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MuleSoft Accelerator for Healthcare

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Use case 8 - Qualified health information networks integration

Streamline the patient onboarding process via QHIN integration

Overview

Healthcare interoperability, the seamless exchange of patient information between disparate systems, has long been a critical issue within the healthcare industry. The lack of standardized data sharing has hindered care coordination, slowed down decision-making processes, and contributed to gaps in patient care. While progress has been made regionally through Health Information Exchanges (HIEs) and nationally through trusted exchange frameworks like Carequality, challenges persist to drive true interoperability at scale for use cases beyond treatment such as public health, benefits determination and patient access.

The Trusted Exchange Framework and Common Agreement (TEFCA) initiative, spearheaded by the Office of the National Coordinator for Health Information Technology (ONC), represents a significant step towards nationwide healthcare interoperability for a variety of use cases. TEFCA aims to establish a standardized and secure framework for data exchange across the United States with QHINs (Qualified Health Information Networks) serving as nodes facilitating the sharing of information across organizations.

Use case description

This use case enables customers to quickly integrate with external organizations, via pre-built applications to connect with Kno2 (Candidate QHIN), to streamline the patient onboarding process. This solution provides customers with the ability to search for patient information across a vast network of healthcare organizations and ingest the relevant records into their systems to remove manual data entry. To support this use case, the solution features MuleSoft’s C-CDA to FHIR Converter to convert the retrieved documents into a FHIR bundle that can be consumed by a variety of downstream applications including Salesforce Health Cloud, the organization’s EHR and many others.

Functional view

Qualified health information networks functional view

Glossary

TermDefinition
QHINQualified Health Information Network is a network that securely shares health information between different organizations, like hospitals or clinics, meeting specific standards and requirements established by TEFCA to ensure privacy and security.
TEFCATrusted Exchange Framework and Common Agreement is a set of guidelines established by the U.S. government to create a unified approach for sharing health information nationwide. It includes both technical standards (TEF) and rules (CA) to allow for interoperable exchange of health data between different health information networks.
CDAThe HL7 Version 3 Clinical Document Architecture is a document markup standard (XML-based) that specifies the structure and semantics of "clinical documents" for the purpose of exchange between healthcare providers and patients.
FHIRFast Healthcare Interoperability Resources is an HL7 specification for healthcare interoperability. It is a JSON-based standard describing data formats, elements and an application programming interface for exchanging electronic health records.

High-level architecture

Qualified health information networks integration architecture

Workflow

End-to-end scenarios

  • Existing Patient: When a user searches using the Patient Sync LWC component from Health Cloud, the organization’s EHR system is searched, and then Salesforce Healthcare APIs synchronize the patient information into Health Cloud from the organization’s EHR.
  • New Patient: When a user searches using the Patient Sync LWC component from Health Cloud, MuleSoft searches outside provider organizations via Kno2 where the patient has previously received care to synchronize the patient demographics and patient clinical information into Health Cloud & the organization's EHR system.

Processing logic

The primary handling and orchestration of new patient onboarding will be implemented in the QHIN Process API. This process can be described as follows:

  1. A user action from the Health Cloud Patient Search LWC component initiates the flow.
  2. Process is triggered to search for the patient from the community network of providers.
  3. Initiate the search in the organization’s EHR system via the Patient Summary EMR Integration. If there is a match then navigate the user to leverage the organization’s EHR search and sync the patient information into Health Cloud. If there is no match found then continue with the steps captured below.
  4. Initiate the search to get the list of participating provider organizations of interest based on the provided zip code.
  5. Retrieve the metadata of the patient records from the list of organizations returned in Step 4 based on the patient demographic information collected by the user, such as first name, last name, date of birth, gender, and address.
  6. The user then selects which participating provider organization to use which will allow retrieval of key metadata to determine which of the available documents to choose.
  7. A user action is required to select a particular CDA document to trigger the process to fetch the CDA document via Kno2 from the responding provider organization.
  8. The CDA document is converted to a FHIR Bundle via MuleSoft C-CDA to FHIR Converter.
  9. The patient record is created in the organization's EHR via Generic FHIR Client System API.
  10. The patient record is created in Health Cloud (which includes the organization's EHR generated Medical Record Number to appropriately tie the records together).
  11. The FHIR Bundle is processed into the organization's EHR asynchronously to store the required patient clinical information.

Sequence diagrams

Refer to this use case page and navigate to Sequence diagram section that illustrates the steps in the orchestration of onboarding a patient from the organization's EHR to Salesforce Health Cloud.

This diagram illustrates the steps in the orchestration of onboarding a patient from a network of providers via QHIN (Kno2) integration into Salesforce Health Cloud.

Qualified health information networks sequence diagram

Success conditions

Upon successful completion of the process, the following conditions will be met:

  • Patient account is created in Health Cloud
  • Patient account and key clinical information is ingested into the organization's EHR. Clinical information includes the following:
    • Allergy Intolerances
    • Conditions
    • Procedures
    • Medication Requests

Assumptions and constraints

  • Search for Patient in organization’s EHR before performing a search in QHIN network to minimize risk of creating duplicate patient records
  • Create Patient person account with demographic information in Salesforce Health Cloud
  • Create patient profile including demographics and key clinical data in organization’s EHR
  • Create Patient in organization’s EHR before synchronizing to Health Cloud as organization’s MRN identifier can be loaded into Health Cloud
  • Process Patient’s clinical information into organization’s EHR asynchronously
  • Filter out document types that are not supported by MuleSoft C-CDA to FHIR converter (see list of supported document types here)
  • Leverage Salesforce Healthcare Administration API to create Patient account in Health Cloud
  • Enable Hospital Referral Region (HRR) that utilizes a crosswalk of zip codes and common referral patterns to group a geographic area while searching for list of organizations to find patient information in Kno2 network
  • Required Code sets from code systems are preloaded into organization’s EHR

Before you begin

bulb.png The Getting Started with MuleSoft Accelerators guide provides general information on getting started with the accelerator components. This includes instructions on setting up your local workstation for configuring and deploying the applications.

Downloadable assets

Process APIs

System APIs

Custom components

  • Patient Sync Lightning Web Component | Source

MuleSoft Direct assets

For Salesforce Health Cloud customers interested to deploy MuleSoft applications via MuleSoft Direct, access the assets and documentation below:

References

Here are some links to related and supporting documentation.

Demonstration

Interested in seeing these assets in action? Check out this demo recording highlighting this use case!

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Reviews

TypeCustom
OrganizationMulesoft Inc.
Published by
MuleSoft Solutions
Published onMay 30, 2024

Asset versions for 2.23.x

Version
2.23.0