Overview

Applications integrated into the EHR often want to document (notes) to the patient's chart.  These notes commonly is one of:

• A statement from the clinician within the context of the application and patient (such as a shared-decision statement)
• An output from the use of the application's algorithm (such as a score, a chart, or a report)
• An output from the use of the application's vendor integration (such as the vendor's system providing a report for the patient)
• A method of communicating between clinicians that are separately interacting with the patient (such as a referral or the output of a referral)
• A method of communicating from the patient to the clinician (such as a pre-visit questionnaire response)
• A method of communicating from the clinician to the patient (such as documenting for discharge instructions)
• A method of providing education material to the patient (such as attaching to the chart so the material is downloadable by the patient at the patient portal)

Notes are not considered discrete data.  There are other methods of providing discrete data to the patient chart if that is your desire.

This recipe will describe several approaches to providing these types of integrations.

Features

• Plain text-based notes
• Rich text-based notes
• Notes containing binary documents (images, brochures, scans, etc.)

Benefits

There are many benefits to using interopiO's Gateway API to save notes to the patient's chart.  

First, interopiO's Gateway provides a standards-based abstraction for your application.  You will use the HL7 FHIR DocumentReference resource to send your note to the EHR.  interopiO's Gateway translates your note and sends to the EHR using the appropriate EHR vendor's interface.  interopiO supports binding to EHR vendor interfaces including:

• EHR FHIR API
• EHR Proprietary API
• HL7 V2 Messaging Interface

Second, you can use notes as a method for documenting important application state for the patient.  This state should be relevant to any clinician or user that reads your note.  You can parse your note to determine interactions that have occurred and actions that have been taken.  You can extract scores and measurements from your notes.  An example note for maintaining state is:

Jan 5, 2022
Assigned the following education resources:
 - Type 2 Diabetes: Tips for Healthy Living
 - What is a Pediatric Endocrinologist?

Third, you can create notes from various authorization models (as a system, as a clinician, as a patient).  These authorization models allow for a wide variety of information exchange.  An example to illustrate this information exchange is:

A medical device manufacturer (client) maintains a database of daily data feeds from the device implanted in the patient.  The client determines a patient is trending poorly.  The client sends a report on the patient's condition and trend to the patient's EHR system using their interopiO Gateway and DocumentReference resource containing a PDF document with charts and explanations.  interopiO translates that DocumentReference into an HL7 message for the corresponding patient record and saves it to the patient chart using the EHR HL7 interface.  In addition, the client notifies the patient's PCP using a clinician notification recipe.

Requirements

Required

• Your application maintains an interopiO subscription
• Your application uses the HL7 FHIR Launch flow (service or clinician-facing app)
• Your application configures an interopiO Gateway to the EHR using a standard or external data adapter
• Your application sends a DocumentReference to the EHR via your interopiO Gateway

Recipe

Due to the standards-based abstraction provided by the interopiO Gateway, this recipe is very straight-forward.  The following data flow diagram shows how this recipe works:

First, prepare your EHR account to allow your application (via interopiO) to submit the clinical/provider notes using the desired interface.  This interface may be HL7 FHIR, HL7 v2, or EHR proprietary.  

Second, configure your interopiO Data Adapter to connect to your EHR system.  From your interopiO Data Adapter, you can see what features are supported by your EHR system.

Third, configure your interopiO Gateway to utilize your interopiO Data Adapter.  From within your interopiO Gateway, you can see what operations are supported for your application as it uses the interopiO Gateway.  

Fourth, your application sends a DocumentReference FHIR resource to the EHR using your interopiO Gateway.  Depending on your configuration and your data adapter support, this clinical note will be delivered to the EHR using their FHIR API, EHR proprietary API, or HL7 interface.