Learn how to perform importing of NEMSIS XML documents directly into AngelTrack's billing workflow.
If you use a different product for your PCR, you can import that PCR's charts directly into AngelTrack's billing workflow. This allows you to use AngelTrack's billing system and maybe also its CAD in situations where you are required by contract to use some other PCR for your patient charting.
Configuring AngelTrack to Run Without Its PCR
To configure your AngelTrack server for use without its PCR, perform the following steps:
- From the Home page, navigate to the Settings page.
- Select the "Service Levels Configuration" item.
- Mark all service levels as "Not Reportable". That will disable all state data validation rules and the state uploader(s).
Your other PCR is responsible for satisfying any state data validation rules, and for performing all necessary state uploads.
Training Crew Members on AngelTrack Without Its PCR
If you have crew members who have access to AngelTrack, they will still be able to visit their Crew Home Page, see their recent calls, and even open the PCRs to see what AngelTrack imported from your other PCR.
Teach your crew members the following:
- Any modifications to PCR data must be made in the other PCR, and then re-imported to AngelTrack, because the other PCR is responsible for state uploads and therefore needs to have all pertinent data.
- Likewise QA review will occur in the other PCR, not in AngelTrack.
- Even though your crew members have already input their patch numbers into the other PCR, they must also maintain their certificate records in AngelTrack. This is mandatory because AngelTrack uses their certificate numbers to match up the assigned crew IDs in the data arriving from the other PCR. If the other PCR says, "Crew member 012345 and 67890 ran this call," AngelTrack must be able to find two crew members who have certificate numbers or driver's license numbers 012345 and 67890, otherwise the import will fail.
Manual Import of NEMSIS XML Data
To manually import a NEMSIS XML document into AngelTrack's billing system, perform these steps:
- Login to AngelTrack with Biller or Captain privileges.
- Visit the Billing Home page.
- On the "Compliance" menu, find and click the "NEMSIS XML Import" link.
- Review the available import options and make any changes as necessary; the options are explained below.
- Click the button to upload your document.
- Wait while the importer processes the document.
- Review the result messages. If any errors occurred, if you don't understand the reason, then take a screenshot and contact AngelTrack support.
The most common cause of a failed import is the inability of AngelTrack to match the vehicle and crew specified in the imported PCR. This issue is described in greater detail below.
AngelTrack has a file size limit on its file uploads, in order to protect against denial-of-service attacks. If your NEMSIS XML document exceeds this limit, you will receive an error message. This normally occurs only for multi-trip XML documents, in which case, see if you can obtain an XML document for each trip separately, rather than a single large combined XML.
Automatic Import of NEMSIS XML Data
AngelTrack has an API by which NEMSIS XML documents can be automatically pushed into the system. The API accepts plain NEMSIS XML documents and has very simple authentication -- using an AngelTrack API key.
A technical consultant or contract programmer could easy create a simple uploader tool for this task. All of the documentation for the API is available here: NEMSIS Import API Guide
The more challenging part of connecting a third-party PCR to AngelTrack's billing system is the automated extraction of completed NEMSIS XMLs from the other PCR. Every PCR software app is different, and each will have its own way of retrieving completed charts, so AngelTrack does not provide a general-purpose trip extractor that can pull from any third-party PCR. You must contract out that job yourself, or consult with AngelTrack LLC to study the task and recommend an implementation plan.
PCR Push of NEMSIS XML Data Directly Into AngelTrack
If your PCR software can upload to a state trauma registry, then it can also upload directly into AngelTrack, because AngelTrack has a webservice that emulates* a state trauma registry.
Your AngelTrack server's trauma registry webservice is located at:
https://your_server_name.angeltrack.com/Nemsis3WS.asmx
It supports three functions:
- SubmitReport, the standard interface for pushing trip data, which immediately imports each submission while-u-wait, using AngelTrack's very tolerant NEMSIS importer, returning an error only if the submission is a malformed SOAP request or if the NEMSIS payload is missing critical fields;
- QueryLimit, which returns the maximum payload size accepted by SubmitReport; and
- RetrieveStatus, which always returns "1" (success) because any import errors will already have been reported to you during SubmitReport().
It does not perform XSD or schematron validation on the uploaded trips, as that is the responsibility of the PCR. It accepts any NEMSIS version. Uploaded trips go straight to Billing Office, bypassing the QA review workflow. It performs automatic de-duplication, to gracefully tolerate reuploads of the same call. It does not accept DEM payloads.
*The emulation conforms to the NEMSIS 3 Webservice WSDL.
Whether AngelTrack performs the legally required upload of the trips to your state trauma registry, or whether the PCR does that, is your decision. As a general rule in this situation, it is better for the PCR to do it, in case a validation error occurs requiring edits to the chart and a reupload. Thus you would disable AngelTrack's state upload requirement for all EMS service levels by visiting the Service Levels Configuration guide, and then you would enable an additional upload URL (for your state) in the PCR software.
The PCR software will need a credential to make use of this webservice. Issue an AngelTrack API key with CAD/NEMSIS privileges. The PCR software will have an uploader configuration page where you can input this information:
Webservice URL: Input your AngelTrack server's URL as shown above
Username: [anything / doesn't matter]
Password: Your API key goes in this field
Additional info: You can also send your API key in this field, if you prefer
Retrieving the requestHandle from SubmitReport()
Prior to AngelTrack build 566, the requestHandle returned by SubmitReport() is always zero, since there is never any need to call back later to check on import progress; success/fail is reported synchronously by SubmitReport(). Beginning in AngelTrack build 566, requestHandle will contain the dispatch ID of the imported (or reimported) trip.
Trip IDs
AngelTrack imports the trip IDs (eRecord.01, eResponse.03, and eResponse.04) but does not use these to create the AngelTrack dispatch ID. AngelTrack dispatch IDs are sequential integers, subject only to the "next dispatch ID" value (if any) that you've configured in your preference settings.
Anyway, many third-party PCR trip IDs are alphanumeric and so will not fit into an AngelTrack dispatch ID because it's an integer.
AngelTrack nevertheless stores the PCR's trip IDs on the Followup page, as "Incident number" (eResponse.03) and "Response number" (eResponse.04), and it also mentions them in the journal.
Assigned Vehicle and Crew During NEMSIS Import
If you import a NEMSIS XML document that represents a completed call, the XML will include the callsign of the responding vehicle, and the patch numbers of the responding crew members. (To learn the technical details of how this data is represented inside a NEMSIS XML document, please refer to the NEMSIS Import API Guide.)
During import, AngelTrack will attempt to match this information with its own records, in order to create and link the proper shift record to the trip. This means that your AngelTrack server must already have the following records created ahead of time:
- Vehicles: Name or callsign must exactly match what's in your PCR application.
- Employees: EMS certificate numbers must exactly match what's in your PCR application. (Alternatively, you can input an employee's patch number in the "Provider-issued
ID number" field of their employee record.) For wheelchair van drivers and other unpatched crews, AngelTrack will attempt to match based on their drivers' license, if they have recorded it among their certificates. - Stations: There must be at least one station in each of your zones, assumed to be the home of any vehicles marked "float" for calls originating inside zone.
If you import the NEMSIS XML for a completed call but AngelTrack cannot match a vehicle and at least one crew member, then AngelTrack would have to import the call as a cancellation, since every completed non-cancelled call in AngelTrack must have an assigned shift. In this situation AngelTrack's NEMSIS importer will reject the XML document and give the reason why; you can over-ride this, and force the import as a cancellation, by enabling the relevant import option.
Automatic Creation of Facility Records During Import
AngelTrack can automatically create the necessary facility records during import of a NEMSIS document, where possible. This option is always enabled for any import received by the CAD API; it is a selectable option during manual imports which defaults to 'on'.
Facility records are keyed by the jurisdiction state and the state-issued facility codes, therefore AngelTrack can auto-create them only when the imported NEMSIS XML document provides all of the following information:
- State facility code; cannot be a state-issued generic facility code such as "999999 = Other hospital"
- Facility name
- Facility street address
- Facility state
AngelTrack knows your state's generic facility codes and will automatically ignore them when claimed by an imported NEMSIS XML. As a result, imported trips that specify a generic code like "Other Hospital" will not auto-attach a facility record in AngelTrack, even if a facility record exists with that name.
Attached PCR Documents
AngelTrack will import electronic documents attached to the PCR, from the /eOther node.
The NEMSIS XML specification allows only rudimentary identification of attached documents, so AngelTrack must guess the type of each attached document. For example, a face sheet might be marked as 4509003 "Billing Information", or it might be 4509017 "Patient Identification", or it might be 4509013 "Other Healthcare Record". AngelTrack will examine the filename for clues, but this is not reliable. As a result, your imported documents will often show an incorrect document type, which you might have to manually correct.
AngelTrack does not import the following document types from NEMSIS XML:
- 4509001 "Other Audio Recording"
- 4509025 "Video/Movie"
Delegations to Affiliates
The NEMSIS XML importer does not support the import of trips delegated to an affiliate. Each trip's assigned vehicle and crew must be on file as your vehicle and your employees. As such, you cannot use this system to do the billing for a subcontracting provider.
QA Review
You cannot import NEMSIS trip XMLs into AngelTrack's QA review system. Instead they must bypass QA and go straight to billing. This is so for two reasons:
- The loss of fidelity when data is converted from one PCR, to NEMSIS XML, then to a different PCR, particularly as regards custom fields which often cannot be adequately represented in NEMSIS; and
- There is no mechanism to fail a report back to the originating PCR.
That means that QA review must be performed within your PCR application, before importing the charts into AngelTrack for billing.
State Uploads
Because imported trips do not pass through QA review, and because of the possible loss of fidelity when data is double-converted converted from a third-party PCR into a NEMSIS XML and then into AngelTrack's PCR data structures, you should disable AngelTrack's state uploader, and leave the upload responsibility to the originating PCR.
Import Option: Halt If No Crew Match
The manual importer offers the option to ☑ Halt the import if the assigned vehicle and crew member(s) cannot be matched to our records. This option is enabled by default, because if you are importing a completed trip but AngelTrack can't match the vehicle callsign and/or crew patch number(s) to its own records then it has to mark the call as a cancellation.
If an import fails for this reason, then review the error messages; they will tell you which vehicle callsign or crew patch number is missing from AngelTrack's records.
Import Option: Postprocess Workflow Location
By default, new trips are created at "Billing office" in the postprocess workflow. The importer's options give you the ability to instead start them at "Awaiting payment" or "Finished", as needed.
Bill-To Settings Auto-Set During Import
AngelTrack's NEMSIS importer will auto-set each new trip's bill-to settings, using information provided in the NEMSIS XML document, combined with the following information from your AngelTrack server:
- Service levels configuration (default "Is billable?" / default "Is insurable?")
- Your facility records' contract-billing settings
To learn which NEMSIS fields are used for this determination, please refer to the NEMSIS Import API Guide.
Unfortunately, the billing-related fields in the NEMSIS XML schema do not fully cover the range of possibilities, so AngelTrack will not always be able to correctly guess the bill-to settings. Both the manual-import and the API-import processes will tell you what bill-to settings where auto-selected for each trip, so you can review it afterward and make any necessary adjustments.
Nor does the NEMSIS XML schema provide a way to transmit price quotes or adjudicated prices, so every imported trip will begin un-priced, and later receive a price by means of AngelTrack's lazy price quoting.
If you do any billing under a facility contract, then the accuracy of the automatic bill-to settings depends on correct match-up of your facility records with the facility IDs or names/addresses mentioned in each NEMSIS XML document. For that to work, both AngelTrack and your PCR application must have matching facility lists installed. That means both apps must be pre-configured with your state trauma registry's facility list and thereafter kept in sync as dispatchers, supervisors, and billers create new facility records in either system.
Import Option: Ignore Claimed Facility Codes
If the originating PCR is not tidy with its facility records, then its NEMSIS data might have mismatched or oscillating facility records. For example, suppose the originating PCR sends two calls:
- Call 1, Destination code 12345, Destination Name "Central Hospital"
- Call 2, Destination code 12345, Destination Name "Central Hospital Dialysis Center"
Because both of these calls specify a destination code, AngelTrack will attach that facility record to the imported trips, which then causes a mismatch because the two destinations are actually different locations with different HCPCS modifiers.
If your PCR data has this problem, then you can use the "Ignore claimed facility codes" option when importing the data into AngelTrack. It will then perform a name+address match when possible.
Re-Import
You can safely re-import an existing NEMSIS XML document without creating any accidental duplicates.
A re-import might overwrite certain information added by a dispatcher, biller, or crew member after the initial import, so do not re-import trips unless you are certain it's necessary.
The importer has an option to skip the import of any trip that was imported previously, and the option is enabled by default, to prevent accidental overwrites of data you modified since the initial import.
Multi-Trip Imports
If your NEMSIS XML document contains multiple trips, i.e. multiple /PatientCareReport nodes, AngelTrack's manual importer will import them all, and display the combined results in a list for review. Your XML document is nevertheless subject to AngelTrack's general file-upload limit, which is 16MB per file.
This privilege is only available when performing manual imports of NEMSIS XML documents. For automatic imports, the NEMSIS Import API does not accept multi-trip submissions; your uploader tool must send each PCR's NEMSIS XML separately.
Custom PCR Fields
The NEMSIS XML format allows for custom datafields, also known as "eCustomResults".
Many states publish custom fields, in a publication called "StateDataSet". AngelTrack automatically imports your state's StateDataSet, and reimports it every weekend, and so any custom fields published by your state will appear in AngelTrack's PCR. To learn more about this, please visit the StateDataSet Import Guide.
Any state custom field results in the incoming NEMSIS XML will be imported into AngelTrack normally.
The originating PCR might also have unique custom fields, either created by the PCR vendor or by the provider. AngelTrack will import these insofar as the matching field definitions are present in AngelTrack's custom EMS PCR fields list.
You can create those definitions manually to match what's in your PCR. You can also auto-create them by feeding your NEMSIS XMLs into the Custom EMS PCR Fields Importer, accessible from AngelTrack's Custom EMS PCR Fields List, under Settings... but be warned, many PCRs emit chaotic or spotty custom field definitions which cannot be adequately reconstructed during import, and so might not recreate in AngelTrack the same data as seen in the originating PCR. For that matter, the NEMSIS spec simply does not provide enough detail in the eCustomResults / eCustomConfiguration sections to fully express the complexity of a custom PCR field. Your mileage may vary.
To learn more, please visit the Custom EMS PCR Fields Guide.
Using AngelTrack's CAD and Billing System with Another PCR App
By means of this system, you can use AngelTrack's CAD and its billing system while performing all charting in another PCR app.
The PCR app must be able to import NEMSIS XML documents exported by AngelTrack's CAD, or else there must already be an integration in place by which AngelTrack's CAD can push trip data into the PCR. Here are some of AngelTrack's current integrations suitable for this purpose:
When the PCR app finishes each trip, it must push or otherwise export the completed NEMSIS XMLs for re-import back into AngelTrack. When that happens, AngelTrack will recognize its own trips and automatically match them back up to the records from the CAD. For this to work right, the PCR app must:
- Accept imports in NEMSIS v3.5.x, or accepts some other data format that includes the @UUID attribute provided by AngelTrack's CAD; and
- Return the same @UUID attribute back to AngelTrack during re-import of the completed chart.