ZAP Pro Subscription Feeds
General
Patients enrolled in our ZAP Pro package are subscribed to data feeds for key events including inpatient admissions, medication activity, and lab results to provide a constantly up-to-date, refreshed picture of the patient's clinical information.
You can consume notification-based data by querying the Zus Operational Data Store (ODS) as you normally would, or optionally work with a Zus representative to configure a ZusHook.
Event Types
Medication Events
For each fill, Zus will create a MedicationRequest and MedicationDispense resource. With each fill, specific labels on the new MedicationDispense resource will alert you to the following scenarios:
- The prescription picked up is a new medication, denoted by a PMANewRx label.
- The prescription picked up is a refill, denoted by a PMARefill label.
- The prescription picked up is from a new prescriber, denoted by a PMANewPrescriber label.
- The prescription picked up is a controlled substance, denoted by a PMAControlledSubstance label.
- The prescription picked up has no refills remaining, denoted by a PMANoRefillsRemaining label.
Additionally, if the patient was due to refill a prescription, but the refill did not occur, the last confirmed MedicationDispense resource will have a specific label indicating:
- The prescription has a refill that is overdue (5 days past the expected refill date), denoted by a PMARefillNotPickedUp label on the most recent MedicationDispense.
The following example MedicationDispense resource illustrates the way that these labels will appear as extension values from the SureScripts patient notification system. In this case, these labels illustrate that the medication filled was a refill and there are no refills remaining. (Note, FHIR resource is truncated to focus on the labels).
{
"resourceType": "MedicationDispense",
"id": "fa6eadd7-baa5-4c86-9527-8acd8d7c5add",
"extension": [
{
"url": "http://surescripts.net/fhir/CodeSystem/notification-generated-time",
"valueInstant": "2022-09-19T10:46:02+00:00"
},
{
"id": "9bbd7253-350c-458a-856e-f8827e9d4c26",
"url": "http://surescripts.net/fhir/CodeSystem/patient-notification-types",
"valueString": "PMARefill"
},
{
"id": "60d1c445-e4e2-4fcd-9361-3e4150d4a80c",
"url": "http://surescripts.net/fhir/CodeSystem/patient-notification-types",
"valueString": "PMANoRefillsRemaining"
}
}
ADT Events
For each event, Zus will create or update an Encounter resource, along with corresponding resources for any diagnoses, practitioners, or facilities relevant to the event.
Encounter resources may contain a flag that will alert you to the following scenarios
- The high utilizer flag applies to any patient who has visited the ED three or more times within the past 60 days.
- The readmission risk flag identifies patients who may be at risk for a 30-Day All-Cause Hospital Readmission.
- The recent inpatient stay flag builds on the readmission risk flag and applies to any current inpatient who also has had a prior inpatient hospital stay within the last 30 days.
- The recent SNF stay flag applies to patients who currently are at the hospital and have been discharged from skilled services at a SNF within the prior 30 days.
Note: Flags are sourced from a third party ADT network, and may or may not be present. The absence of a flag does not indicate that the criteria above do not apply to this patient
When sample patient John is admitted to Community Medical Center with nausea, the following Encounter resource is created in Zus:
{
"resourceType": "Encounter",
"id": "cf53e4ef-611c-48d5-9a22-1031790e583a",
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "VN",
"display": "visit number"
}
],
"text": "visit number"
},
"value": "123456789"
}
],
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "I",
"display": "Inpatient"
},
"serviceType": {
"coding": [
{
"code": "285",
"display": "General Medicine"
}
],
"text": "General Medicine"
},
"participant": [
{
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "ATND",
"display": "attender"
}
]
}
],
"individual": {
"reference": "Practitioner/85fe2ec9-be0a-4329-ad13-6acfe0e27849",
"type": "Practitioner"
}
}
],
"period": {
"start": "2022-11-11T15:45:00.000Z"
},
"diagnosis": [
{
"condition": {
"reference": "Condition/7616e37e-e284-4287-b32f-03dbd0f07926",
"type": "Condition"
},
"use": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
"code": "AD"
}
]
}
}
],
"location": [
{
"location": {
"reference": "Location/2fb8fb58-93b6-4429-99e9-4cfaa370c22c",
"type": "Location"
}
},
{
"location": {
"display": "Community Medical Center"
}
}
]
}
When he is later discharged with a diagnosis of Celiac Disease, the Encounter resource is update to include a stop time and discharge diagnosis:
{
"resourceType": "Encounter",
"id": "cf53e4ef-611c-48d5-9a22-1031790e583a",
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "VN",
"display": "visit number"
}
],
"text": "visit number"
},
"value": "123456789"
}
],
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "I",
"display": "Inpatient"
},
"serviceType": {
"coding": [
{
"code": "285",
"display": "General Medicine"
}
],
"text": "General Medicine"
},
"participant": [
{
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "ATND",
"display": "attender"
}
]
}
],
"individual": {
"reference": "Practitioner/85fe2ec9-be0a-4329-ad13-6acfe0e27849",
"type": "Practitioner"
}
}
],
"period": {
"start": "2022-11-11T15:45:00.000Z",
"end": "2022-11-11T18:10:00.000Z"
},
"diagnosis": [
{
"condition": {
"reference": "Condition/7616e37e-e284-4287-b32f-03dbd0f07926",
"type": "Condition"
},
"use": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
"code": "AD"
}
]
}
},
{
"condition": {
"reference": "Condition/287c9d74-a7d3-9s82-90b6-h8732k73b07f",
"type": "Condition"
},
"use": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
"code": "DD"
}
]
}
}
],
"location": [
{
"location": {
"reference": "Location/2fb8fb58-93b6-4429-99e9-4cfaa370c22c",
"type": "Location"
}
},
{
"location": {
"display": "Community Medical Center"
}
}
]
}
Lab Events
When sample patient John undergoes a lipid panel test, new resources are added to his patient profile in Zus as soon as the results come in. We'd expect to see the following diagnostic report, with references to each test result as an Observation resource:
{
"resourceType": "DiagnosticReport",
"id": "6c03ccbb-9ce2-4c36-9172-68067047a4fbVERSION1",
"code": {
"coding": [
{
"code": "2600000334",
"display": "CHOLESTEROL, TOTAL"
},
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "80061"
}
]
},
"subject": {
"reference": "Patient/28b2fb19-7625-47f4-9fe2-6075eb0262a3",
"type": "Patient"
},
"effectiveDateTime": "2022-11-11",
"issued": "2022-11-23T05:36:00.000Z",
"performer": [
{
"reference": "Practitioner/b0386767-c02b-4512-919f-9fff9843e599",
"type": "Practitioner"
}
],
"result": [
{
"reference": "Observation/60ccfa37-aa1e-4b39-bfe7-2dbd91d16fdc",
"type": "Observation"
},
{
"reference": "Observation/fc6f58b6-b073-4036-98c8-e8914e26321e",
"type": "Observation"
},
{
"reference": "Observation/75cf31ae-d245-4660-8cf4-87e0d376302e",
"type": "Observation"
}
]
}
Data types
Clinical
The main clinical resources generated today are:
Medication Events
ADT Events
Lab Events
Administrative
Several foundational administrative resources are referenced to support the clinical resource:
Auditing and analysis
We also include the raw documents for builders that prefer to process them on their own. These are stored in the following resources:
Change Notifications
Patient data events are captured as new or updated resources in the Zus ODS. To be proactively notified of these events, you must subscribe to changes in the relevant resources. Setting up a change notification currently requires direct Zus support. Please contact the Zus team.
Enrollment and required demographics
The Zus team will be supporting initial pilots with the enrollment process. A customer-led process will be available soon. When enrolling your patients, we recommend including the fullest set of patient demographics you can collect for maximum success in receiving events for your patients, including:
-
*First Name
-
*Last Name
-
*DOB
-
*Gender
-
*Address Line 1
-
*City
-
*State
-
*Zip
-
Phone
-
Email
*Required
Updated 4 months ago