Background

Discharge summaries are one of the most important sources of data when it comes to managing the care of high-risk patient populations. Clinical staff need to review discharge summaries for recently hospitalized patients so that they can determine the critical & time-sensitive follow up actions they need to conduct with the patient to reduce risk of readmission. It is often challenging, however, to find the discharge summaries amidst all of the documents present in a patient record - particularly as the majority of discharge summaries are in unstructured (pdf, png, txt) formats.

Overview

Particle has developed proprietary logic to identify discharge summaries across CCDA (xml) and non-CCDA (unstructured formats such as pdf, png, txt, etc) data. Customers can choose to subscribe to receive Discharge Summary Alerts from Particle whenever a new discharge summary document becomes available for a recently hospitalized patient. These alerts include the fileid(s) to retrieve the discharge summary document(s), as well as key data such as the facility information.

Note that Particle provides additional alerts (including ADTs and Network Alerts) to notify a customer of patient admit / discharge / transfer to an inpatient facility or ER. Customers can combine these alerts with Discharge Summary Alerts for comprehensive alerting on inpatient stays, from admission through post-discharge follow up.

Recommended Implementation

The easiest and most timely way to retrieve discharge summary documents is by subscribing to receive Discharge Summary Alerts in the form of webhook notifications delivered to a callback URL. Particle will check for new discharge summaries each time you initiate a query for a patient (or as part of Particle's proactive monitoring of your patients, if you have the full Signal offering enabled), and will alert you when a new discharge summary is available.

1. Subscribe to alerts either by having Particle automatically enable Discharge Summary Alerts for all of your patients, or, alternatively, you have the option to subscribe to alerts for only a subset of patients using the Subscriptions API.
2. Set up a callback endpoint on your systems and register it with Particle via the steps outlined in Event Notifications.
3. Receive alerts to your registered callback endpoint when a new discharge summary is made available for your patient.
4. Retrieve the discharge summary using the the fileid provided in the Discharge Summary Alert webhook notification.

Discharge Summary Alerts

The Discharge Summary Alerts will be delivered as webhook notifications to the callback endpoint that you have configured and will follow the struct below:

{
  "specversion": "1.0,
  "type": "com.particlehealth.api.v2.dischargesummary",
  "subject": "Discharge Summary",
  "source": "api/notifications",
  "id": "ea77d12d-bb97-438e-82eb-1b0d10a7e3ee",
  "time": "2024-07-22T10:10:10Z",
  "datacontenttype": "application/json",
	"data": {
    "network_organization": {
      "name": "Rochester Hospital",
      "oid": "2.16.840.1.113883.3.8391.5.710576"
    },
    "particle_patient_id": "d939196d-0c80-4e82-b0e1-19f9ee271085",
    "query_id" : "e040207e-1d91-5f93-b0e1-19f9ee271085",
    "network_alert_ids": [
	    "1cac1ea7-f3a9-43b3-bca3-04d3ec4362c5",
    ],
    "adt_message_ids": [
	    "6e7303bd-2c1a-49f2-add0-820babbdb95a",
    ],
    "resources": [
      {
	      "file_id": "d6a96f73-eb18-4faa-b021-143e7777fe8b",
        "resource_ids": [
          "Encounter/b10fe2ef-47f9-4507-97c8-1a8c2215478e",
          "DocumentReference/b10fe2ef-47f9-4507-97d8-1a8c2215478f",
        ]
      }
    ]
  }
}

Note: Typically you will only see a single file_id or resource_id for discharge summaries. However, in scenarios where Particle has identified multiple discharge summary documents for the patient, the file_ids and resource_ids may be an array if Particle identifies multiple files and resources associated with the encounter that triggered the alert.

If you have the full Particle Signal offering enabled, the notifications will also include identifiers for any ADTs or Network Alerts related to the inpatient stay and discharge summary, so that you are able to map the document to an ADT. If you do not have the full offering enabled, the ADT and Network Alert information will not be present.

Retrieving Discharge Summaries in FHIR or FLAT

When you receive a "Discharge Summary" alert you can retrieve the discharge summary file in either FLAT or FHIR format by calling the Deltas API with the resource_idprovided in the webhook notification.

Examples

1. Retrieve the encounter in FLAT: GET /deltas/flat/Encounter/{resource_id}
   1. GET /deltas/flat/Encounter/b10fe2ef-47f9-4507-97c8-1a8c2215478e
2. Retrieve the encounter in FHIR: GET /deltas/R4/Encounter/{resource_id}
   1. GET /deltas/R4/Encounter/b10fe2ef-47f9-4507-97c8-1a8c2215478e

You also have the option of retrieving additional clinical context on the inpatient encounter beyond just the discharge summary. Check out Retrieve Clinical Context for more detail and examples.

❗️

Not all Discharge Summaries are available in FLAT or FHIR format 👇

Retrieving Unstructured Discharge Summary Files

Discharge summary data is frequently captured in unstructured physician notes, and in many cases is shared on the networks in an unstructured, non-CCDA format (e.g., pdf, png, txt, etc). While Particle is able to identify discharge summary files in non-CCDA format, we do not yet parse these types of non-CCDA files into FHIR or FLAT formats. We are working on making discharge summary pdf parsing available in the coming months.

We recognize, however, the criticality of discharge summary notes for our customers to take appropriate action on discharge patients to reduce readmission, which is why we currently make the source data available in the raw format.

ℹ️

If Particle identifies a discharge summary that is only available in an unstructured format, we will surface aDocumentReferenceId in the Discharge Summary Alertfor the document, so that you can retrieve the unstructured source data file via the Files API.

• You will need to pass the query_id and the discharge summaryDocumentReferenceId(as the file_idin the call to the Files API to retrieve unstructured (non-CCDA) discharge summary files. Both ids are provided in the webhook notification.
• The ids for the non-CCDA discharge summary files will be provided in the same array and according to the same schema as the file_ids passed for CCDA files in the Signal Alerts. See example in the Discharge Summary Alert above.

Note you also have the option to retrieve the raw source data file for ANY files via this same workflow (i.e., by calling the Files API with the file_id), including the source CCDA files for any discharge summaries you have retrieved in FHIR or FLAT.

Example

See below for an example of how to pull down a non-CCDA discharge summary file associated with the sample Discharge Summary Alert webhook notification . Note that the DocumentReferenceId will need to be passed in the file_id parameter.

Retrieve the raw source data for discharge summaries captured in non-CCDA format: GET v1/files/{query_id}/{file_id}

GET v1/files/e040207e-1d91-5f93-b0e1-19f9ee271085/b10fe2ef-47f9-4507-97d8-1a8c2215478f

Polling for Discharge Summary Files

If you do not want to receive a webhook notification alerting when Particle has identified a discharge summary, you can opt to poll our Discharge Summary API to retrieve the ids for any discharge summaries identified for a patient. You can leverage these ids to retrieve the discharge summaries via the workflows outlined above.

Testing

All of these workflows are set up to test in our Sandbox environment. Check out Testing Signal in Sandbox for details.