Allergy Web Service Development Overview

First Data Bank Only Systems

Users will be unable to set the ‘Enable Allergen Search Web Service’ Registry Setting if the Allergy Content is being supported only by First Data Bank. If a system has FDB Allergy records defined but also have the Micromedex Content enabled then the Registry Setting can be enabled. All FDB Allergy records would have already been converted to be similar to the Micromedex records, and will therefore be treated as such. 

Netsmart Cloud Configuration for MU 2014 Edition

Those facilities that are being configured for the Netsmart Cloud to support the Meaningful Use 2014 Requirements will use the ‘Enable Allergen Search Web Service’. However, it is unnecessary to define the ‘Allergen Search Web Service URL’ since that information will already be defined within the CareFabric Configuration form. This configuration is part of the Professional Services associated with a Meaningful Use 2014 Implementation project and will be conducted by a Netsmart Associate.

Existing Micromedex Allergy Code Update

Upon configuration, a process is executed that will run in the background for any system that currently has locally defined Micromdex (MMX) Allergy Codes defined. The corresponding Allergy record will be identified hosted on the Netsmart Cloud. The following attributes will be updated on the locally stored allergy codes for historic and active records already assigned to clients.

• RxNorm Code
• SNOMED Code
• NUI Code
• Allergy Type
• MAS Allergy ID

Allergen Code Search - Local Record Saving

Every time an Allergy record is saved in Allergen/Reactant Code Setup or Allergies and Hypersensitivities forms, the record from the Netsmart Cloud will be saved locally to myAvatar . If the Allergy record already exists, then a refresh of the Allergy Code record will be performed and any changes to the RxNorm, SNOMED, NUI, Allergy Type or MAS Allergy ID will be updated. These attributes will not be editable by the user. All codes saved will contain the prefix of ‘MDX’ in order to identify the Micromedex Allergy records.

The updated Allergen Code search logic will omit those Allergen codes that are flagged as DEACTIVATED, HIDE FROM SEARCH or as DEPRECATED, unless the search is invoked from the Allergen/Reactant Code Setup form.

System Task Scheduler - Local Record Refreshing

A system task called Allergen/Reactant Code Update has been added to the System Task Scheduler form. This will allow a facility to set up an automatic refresh of the Allergy Code definitions from the Netsmart Cloud. A refresh of the allergy records will be conducted per schedule and the updated content will be saved to the local definitions in myAvatar . 

Allergen/Reactant Code Setup Form Updates

Upon enabling the Allergy Web Service in myAvatar , the Allergen/Reactant Code Setup form is updated in the following ways:

1. Modified Field - The Add/Edit Allergen Code field is changed to Search/Edit Allergen Code. The choices for searching will be:
   • Search/Edit Locally-Stored Definition - This will search any locally saved allergen record.
   • Search for new Allergen Code - This will search the Netsmart Cloud content using the Allergy Web Service. Only active records will be returned within this search service.
2. New Field: Deprecated - All current user-defined allergy records will be marked as Deprecated. This will prevent anyone from selecting user-defined allergies to assign to a client moving forward. However, these records are still Active since they could already be assigned to current client records.
3. New Field: Hide from Search - In order to hide an allergen record from the search within Allergies and Hypersensitivities the user can now select Hide From Search for specific allergen records. Previously, users used the Deactivate Allergen Code field to hide allergy records they did not wish their users to select. Whether or not an allergy record is deactivated will be dictated by the content in the Netsmart Cloud and will be un-editable.
4. Every time an Allergy record is saved in Allergen/Reactant Code Setup form the record from the Netsmart Cloud will be saved locally to myAvatar . If the Allergy record already exists then a refresh of the Allergy Code record will be performed and any changes to the RxNorm, SNOMED, NUI, Allergy Type or MAS Allergy ID will be updated. These attributes will not be editable by the user. All codes saved will contain the prefix of ‘MDX’ in order to identify the Micromedex Allergy records.

Allergies and Hypersensitivities Form Updates

Upon enabling the Allergy Web Service in myAvatar , the Allergies and Hypersensitivities form is updated in the following ways:

1. Modify the Allergen Code Search logic to call the Netsmart Cloud Web Service when enabled.  If there is ever any interruption to the Netsmart Cloud service this form will revert back to searching the locally stored allergy codes. 
2. Every time an Allergy record is saved in Allergies and Hypersensitivities forms the record from the Netsmart Cloud will be saved locally to myAvatar . If the Allergy record already exists then a refresh of the Allergy Code record will be performed and any changes to the RxNorm, SNOMED, NUI, Allergy Type or MAS Allergy ID will be updated. These attributes will not be editable by the User.  All codes saved will contain the prefix of ‘MDX’ in order to easily identify the Micromedex Allergy records.
3. The following allergy records will NOT appear in the Allergies and Hypersensitivities allergy record search:
   • User Defined Allergy codes
   • Allergy codes marked as Deactivate Allergy Code
   • Allergy codes marked as Hide From Search
   • Allergy codes marked as Deprecated

Allergen Code Load/Update Utility Via Micromedex Form - REMOVED

The Allergen Code Load/Update Utility Via Micromedex form will be removed from myAvatar Order Entry upon enabling the Allergy Web Service. This form will no longer be needed since the facility will not be loading the Truven Micromedex content directly into myAvatar any longer.

Clinical Reconciliation Form Update

The Clinical Reconciliation form will be updated to use the Allergy Web Service in much the same manner as the Allergies and Hypersensitivities form.

File Import

Avatar CWS 2014 Update #88 introduces an updated Allergen Code Setup Import file format. Upon enabling the Allergy Web Service users will no longer be able to Add new Allergy records via import. The File import supports editing the following information for all allergy records locally stored in myAvatar :

• Associated RxNorm Code (RXCUI)
• Associated SNOMED-CT Code
• Associated NDF-RT Unique Identifier (NUI) 
• Interface Code- HL7 related
• Interface Description- HL7 related
• Include/Exclude Numerator/Denominator- Used for the MU 2011 Edition

Autosync Dictionary Functionality

The Autosync dictionary functionality will work in the normal manner. Users won’t be able to edit code in other facilities. Editing of any Allergen code will only be allowed for facilities designated as the ‘Master’.