with, although there are instances in the real world where this isn’t the case.  Sometimes, facilities send the same order code (OBR-4.1) with distinct order descriptions for results that are actually different.  Take a microbiology result for example: a facility might provide an order code of MICRO with an order description (OBR-4.2) of URINE CULTURE, but they might also send an order code of MICRO with an order description of BLOOD CULTURE.

In some HIE systems, the first description loaded with the order code of MICRO is the description that will always display in the patient portal whenever a subsequent result with the same code of MICRO is processed, regardless of the actual description code.  Let’s say a patient first has a URINE CULTURE resulted, then a few months later, that same patient has a BLOOD CULTURE resulted.  That BLOOD CULTURE result is going to display in the patient portal as a URINE CULTURE because the system has already been populated with:

Galen has developed a methodology for working through this issue.  Our analysts can help organizations create a customized strategy for appropriately handling order code and order description data to enable an HIE to correctly display order codes with multiple descriptions.

Properly Linking Microbiology Results to Susceptibilities

Microbiology results are especially tricky when dealing with any consuming system.  Depending on whether the result indicates a need for further testing, microbiology HL7 results contain either:

• Just the initial microbiology result
• Both the initial result and susceptibility follow up results

When a microbiology result does require a susceptibility follow up, it will typically have two OBR segments.  The first OBR segment will pertain to the original culture like a Blood Culture or a Urine Culture.  The second OBR segment will contain information regarding results for the associated susceptibility.

Many systems require that the child (susceptibility) report contain elements from the parent result, though participants don’t always send this information in the parent report appropriately.  Galen is adept at identifying the patterns with which a participant sends their microbiology results, and our consultants have extensive experience developing logic to appropriately process microbiology results into consuming systems.

Overall, there are many challenges that can arise when converting from one HIE to another.  Galen Healthcare Solutions’ experienced interface analysts and HIE specialists can work with you to ensure a successful and timely migration that best serves your patients and physicians.  For additional information, feel free to contact us below: