Outflows

Your mandatory data uploads to your state and county trauma registry, and to other downstream consumers of your trip data, are handled by AngelTrack's Outflows system.

Outflow Demands

For each dispatch, the Outflows system calculates and maintains a list of outflow demands.

An outflow demand is a requirement by a state, county, city, region, biller, facility, or registry to receive copies of your dispatch records at designated times. For example, your state trauma registry is an outflow demand, wanting to receive copies of all BLS+ trips as soon as they go to QA. You could also have a biller configured as an outflow demand, who receives copies of all trips as soon as they graduate from QA.

You can see a dispatch's list of outflow demands by opening its run ticket and clicking on the "Outflows" tab.

AngelTrack calculates each dispatch's outflow demands from the criteria recorded in your outflow credentials.

Outflow Credentials

An outflow credential is a set of parameters that tells AngelTrack how, when, and where to send copies of your trip data.

For example, your state trauma registry will issue you a credential for itself, by which you are to upload copies of all BLS+ charts. You will input that credential into AngelTrack as an outflow credential, and configure it to send only BLS+ trips, plus some additional options as needed.

Your outflow credentials are all accessible from the Outflow Status page, under Settings.

You can add as many outflows as you need. You can also deactivate or reactivate old ones.

State/State-Forwarder Outflow Demands

If an outflow credential is marked as a state or state-forwarder, a special rule applies, which does not affect your owner outflow credentials:

A dispatch is reportable to only one state or state-forwarder credential.

Therefore you can have multiple state/state-forwarder credentials, perhaps one for each county where you have a station, plus a statewide catchall credential. For each dispatch, AngelTrack calculates which of those credentials best fits the trip, and sends it to them, and not to any of the others even if they also match.

This rule expresses the assumption that a county registry forwards your data to the state. If your county registry does NOT forward your data to the state (e.g. the Texas RAC registries), then do not mark their outflow credentials as state/state-forwarder, thus forcing AngelTrack to also upload your trips directly to the state.

Outflow Options and Filters

Each outflow credential has its own set of filters and options which govern the flow of data that AngelTrack sends to it.

These are the basic options for every outflow credential:

Webservice type (NEMSIS3 Webservice or NFIRS SFTP) and URL;
Data payload type (NEMSIS or NFIRS);
Data version;
DEM pre-upload requirement; and
Agency license, agency number, and agency name overrides.

Each outflow credential then has the following filters available, to constrain which trips are sent:

Jurisdiction state, county, and city;
Service levels;
Destination facility;
Send only if 'billable';
Send only if 'emergent';
Send only if 'patient contact'; and
Send only if transport occurred.

Furthermore, each outflow credential has reupload settings:

What point in the Postprocess Workflow to begin uploads; and
Whether to send a re-upload if underlying data changes.

Retroactive Changes to Outflow Credentials

Additions, deletions, and modifications to your outflow credentials ARE NOT RETROACTIVE.

That means that any changes will take effect for all validations going forward, but will not apply to older trips unless and until those trips experience a validation point and thus go through the system again.

Validation Points

As discussed above, the validator controls all outflows, blocking or releasing each trip for upload to its downstream consumers.

The validator runs for each trip after any of the following events occur:

The attending finishes the report and sends it to QA*;
QA passes the trip onward, or fails it back to the crew;
The trip finishes QA and moves onward;
The trip moves from 'Billing office' to 'Awaiting payment' or to 'Finished'.
Someone makes a change to pertinent data in the PCR, in the associated PMHx record, in the Followup, or in the run ticket.

Whenever any of those events occur, the validator waits for 20 minutes to see if anything else is going to happen, and if no further events occur, validation proceeds.

*The 20-minute delay does not apply when the attending finishes a report and sends it to QA for the first time, instead AngelTrack immediately sends the chart to whichever state or county outflow credential has jurisdiction.

Validation Rulesets

AngelTrack has three validation rulesets which apply to your dispatches:

NEMSIS (including all applicable schematrons);
NFIRS; and
NULL (no rules).

In the Service Levels Configuration page, you control which validation rulesets apply to the various service levels you offer. For example, by default the Wheelchair service level has NULL validation (no rules), but you can enable NEMSIS validation instead if your state requires it.

All Trips Pass Through the Validator

All normal dispatches pass through the validator, even if the trip's service level uses the NULL ruleset. This is because it is the validator that decides jurisdiction, calculates each trip's outflow demands, and queues uploads to any waiting demand.

Thus you might occasionally see a car-service or wheelchair call report itself as "Awaiting validation," even though no validation rules apply to it.

Dispatches marked 'Cancelled' or 'Delegated' are exempt from validation and never participate in the Outflows system. Any dispatch older than 2 years also does not participate in the system.

Schematrons

Trips subject to the NEMSIS ruleset use schematrons, which are electronic rulesets that can perform computerized checks on a NEMSIS XML payload.

AngelTrack calculates each trip's governing jurisdiction, and then selects from all of the following schematrons when validating it:

National schematrons, published by NEMSIS TAC;
State schematrons, published by most state health departments and disseminated by NEMSIS TAC;
County schematrons, published by some counties; and
An agency schematron that you can create yourself from AngelTrack's schematron rules library.

Each rule in a schematron can generate one of four different kinds of result: a PASS, a WARNING, an ERROR, or a FATAL.

Any ERROR or FATAL result causes the dispatch to fail validation, and hence cannot be uploaded by the Outflows system until the chart is corrected and re-validated. That includes non-state outflow demands, such as a a billing outflow or a non-forwarding county outflow; a trip must pass validation before it can be uploaded to any party.

Automatic Retries

Whenever an outflow upload fails, AngelTrack analyzes the failure and takes appropriate next steps.

If the failure was a rejection by the destination, such as a schematron error, AngelTrack queues up the trip for re-validation, since the destination's schematron might've changed since the last validation.

If the failure was a wrong-username or wrong-password error, AngelTrack pauses the outflow credential for a while, using a technique called "linear backoff". Later it will automatically unpause and retry the failed outflow.

If the failure was some other error, such as a connection failure or service-not-available, AngelTrack pauses the outflow credential for a shorter period of time, then automatically unpause and retry.

For failed validations that have sat for a long time awaiting corrections, AngelTrack will periodically retry them, in case the relevant schematrons have changed and the trips might now pass validation.

Manual Intervention

Because AngelTrack frequently recalculates each trip's outflow demands, you cannot manually add or remove an outflow demand from a dispatch.

Instead, once you've got your outflow credentials configured the way you like them, you can one-shot or bulk revalidate your trip backlog. After each trip validates, AngelTrack will recalculate its outflow demands according to your current outflow credentials.

The bulk-revalidation controls are on the Outflow Status page under Settings. The one-shot revalidation control is on the "Outflows" tab of any dispatch's run ticket.

Reuploads

Every outflow credential can specify whether it wants to receive reuploads, when the underlying data changes. Probably everyone other than billing platforms wants to receive such reuploads.

There are many validation points in AngelTrack, as listed above, which can trigger a re-validation and potential reupload; one such point is "Any change to pertinent underlying data". To wit: If a crew member opens a completed PCR and adds another set of vital signs, AngelTrack will wait 20 minutes for more modifications, then re-validate the trip, and then reupload to all active demands who are configured as wishing to receive such updates.

As noted, other events in AngelTrack can cause a revalidation, and hence a re-calculation of outflow demands; however, if the underlying data has not changed, then AngelTrack will not reupload the trip to any outflow credential which has previously received an upload containing the latest data.

Deactivating an Outflow Credential

If you deactivate an outflow credential, AngelTrack will deactivate all associated outflow demands, which will stop any pending uploads meant for it. Reactivating the credential will restore any of its previously pending uploads.

Setting Up a Billing Outflow

If your billing system or outside biller has a webservice endpoint that confirms to the Nemsis3WS SOAP standard (i.e. acts like a trauma registry), you can configure an outflow in AngelTrack to automatically send data to it.

Configure an outflow credential like this:

Payload type: NEMSIS XML
Web-service type: ImageTrend
NEMSIS version: Choose the newest version your billing system supports
Trip upload: Choose "Embed a PDF of the completed report within each upload"
Jurisdiction: Statewide / Non-forwarder
Trip filters: All service levels; choose "Send only if marked 'billable'"
Workflow options: Upload at 'Billing office'; choose "Never reupload" (unless your billing system expects reuploads)

AngelTrack will then send every billable trip once it graduates from QA.

The outflow system will not perform insurance reviews or make any postprocess workflow moves; you must still do those yourself, or in bulk using the Bulldozer.

Reporting

All outflow data is available in the Data Hub / Report Builder category named "Dispatches", in the dataset named "Dispatches-Uploads".

Validations and outflows are also noted in each dispatch's journal, and thus can be searched using the "Dispatches - Journal" category.

Los Angeles County

AngelTrack understands that Los Angeles county wishes to receive only certain types of trip; all other trips are reportable to the state instead.

Thus, any trip in Los Angeles County uses certificates and custom fields for Los Angeles County, but may or may not use the Los Angeles County schematron, depending on whether the trip is reportable to the county or to the state. You will see this reflected in the "Outflows" tab of the relevant run tickets.

Other Options for Data Streams

If the outflows system does not meet your needs, AngelTrack has many other APIs and automatic senders that might suit your situation: