Order HL7 ORM => FHIR

[JohnNKing]

Story

As a hospital, to be able to transmit an NBS order via my EHR’s native order interface, I need the CDC ReportStream ecosystem to be able to receive an HL7 ORM order message and then send out an HL7 OML order message to a synthetic lab.

Pre-conditions

• [x] The EHR is able to create an order that matches the HL7 v2 ORM standard.
• [x] The ability to convert outgoing FHIR to OML messages is already supported

Acceptance Criteria

• [x] Inbound ORM messages can be received by ReportStream.
• [x] The order is transmitted to the synthetic lab soon after it has been received. Note: Not all data elements in the order need yet be included in the OML message.

Related Stories

https://github.com/CDCgov/prime-reportstream/issues/10370

Tasks

Research

• [x] Contrast CA, MN, & LA sample messages and/or IGs
• [x] Ecosystem Mapping
  • [x] Identify how ORM data is collected for each state
• [x] Review CA's IG (https://drive.google.com/drive/folders/1JxbGZY9kRG8HwFaepSCJIntgORe9edUT)
• [x] Review Epic's Orders Tech Spec (https://open.epic.com/Tech/TechSpec?spec=staged%2FOutgoing%20Results%20and%20Orders%20Interface%20Technical%20Specification.zip or https://drive.google.com/drive/folders/1teOpcHrF74PwJB9FmssEOTfyNhlY6j4Z)
• [x] Review feedback on Cerner IGs (see https://aphlinformatics.atlassian.net/wiki/spaces/IR/pages/1981383536/6+28+2023+CDC+APHL+Flexion+Oracle+Cerner+-+Biweekly+ETOR+Mtg+Notes comments and attachment from Alexa; also reply via email forwarded 7/12 titled "RE: CDC/APHL/Flexion/Oracle Cerner - Biweekly ETOR Mtg")
• [x] Develop a matrix (contrasting info with EHR) of how EHRs may be able to provide mother's name and specimen ID. (e.g. mother's name via PID.6, PID.21, GT1, NK1, OBX; specimen ID via OBR, SPM, OBX; practitioner info via OBX, PD1) - [ ] Then request feedback from Epic and Cerner
  • [x] Share this with RS, to help identify parts of the message that may deviate from the current ORM sample message (https://github.com/CDCgov/trusted-intermediary/blob/main/examples/hl7/MN/MN%20NBS%20ORM_O01%20Lab%20Order%20Message.txt)
  • [x] Document deviations from standards that this would introduce - [ ] Develop more ORM sample messages (if needed? More discussion needed) - [ ] Determine if we can easily generating a FHIR message via Linux4Health or Synthea - [ ] Get a copy of Alabama's insurance side of NBS card

Engineering

All uncompleted tasks are moved to story #472. These are all items we are awaiting feedback for.

• [x] Watch both RS HL7v2 -> FHIR knowledge sharing sessions. - team
• [x] Review LinuxForHealth HL7 to FHIR Converter documentation for templating (+ techniques and best practices)
• [x] Meet with Jessica. - team
• [x] Create stand-in ORM file and explore. - team
• [x] Create simplified FHIR to coincide with our simplified HL7 file.
• [x] MessageHeader
  • [x] name in the destination we think should be NATUS, but NATUS showed up as its own Device.
• [x] Organizations
  • [x] identifier is used instead of name. Is this OK?
• [x] Device
  • [x] We have a NATUS device (which is referenced in the MessageHeader). Is this OK?
• [x] Practitioner
• [x] PractitionerRole
• [x] Patient - Jessica
  • [x] contact field has the mother's information from PID.6 but instead the mother's info is put into an extension (maiden name). This is an ETOR NBS-specific requirement. This would need to be accomplished on some TI-receiver-specific transformation in RS or directly in TI (this may be the better answer).
  • [x] birth date time extension added puts it as a valueString which is incorrect.
  • [x] _birthDate extension shows up in the extension list, not under _birthDate. Probably not OK, but maybe is OK?
• [x] ServiceRequest - Jessica
  • [x] Figure out what proper identifier is for this resource. It should be the early ORC or OBR sub-segments.
  • [x] Work with Jessica if there's any overlap.
  • [x] status should be unknown or active? It should be unknown. Our example is missing ORC.5 which means status needs to be unknown.
• [x] Specimen - team in progress
  • [x] subject should be a patient reference. - @halprin
  • [x] collection and its collectedDateTime in test.fhir compared to receivedTime in expected.fhir. Is it OK the way it is? Or should we really change things to be as in the expected FHIR?
• [x] Observation
  • [x] Fix rounding of value.
  • [x] Create an issue with LinuxForHealth to create a DOUBLE type that handles bigger decimal numbers, and potentially create a PR to add it - @basiliskus
    • [x] Created a PR to fix above issue - @jorg3lopez
  • [x] Figure out rest of the way what the proper identifier is for this resource. It was MSH.7 (a date/time), but now is some field out of ORC or OBR.
  • [x] status should be unknown or final? Should be unknown, but we need a custom extension to persist this value because O doesn't map to anything in FHIR.
• [x] Contact WG with our questions. - @halprin (contacted)
• [x] Communicate back with WG group. - @halprin
• [x] Change RS's RESTTransport.kt (around line 450) to work for the orders endpoint in addition to demographics. See this Slack message. @basiliskus
• [x] Update our RS organization information such that it hits our orders endpoint and correctly forwards the FHIR to us. This means also in staging. This may need updated jurisdictionalFilter, qualityFilter, and reportUrl. @jorg3lopez
• [x] Have our orders convert to be OML orders when they come into our orders endpoint. This can be implemented in a similar way to how we convert demographics to an order. See ConvertAndSendDemographicsUsecase.java and OrderConverter. - @halprin
• [x] Add local set up for RS <-> TI connection to the main readme file - @basiliskus

Definition of Done

• [x] Documentation tasks completed
  • [x] Documentation and diagrams created or updated
  • [x] ADRs (/adr folder)
  • [x] Other READMEs in the repo
  • [x] Implementation guide (/ig folder) - check w/ @sfradkin @tjohnson7021
    • [x] create ORM message definition @tjohnson7021
  • [x] Threat model updated - check w/ @JohnNKing @jorg3lopez
  • [x] API documentation updated
  • [x] Source code documentation created when the code is not self-documenting
• [x] Code quality tasks completed
  • [x] Logging added where useful
  • [x] Code refactored for clarity and no design/technical debt
  • [x] Adhere to separation of concerns; code is not tightly coupled, especially to 3rd party dependencies
  • [x] Code is reviewed or developed by pair; 1 approval is needed but consider requiring an outside-the-pair reviewer
  • [x] Code quality checks passed
• [x] Security & Privacy tasks completed
  • [x] Security & privacy gates passed
• [x] Testing tasks completed
  • [x] Load tests passed
  • [x] Unit test coverage of our code >= 90%
• [x] Build & Deploy tasks completed
  • [x] Build process updated
  • [x] API(s) are versioned
  • [x] Feature toggles created and/or deleted. Document the feature toggle
  • [x] Source code is merged to the main branch

Research Questions

• Optional: Any initial questions for research

Decisions

• Optional: Any decisions we've made while working on this story

Notes

• Engineering should branch off of jessica/10370-orm-mapping in the RS repository.

[JohnNKing]

Discussed 4/25: Narrow to min required data for ORM?

[JohnNKing]

Defer until HL7 orders need to be supported

[JohnNKing]

@JohnNKing to clean up and prep for Sprint Review on Wednesday. Update this based upon RS/TI Planning document.

[halprin]

Reached out to the FHIR Chat on clarification on some of the conversions.

[scleary1cs]

This Story helps complete the requirement: MVP-REQ-06 - Each intermediary will support at least one format for inbound orders