FHIR Device resources extracted from CDAs are now available to customers through data marts, in FHIRplace, and via the Zus APIs. These resources typically contain information on device types (implant, instrument, etc), how the device is associated with a specific patient, and the device’s operational status (active, inactive, etc). For example, a Device resource may describe that patient John Doe (with an ID: 12345) has an active cardiac pacemaker, with a SNOMED CT code of 14106009.

Improvements have been made to the organization of conditions in the Conditions Component to help clinical users more easily make sense of a patient’s condition history. These changes will begin rolling out today!

Indicating High-Risk Conditions

A previously released update now indicates conditions that qualify for Hierarchical Condition Categories with a blue HCC badge. HCCs can be used to identify patients with serious acute or chronic conditions as part of a risk-adjustment model. Specific HCC and ICD codes can be found by opening the condition’s details side panel.

⚠️ The HCC indicator is currently displayed based off of the CMS risk-adjustment model. Please reach out if your organization would like to switch to the HHS model, or disable the HCC indicator.

Grouping Conditions by Category

Patient problem lists are messy. In addition to ongoing work to reduce the number of duplicate conditions, we’ve also grouped conditions by Clinical Classifications (CCSR) category by default. Now, clinical users can more easily understand a patient’s overall problem areas, as well as compare diagnoses within a category. Conditions will remain grouped by category even when filters are applied.

Ongoing Improvements

Over the coming weeks, additional improvements will be made to dates related to conditions.

• Enhancements to the Last Diagnosed date will more accurately indicate the last time a condition was recorded by a physician in the patient’s chart. This date will be reflected on the Overview card, as well as in a dedicated column in the Conditions Component.
• The Onset Date field will be updated to include the earliest known physician recorded date if no Onset Date is specified.

Starting today, the Transition of Care Lens will include a nested extension to help understand the most relevant discharge summary for a given Episode of Care.

The existing Zus discharge narrative extension is a list of references to Binarys that have a discharge narrative for the episode.

Beginning today, the nested extension "url": "https://zusapi.com/lens/extension/preferredDischargeNarrative" will be included in the Lens when available. This indicates which document will provide the most valuable content relating to that episode of care. Zus is matching codes based on the Commonwell/Carequality document standardization project.

In the Hospitalization Page of the Zus App, we will continue to display an icon when one or more relevant documents are available, and list them each in the details panel.

⚠️ In addition to this updated extension, users can expect to see more returned Binary documents per Episode of Care, as we've been continuously improving our matching and querying logic to return as many documents as possible.

Starting today, users will no longer see red dot icons in the ZAP to indicate the presence of data in each component.

Now, presence of available data is noted by bolded, black text. If a component is empty, it will appear gray and lighter in color.

3rd party data networks like Carequality and Commonwell require a Type 1, individual NPI number for a treating practitioner in order to submit a request for records. To ensure that all patients meet the minimum requirements to access records from all services in their subscription package, the ZAP data subscriptions API will now perform an additional validation check on enrollment requests and return the following message for Organization NPIs:

{
  "errors": [
    {
      "title": "Invalid request body.",
      "detail": "Practitioner NPI has to be an individual NPI (NPI-1).",
      "status": "400"
    }
  ]
}

Zus is implementing an adjustment in our utilization of Surescripts medication history services in order to improve coverage of ongoing prescription activity for ZAP Pro patients.

By shifting to more frequent and intelligent 'full' pharmacy history refreshes, and away from the pharmacy notification feed, we will improve the volume of prescription data available significantly due to additional aggregation of PBM/Payer claims data in Surescripts history products when compared to their notifications offering.

There will be no change in package cost associated with this shift.

What you gain: Better coverage of dispenses (and associated requests) at pharmacies that do not contribute to the notification feed.

What changes: For now, Zus will stop delivering proactive notifications or flags for new prescriptions or prescribers, first fills, no remaining refills, or missed refills. If these notifications are of interest to you, please reach out to us. Upon the initial transition, Zus will refresh medication data before upcoming appointments and after ADT discharges, and on the same schedule as EHR data refreshes. We will continue to add triggers over time, but would love to hear from you if you have use cases such as med adherence that require more frequent monitoring.

The Hospitalizations Page now displays an icon to indicate that a Discharge Summary is available for a patient and has filters available to filter by Location Type!

Find discharge summaries more easily

An icon 📄 is now displayed to indicate the presence of a discharge summary.

Click on a patient row to open the details panel tp read the information about the hospitalization and open the discharge summary document.

Filter by location type

In addition to filtering by Status, users can now filter by Admitting or Discharge Location Type.

We have added a new connector-level status to the patient history API. When Zus skips a particular connector due to our intelligent refresh logic or because that data source is otherwise unavailable, that connector will now show a status of skipped in the API and in the Zus App Records Request log.

Until the CommonWell network is back online, all patient history jobs will show a skipped status for that connector.

More details about patient history API status definitions are available here.

Outbound ZusHooks messages will now include an "Operation Type" field in order to provide insight on what has changed for a given FHIR resource.

UPSERTindicates that the resource has been created or updated

DELETEindicates that the resource has been deleted

The below examples depict messages for an update to a Patient resource followed by deletion of that resource:

{
  "message_id": "88ff081c-345c-46be-9306-a43252dc79c1",
  "source": "com.zushealth.zushooks",
  "time": "2024-02-29T02:09:27Z",
  "resourceId": "Patient/7129905b-45cf-4bb1-9129-1f077a39deec",
  "ownerId": "builder/a870079b-b6b2-483d-a5b0-b14d0ac38634",
  "resourceIncluded": false,
  "resource": {
    "UPID": "0fae3a5d-b3f9-4412-b0ed-5d2224aba635"
  },
  "operationType": "UPSERT"
}

{
  "message_id": "88ff081c-345c-46be-9306-a43252dc79c1",
  "source": "com.zushealth.zushooks",
  "time": "2024-02-29T02:27:27Z",
  "resourceId": "Patient/7129905b-45cf-4bb1-9129-1f077a39deec",
  "ownerId": "builder/a870079b-b6b2-483d-a5b0-b14d0ac38634",
  "resourceIncluded": false,
  "resource": {
    "UPID": "0fae3a5d-b3f9-4412-b0ed-5d2224aba635"
  },
  "operationType": "DELETE"
}

This update is purely additive - please review parsing logic in any downstream applications to ensure such changes are tolerated.

It's now easier than ever to update a patient's ZAP subscription package. The ZAP data subscriptions api will now accept a PATCHrequest to update practitioner or package details.

PATCH /zap-data-subscriptions/enrollment-statuses/{{patient_id}}:{{current_package_id}} HTTP/1.1
Host: zap-data-subscriptions.zusapi.com
Content-Type: text/plain
Authorization: Bearer {{token}}

{
    "data": {
      	"attributes": {
           "practitioner": {
               "name": "{{practitioner_name}}",
               "npi": "{{practitioner_npi}}",
               "role": "{{practitioner_role}}"
            }
        },
        "relationships": {
            "package": {
                "data": {
                    "type": "zap-data-subscriptions/package",
                    "id": "{{new_package_id}}"
                }
            }
        }
    }
}