In the Care Management Framework, Data Sources are used to retrieve claims and other clinical data for patients. Data sources are configured in activities.

When a Data Source activity is configured, it becomes available for use by business users to create the data source templates that are used in care plans and programs and provide the Alert Processor with the data it evaluates against the runtime criteria set in an Alert template.

Data Source Activities

The framework ships with the following sample Data Source activities for demonstration purposes that are configured to retrieve data from the sample data included in the framework. You can copy them to create your own.

• getMedicalClaims
• getMedicalClaimsWithDiabetesDiagnosis
• getPharmacyClaims
• getPharmacyClaimsForVytorin

To create Data Source Activities

1. Create a new activity in Rule-PegaCare-DataSource class and save it to your RuleSet.

Configure the activity to retrieve the data to meet your requirements.

The name of the top level clipboard page holding the result of the query must be named RecordsFound.

2. When the activity is saved, add the activity and a user friendly description to the Prompt Values list located on the General tab of the Rule-PegaCare-.RuleName property.

Data Source Types

Data source types define the category of data sources available to business users in the Maintain Data Source Template wizard. The Care Management framework is shipped with two sample Data Source types that you can use as examples to create your own.

• Medical Claims
• Pharmacy Claims

Creating a Data Source Type

1. Map the data source class in the declarative space of the LOAD_CM_ENV activity.
2. Map the data source class ID property into the step of the declarative space of theactivity.

2. Update the FilterCodeForDataSourceWhen rule to filter code group types that do not apply to this data source type.

   

3. Update the GetSourceDataClassdecision table to map the data source type to the data source class you configured in step 1.

   

4. Update the GetSourceDataClassIDdecision table to map the property that holds the ID of the data source class.

   

5. Add the data source type as a Rule-Obj-FieldValue to the Rule-PegaCare-DataSource.pyCategoryproperty.

   

Design Considerations

When you design your data sources:

• Plan the use of data source activities carefully since their design plays a key role in the efficiency of the Alert Processor
• Try to limit the amount of data brought back for processing to only what is needed

Examples of typical considerations

• An alert needs to look only at claims with a principal diagnosis of diabetes. What should you consider?

When a high number of alerts are being processed, unnecessary computing cycles become a factor and reduce efficiency. In this case, the Alert template should reference only the Data Source that retrieves claims with a principal diagnosis of diabetes.

• A clinical guideline that states that every member with diabetes must have routine foot care at least once a year. If that care is not found, the case owner should be notified. How can you implement this guideline using a Data Source activity?

1. Create the Data Source activity getMedicalClaims_with_Diabetes_Diagnosis. This activity needs to use the patient ID and the last processing date at runtime from the Alert. It also needs to get data going back as many months as specified on the Data Source template the first time the Alert runs. When the Alert runs, only new claims that have been added since the last run have to be considered as the older claims have already been evaluated.
2. Create the Data Source template using the Maintain Data Source Templates wizard specifying the Data Source activity and that the Data Source template should  go back 12 months.
3. Create an alert template rule using the alert wizard. Include the Data Source template and adjust the schedule as necessary allowing the alert to expire after no less than one year.
4. Add the routine foot care code group to the alert.
5. Add a task template to notify the case owner of the exception to optimal care.
6. Ensure the alert is added to the case of all patients to be monitored either as part of a care plan or at the case level.

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