Projects

The integration comprises three modules, handled by three teams:

• EHR and Internal Rhapsody: Handles EHR integration, primary data enrichment, and customization
• DMZ Rhapsody: Handles data-format transformation, registry service & API calls, and integration with nphies endpoints
• .NET Development: Develops and maintains the data-mapping API, NHIC Registry Proxy Services, and SSO Launcher module

The integration comprises nine outbound interfaces from the EHR to nphies through two Rhapsody engines (Internal and DMZ)

• ADT: Patient Encounter Information. It include message trigger events – A01, A02, A03, A04, A06, A07, A08, A1, A12, A13, A35, and A38
• ORM^O01: Pharmacy Prescription Order
• RDS^O01: Pharmacy Dispense
• ORM^O01: Laboratory Order
• ORM^O01: Radiology Order
• ORU^R01: Laboratory Result
• ORU^R01: Radiology Result
• VXU^V04: Vaccination and
• CCD (XML): For Clinical Notes

The main challenges we faced and the solutions we implemented are as follows:

1. Data Gap Analysis:

This phase involved analyzing the existing EHR data (HL7 v2.x messages) to identify fields available in the EHR and those missing or optional in the EHR but required by nphies specifications. This is performed for each interface.

Since we are transforming HL7 v2.x messages to FHIR R4 for pharmacy, and CDA for laboratory and radiology orders and results, we needed to understand each field and its meaning in greater depth to perform accurate mapping. We referred to the relevant specifications and documentation, using examples where available, to understand field definitions and usage and ensure accurate mapping.

This gap analysis formed the foundation for the subsequent data-enrichment phase.

2. Data Enrichment Requirement:

The EHR’s standard HL7 v2.x messages did not contain all the data required by nphies specifications, requiring extensive data enrichment from the EHR backend through interface-specific scripts. Additionally, some previously optional fields had to be made mandatory in the EHR application.

3. Code & Terminology Mapping Requirement:

The administrative and clinical codes used in the EHR differ from those required by the Nphies platform. Extensive code mapping was therefore required in collaboration with specialized departments, including Registration, Scheduling, Physicians, Pharmacy, Laboratory, and Radiology. 

Code mapping was the most time-consuming part of the project and one of its biggest challenges, particularly the accurate mapping of laboratory orders and results. 

Some of the fields for which we maintain mappings include:

• Allergy
• Allergy Type
• Country
• Diagnosis Type
• Dosage Form
• Facility
• Gender
• Marital Status
• Nationality
• Order Status
• Result Status
• Result Unit
• Order Catalog (Laboratory and Radiology Orders)
• Clinical Event (Laboratory Results)
• Patient Class
• Procedure Code (Modality and Body Region)
• Route
• Vaccination Name
• Medication Name, Unit, and Strength mappings for prescriptions and dispensing items with NHIC generic and brand medication items

4 . Secure Connectivity and Data Exchange:

Since the integration involves systems outside the hospital premises, we had to address various security and firewall requirements. These were mainly resolved in collaboration with the hospital’s security, systems, and network teams. To ensure secure data transmission, we used HTTPS with certificates for encrypted communication.

The second team was responsible for implementing the interfaces in the DMZ Rhapsody environment. These interfaces perform two main tasks:

• Transform message formats from HL7 v2.x to FHIR R4 resources, CDA, and JSON according to the mappings defined during the Data Gap Analysis phase
• Perform final data enrichment by calling registry services to retrieve the patient Health ID and physician ID, and API services to retrieve additional mappings from the maintained database lookup tables
• Send the final data to the nphies endpoints and return the processing status to the internal Rhapsody for logging and reporting purposes

• Database Mapping API: Developed an API to retrieve additional mappings from the database lookup tables
• SAML SSO: Developed SAML-based Single Sign-On (SSO) to launch the Nphies portal directly from the EHR Physician Module.

How It Works

• Data Enrichment – Level 1: When an event occurs in the EHR, the corresponding HL7 v2.x message is triggered with additional customized data in Z-segments and sent to the internal Rhapsody interfaces.
• Data Enrichment – Level 2: Internal Rhapsody further enriches the HL7 message using database lookup tables maintained for code mapping. After processing and cleanup, the message is sent to the DMZ Rhapsody for further processing.
• Data Enrichment – Level 3: DMZ Rhapsody further enriches the data using Patient and Practitioner Registry APIs to retrieve the Patient Health ID and Practitioner ID, along with the Facility OID and additional mapped values from database lookup tables through API services.
• Data Transformation: The data is transformed from HL7 v2.x (except clinical notes, which use CDA) into the required FHIR R4 resources, JSON, or CDA format and sent to the external nphies secured endpoints.
• Message Dropping: In some cases, the Patient and Practitioner Registry APIs may not return the Patient Health ID or Practitioner ID due to incorrect input parameters (National ID and DOB) or for newborn patients. Since these IDs are mandatory, the DMZ interface drops the message.
• Status & Logging: Whether the message is sent or dropped, the DMZ Rhapsody interface returns the processing status to the internal Rhapsody interface, which logs it in a database table.
• Weekly Reporting: A separate interface reads the log table and generates a weekly report showing the number of messages sent to nphies and the number dropped.

My Contributions

• Contributed to the full development lifecycle and technical implementation, from requirements analysis and interface design through testing, deployment, monitoring, support, and documentation
• Performed data gap analysis and field mapping in collaboration with the vendor team
• Maintained administrative and clinical data mappings in collaboration with the database team
• Performed EHR back-end data enrichment through customized CCL scripts. The EHR has its own built-in integration module
• Implemented all interfaces in the internal Rhapsody environment, with a second level of data enrichment through database lookups
• Collaborated closely with the EHR team, various departments (Pharmacy, Physicians, Laboratory, and Radiology), and the vendor team