Technical Considerations > Carequality Technical Overview
Technical Considerations

Carequality Technical Overview

Use Redox to integrate with the nation’s largest medical record retrieval network.

Executive Summary

Patient summary documents, including discrete information like allergies, medications, and problems, are a widespread tool to facilitate transfer of care between healthcare professionals as patients move between organizations. This enterprise-level interoperability is important in both planned and emergent care scenarios.

Carequality represents a common interoperability framework with over 17,000 participating healthcare organizations using more than 35 health technology systems. Offering common rules of the road, well-defined technical specifications, and a participating organization directory, Carequality is leading in terms of promoting enterprise interoperability nationwide.

Carequality helps simplify trust between provider organizations, allowing them to pull patients’ records by signing one simple agreement.  As a certified Implementer, Redox helps vendors and their customer healthcare organizations join this growing network and exchange clinical summaries. 

Partners participating through Redox can use the same simple API that is available for traditional integration use cases. In addition, Redox has advanced features that make this interoperability even easier, with improved organizational directory tools, identity management for reduced query volume, and data retention for quicker product onboarding.

In this overview, we outline the strategies and information application developers can use when architecting their solutions, as well as some of the advantages and drawbacks of different approaches.

Relevant Data Models

There are a number of Redox Data Models that third-party applications connecting to healthcare organizations through Carequality may utilize. These include models where data is pushed via webhook and models where data can be queried.

Organization

In order to synchronize the list of organizations available on the Carequality framework, Redox offers the Organization Data Model. This contains key information about organizations and their facilities, such as name, address, points of contact, and underlying facilities. By searching for and pulling this list, connecting applications can allow their users to choose which organizations they’d like to pull data from or develop automated algorithms based on criteria such as zip code. 

The Organization Data Model also allows connecting applications to manage their own facilities on the network, adding, updating, and deactivating sites as needed.

PatientSearch

After determining the relevant organizations to search, the Redox PatientSearch Data Model can be used to retrieve the local identifier for the patient at the relevant facilities. Applications can launch queries with demographic inputs to search for a match and obtain the patient’s relevant demographic data and the full set of identifiers from the external sites. 

ClinicalSummary

Upon determination of a match at an external site, Redox offers the ClinicalSummary Data Model for search and retrieval of available documents for that patient at the site. Carequality participants offer a variety of document types, but most commonly respond with patient-level and/or visit-level summaries. These documents include both human readable and discrete encoded medications, allergies, problems, and other data. 

Workflows

Query Responder

All Carequality participants are required to respond to incoming PatientSearch and ClinicalSummary queries with the Treatment purpose of use. Participating organizations must treat all other Carequality members equally when responding, in a non-discriminatory and uniformly applied policy. This helps create a robust network for transition of care between providers. Other use cases beyond Treatment such as Payment, Operations, and Patient Request are allowed on the Carequality network, but not yet widely supported by Implementers. If you would like to join the Carequality network using one of these use cases, reach out to a Redox representative for further information. You can use the hierarchy here as guidance about your own purpose of use.

As a distributed network, acting as a query responder can entail high incoming query volumes. These volumes are influenced by a variety of factors, such as geographic location of facilities, total number of facilities, and the extent to which the participant has a master patient index across its sites. Redox helps participants implement best practices in regards to organizational structure and has additional product features available to help customers reduce engineering investment such as our Carequality Gateway Responder or Clinical Data Storage offering.

There are a limited number of defined exceptions to participating as a Query Responder. 

  • If acting as a query responder would violate applicable law 
  • The data available through the participant is of a nature such that it is inappropriate for treatment
  • The participant is a government agency
  • The participant is is a provider organization with no clinical information that could reasonably be made available for response 
  • The participant is an EMS provider with alternative provision of data, such that: 
    • Its primary healthcare activity is patient transport with paramedic support 
    • The organization to which it is transporting the patient can reasonably expect to receive a summary of any care in a format such that the summary can be included in the organization’s electronic record for the patient.

Query Initiator

Once you’ve established your strategy as a Query Responder, you can consider the most effective way to retrieve external data and provide value to your own users. Participants implement this in a number of ways, with some opting for automated retrieval based on workflow triggers such as scheduling events. Others build a robust user interface so that doctors, nurses or other healthcare professionals can select and retrieve from known patient care locations.

Redox Solutions Architects can help you navigate these workflow choices, designing an integration that works for your use case and workflows, including organization selection, patient matching, document retrieval and rendering, and discrete data reconciliation. 

Redox Products

Integrating with a nationwide clinical data exchange network isn’t one-size-fits-all. Redox has a number of solutions to meet your needs.

Organization Management

Many advanced features are enabled by default when integrating with Carequality through Redox.

Self-service organizational management for easier onboarding 

General Initiator

Standard outbound clinical data retrieval

For those preferring a JSON payload and simpler API experience may use the ClinicalSummary.PatientQuery:

Simplified outbound clinical data retrieval

Carequality Gateway Responder (beta)

Best for: Software vendors with widespread national deployment

For scaling or enterprise customers with many facilities, volume can be an issue. Redox offers a simple and easy-to-use patient identity service to act as a gateway to your sites, protecting them from duplicative traffic.

Carequality Clinical Data Storage & Responder (beta)

Best for: Software vendors of any size that don’t want to build out ability to respond to the high volume of queries

For partners looking to join CEQ without the engineering investment required to respond to XPCD and XCA requests, Redox offers Carequality connectivity powered by Data on Demand. In this model, Redox can respond to queries from Carequality participants and insulate your infrastructure as the network grows.

Redox Services

Redox’s support for Carequality does not stop with just technical features. As a full-service solution, by working with us, our services help ease and accelerate Carequality for you every step of the way.

Best Practice Guidance 

As you begin your Carequality journey, Redox will work with you to scope and design all aspects of your integration. By providing you with advice on user experience, known gotchas, and roll-out planning, Redox is your complete partner.

Quick Onboarding and Implementation 

Redox’s Carequality Implementer experience and status reduces overhead and streamlines processes so you can get your facilities exchanging data rapidly. Self-service organization management APIs enable you to automate onboarding or even delegate implementation to your customers with the click of a button.

Ongoing Maintenance and Support

Once you’ve brought sites live, every Redox integration is backed by 24/7 monitoring and support to ensure connectivity errors from other Implementers are resolved. We are the first to identify and triage any issues that may arise. 

FAQ

How can I get started?

You can reach out to us at [email protected] or use this 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?

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 widely support push notifications, other enterprise interoperability networks and health information exchanges specialize in those workflows. Reach out to a Redox representative to help you identify the right fit for your use case.

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.

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. Reach out to a Redox representative to learn more about our network.

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. Redox can help mitigate the risk this poses to your system and customers.

What about Commonwell?

Commonwell is a national health information exchange that is a certified Carequality Implementer with over 300 facilities live on Carequality and 10-15 new sites joining each week. Redox is also a member of the Commonwell network. If interested in connecting with a particular Commonwell site, reach out to the Redox team for more information.

Additional Links

Review Developer Documentation about patient information and start building applications that seamlessly integrate with any EHR.

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