Healthcare

Healthcare - Establish AIMS Connectivity for Testing 

This page details the steps that should be taken when a healthcare organization (HCO) is ready to establish a connection with the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) platform. Prior to establishing connectivity, HCOs, in coordination with their EHR company, should have completed the healthcare readiness and implementation checklist items, including determining the appropriate policy path.   

If, based on policy/network membership determinations, the HCO intends to use a Health Information Exchange (HIE) or Health Information Network (HIN) to connect, the HIE may need to contact the eCR Support Team to ensure that their connection to the AIMS platform is in place.  

There are two secure transport options for eCR connections: 

 1. Direct Secure Messaging  

Direct Secure Messaging provides secure transport for the sending and receiving of encrypted health information. Administered by DirectTrust (external link), Direct Secure Messaging is a secure transport mechanism for communicating sensitive health information using The Direct Standard® via a “push” interoperability mechanism from the sender to the AIMS platform. Connecting with Direct Secure Messaging involves the use of the specifications outlined on the Direct Project Applicability Statement for Secure Health Transport wiki (external link).  

 2.  XDR (ITI-41) specification using the eHealth Exchange HUB  

XDR ITI-41 is the other common industry specification for “push” information exchange. The XDR (ITI-41) specification (file download) is a slightly more constrained version of XDR that makes it more consistently usable.   

Technical Prerequisites to Establish Connection 

HCOs should work in collaboration with their EHR and/or HIE/HIN (as needed) to ensure their organization completes the prerequisites for connecting to the AIMS Platform based on the secure transport option.  

There are a few technical prerequisites to establishing either connection. Specific setup prerequisites and configurations steps for HCOs will be outlined in their EHR’s documentation.  

Direct Secure Messaging Technical Prerequisites 

To establish a Direct Secure messaging connection, HCOs first need to: 

HCOs Health Information Service Provider (HISP) representative will be able to confirm the DirectTrust registration status of their addresses.  

XDR (ITI-41) Technical Prerequisites 

To establish a XDR (ITI-41) connection, HCOs first need to: 

  • Establish a Health Level Seven International (HL7) Object Identifier (OID) for both their production and testing environments.  
  • Establish a XDR (ITI-41) endpoint URL for both their production and testing environments. If their EHR company has implemented eCR in multiple other settings, it may be possible to bypass the testing connection, but, otherwise, its use is strongly encouraged.  
  • Establish trusted certificates with a chain for mutual authentication.  

How to establish a connection with Direct Secure Messaging 

Once all EHR setup and configuration tasks are complete, including the ability to trigger a test electronic initial case report (eICR), HCOs can now test their connectivity with the AIMS platform. During this process, HCOs may need to work with their Health Information Service Provider (HISP). Follow the below steps to establish a Direct connection for eCR:  

  1. Contact HISP.  HCOs should reach out to their HISP to confirm they have the latest certificates on their test environment and determine if the Direct address they will be using for testing is on the Interoperability Testing Bundle or the Production Accredited Trust Bundle.    
  2. Send test eICR. Trigger and send a test eICR using a test patient that has fully populated demographic information. Only send synthetic test data. Do not send Protected Health Information (PHI) during these tests.  
  3. Ensure Reportability Response (RR) is received. Once the test eICR is sent, the AIMS eCR platform will automatically send an RR message back to the sending Direct address upon receipt.  
    • If an RR is not received, HCOs should verify their configuration to rule out the most common issues found below.  
      • Confirm the eICR was generated and sent. 
      • Confirm the eICR made it to the HCOs HISP.  
      • Confirm the eICR was attached to a Direct Secure Message.  
      • Confirm the receipt of a successful Message Disposition Notification (MDN) response from AIMS.  
      • Confirm the patient-matching configurations allow for matching the RR to an existing patient.  

  4. Confirm Success. Inform the eCR Support Team by creating a ticket through our service desk customer portal. In the subject line, include the name of the HCO and “Direct SMTP in TEST.” Communicate in the message that a test eICR was sent via Direct. Include the time and date of the message, the Direct address, and note if the RR was successfully received. If the RR was not received, include the troubleshooting steps completed.  

 How to establish a connection with XDR (ITI-41) 

Once all EHR setup and configuration tasks are complete, including the ability to trigger a test eICR, HCOs can begin testing their connectivity with the AIMS platform. Follow the below steps to establish a XDR (ITI-41) connection for eCR:   

  1. Inform the eCR Support Team by creating a ticket through our service desk customer portal. In the subject line, include the name of the HCO and “XDR (ITI-41) Connection Request.” In the message, include information for any technical point(s) of contact.  
  2. The eCR Support Team will reach out with further onboarding instructions.  

What to do after establishing a connection 

After a test connection for eCR has been established, test eICRs can then be validated and processed, and a RR will be returned to the HCO. HCOs should not, however, send actual patient data to the test address. Proper testing will require that data for synthetic patients (test patients with no real personal health information) be exchanged; however, test patient data should resemble production patient data as much as possible.  

Additionally, when using the test environment, the test eICRs and RRs will be transmitted via a test channel to appropriate PHAs to validate those pathways. When in production, "reportable" and "may be reportable" RRs should be attached to the patient chart or directed to the appropriate provider/support staff work queue, and all RRs should be reviewed by system administrators for errors and warnings. 

See the Healthcare – Conduct Testing page for additional context on testing.