Concept

Hook: PHTriggerS Hook

Purpose: Provide initial decision support if a EHR event qualifiers as a possible reportable event.

Description: The PHTriggers hook will provide a response back based on the RCTC implementation. If a set of code matches are found the service will send back a "reportable" indicator. Otherwise, a "not reportable" determination will be returned.

Disclaimer: This is a coarse grained first line decision support that determines that this event may be of interest and possibly reportable. Further adjudication would be required to determine actual reportability.

Implementation

This project is being implemented in java with spring framework. Refer to the swagger yaml file for documentation on endpoints.

Swagger:
http://editor.swagger.io/?url=https://raw.githubusercontent.com/mscaldas2012/CDS_PHTriggers/master/src/docs/apidoc.yaml

Travis:
https://travis-ci.org/mscaldas2012/CDS_PHTriggers

Docker:
Build docker image:
docker build -t mscaldas/phtrigger:x.y .

Push Image to Docker hub:
docker push mscaldas/phtrigger:x.y

Running as docker:
docker run -p 80:10005 mscaldas/phtrigger:x.y

#Sample Request

{
   "hookInstance" : "<d1577c69-dfbe-44ad-ba6d-3e05e953b2ea>",
   "fhirServer" : "<EHR FHIR URL>",
   "hook" : "lab-create",
   "redirect" : "<http://hooks2.smarthealthit.org/service-done.html>",
   "user" : "Practitioner/example",
   "context" : [
                  {
                    "context": {
                      "resourceType": "Observation",
                      "status": "preliminary",
                      "code": {
                        "coding": [
                          {
                            "system": "http://loinc.org",
                            "code": "<43890-3>",
                            "display": "<Bordetella pertussis [Presence] in Sputum by Organism specific culture>"
                          }
                        ]
                      }
                    }
                  }
   ],
   "patient" : "<1288992>",
   "prefetch" : {   
   	"patient": "Patient/{{Patient.id}}",
        "observations": "Observation?patient={{Patient.id}}"
      }
   }
}

#Sample Response

{
  "cards": [
	{
      "summary": "This case is Possibly Reportable. It should be sent as an eICR to Public Health Intermediary for final Adjudication",
      "detail" : "This card shows the action to be taken" ,
      "indicator": "info",
      "suggestions":
      [
      	{
      		"label": "Send Case Report",
      		"uuid" : "<generateduuid>",
      		actions: 
      		[
      			{
   				"type": "create",
   				"description" : "Send Case Report for Adjudication to Public Health Intermediary", 
   				"resources" : "<new_order>"
      			}
      		]
      	}
      ],
      "links"
      "source": {
        "label": "PHTriggers RCTC Service",
        "url": "https://cds-services.ng-atl.com/cds-services/code_reportability",
        "type": "smart"
      }
    ],

    "decisions" : 
    [
    	{
    	"create" : ["<new_order_id>","<new_order_id>"],
    	"delete" : []
    	}
	]
}

DSTU2 FHIR Observation

{
  "resource": {
    "resourceType": "Observation",
    "id": "M5851276",
    "meta": {
      "versionId": "1-5851275",
      "lastUpdated": "2016-01-26T19:54:14.000Z"
    },
    "text": {
      "status": "generated",
      "div": "<div><p><b>Observation</b></p><p><b>Patient</b>: 3998008</p><p><b>Status</b>: Auth (Verified)</p><p><b>Category</b>: Laboratory</p><p><b>Code</b>: RBC</p><p><b>Result</b>: 5 x10(3)/mcL</p><p><b>Risk Level</b>: Normal</p><p><b>Date</b>: 2016-01-26T19:41:00.000Z</p><p><b>Risk Level Detail</b>: Low: 4 x10(3)/mcL High: 6 x10(3)/mcL</p></div>"
    },
    "status": "final",
    "category": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        }
      ],
      "text": "Laboratory"
    },
    "code": {
      "coding": [
        {
          "system": "http://loinc.org",
          "code": "789-8",
          "display": "ERYTHROCYTES:NCNC:PT:BLD:QN:AUTOMATED COUNT"
        }
      ],
      "text": "RBC"
    },
    "subject": {
      "reference": "Patient/3998008"
    },
    "encounter": {
      "reference": "Encounter/3651924"
    },
    "effectiveDateTime": "2016-01-26T19:41:00.000Z",
    "issued": "2016-01-26T19:54:07.000Z",
    "valueQuantity": {
      "value": 5,
      "unit": "x10(3)/mcL",
      "system": "http://unitsofmeasure.org",
      "code": "10*3/uL"
    },
    "interpretation": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/v2/0078",
          "code": "N",
          "display": "Normal"
        }
      ]
    },
    "comments": "{\\rtf1\\ansi\\ansicpg1252\\uc0\\deff0{\\fonttbl\r\n{\\f0\\fswiss\\fcharset0\\fprq2 Arial;}\r\n{\\f1\\froman\\fcharset2\\fprq2 Symbol;}}\r\n{\\colortbl;\\red0\\green0\\blue0;\\red255\\green255\\blue255;}\r\n{\\*\\generator TX_RTF32 10.1.323.501;}\r\n\\deftab1134\\pard\\plain\\f0\\fs24\\cb2\\chshdng0\\chcfpat0\\chcbpat2 This is interpretative data for RBC.  This should apply to all routed to service resources.\\par\\pard\\par }",
    "referenceRange": [
      {
        "low": {
          "value": 4,
          "unit": "x10(3)/mcL",
          "system": "http://unitsofmeasure.org",
          "code": "10*3/uL"
        },
        "high": {
          "value": 6,
          "unit": "x10(3)/mcL",
          "system": "http://unitsofmeasure.org",
          "code": "10*3/uL"
        }
      }
    ]
  }
}