Carequality FAQ

Table of Contents

How can I get started?

You can get started exploring using the wizard here, reach out to us at [email protected] or use the contact form. We recommend collecting/thinking about the following questions to help you get started:

  • What purpose of use applies to your software and your users?
  • How many facilities using your software will you connect to Carequality?
    • What is your intended roll-out for your facilities?
  • Will your outbound querying be automated off of workflow steps, rely on a user-facing interface, or both?
  • Will you be responding to queries directly or will Redox provide that service?

What is a Carequality Implementer? Who is my Carequality Implementer?

An organization that has signed the Carequality Connected Agreement and been accepted as such by Carequality. Implementers have developed the legacy exchange technologies, tested successfully against the Carequality community, and been approved as using those technologies successfully. This process of community testing usually takes between 3-6 months.

Implementers serve as on-ramps to the Carequality Framework. By working with Redox as your Implementer, you can start exchanging across the Carequality framework in a manner of days rather than months.

Can I still become a Carequality Implementer if I use Redox?

Yes. Some Redox customers would like to join the Carequality community to contribute to future national interoperability initiatives. These customers can utilize Redox’s platform and services to accelerate their certification and onboarding process while avoiding the need to build to legacy content and transport standards.

The workflows are pull/query. What if I want to push or be pushed data?

While pulling data is powerful for various use cases such as emergency care, it doesn’t solve all problems. Pushing data can be useful for workflows such as provider-to-provider messaging, event notification, diagnostic test ordering, and referrals. While Carequality and Commonwell currently don’t support push notifications, Redox has other options to help you accomplish your goals! We can help you push data through the DirectTrust network and other technical means.

Do I have to respond to other Carequality participants? Can I just pull data?

Carequality has two main requirements for participation:

  • Mutual Exchange – Carequality Connections must respond to all incoming queries with a purpose of use of Treatment
  • Open Exchange – Carequality Connections must respond in a non-discriminatory fashion with no terms, fees, or conditions

These two foundational principles are what makes Carequality so successful. They ensure that all of a patient’s clinical information is available nationwide for you to retrieve.

The only exceptions to the mutual exchange principle are:

  • Government agencies
  • On-paper organizations
  • Emergency Medical Services
  • Specialty Pharmacies
  • New organizations during the COVID pandemic
    • Temporary for the duration of the pandemic as decided by the Carequality steering committee

If you do not fall into these exceptions, responding to incoming queries with the unique clinical data you have as a result of your Treatment of the patient is required in order to make outbound Treatment queries. Any Implementer offering otherwise is putting you and your organization at risk of legal liability.

Redox can do this for you as part of our responder functionality since this is difficult to support and scale–you simply need to push us the relevant data.

If I’m using Redox to respond, when do I have to push?

To fulfill the requirements of participation stipulated in the previous answer, any instance where you treat a patient, you must push their data (via ClinicalSummary.VisitPush) to Redox so that we can fulfill the responder requirements. This doesn’t have to be immediately after their encounter. You may do this on a daily batch for example. For patient demographics updates, we expect all updates so that we can keep your patient demographics up-to-date and provide accurate responses to the other participants on the network when they request whether or not a patient has been seen at your location.

How can I re-use my Redox connection?

A single, easy-to-use Redox connection enables not only Carequality, but can be used for connecting to other health information exchanges, individual health systems, and other integration partners you may have. The same API queries used to search for patients and clinical documents can be used with workflows that leverage a direct connection to a healthcare organization’s EHR or to send data nationwide over the DirectTrust network.

Explore our network and the Carequality participants here!

What Redox event types do I use with Carequality?

For outbound queries, you’ll use the following Data Models:

PatientSearch

  • Query
  • (optional)LocationQuery

ClinicalSummary

  • PatientQuery

For responding to inbound queries, you’ll use the following Data Models:

PatientAdmin

  • New
  • Update
  • Merge

ClinicalSummary

  • VisitPush

What volumes will I see once connected to Carequality?

Many Carequality participants use automated workflow triggers to send outbound queries using algorithms based on radius-based searching around the patient’s address. While more rural areas may receive 10,000-25,000 daily, in geographic areas with high population density, such as the San Francisco Bay Area or New York metropolitan area, we have seen daily query volumes of up to 200,000 per location. Though Redox’s Gateway and Clinical Data Responder functionality, we help mitigate the risk this poses to your infrastructure and customers and reduce the overall development burden.

What about Commonwell and the eHealth Exchange?

Commonwell and eHealth Exchange are two of the nation’s largest centralized health information exchanges. Both are certified Carequality Implementers with thousands of sites live, meaning they can be queried seamlessly through the Carequality framework. Redox is also a member of the Commonwell network.

What are OIDs? Why are they important?

An OID is a globally unique ISO (International Organization for Standardization) identifier. They are important in the context of Carequality in that they uniquely identify organizations in the network. When creating your organization and facilities, you’ll need to use an OID as the primary identifier. You can read more about OIDs here.

What OID should I use when creating my organization?

Redox has a base OID and is a Registration Authority, so you will have an OID branch assigned for your use. This will typically be a branch off of the base OID 2.16.840.1.113883.3.6147.458.  

Alternatively, you can register and pay HL7 for an independent OID branch. Work with your Redox representative to determine the best strategy for your organizational identifiers.

Organization

I’m seeing errors when trying to create/update an Organization on Carequality

Here are a few error responses and what they mean:

  • Invalid “your Redox org ID”.DestinationID: This must be set to the Redox Destination ID of your clinical data repository (Data on Demand Destination)
  • “your Redox org ID”.Identifiers[] missing an Identifier with IDType ‘OID’: Be sure one of your Organization identifiers includes an ID with ID Type ‘OID’
  • OID for “your Redox org ID” is invalid; it must be an OID without the ‘urn:oid:’ prefix: Be sure to include an Organization OID from the branch Redox assigned in the wizard to you.
  • .ParfOf.Identifier.Value is invalid; it must be an OID without the ‘urn:oid:’ prefix: This should either be Redox if it’s your top-level Organization or an upper-level Organizatino if this is a lower-level.
  • .Contacts[] must include a contact for your organization: Create at least a “Technical” contact from your Organization and potentially a “Business” contact. Do not use Redox’s.
  • .Address must be the address of your organization, not Redox: Include the address of this Organization for you, not Redox’s. This is important as it helps other participants on the network locate you.

PatientSearch

What demographic information should I include in my queries?

At a minimum, you should include:

  • First name
  • Last Name
  • Date of Birth
  • Sex
  • Address

It is best practice to include as much information as possible. Most responding systems use advanced matching algorithms that have higher success rates as more information is included. Other valuable data points you may include:

  • Social Security Number
  • Phone numbers
  • Email

ClinicalSummary

I’m getting a lot of documents back on the response. What can I do?

ClinicalSummary.DocumentQuery has a number of useful parameters you can use to limit the number of documents returned or to find the documents that are relevant for you. Not all parameters are supported by all vendors. When supported, using the Visit.StartDate parameter can help you pull documents after a given date of service.

DocumentGet returns the full XML document. Why is that?

Some customers have pre-built capabilities to render XML C-CDA documents. Additionally, there are many open source CDA renderers (such as this one or this one) available that can be useful in viewing the document. We offer the option to return the XML document for this reason. If you’d like the ClinicalSummary contents in JSON format only, let your Redox representative know and they can help configure that setting.

Repository PatientAdmin/ClinicalSummary Push

When sending PatientAdmin or ClinicalSummary to my repository destination, I get an error such as “Cannot process messages for Data Chateau environment ‘environment’, the environment is in a ‘error’ state.”

Redox has a safety valve to ensure First-In-First-Out (FIFO) in production environments–this implies this valve was hit and the environment is not accepting new data. Currently, this is duplicated in development and staging environments, but may be reconsidered in the future. Please contact your Redox representative to reset the environment.

Other

No subscriptions. Meta.Destinations needs to contain a destination from existing subscription

This means that the right ID is not being specified in the “Meta.Destinations” array. This should contain a single entry with an “ID” as a property as appropriate depending on what you’re trying to do. Look for what you need in the below based on environment and data model (and event types):

  • Validation/Staging – Organization Query: adf917b5-1496-4241-87e2-ed20434b1fdb
  • Validation/Staging – Organization Create/Update/Delete: a07afe3b-d247-4415-827f-6837707e1b8b
  • Validation/Staging – Network-wide Location Patient Searching: adf917b5-1496-4241-87e2-ed20434b1fdb
  • Validation/Staging – Org-Specific Patient Searching: 1ca254a8-8d42-4593-abb4-b21399d9de57
  • Validation/Staging – Clinical Summary/Document Searching: ec745338-8849-43ad-a7ce-4bc5bf1d8b89
  • Production – Organization Query: 97f2dc1d-c71b-43a7-a436-9b789d44c804
  • Production – Organization Create/Update/Delete: 5d0fd248-6c52-4ad9-b907-ae10bf2dcc39
  • Production – Network-wide Location Patient Searching: 97f2dc1d-c71b-43a7-a436-9b789d44c804
  • Production – Org-Specific Patient Searching: 6391b961-55ae-430b-a789-cf575f03fca0
  • Production – Clinical Summary/Document Searching: 628cbf79-1156-4923-b9d0-285906160ed6