You must inventory which external applications exist at your site and plan how to connect to them.

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

Use the Integration worksheet in the Implementation Planning Workbook to record your decisions during this procedure.

1. Identify all integration points for your application.
2. Identify which data is needed from each system of record, if you have not already done so.
3. Determine whether an interface to that system of record already exists and how to connect to it.

Integration points

Based on your needs, you can integrate with the following options:

• Patient 360 data view
• McKesson InterQual
• MCG CareWebQI
• Clinical Interaction Manager

Patient 360 data view

You must plan for the integration of systems that provide the data for the Patient 360 view. You create some of the data such as cases, care plans, and communication in the Care Management Application and you leverage some of the data from the Healthcare Industry Foundation. For other information, you have to integrate with external systems. Consider how you will integrate the following types of information:

• Profile
  • Demographics
  • Primary care provider
  • Contacts, care team
  • Claims
• Clinical
  • Vitals
  • Medications and allergies
  • Lab results
  • Medical and family history
  • Assessments

McKesson InterQual

The McKesson InterQual® Integration Solution is bundled with the Care Management Application and is referred to as the Connector. It integrates the Care Management Application with McKesson’s CareEnhance® Review Manager Application (InterQual®). This capability is licensed separately and is dependent on a subscription service with McKesson.

This connectivity allows you to leverage InterQual® directly from within the Pega 7 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 additional information, refer to the following information on the Pega Discovery Network:

• Integration Overview
• McKesson Interqual® Integration Solution Installation/Integration Guide

MCG CareWebQI

The MCG CareWebQI® Integration Solution is bundled with the Care Management Application and is referred to as the Connector. It integrates the Care Management Application with the MCG CareWebQI® application. This capability is licensed separately and is dependent on a subscription service with MCG.

This connectivity allows you to leverage CareWebQI® directly from within the Pega 7 Platform and have real-time bi-directional interaction with the CareWebQI® system.

 Features of the connector include:

• CareWebQI chronic care guidelines lookup from the patient portal
• Automated CareWebQI Episode generation
• Seamless integration of CareWebQI guidelines during a UM Review
• Dynamic submission of Pre-Cert information for a targeted guideline search
• Hospital stay concurrent review
• Automated Pre-Cert decision-based CareWebQI criteria met status
• CareWebQI Episode associated with a Pre-Cert request

For additional information, refer to the following information on the Pega Discovery Network:

• Integration Overview
• MCG CareWebQI Integration Solution Installation/Integration Guide

Clinical Interaction Manager

Clinical Interaction Manager is an option for purchase by the client. It is part of Customer Service for Healthcare. The Clinical Interaction Manager is the first in the market to integrate customer service and care management to give health organizations a 360-degree view of all customer interactions, extending their ability to engage customers, improve health outcomes, and reduce costs.

Care Management Application provides the Clinical Interaction ruleset as part of this process. The ruleset is on top of the application and is used for integration with Customer Service for Healthcare.

For information on integrating with Clinical Interaction Manager, refer to Clinical Interaction Manager in the Pega Customer Service for Healthcare Implementation Guide on the Pega Customer Service for Healthcare landing page on the Pega Discovery Network.