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Integrating your Pega Care Management application with external systems

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Updated on March 19, 2021

You can integrate with other applications or systems that support your organization.

The following list describes items that are related to integration:

  • Defining integration
  • Using the Integration Designer
  • Connector implementation
  • Microsoft Exchange Web Services
  • Integration using FHIR

Defining integration

Inventory the external applications that exist at your site and plan how to connect to them.

    An example is determining how the member profile information will be integrated.

      Note: Identify integration points as early in your planning as possible. If a connection to an external data source is required and either the data does not exist or the interface to that data does not exist, you must account for the time to publish these data sources and the time to configure the interface for this application.
      1. Identify all integration points for your application.
      2. Identify which data is needed from each system of record.
      3. Determine whether an interface to that system of record already exists and how to connect to it.

      Using the Integration Designer

      Use the Integration Designer to manage data at the application level. In the Integration Designer, you can access a comprehensive view of all business objects in your application and their associated data, such as references, data sources, and data views. You can easily create and modify data objects and connect to data sources.

      1. In the navigation pane of App Studio, click Data.
      2. Locate each data type that is marked SIMULATED, and then click the FIX NOW link to configure that data type to connect to real data.

      Connector implementation

      When you integrate your care management application with a Change Healthcare Interqual, MCG CareWebQI, or MCG Disease Management connector, you can access more healthcare information for patients.

      Pega Change Healthcare Interqual

      The Pega Change Healthcare Interqual® Integration Solution is bundled with the Pega Care Management and is referred to as a connector. It integrates your care management application with Change Healthcare's CareEnhance® Review Manager Application. This capability is licensed separately and depends on a subscription service with Change Healthcare Interqual.

      With this connectivity, you can use Change Healthcare InterQual directly from within the Pega Platform and have real-time, bi-directional interaction with the InterQual system.

      Features of the connector include:

      • Interqual book view for research on guideline subsets from the patient portal
      • Seamless integration of Interqual guidelines during a UM Review
      • Dynamic submission of Pre-Cert information for targeted criteria search
      • Hospital stay concurrent review
      • Automated Pre-Cert decision-based Interqual criteria met status
      • The Review Manager case associated with Pre-Cert request

      For more information, see the following references:

      Pega Integration Solution for MCG CareWebQI

      The Pega Integration Solution for MCG CareWebQI integrates Pega Care Management with the MCG CareWebQI application to give you access to evidence-based best practices and guidelines so that you can document your utilization man re comprehensive, consistent, utilization management practices.

      For more information, see the following references:

      Pega Integration Solution for MCG Disease Management

      The Pega Integration Solution for MCG Disease Management integrates Pega Care Management with the Informed by MCG for Disease Management solution to provide chronic care assessments and care planning tools for use in patient care. With real-time access to chronic care guidelines, care managers can integrate these services into their workflows and rapidly build, document, and share care plans. The modular guidance makes it easy to provide patients with education and self-care. This helps to reduce the incidence of emergency care utilization, 30-day readmissions, and preventable adverse outcomes for individuals with chronic disease and other complex conditions.

      For more information, see the following references:

      Testing the connectors

      After you install and configure the connector software in your environment and update the security parameters, you can test and validate the connector.

      See the testing sections in the following resources for each of the connectors:

      Microsoft Exchange Web Services

      Optionally, you can integrate your application with Microsoft Exchange Web Services to schedule appointments, check the availability of the participants, and also send them invitations to the meeting for visit planning.

      For information about the preconfigured SOAP web services for integrating with Microsoft Exchange Web Services, see the Pega Foundation for Healthcare Implementation Guide on the Pega Foundation for Healthcare product page.

      Integration using FHIR

      With the Pega Fast Healthcare Interoperability Resources (FHIR) APIs in Pega Foundation for Healthcare, you can integrate your application with external electronic medical or health record (EMR/EHR) systems and other clinical data repositories. By using a FHIR API, you can obtain specified information about the patients that are managed in your application. For example, you might want all new referrals or authorization records for a patient from a third-party system. Or once you have the initial policy information for a patient, you might want to receive updated policy records on demand.

      Fast Healthcare Interoperability Resources (FHIR) supports the interoperability and exchange of healthcare-related information between organizations. This includes clinical, administrative, public health, and research data.

      Before you begin: Identify the FHIR APIs that will be used for integration with your care management application. For more information, see the Pega Foundation for Healthcare FHIR API Technical Specification Guide on the Pega Foundation for Healthcare product page.
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