Extending the Healthcare Foundation Data Model

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Extending the Healthcare Foundation Data Model

Description How to extend PFHC's data model
Version as of 8.7
Application Pega Foundation for Healthcare
Capability/Industry Area Healthcare and Life Sciences



Overview[edit]

In the event you determine that the Pega Foundation for Healthcare’s current out-of-the-box data does not adequately represent the properties and classes required for integration with an external source of truth, you have the option of extending the existing data model.

Extending the data model[edit]

The high-level steps for extending the data model are summarized below:

  1. Identify the data model for the system of record to be used in the application.
  2. Map the data properties and data classes from the new system of record to the current out-of-the-box healthcare foundation data model.
  3. Identify the gaps in the out-of-the-box data model.
  4. Add properties and data classes based on identified gaps.

Adding data classes and properties[edit]

Instead of building data classes yourself, you can map the system of record properties to the data class and properties of the healthcare foundation data model. Use the data classes and properties from the foundation data model as much as possible, and only create new data classes and properties when your application requires that data from the source system.

Note: Unless a property or a set of properties necessitate the creation of a new data class, and collectively represent a unique data entity, a new property or properties could be verified to check whether they fit into any existing data classes of the healthcare foundation data model. In the illustration below, properties such as National Provider Identifier (NPI), location, phone, email, and so on could be added to the parent ‘Provider’ data class and reused in child data classes (For example, practitioner, servicing organization, pharmacy) rather than creating a new data class to hold these properties.

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This article provides step-by-step instructions for extending the out-of-the-box data model using Prior Authorization as the example.

Use Case: Foundation for healthcare prior authorization data model[edit]

The Pega Foundation for Healthcare’s prior authorization data model is in the following class: PegaHC-Data-Authorization.

There are greater than 200 properties included in the Authorization data class. To see all the data properties in the Authorization class, please review the Pega Foundation for Healthcare Data Model.

Before you begin[edit]

Log into the Pega Foundation for Healthcare environment as Administrator. From Dev Studio, click on the Application tab at the top of the landing page and select Healthcare Appeals and Grievances application.

Note: Pega platform allows the creation of properties in both App and Dev studios; however, adding a property using the ‘Create’ menu in Dev Studio provides the user with several options. One such process is detailed below:

Adding a property to the data model in Dev Studio[edit]

  1. Navigate to App explorer in Dev Studio.
  2. Search for the PegaHC-Data-Authorization class in the left-hand navigation panel. Click on Data Model to expand it and then click on Property in the sub-menu.
  3. In the top right-hand corner of the landing page, click on the Create button.
  4. In the Create Property screen, enter a brief description, an identifier for this field (property), and choose its type.
  5. In the Context section, select the application class (described next in this document) and the ruleset to which this new property belongs.
  6. Click on Create and close to finish creating a property.
  7. A new rule pertaining to this property is added to the rule set based on type.
  8. Repeat the steps described above to create additional properties as needed.


Note: While a class in Pega is generally a container of rules, and defines the scope of rules within, a Data Class is a collection of Data Types/Data Objects comprised of related data elements (properties) and other rules to work with that data.

Adding a data object to the data model in Dev Studio[edit]

  1. Navigate to Data types in left-hand navigation panel of Dev Studio.
  2. Click on Data types at the top and then click on Add data type in the menu.
  3. In the Add Data Type modal window, enter the name (label) and brief description of this new data type.
  4. Click on Advanced to select the parent class this new class will inherit from, development branch, application, and the ruleset this new class will belong to. Then click on Submit to create this data type.
  5. Use the Add field option to start adding properties relevant to this data type.
  6. Click on Save to finish and a new rule pertaining to this data type is added to the rule set.

Best Practices[edit]

  • Start small when mapping from system of record to Healthcare Foundation data model.
  • When creating a new property, ensure the class chosen is most relevant.
  • For accuracy of data, set the correct type, character limits, validations, and so on when creating a property.
  • Identify specifically the application or framework in which the new class will be created.
  • Understand if the new class needs to share rules from other class(es) or needs a parent class.
  • Appropriate class and property names, descriptions help other users in understanding the context.

Resolution[edit]

The mapping of data from a new external data source to Pega's Healthcare data model will enable you to identify gaps in the out-of-the-box Pega Healthcare data model, while the creation of new properties and data classes will help you to close those gaps.  For more information, please be sure to visit Pega Foundation for Healthcare’s most current release documentation.

Appendix[edit]