APHL Detor Post-Production Monitoring Guide
Although Detor significantly reduces the burden associated with managing test orders and results, some oversight will be necessary to identify issues (errors) and opportunities for improvement (warnings). The following reconciliation processes should be incorporated into your monitoring practices:
Monitoring for errors and addressing them promptly
Monitoring for accuracy of number of orders (i.e., is the PHL receiving samples that did not have an electronic order?)
Monitoring for missing information (warnings) (i.e., is an HCO or PHL consistently failing to send a piece of information, requiring manual updates?)
Monitoring for accuracy of number of results (i.e., is a result provided for every order?)
Public Health Laboratories (PHLs) and Healthcare Organizations (HCOs) can leverage a number of tools for daily monitoring.
DASH
APHL’s DASH product can be used as part of the daily process for reconciling messages and managing any errors and warnings.
Detor users should monitor DASH daily to:
identify/resolve messaging errors and
ensure that all expected orders/result messages are sent/received by AIMS.
DASH cannot confirm that messages are being received by the PHL/HCO without error—DASH only monitors that messages have been successfully received by AIMS, translated/transformed, and sent.
Note that DASH is available for many APHL solutions, including Detor. A general DASH User Guide is available online. A step-by-step DASH training for Detor, with screenshots, has been included below.
Note that no PHI is accessible through DASH.
DASH Detor Login
Navigate to the appropriate DASH environment via the links below and log into DASH using the user information provided by the AIMS Support Team.
Onboard and Production environments require separate logins. When onboarded onto DASH, please be sure to set up both accounts.
If you are not prompted to change your password, you can do so by 1) clicking your initials on the top right, 2) selecting ‘Edit Profile,' 3) selecting ‘Signing In’ under Account security, 4) and selecting ‘Update.’
DASH Home Screen
In the top left corner, the user can select the environment (Onboard or Production) in the drop-down. Note that when selecting a different environment, a new window will open with a login page for that environment as Onboard and Production environments do not share the same authentication context.
Filters
On the top right corner, information can be filtered by timeframe.
Message Counts & Filters
At the top right of the page, there are four status filters, which include Routed, Processing, Unknown and Errors. Clicking one of these filters changes the messages in view to those with that specific status.
The Routed message count represents messages that have been processed and sent to the intended recipient.
The Processing message count represents messages that are currently being translated/transformed in AIMS. This should almost always read 0.
The Unknown message count represents messages that have failed for unidentified reasons that don’t fit in another category.
The Error message count represents messages that have failed in a manner that DASH can identify (e.g., unexpected format such as JSON instead of HL7). Some error information will be provided in DASH, and the original message will be available in your S3 bucket.
Messages can also be filtered using the message count aggregate views. The different types of aggregate views are described below. To filter, hover over the category (or categories) of interest and select the “+” button.
For Detor, Event Types are separated by order or result, and you can filter to view one or the other as needed.
The Use Case for this training is Newborn Screening, but if you are using Detor for other use cases (e.g., clinical, environmental samples), that would be displayed and could be filtered here as well.
Senders/Recipients
The HCO and the PHL are listed under both senders and recipients since HCOs will typically send orders / receive results, while PHLs will send results / receive orders.
Users can be restricted to the organization or individual location. If a user has access to all hospital locations within an HCO system, each location can be filtered separately. However, since ordering facilities are identified by unique identifiers, hospitals with the same unique identifier will file under the parent name.
Note that recipients will only display at a parent level. They cannot be displayed by sub-sender.
Warnings are generated when a message fails to meet validation criteria (e.g., when a required field is received blank, if a field does not have the required number of characters). Messages containing warning messages can be filtered by warning type, and errors can be selected by clicking on ‘Errors’ in the top right corner
Graph: Message Activity
As users update filters, the graph below updates to show message volume in the designated time period. Trendlines can be filtered on/off by clicking the information in the legend to the right of the graph. This is an easy way to confirm that messages are still being transmitted after any network change that could affect connectivity. The graph can be toggled to view absolute message counts over time or message rate per a given time unit (e.g., messages per hour).
The view below shows message flow by absolute count.
The view below shows message flow by rate per hour with the absolute count toggle off.
Message Details
The grid on the bottom displays the messages selected based on the filters above. The column definitions for the grid are as follows.
Date EDT displays the date/time for the latest information available on the message.
Paper Order Link displays the identifier in the message that labs use to select records once the message is imported into the lab system. This is typically the barcode ID from the specimen card.
Placer Order ID displays the placer order ID for orders.
Filler Order ID displays the filler order ID for results.
Type is the type of message.
Status is the current processing status for the message.
Senders is the sender for the message.
Recipients is the recipient of the message.
Clicking on a message will open a pop-up window with more information regarding the metadata associated with the message. If both order and result messages are available, users can select either message to review metadata.
Note that no PHI is accessible through the DASH system.
Users can review all errors/validation warnings associated with a message. These warnings are populated based on the validation criteria established for the PHL. If changes need to be made to the validation criteria, users can submit a change request through the AIMS Service Desk (instructions begin here: https://aphlinformatics.atlassian.net/wiki/spaces/EPI/pages/2975629313/APHL+Detor+DASH+Training+v2#DASH-Support ).
Transcode failures occur when AIMS cannot translate information received in the message. These translations are managed by https://aphl.clinicalarchitecture.com/SymedicalAPHLWaypoint/#. Users should review the information in the transcode failure to verify that what was supposed to be sent is correct. If not, this information must be corrected in the EHR/LIS and resent.
Transcode Failures In refer to AIMS inbound messages, and Transcode Failures Out refer to AIMS outbound messages. As a reminder, every message is mapped twice by AIMS. It is first mapped from sender to Detor (Transcode In) and then Detor to recipient (Transcode Out).
If the information in the original message is correct, then there is likely a mapping issue, and Symedical catalogues need to be updated. In this case, the user must submit a change request to the AIMS Service Desk (instructions begin here: https://aphlinformatics.atlassian.net/wiki/spaces/EPI/pages/2975629313/APHL+Detor+DASH+Training+v2#DASH-Support ).
Lastly, the metadata from the message can be reviewed, as seen below.
Search
The search bar at the top of the screen can be used to look up messages by ETOR ID, Paper Order Link, Placer Order ID, or Filler Order ID. Since no PII or PHI is viewable through DASH, patient name, date of birth, etc. cannot be used as search terms.
Note that to use DASH for other projects, you can navigate to the project list and select from those projects you have access to.
Summary
DASH is a powerful tool for supporting the reconciliation and error/warning management processes.
Use DASH to monitor for errors and address them promptly.
Are any orders or results failing to successfully be processed?
Use DASH to support your process of monitoring for accuracy of number of received orders by HCO.
Are you receiving samples that did not have an electronic order? Are you receiving electronic orders without an accompanying sample?
Use DASH to support your process of monitoring for missing information.
Is an HCO consistently failing to send a piece of information, requiring manual updates in your LIMS?
Use DASH to support your process of monitoring for accuracy of sent results by HCO.
Are you sending results for every received order?
DASH Support
By clicking on the user initials on the top right corner, users can access the user guide or report an issue through the AIMS Service Desk. Refer to the Post Production & Support page for more information.
Activity Reports
Similar to DASH, Detor Activity Reports can be helpful in identifying recurring warnings or errors with either the messages you are sending or receiving. These items should be addressed by you or your sending partner. In addition, this report will provide easy insight into pending orders that have not been resulted. This can help identify any delays or specific issues associated with the resulting process. Detor Activity Reports will be emailed to the PHL and HCO selected contacts. The activity reports will provide the following:
A summary of all warnings and errors that occurred during the last week
A list of orders your organization has sent and received during the last week
A list of results your organization has sent and received during the last week
A 60-day order aging summary
A list of orders that have not yet received results during the last 60 days
The frequency for receiving these reports is configurable per each organization. Your preferences will be discussed and documented during the implementation and can be adjusted via a support request ticket. You can choose to receive them once a week on your preferred day, several days a week, or daily. The reports will be delivered between approximately 10:00AM-11:00AM EDT.
Sample Files:
The Activity Report is formatted as an Excel document with 5 tabs.
Tab 1: Overall
The first tab provides summary information including the reporting period timeframe, total orders and results, average result turnaround, a summary of all errors and warnings including an occurrence count, message activity details, and pending orders for the past 60 days.
PHL Version
HCO Version
Tab 2: Order Messages
The second tab provides a list of all orders either sent to you (for PHL) or sent by you (for HCO). This list includes the order sender, time that Detor sent the order, order identifiers (OrderLink and Placer OrderID), use case (e.g. Newborn Screening), and any errors or warnings associated with a particular order message. This list is sorted by the order sender and descending date/time.
Reviewing the order list and validating the accuracy of the counts can be valuable in identifying any issues (e.g. sender is transporting the same order multiple times). Reviewing any errors or warnings associated with a particular message can be helpful in identifying any problems that should be addressed by the order sender.
NOTE: Duplicate order identifiers will be highlighted to indicate possible issues with orders being sent multiple times.
PHL Version
HCO Version
Tab 3: Result Messages
The third tab provides a list of all results either sent by you (for PHL) or sent to you (for HCO). This list includes the result recipient, time that Detor sent the result, result identifiers (OrderLink, Placer OrderID, Filler OrderID), turnaround time between order received and result received by Detor, use case (e.g. Newborn Screening), and any errors or warnings associated with a particular result message. This list is sorted by the result recipient and descending date/time.
Reviewing the results list and validating the accuracy of the counts can be valuable in identifying any issues (e.g. sender is transporting the same result multiple times). Reviewing any errors or warnings associated with a particular message can be helpful in identifying any problems that should be addressed by the result sender.
NOTE: Duplicate result identifiers will be highlighted to indicate possible issues with results being sent multiple times.
PHL Version
HCO Version
Tab 4: Pending Orders
The fourth tab provides a list of all orders from the last 60 days that have not been resulted. This list includes the order sender, time that Detor sent the order, order identifiers (OrderLink and Placer OrderID), order age, use case (e.g. Newborn Screening), and any errors or warnings associated with a particular order message. This list is sorted by the order sender and descending order age.
Reviewing this list is valuable to identify any orders that are pending for an extended period of time so that they can be investigated by your team.
PHL Version
HCO Version
Tab 5: All Orders
The fifth tab provides a consolidated list of all orders that were either ordered or resulted. This list includes the order sender, times that Detor processes the message(s), status of the order, order identifiers (OrderLink, Placer OrderID, Filler OrderID), result status, turnaround time or order age, and use case (e.g. Newborn Screening). This list is sorted by the order sender and start date.
PHL Version
HCO Version
PHL Bucket/Folder Monitoring
PHLs will be leveraging either an S3 bucket (preferred) or SFTP folder for managing messages and their associated errors and warnings. PHLs can opt to generate their own alerting and follow up via the messages provided. The organizational structure is depicted here: APHL Detor Error & Warning Handling - Detor Resources - Confluence.