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Interoperability through FHIR

Updated on January 6, 2022

Fast Healthcare Interoperability Resources (FHIR) is a next-generation standards framework from the HL7 organization. It supports the interoperability and exchange of healthcare-related information, including clinical, administrative, public health, and research data between organizations. Pega Care Management uses the HL7 FHIR resources to enable interoperability through a common data structure. The Pega Care Management application leverages FHIR APIs from the Healthcare Foundation to receive and transmit electronic health data and populate the eligible sections in the Patient 360.

By installing Pega Foundation for Healthcare and using its pre

Before you begin: The LoadFHIR4Settings data transform rule is configured out-of-the-box with URLs for a test reference system that is used internally for testing. Ensure that you configure this rule.
  1. In the header of Dev Studio, search for LoadFHIR4Settings.
  2. Copy and save the rule into your ruleset.
  3. In the Source field, enter the end point URL for each desired API.
  4. Save the rule.

Multi-source configuration in data pages

Pega Foundation for Healthcare provides an option to conditionally call a source of data: either the FHIR repository or an alternative source of data (for example, an internal source of data). This option allows you to easily configure various sources of data based on your business needs. It means that you do not need to build additional data pages to connect to a separate source of data.

Because Pega Care Management is built on Pega Foundation for Healthcare, you can leverage the out-of-the-box data pages that are related to member, clinical, and care information. For more information, see the documentation on the Pega Documentation home page.

The following table lists the out-of-the-box data pages that are related to member, clinical, and care information:

Data pages

Object typeData page



Allergies D_GetAllergies
Conditions D_GetClinicalConditionByMember
Encounters D_MemberEncounterDetails
Medications D_PatientMedications
Observations D_ObservationsByLoincNum
Family Medical History



Dynamic settings to configure the data source

The data sources for all configured resources are fetched through the D_CheckDataSource dynamic settings data page.

The following figure shows the D_CheckDataSource data page:

D_CheckDataSource data page
Use this data page to fetch data sources for all configured resources

The CheckDataSource data transform is configured to fetch the data source. This rule is configured with PEGA DB as a default source as shown in the following figure. Use the extension rule to update your application with the data source of your choice for each resource.

CheckDataSource data transform
Shows the data transform that you must update to fetch the data source

Display of family and patient history

When the FHIR API is used to fetch information, the Encounters section on the Administrative tab for a Pega Care Management care plan includes the patient encounter details. The Family Medical history section on the Health History tab includes the family history. If you use the common object model, both family and patient history are displayed in the Family medical history on the Health History tab.

The following figure shows that the Encounters section includes only the patient history when you use the FHIR API:

Encounters section
Displays information about encounter types and reasons for the

The following figure shows that both the family and patient history are included in the Family medical history section when you use the common object model.

Family medical history section
Displays medical information about the family

Care plan API

The ability to create care plans with data from external sources is supported for healthcare organizations that manage their patient populations through programs in Pega Care Management. Use existing FHIR APIs to configure GET and PUT methodologies to fetch and display care plans. The methodologies also support the transmission of certain care plan elements from the Pega Care Management application to external electronic medical records to improve patient safety and clinical efficacy.

As part of the enrollment, the system generates a care plan and can include tasks and goals. However, adding care plan elements and edit options are not supported for care plans that the system generates from EMR. When the care plan uses the FHIR API, a care manager can update the tasks that originate from the EMR, and a PUT API call updates the EMR. Pega Care Management appends EMR-based care plans with the EMR logo to differentiate from care plans that users create by using the Pega Care Management application.

The job scheduler runs daily to fetch the care plans from external systems (EMR) and display them in the Pega Care Management application. Organizations can update the frequency of the job scheduler based on their business requirements. By default, the job scheduler is disabled, and you need to enable it so that the job scheduler can get the care plans from EMR. For information on enabling the job scheduler, see Enabling the job scheduler to get care plans from the EMR.

The following figure shows that a patient is enrolled in a Respiratory therapy program from an EMR:

EMR logo on the Member care page
EMR logo shows that
                    member is enrolled in an EMR

Enabling the job scheduler to get care plans from the EMR

Implementation teams need to enable the job scheduler to get the care plans from the EMR system.

  1. In the header of Dev Studio, enter and search for ProcessCarePlansFromEMR.
  2. On the Job Scheduler page, turn on the Enable Job Scheduler switch.
  3. Click Save.
    Job Scheduler
    The job scheduler configuration for the ProcessCarePlansFromEMR

Optional: Mapping from external systems to the care plan

You might need to map from your EMR to the care plan by using the MapCustomerIDforCarePlanExtn data transform so that the patient information is updated in the care plan.

  1. In the header of Dev Studio, enter MapCustomerIDforCarePlanExtn in the search box.
  2. Click the data transform.
  3. On the Data Transform page, click the plus icon to add a row.
  4. Complete the fields. For more information about data transforms, see Data transforms.
    Maps notes from provider organization to the care plan
    Sets the notes from FHIR data to the care plan work object
  5. Click Save.

Use of queue processing in care plan creation and updates

Pega Care Management uses queue processing to create care plans and post updates to EMR/EHR systems.

Care plan creation

By searching for the CreateCarePlanCaseFromFHIR queue processor, you can view the settings as shown in the following figure:

Queue processor

Updates to the care plan

Pega Care Management creates queue items when a goal or task is updated on the Care tab. By using the PostCareplanUpdates queue processor, you can see the settings, as shown in the following figure:

Care plan updates

Optional: Setting delay time for queue entry

By default, the queue item processing is delayed by 30 minutes to ensure a single API call in case of multiple updates. Based on your organization's requirement, you can configure this time delay.

  1. In the header of Dev Studio, enter SetDelayTimeForQueueEntry in the search box.
  2. Click the data transform.
  3. On the Set delay time for queue entry page,
  4. Click the plus icon to create a new row.
  5. Complete the fields, and then click Save. For more information, see Data transforms.
    Example of processing delayed by 45 minutes
    Shows example of changing the processing time
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