Traverse Exchange

Traverse Exchange is an advanced nationwide private network that enables participating MEDITECH US customers to share health data seamlessly and securely with one another and with organizations using other vendor EHRs. By leveraging existing standards and policies it enables scalable, secure and reliable interoperability. It is the same process we use with WISHIN, but on a much greater scale.

During the registration process, Expanse sends out a request to the Health Information Exchange partners. If they have medical data, it is then sent back to the system. If there is external data available, indicators will be present in the patient chart. See below for an example.

Home Medication Review

Accessing the home medication overlay* displays a CCD tab to the right of the medication if external medication details exist. Medications are matched using RXQER or RXNorm codes. Data provided includes the medication source, reported on date, dosing data, and last edit date.

Medications that appear in the External Data not on Active list section can be acted upon using the Add to Active List or Not Taking buttons. Adding a home medication from the CCD will display “Added from CCD” below the medication details. The See More Data button will display if there are multiple external sources for the medication.

Patient Allergy review

Matched external allergies are those external allergies and adverse reactions that already exist on the patient’s allergy list. If an external allergy matches an allergy already on the patient, this will be displayed in a new CCD tab on the right side of the screen, in the same location as the Details tab. An external allergy will be matched to an existing patient allergy by a description match (case insensitive) or RxNorm code match. The CCD tab will include the source, type, severity, status, reaction, reported on, and any comments. Discrepancies will be reflected by  See More Data will display if there are multiple external sources for the allergy.

When an action is taken on an existing allergy that also has external CCD data, the matched external data will always be treated as "Not Added" in the allergies Audit and discarded (Summary screen will display "No" in the “Added to Patient” column).

The External Allergies Not On Patient accordion displays those allergies that are matched to the patient but not already on the patient’s allergy list. For any external allergies that are displayed in this section, the user will be able to choose if they want to add the allergy or discard it in order to remove the external data from the accordion.

Problem list reconciliation

External Problems are now part of the main overlay. Within the External Problems accordion there are two additional sub-accordions, Unmatched and Matched. The Unmatched accordion will display all external problems that do not already exist on the patient's Active Problem List, Resolved/Inactive/Ruled-Out (R/I/R) List, Medical History, or Surgical History. The external problem will be considered "unmatched" if there are no existing problems that have the same description or SNOMED code.

The Matched accordion displays any external problems where we have found at least one match to an existing patient problem from the Active List, R/I/R List, Medical History, or Surgical History. The external problem will be considered "matched" if there is an existing problem(s) that has the same description or SNOMED code. Problem description match is not case sensitive. External problems will display the Problem Description, List, Onset Date, Report Date, and Source.

This process is best completed with the use of Chart Viewer.

Users will be able to add an external problem to the Active Problem List, to the appropriate History List, or choose to Discard the external problem. The EMR Toolbox Exclusivity for History and Problems parameter is taken into account to determine if a user can manage a patient’s active Problem list and History together and will determine if the Both option displays or if the user is limited to only Active or History. to the right of the external problem description. The user will see radio button options to determine what list they want to add the external problem to. Should the user wish to modify or refine the external problem they are adding, they can invoke a problem search by selecting the search icon. This search is optional.

For any external problems where we cannot find a match with the background search, these problems will be considered free text. Free text problems will display within brackets once an external problem has been selected to be added to a list via one of the action radio buttons (Active, Hx, Both) which defaults the problems into a search field. The "Disable Free Text Patient Problems" EMR Parameter will be respected to determine if a user is able to file a free text problem if they so choose or if they will be required to search and replace the free text problem with a coded problem concept.

Using the Apply External Problem Selections button will push the problems to the appropriate Active or History sections at the bottom of the page. External problems without action will remain in the Unmatched and Matched sections, and problems added to the patient will allow for additional edits prior to saving.