Most of the setup process and instructions you can find Third-Party App Setup and Support Guide on Galaxy. This document serves as a supplement - it adds details specific to Way to Health, and points you to specific sections of the Galaxy document as not all portions of that document are necessary.

Overview

Way to Health is a platform used to power a range of programs in the realms of connected health, remote patient monitoring, and patient engagement. Most of our clinical programs use text messaging, but we also use surveys, connected devices, and other data sources.

Different programs, different integration needs

Different Way to Health programs will have different workflows and integration needs. For example, Heart Safe Motherhood (a postpartum BP monitoring program) requires a way to enroll patients, start them in the program post-discharge, and send BPs received from the patient back to the medical record. Coloprep (a text program to improve colonoscopy prep) does not require manual enrollment, but instead uses an HL7 scheduling feed to enroll patients and trigger the text messages at the right time.

Your Way to Health implementation lead will guide your clinical, operational, and IT teams in deciding which features are needed for the specific program(s) you are implementing.

Setup once, use for multiple programs

Way to Health’s Epic integration requires a one-time setup before it can be used for any number of programs. For example, once the embed is available, health systems can begin enrolling and monitoring patients in as many W2H programs as they’d like with no additional IT setup. Similarly, once an outbound ADT feed is established, this can be used by any number of programs to start the intervention after discharge. This applies to all of the features described below except for flowsheets and InBasket messaging, which are typically configured for a specific program or care team and therefore require program-specific customization.

Use Cases, features, and required setup

Our app listings specify the broadest set of APIs and interfaces we use, but each connected health program will only use a subset. This table summarizes which integration features are available to support workflow needs, and the setup required.

Use Case	Feature	Required Setup
Enrolling patients Monitoring patients (data, messaging, and more)	Embed	Webservices access (via frontend OAuth2/SMART on FHIR) Web App Integration Record (details below) Web App Integration Launch Point (see Galaxy for details) “Way to Health” client ID
Sending patient-entered data to the medical record via flowsheets (Requires only one of these 3 approaches)	Inbound HL7 flowsheet via TCP/IP	VPN between your interface engine and ours Flowsheet identifiers for use in OBX-3
	Inbound HL7 flowsheet over HTTPS	“Way to Health - Backend” client ID Flowsheet identifiers for use in OBX-3
	Flowsheet - via Observation.Create	Webservices access (via Backend OAuth2) Flowsheet identifiers (see details below) “Way to Health - Backend” client ID
Alerting clinicians or care teams of patients needing attention	InBasket	Webservices access (via Backend user) Inbasket pool/HIP (details below) “Way to Health - Backend” client ID
Triggering text outreach programs post-discharge Turning participant messaging on and off during readmissions	Outbound HL7 ADT feed	VPN between your interface engine and ours Establishing outbound interface
Triggering text outreaches prior to a procedure	Outbound HL7 Optime Scheduling feed	VPN between your interface engine and ours Establishing outbound interface
Triggering text outreaches prior to an appointment	Outbound HL7 Cadence Scheduling feed	VPN between your interface engine and ours Establishing outbound interface

Implementation process

Build and testing for a connected health program

TODO

Setup and testing for Epic integration

TODO

Information to send to Way to Health

(reference: Send Specific Information to Your App Vendor)

	When do we need this?	Example
Patient ID Type	Always	`MRN`, `HUP MRN`, `MR`, etc.
Interconnect Base URLs Prod OAuth Non-prod OAuth	Always	`https://vendorservices.epic.com/interconnect-amcurprd-oauth/`
Inbasket pool Pool ID (HIP .1)	Each Inbasket where we’ll send escalations	`14234`
Flowsheet information	For each data point (e.g. systolic BP) that we’ll send via WebServices or HL7	Either FLO .1 (e.g. `1320`) AND Health-system-specific OID (e.g. `urn:oid:1.2.840.114350.1.13.0.1.7.2.707679`) OR Flowsheet FHIR ID
Network configuration	If needed to access Interconnect
VPN info To be worked out between your networking/security team and our sysadmin team	If we’re using a TCP-based HL7 feed (in either direction) For inbound HL7 flowsheet, we can use the HL7v2 webservice instead
Root CA	If Interconnect’s TLS certificates are self-signed or issued by a private CA	PEM file such as `yourhospital_root_ca.pem` Once we can access Interconnect, we have tools that can extract this PEM file

Program changes and shutdown

Once a program is live, all program changes (including shutdown requests) should be submitted through our help desk located at http://support.waytohealth.org

Epic embed

Desktop Integration

The Galaxy document Create Integration Records for Active Guidelines describes how to create the embedded view. Here are the details you’ll need to supply as you complete that setup:

Recommended method, using SMART launch

reference: Configure the Integration Record for SMART on FHIR

Client ID	Prod:	`3aa086b8-6dfb-4143-9100-b8e003ebe2a2`
Client ID	Non-prod:	`3ced6ceb-0741-4cf1-83ba-99f3b34d600a`
Integration type	SMART on FHIR
Authentication Method	SMART on FHIR
Launch URL	Prod:	`https://app.waytohealth.org/epic/smartLaunch`
Launch URL	Non-prod:	`https://staging.waytohealth.org/epic/smartLaunch`
Launch Context	`epicUsername`	`%SYSLOGIN%`
	`userFirstName`	`%USERFNAME%`
	`userLastName`	`%USERLNAME%`
	`mrn`	`%EPTID;;; ; ;nnnn;NONE;%` Instead of `nnnn`, use the (numeric) ID type that w2h will use. See the launch token library for details.
	`csn`	`%CSN%` In some contexts this value will be empty, but if the embed is launched in the context of an encounter, having the CSN is useful for some workflows
	`frameAncestor`	`%CLIENTHOSTSOURCE%`

Legacy launch, using AES encryption

reference: Configure the Integration Record for HTTP GET

Type	1-PACS
Model	10-Web PACS
Patient ID Type	A value should be specified here, but will depend on your health system
CRYPTURL	Prod:	`https://app.waytohealth.org/epic/embed?encrypted=%CRYPTSTR%`
CRYPTURL	Non-prod:	`https://staging.waytohealth.org/epic/embed?encrypted=%CRYPTSTR%`
CRYPTALGO	AES128
CRYPTIVLENGTH	0
Launch Context	`EPICUSERID`	`%SYSLOGIN%`
	`USERFNAME`	`%USERFNAME%`
	`USERLNAME`	`%USERLNAME%`
	`PATID`	`%EPTID;;; ; ;nnnn;NONE;%` Instead of `nnnn`, use the ID type that w2h will use. See the launch token library for details.
	`CSN`	`%CSN%` In some contexts this value will be empty, but if the embed is launched in the context of an encounter, having the CSN is useful for some workflows
	`frameAncestor`	`%CLIENTHOSTSOURCE%`

Flowsheet

We currently only support writing to Clinical Documentation Flowsheets - Patient Entered Flowsheets include workflow constraints that are not feasible for how our programs operate. (Either they require a MyChart account limiting patient access/equity, or they require an order to be placed by the provider to create the flowsheet.) We recommend creating new flowsheet rows and naming them to make clear to any users that the data is patient-entered.

We can send flowsheet data using any of the following three mechanisms:

Mechanism	Content	Flowsheet row identifiers	Encounter	Receiving system	Requires VPN
HL7 over TCP	HL7 message (ORU^R01)	OBX-3 identifier	Can be created by interface	Interface engine or Bridges	Yes
HL7 over HTTPS	HL7 message (ORU^R01)	OBX-3 identifier	Can be created by interface	Interconnect	No
Observation.Create	JSON	flowsheet ID (FLO .1)	Must already exist, and encounter ID in w2h	Interconnect	No

HL7

More information on setting up HL7v2 over HTTPS can be found in the Galaxy document Incoming HL7v2 Over HTTP or HTTPS Using Interconnect.

Setup required:

New interface setup:
- Interface Kind: Incoming Clinical Documentation Flowsheet Data [97]
- No custom setting or custom executable codes used. All standard settings.

We have found success with having Bridges create a new encounter for each new data point received. That can be done by setting Bridges Profile variable VISIT_MATCH_USE_DATE_RANGE [80604] to 0 - Use visit ID only (default 1 - Use visit ID, then search by date range).

Sample message:

MSH|^~\&|WAYTOHEALTH|WAYTOHEALTH|YOUR_HOSPITAL|EPIC|20230614112200||ORU^R01^ORU_R01|12234|T|2.6
PID|1||0123456^^^^MR|876876^^^^WAYTOHEALTH|Doe^Jane||19600101
PV1|1||DEPT_A|
OBR|1||148745|29274-8^VITAL SIGNS MEASUREMENTS^LN|||20230614112132||||||||||||||||||F
OBX|1|NM|SYSTOLIC^INTRAVASCULAR SYSTOLIC^||126|^mmHg|||||F|||20230614112132
OBX|2|NM|DIASTOLIC^INTRAVASCULAR DIASTOLIC^||71|^mmHg|||||F|||20230614112132

Identifiers

The identifiers in OBX-3-1 (SYSTOLIC an DIASTOLIC in the sample message above) can be modified if needed to match other flowsheet rows in your system.
The dept ID (DEPT_A in the sample message) is used by Bridges to determine which dept to create an encounter in
We send MRN, First Name, Last Name, and Date of Birth in the PID segment. These are used for identity verification by Bridges. PID 4 contains the patient’s Way to Health ID, which isn’t used by Bridges but can be helpful for troubleshooting.

Observation.Create

Flowsheet identifiers

We can use two types of identifiers for flowsheet rows - either the FHIR ID or the FLO .1 ID coupled with an OID specific to your health system. FHIR flowsheet IDs can be generated in the Interface Programmer Menu in Text. (d ^AI -> Support Utilities -> Web Service Utilities -> Generate Encoded Flowsheet IDs. If you don’t know the health-system specific OID for flowsheet rows, your Epic TS can help. Reference SLG 4392308.

Inbasket

Base requirements:

Webservices access (see “User and Security Setup” above)
Requires installing backend app

Project setup

We need Pool ID (HIP.1)
We typically send messages as Staff Message (message id type = 1). Sending messages into other folders requires more complex setup - consult your Epic TS for details on which message types can receive messages via API.

Other optional setup

Some of our health system customers use Smart Forms to drive some of the enrollment or tracking process. Some programs have set up Smart Phrases to pull flowsheet data sent from Way to Health into clinical notes. If you’re interested in using these tools, we can connect you with the IT staff or physician builders who set these up.

Implementation guide