Quickly and easily connect your Imaging System with Practice Fusion s Electronic Health Record (EHR) System. HL7 Results Specification

Transcription

1 HL7 Results Specification Imaging Quickly and easily connect your Imaging System with Practice Fusion s Electronic Health Record (EHR) System 1 P a g e HL7 Results Specification

2 About This Document This document describes how to integrate with Practice Fusion s Electronic Health Record (EHR) system by submitting Observation Result Unsolicited messages that contain imaging results data to the Practice Fusion API. Audience This document is intended for developers who are familiar with the nature of Health Level Seven (HL7) messages and have previously integrated imaging results information with other systems. It is not intended to provide a comprehensive education about HL7 messages and integrations. For comprehensive information about the HL7 specification, go to Practice Fusion also provides a tool named Practice Fusion Client that monitors a directory for ORU_R01 messages and sends them to Practice Fusion for RIS that do not wish to integrate directly with the API. For information on how to use this tool instead of the API, see the Practice Fusion Client Quick Start Guide or the Practice Fusion Client User Guide. How to Use This Document You should read Understanding the Practice Fusion ORU_R01 Implementation first. That section attempts to summarize the most important details about the Practice Fusion specification to pay attention to without reading the entire document. The Sample Messages section gives examples of messages that validate successfully against the Practice Fusion API. The ORU_R01 Detailed Segment Definitions section then documents each field in detail, which can be helpful if your messages are being rejected because of a specific field. The Practice Fusion User Interface section identifies the user interface elements in Practice Fusion that display fields in a message. The Practice Fusion SOAP-Based Services and Practice Fusion RESTful Services sections describe how to invoke those services to send HL7 data to the Practice Fusion API. The Appendix section details the cardinality, requiredness, and data type information about each field. Recommended Utilities There are several utilities you can use to view and edit HL7 files while testing your integration, which can be more helpful than trying to count delimiter positions in a text editor. Some are: QuickViewHL7 ( HL7 Analyst ( HL7 Inspector ( 2 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

3 Versions and Code Sets HL7 version 2.3 The Practice Fusion lab result API operates on HL7 version 2.3. More information about HL7 and version 2.3 of the standard can be found at LOINC version 2.27 or higher The Practice Fusion lab result API works with observation requests and observations based upon the LOINC 2.27 standard or higher. All incoming results are expected to be primary coded using LOINC, and optionally coded with internal identifiers. More information about LOINC can be found at 3 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

4 Understanding the Practice Fusion ORU_R01 Implementation The next section ORU_R01 Detailed Segment Definitions documents the properties of each segment and field in an ORU_R01 message that can be processed by Practice Fusion. This section presents a higher-level overview of the Practice Fusion implementation to provide you with an idea of where to focus most of your effort, and how this integration project might differ from other integration projects. Practice Fusion ignores all data in the Order Common (ORC) segment. The order number, accession number, and date and time of the report are all taken from the last Observation Request (OBR) segment contained in the message. Make sure that the value generated for the OBR-2 Placer Filler Number contains a unique value for each imaging order; if it does not, the result will be imported as a corrected or final result. Note (NTE) segments can be associated with the following segments: The Patient Identification (PID) segment, where the note applies to the entire imaging result The OBR segment, where the note applies to all observations related to that procedure The OBX segment, where the note applies to only that one observation or test Although the PID-5 Patient Name field is the only field required in the PID segment (aside from the segment type id field), Practice Fusion recommends that you populate as many fields as possible to equip providers with as much information as possible to deliver quality healthcare. Phone numbers in every field in the message must be formatted in a specific way for the message to validate successfully. The rules for valid phone numbers are: Opening parentheses Three-digit area code Closing parentheses Three-digit exchange number Hyphen Four-digit subscriber number No spaces in data Example: (555) All fields containing Social Security Numbers must match the following regular expression: \\b(?!000)(?!666)(?!9)[0-9]{3}[-]?(?!00)[0-9]{2}[- ]?(?!0000)[0-9]{4}\\b The rules for invalid SSN's are: Numbers with all zeros in any digit group (000-##-####, ###-00-####, ###-##-0000) Numbers with 666 in the first digit group (666-##-####) Numbers with 900 through 999 in the first digit group Example: P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

5 Sample Messages This section contains sample messages that conform to the Practice Fusion ORU_R01 message specification. Bare Minimum File MSH ^~\& madhatterpracti ORU^R01 MessageControlID P 2.3 PID Smith^John^Pete PV1 AttendingPhysicianID^AttendingPhysicianLastName^AttendingPhysicianFirst Name OBR 1 Placer1234 Filler56789 TestID^TestName^IDSystem ObservationDate/Time SpecimenReceivedDate/Time ResultChangeDate/Time ResultStatus(From HL7 table 0123) OBX 1 OBX5- DataType ObservationID^ObservationName^IDSystem ResultValue With Two Attachments MSH ^~\& SendingApplication SendingFacility PracticeAccount# ORU^R01 MessageCo ntrolid P 2.3 PID PatientLastName^PatientFirstName^PatientMiddleName PV1 AttendingPhysicianID^AttendingPhysicianLastName^AttendingPhysicianFirst Name OBR 1 Placer1234 Filler56789 TestID^TestName^IDSystem ObservationDate/Time SpecimenReceivedDate/Time ResultChangeDate/Time ResultStatus(From HL7 table 0123) OBX 1 OBX5- DataType ObservationID^ObservationName^IDSystem ResultValue LastObservatio ndate/time NTE 1 TX A note on the order NTE 2 TX Another line in the note OBX 2 ED PDF^PDF BASE64 1 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 OBX 3 ED PDF^PDF BASE64 1 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 OBX 4 ED PDF^PDF BASE64 1 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 OBX 5 ED PDF^PDF BASE64 1 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 OBX 6 ED PDF^PDF BASE64 1 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 OBX 7 ED PDF^PDF BASE64 1 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 OBX 2 ED PDF^PDF BASE64 2 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 5 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

6 OBX 3 ED PDF^PDF BASE64 2 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 OBX 4 ED PDF^PDF BASE64 2 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 OBX 5 ED PDF^PDF BASE64 2 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 OBX 6 ED PDF^PDF BASE64 2 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 OBX 7 ED PDF^PDF BASE64 2 ^PDFReport^PDF^Base64^RTlENTUxOTFDMTIwQzQ3OUE0MDU2NzZDNkM4ODI1Mz5dL0luZG V4WzE4IDI4 6 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

7 ORU_R01 Detailed Segment Definitions This section of the document provides detailed information about every field in every segment. Each item in the following bulleted list links to the section that describes the identified segment: Message Header (MSH) 9 Patient Identification (PID) 13 Patient Visit (PV1) 18 Order Common (ORC) 29 Observation Request (OBR) 34 Observation Result (OBX) 43 Note (NTE) 49 File Trailer Segment (FTS) 50 Each subsection provides a brief description of the segment and an example of the data it might contain in a valid message. The fields of each segment are detailed in a table with eight columns. When a field should contain values from a table identified by HL7 and the number of values is manageable, those values are included for convenience; if the number of values is too large (for example, in the case of Country Codes), the table is identified but only a few examples are given to avoid making the guide too large. Table 1: Field Information identifies each column and describes what information it provides about the field. Table 1: Field Information Column Name Seq Name Value Type Req d Length Contents Contains the sequence number of the field within the message. Contains the name of the field. Contains the value that must appear in the field (such as ORU^R01 for the Message Type field) or that might appear in the field (such as an example value for a date field that will not always contain the same value), as well as rules that must be applied to the data (such as the required structure for a Social Security Number). Hard-coded or example values are formatted in Courier font to make them easy to identify from surrounding text. Identifies the data type of the field. For detailed information about each data type, see Data Types in the appendix. The value in this column is linked to its definition in the appendix. Identifies whether the field is required, optional, or required in certain conditions. For detailed information about each possible value, see Requiredness in the appendix. The value in this column is linked to its definition in the appendix. Identifies the maximum length of this field. Fields that contain more characters in this field than are specified by the maximum length are truncated when processed by the API. 7 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

8 Column Name Card Used? Disp? Contents Identifies the cardinality of the field. For detailed information about each possible cardinality state, see Cardinality in the appendix. The value in this column is linked to its definition in the appendix. Indicates whether or not the field is used at all in the business logic of Practice Fusion. Indicates whether or not the field is displayed or not in the Practice Fusion application; some fields might be used in the logic layer, but never displayed in the presentation layer. 8 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

9 Message Header (MSH) The MSH segment is the first segment in every HL7 message, and defines the message s source, purpose, destination, and certain syntax specifics such as the delimiters and character sets used in the message. The MSH segment is required and may only appear once. MSH ^~\& accountidentifer ORU^R01 MessageID1234 P 2.3 Seq Name Value Type Req d Length Card Used? Disp? MSH-0 MSH-1 MSH-2 Segment identifier Field delimiter Encoding characters MSH ST R Y N (the pipe character) ST R Y N ^~\& ST R Y N MSH-3 Sending application Identifies your application Example: Radiology InformationSystemNa me HD O N N MSH-4 Sending facility Identifies the sending radiology or reporting site HD O N N Example: Wildfire_Atlanta^45 D ^CLIA MSH-5 Receiving application Identifies Practice Fusion as the destination HD O N N Example: Practice Fusion MSH-6 Receiving facility Identifies the healthcare organization for which the message is intended HD R Y MSH-6 Example: DrSussmanPractice 9 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

10 Seq Name Value Type Req d Length Card Used? Disp? MSH-7 Message date and time Identifies the date and time the message was created TS R Y N Example: MSH-8 Security Used in some implementations for security features ST O N N MSH-9 Message type ORU^R01 CM R N N MSH-10 Message control ID Contains the value the system uses to associate the message with the response to the message ST R Y N Example: UNX3ZMH5YAPHBL63SB3 V MSH-11 Processing ID P for in production D for in debugging T for in training PT R N N MSH-12 HL7 version 2.3 VID R N N MSH-13 Sequence number A non-null value in this field indicates that the sequence number protocol is in use NM O N N MSH-14 Continuation pointer Contains the value used by a system to associate a continuation message with the message that preceded it when the data of an unsolicited observation request must be split into multiple messages ST O N N 10 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

11 Seq Name Value Type Req d Length Card Used? Disp? MSH-15 Accept acknowledge ment type AL to always require accept acknowledgement messages to be returned ID O N N NE to never require accept acknowledgements SU to only require accept acknowledgements for successfully transmitted messages ER to only require accept acknowledgements in the event of an error MSH-16 Application acknowledge ment type AL to always require application acknowledgements to be returned ID O N N NE to never require application acknowledgements to be returned SU to require application acknowledgements to be returned only in response to successfully transmitted messages ER to only require application acknowledgements in the event of an error MSH-17 MSH-18 Country code HL7 recommends values from ISO table 3166 Example: US for United States Character set Valid character set codes are defined in HL7 table 0211 Example: ASCII for the ASCII character set ID O N N ID O N N 11 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

12 Seq Name Value Type Req d Length Card Used? Disp? MSH-19 Principle language of message HL7 recommends values from ISO table 639 Example: en for English CE O N N 12 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

13 Patient Identification (PID) The PID segment is used by all applications as the primary means of communicating patient identification information. This segment contains identifying and demographic information about the patient that is not likely to change frequently. The PID segment is required and may only appear once. PID PF00001 TEST^PRESTON M 555 South Main St.^APT #123^Some City^CA^94066 (555) Seq Name Value Type Req d Length Card Used? Disp? PID-0 Segment type ID PID SI R N N PID-1 Sequence number Identifies the number of the PID segment in circumstances where the message contains multiple patient reports SI O N N Example: 1 PID-2 External patient ID Unique identifier for the patient; retained for backward compatibility CX O Y PID-2 Example: PID-3 Patient identifier list Uniquely identifies the patient using values such as a medical record number, billing number, birth registry, and so forth ST O Y N Example: ^^^^PATGU ID PID-4 Alternate patient ID Contains alternate, pending, or temporary optional patient identifiers to be used, such as a social security number, a visit date, or a visit number; it has been retained for backward compatibility ID O N N 13 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

14 Seq Name Value Type Req d Length Card Used? Disp? PID-5 PID-6 Patient name Example: Beth Emhoff Mother s maiden name <family name>^<given name>^<middle initial or name>^<suffix>^<prefix >^<degree>^<name type code> HD R Y PID-5 Example: Jenner XPN O N N PID-7 Patient date of birth Example: DT O Y PID-7 PID-8 Patient gender Valid gender codes are defined in HL7 table 0001 IS O Y PID-8 Example: M for male PID-9 Patient alias ^White^HL70006 PID-10 Patient race Valid race codes are defined in HL7 table 0005 XPN O N N CE O N N Example: WH PID-11 Patient address Example: 123 MAIN ST^APT 4J, MIDDLE ROOM^NEW YORK^NY^10021^ XAD O Y PID-11 <street address> ^ <other designation> ^ <city> ^ <state> ^ <zip> ^ <country> ^ <address type> ^ <other> ^ <county> ^ <census tract> PID-12 Patient county code Valid county codes are defined in HL7 table 0289 IS O N N Example: P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

15 Seq Name Value Type Req d Length Card Used? Disp? PID-13 Patient home phone number The rules for valid phone numbers are: Opening parentheses Three-digit area code Closing parentheses Three-digit exchange number Hyphen Four-digit subscriber number No spaces in data XTN O Y PID-13 Example: (555) PID-14 Patient work phone number Example: (555) XTN O N N PID-15 Patient language HL7 recommends values from ISO table 639 CE O N N Example: en for English PID-16 Patient marital status Valid marital status codes are defined in HL7 table 0002 CE O N N Example: M for married PID-17 Patient religion Valid religion codes are defined in HL7 table 0006 CE O N N Example: OTH for Other PID-18 Patient account number Contains the number assigned by accounting for the patient against which all charges and payments are recorded CX O N N Example: P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

16 Seq Name Value Type Req d Length Card Used? Disp? PID-19 Patient Social Security Number Social Security Numbers must match the following regular expression: ST O N N \\b(?!000)(?! 666)(?!9)[0-9]{3}[- ]?(?!00)[0-9]{2}[- ]?(?!0000)[0-9]{4}\\b The rules for invalid SSN's are: Numbers with all zeros in any digit group (000-##-####, ###-00-####, ###- ##-0000) Numbers with 666 in the first digit group (666-##-####) Numbers with 900 through 999 in the first digit group Example: PID-20 Driver s license number Example: B DLN O N N PID-21 Mother s identifier Used to link a newborn to its mother by her unique identifier CX O N N Example: PID-22 Patient ethnic group Valid ethnic groups are defined in HL7 table 0189 CE O N N Example: H for Hispanic PID-23 Patient birth place Example: 123 MAIN ST^APT 4J, MIDDLE ROOM^NEW YORK^NY^10021^ ST O N N 16 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

17 Seq Name Value Type Req d Length Card Used? Disp? PID-24 Multiple birth indicator Valid multiple birth indicators are defined in the HL7 yes/no table 0136 ID O N N Example: Y to indicate the patient was part of a multiple birth PID-25 Birth order Indicates the order in which the patient was born if part of a multiple birth NM O N N Example: 1 PID-26 Citizenship HL7 recommends values from ISO table 3166 CE O N N Example: US for United States PID-27 Veteran s military status Specifies the code in userdefined table 0172 to identify the military status of a veteran CE O N N PID-28 Nationality Contains a code that identifies the nation or national grouping to which the person belongs. This information may be different from a person s citizenship in countries in which multiple nationalities are recognized, such as Basque and Catalan in Spain Valid nationality codes are defined in HL7 table 0212 CE O N N PID-29 Patient death date and time Example: TS O N N PID-30 Patient death indicator Valid death indicators are defined in the HL7 yes/no table 0136 ID O N N Example: N to indicate the patient has not died 17 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

18 Patient Visit (PV1) The PV1 segment contains information about a specific patient visit. This segment can be used to send multiplevisit statistic records to the same patient account or single-visit records to more than one account. The PV1 segment is required and should appear only once. PV ^Who^Doctor Seq Name Value Type Req d Length Card Used? Disp? PV1-0 PV1-1 Segment identifier Sequence number PV1 SI R N N 1 SI O N N PV1-2 Patient class Valid patient classes are defined in HL7 table 0004 C for commercial account N for not applicable U for unknown E for emergency I for inpatient O for outpatient P for preadmit R for recurring patient B for obstetrics IS O N N PV1-3 Assigned patient location Identifies the patient s initial assigned location or the location to which the patient is being moved. The first component may be the nursing station for inpatient locations, or clinic or department for locations other than inpatient. For situations where a transaction is being cancelled or a patient is being discharged, this field identifies the current PL O N N 18 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

19 Seq Name Value Type Req d Length Card Used? Disp? location of the patient. If a value exists in the fifth component (location status), it supersedes the value in PV Bed Status PV1-4 Admission type Valid admission type codes are defined in HL7 table 0007 IS O N N A for accident C for elective E for emergency L for labor and delivery N for newborn R for routine U for urgent PV1-5 Pre-admit number Identifies the patient s account prior to admission CX O N N PV1-6 Prior patient location Identifies the prior location of the patient when being transferred; the old location is null if the patient is new. If a value exists in the fifth component (location status), it supersedes the value in PV Bed Status PL O N N PV1-7 Attending provider Unique identifier for the attending provider XCN R Y PV1-7 PV1-8 Referring provider Unique identifier for the referring provider XCN O N N PV1-9 Consulting provider Unique identifier for a consulting provider XCN O N N PV1-10 Hospital service Valid hospital service codes are defined in HL7 table 0069 IS O N N CAR for cardiac service MED for medical service 19 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

20 Seq Name Value Type Req d Length Card Used? Disp? PUL for pulmonary service SUR for surgical service URO for urology service PV1-11 Temporary location A location other than the assigned location required for a temporary period of time, such as an operating room; if a value exists in the fifth component (location status), it supersedes the value in PV Bed Status PL O N N PV1-12 Preadmit test indicator Specifies the code in userdefined table 0087 that Indicates whether the patient must have preadmission testing done in order to be admitted IS O N N PV1-13 Readmission indicator Indicates whether or not the patient is being readmitted to the facility IS O N N HL7 recommends a null value, or R for readmission PV1-14 Admit source Valid admission source codes are defined in HL7 table for physician referral 2 for clinic referral 3 for HMO referral 4 for transfer from a hospital 5 for transfer from a skilled nursing facility 6 for transfer from another healthcare facility 7 for emergency room 8 for court/law enforcement 9 for information not IS O N N 20 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

21 Seq Name Value Type Req d Length Card Used? Disp? available PV1-15 Ambulatory status Valid ambulatory status codes are defined in HL7 table IS O N N A0 for No functional limitations A1 for Ambulates with assistive device A2 for Wheelchair/stretcherbound A3 for Comatose; nonresponsive A4 for Disoriented A5 for Vision impaired A6 for Hearing impaired A7 for Speech impaired A8 for Non-English speaking A9 for Functional level unknown B1 for Oxygen therapy B2 for Special equipment (tubes, IVs, catheters, etc.) B3 for Amputee B4 for Mastectomy B5 for Paraplegic B6 for Pregnant PV1-16 VIP indicator Valid very-importantperson (VIP) status indicators are defined in the HL7 yes/no table 0136 Y to indicate VIP status N to indicate standard status IS O N N PV1-17 Admitting provider Unique identifier for the admitting provider XCN O N N 21 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

22 Seq Name Value Type Req d Length Card Used? Disp? PV1-18 Patient type Specifies the code in userdefined table 0018 to identify the type of patient IS O N N PV1-19 Visit number Contains the unique number assigned to the patient visitation CX O N N PV1-20 Financial class Valid financial classes are defined in HL7 table 0064 FC O N N V01 for Not VFC eligible V02 for VFC eligible Medicaid/Medicaid Managed Care V03 for VFC eligible Uninsured V04 for V eligible American Indian/Alaskan Native V05 for VFC eligible Federally Qualified Health Center Patient (underinsured) V06 for VFC eligible State-specific eligibility (for example S-CHIP plan) V07 for VFC eligible local-specific eligibility V08 for Not VFC eligible Under-insured PV1-21 Charge price indicator Specifies the code in userdefined table 0032 to determine which price schedule is to be used for room and bed charges IS O N N PV1-22 Courtesy code Specifies the code in userdefined table 0045 to identify the type of insurance coverage or types of services that are covered for the billing system; for example, a physician s billing system might only IS O N N 22 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

23 Seq Name Value Type Req d Length Card Used? Disp? want to receive insurance information for plans that cover physician or professional charges PV1-23 Credit rating Specifies the code in userdefined table 0046 to determine past credit experience IS O N N PV1-24 Contract code Specifies the code in userdefined table 0044 to identify the type of contract entered into by the healthcare facility and the guarantor for the purpose of settling outstanding account balances IS O N N PV1-25 Contract effective date Specifies the date the contract started or is to start DT O N N Example: PV1-26 Contract amount Specifies the amount to be paid by the guarantor each period according to the contract NM O N N PV1-27 Contract period Specifies the duration of the contract NM O N N PV1-28 Interest code Specifies the code in userdefined table 0073 to identify the amount of interest that will be charged the guarantor on any outstanding amounts IS O N N PV1-29 Transfer to bad debt code Specifies the code in userdefined table 0110 to indicate that the account was transferred to bad debts and specifies the reason IS O N N PV1-30 Transfer to bad debt date Example: DT O N N 23 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

24 Seq Name Value Type Req d Length Card Used? Disp? PV1-31 Bad debt agency code Specifies the code in userdefined table 0021 to identify the bad-debt agency to which the account was transferred IS O N N PV1-32 Bad debt transfer amount Contains the amount of money transferred to baddebt status NM O N N PV1-33 Bad debt recovery amount Contains the amount of money recovered from the guarantor on the account NM O N N PV1-34 Delete account indicator Specifies the code in userdefined table 0111 that indicates that the account was deleted from the file IS O N N PV1-35 Delete account date Example: DT O N N PV1-36 Discharge disposition Specifies the code in userdefined table 0111 that identifies the patient s anticipated location or status following the encounter IS O N N 01 for Discharged to home or self care (routine discharge) 02 for "Discharged/transferred to a short-term general hospital for inpatient care" 03 for "Discharged/transferred to skilled nursing facility (SNF) with Medicare certification" 04 for Discharged/transferred to an intermediate care facility (ICF) 05 for "Discharged/transferred to another type of institution not defined elsewhere in 24 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

25 Seq Name Value Type Req d Length Card Used? Disp? this code list" 06 for "Discharged/transferred to home under care of organized home health service organization" 07 for Left against medical advice or discontinued care 08 for Discharged/transferred to home under care of a Home IV provider 09 for Admitted as an inpatient to this hospital 20 for Expired 30 for Still Patient 40 for Expired at home 41 for Expired in a medical facility (e.g. hospital, SNF, ICF, or free-standing hospice) 42 for Expired - place unknown 43 for "Discharged/transferred to a federal health care facility" 50 for "Hospice - home" 51 for "Hospice - medical facility" 61 for "Discharged or transferred to hospitalbased Medicare approved swing bed" 62 for "Discharged or transferred to an inpatient rehabilitation facility (IRF) including rehabilitationdistinct part units of a hospital" 63 for "Discharged or transferred to a Medicare- 25 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

26 Seq Name Value Type Req d Length Card Used? Disp? certified long-term-care hospital" 64 for "Discharged or transferred to a nursing facility certified under Medicaid but not certified under Medicare" 65 for "Discharged or transferred to a psychiatric hospital or psychiatricdistinct unit of a hospital" 66 for "Discharged or transferred to a Critical Access Hospital" PV1-37 Discharged to location Specifies the code in userdefined table 0113 that identifies the location to which the patient was discharged CM O N N PV1-38 Diet type Specifies the code in userdefined table 0114 that identifies a diet the patient must adhere to, such as liquid or fasting IS O N N PV1-39 Servicing facility Specifies the code in userdefined table 0115 that identifies the particular facility in a multiple-facility environment that is associated with the visit IS O N N PV1-40 Bed status Specifies the code in userdefined table 0116 that identifies the status of the patient s bed; for example, that the bed is occupied, available, or requires cleaning IS O N N PV1-41 Account status Specifies the code in userdefined table 0117 that identifies the status of the patient s account IS O N N PV1-42 Pending The location to which the PL O N N 26 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

27 Seq Name Value Type Req d Length Card Used? Disp? location patient may be moved. The first component may be the nursing station for inpatient locations, or the clinic, department, or home for locations other than inpatient. If a value exists in the fifth component (location status), it supersedes the value in PV bed status PV1-43 Prior temporary location Identifies the patient s temporary location (such as the operating room or x-ray facility) prior to a transfer from a temporary location to an actual location, or from a temporary location to another temporary location. The first component may be the nursing station for inpatient locations, or the clinic, department, or home for locations other than inpatient PL O N N PV1-44 PV1-45 Admit date and time Discharge date and time TS O N N TS O N N PV1-46 Current patient balance Specifies the balance due for the visit NM O N N PV1-47 Total charges Specifies the total charges for the visit NM O N N PV1-48 Total adjustments Specifies the total adjustments for the visit NM O N N PV1-49 Total payments Specifies the total payments for the visit NM O N N PV1-50 Alternate Specifies the code in HL7 table 0061 that contains the CX O N N 27 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

28 Seq Name Value Type Req d Length Card Used? Disp? visit ID alternative, temporary, or pending optional visit ID number to be used if needed PV1-51 Visit indicator Specifies the code in HL7 table 0326 that indicates the level at which the data is being sent A for account-level V for visit-level IS O N N PV1-52 Other healthcare provider Identifies other healthcare providers (for example, nurse care practitioner, midwife, or physician assistant) XCN O N N 28 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

29 Order Common (ORC) The optional ORC segment identifies basic information about the order for interpretation of the image. This segment includes identifiers of the order, who placed the order, when it was placed, what action to take regarding the order, and so forth. The ORC segment is not required, but if it is present, the minimum information needed for the segment to be valid are the ORC-0, ORC-1, and ORC-5 fields. ORC RE F Seq Name Value Type Req d Length Card Used? Disp? ORC-0 Segment type ORC SI R N N ORC-1 Order control Specifies the code in HL7 table 0119 that identifies the action to be taken for the order Examples: NW for new order or service request CA for cancel order or service request ID R N N ORC-2 Placer order number Identifies the application requesting the order ED O N N Example: 04fc7500-9e eb97fdd3c49d5 ORC-3 Filler order number The order number of the application filling the order ED O N N Example: ^RIS ORC-4 Placer group number Used by the application placing the order to group sets of orders together and identify them ED O N N ORC-5 Order status Specifies the code in HL7 table 0038 that identifies the status of the order. The purpose of this field is to report the status of an ID O N N 29 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

30 Seq Name Value Type Req d Length Card Used? Disp? order either upon the receipt of a solicited request, or when the status changes unsolicited. It does not initiate action. It is assumed that the order status always reflects the status as it is known to the sending application at the time that the message is sent. Only the filler can originate the value of this field. Although HL7 Table Order status contains many of the same values contained in HL7 Table Order Control Codes and their meaning, the purpose is different. Order status may typically be used in a message with an ORC-1 - Order Control value of SR or SC to report the status of the order on request or to any interested party at any time ER for Error, order not found SC for In progress, scheduled IP for In process, unspecified RP for Order has been replaced CM for Order is completed HD for Order is on hold CA for Order was cancelled DC for Order was discontinued A for Some, but not all results are available ORC-6 Response flag Specifies the code in HL7 table 0121 that allows the ID R N N 30 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

31 Seq Name Value Type Req d Length Card Used? Disp? placer application to determine the amount of information to be returned from the filler. Sometimes the requested level of response may not be possible immediately, but when it is possible, the filler application must send the information. When the field is null, D is the default interpretation of the field N for Only the Message Acknowledgement (MSA) segment is returned E for Report exceptions only R for Report exceptions, Replacement, and Parent- Child D for Report exceptions, Replacement, Parent-Child, and associated segments F for Report exceptions, Replacement, Parent-Child, associated segments, and explicit confirmations ORC-7 Quantity and timing Specifies the priority, quantity, frequency, and timing of an order request TQ O N N Example for administration of a unit of blood: 1^QAM^X3 for three units given on successive mornings ORC-8 Parent Associates a child order request with its parent order request. For example, an application might receive a request to administer an electrocardiogram test on each of three successive mornings. The application creates three child orders CM O N N 31 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

32 Seq Name Value Type Req d Length Card Used? Disp? one for each morning and uses this field to associate them. After the first test is performed, a request might be received to cancel the test; the parent cannot be cancelled because one child has already been performed, but the remaining two children can be cancelled ORC-9 Date and time of transaction Identifies the date and time the request enters the application TS O N N ORC-10 Entered by Identifies the individual responsible for entering the request into the application ORC-11 Verified by Identifies the individual responsible for verifying the accuracy of the request, such as when a technician enters the request and a nurse needs to verify it XCN O * N N XCN O * N N ORC-12 Ordering provider Identifies the individual responsible for creating the request, such as the ordering physician XCN O * N N ORC-13 Enterer s location Identifies the location of the individual who entered the request, such as a nursing station or clinic PL O * N N ORC-14 Callback phone number Identifies the telephone number to call for clarification of a request or other information regarding the order; identical to the value populated in OBR-17 Order Callback Phone Number XTN O N (2) N N Example: (555) P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

33 Seq Name Value Type Req d Length Card Used? Disp? ORC-15 Order effective date and time Specifies the date and time that changes to the request took effect or should take effect TS O N N Example: ORC-16 Order control code reason Describes the reason that the ORC-1 Order Control field contains the value that it does; in the event of a cancellation, for example, it might explain that a physician s drug order was cancelled because of a possible allergic reaction to the drug CE O N N ORC-17 Entering organization Identifies the organization (such as a medical group or department) that the individual identified in the ORC-10 Entered By field belonged to at the time they entered the order CE O N N ORC-18 Entering device Identifies the physical device, such as a computer or ipad that the individual identified in the ORC-10 Entered By field used to enter the order CE O N N ORC-19 Action by Identifies the individual who initiated the event represented by the corresponding order control code; for example, if the order is being cancelled, this field identifies the individual who initiated the cancellation XCN O * N N 33 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

34 Observation Request (OBR) The OBR segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (for example radiology or EKG) or clinical observations, (for example, vital signs or physical exam). The OBR segment is required and may repeat. OBR 1 Placer1234 Filler56789 SOL23010^Potassium Seq Name Value Type Req d Length Card Used? Disp? OBR-0 Segment type OBR ST R N N OBR-1 Sequence number SI R N OBR-1 OBR-2 Placer order number Identifies the application requesting the order; identical to the value in ORC-2 Placer Order Number ED R Y OBR-2 Example: 04fc7500-9e eb97fdd3c49d5 OBR-3 Filler order number Contains a permanent identifier for an order and its associated observations ED O Y OBR-3 OBR-4 Universal service ID Specifies the code for the requested observation or test battery CE O N OBR-4 Example: ^SNOMED- CT^Continuous ECG monitoring OBR-5 Priority Specifies the priority of the request, but exists for backward compatibility only; in current implementations, the priority value is specified by the sixth component of the OBR-27 Quantity/Timing ID O N N 34 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

35 Seq Name Value Type Req d Length Card Used? Disp? field OBR-6 Requested date and time Specifies the date and time of the request, but exists for backward compatibility only; in current implementations, the value is specified by the fourth component of the OBR-27 Quantity/Timing field TS O N N OBR-7 Observation date and time Identifies the clinicallyrelevant date and time of the observation TS R Y OBR-7 In the case of observations taken directly from a subject, it is the actual date and time the observation was obtained In the case of a specimenassociated study, this field identifies the date and time the specimen was collected or obtained Example: OBR-8 Observation end date and time Identifies the end date and time of a study or timed specimen collection. If an observation takes place over a substantial period of time, it will indicate when the observation period ended. For observations made at a point in time, it will be null. This is a results field except when the placer or a party other than the filler has already drawn the specimen TS O N N Example: OBR-9 Collection volume Specifies the collection volume of a specimen. Valid values are identified in Figure Common CQ O N N 35 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

36 Seq Name Value Type Req d Length Card Used? Disp? ISO derived units and *ISO extensions in Chapter 7 of the HL7 specification Example: ML OBR-10 Collector identifier Identifies the individual, department, or facility that collected the specimen XCN O * N N OBR-11 Action code Specifies the code in HL7 table 0065 that identifies the action to be taken with respect to the specimens that accompany or precede the order ID O N OBR-11 A for Add ordered tests to the existing specimen G for Generated order; reflex order L for Imaging to obtain specimen from patient O for Specimen obtained by service other than a lab P for Pending specimen; order sent prior to delivery R for Revised order S for Schedule the tests specified below OBR-12 Danger code Contains the code, or text, or both that indicate any known or suspected patient or specimen hazards, such as a patient with active tuberculosis or blood from a patient with hepatitis. The code must always appear in the first component position and text must always appear in the second component; if the code is absent, the text must be preceded by a component delimiter CE O N N 36 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

37 Seq Name Value Type Req d Length Card Used? Disp? OBR-13 Relevant clinical information Contains additional clinical information about the patient or specimen, such as the suspected diagnosis and clinical findings on requests for interpreted diagnostic studies. For example, this field might identify the amount of inspired carbon dioxide for blood gasses, the point in the menstrual cycle for cervical pap tests, and other conditions that influence test interpretations. For some orders this information may be sent on a more structured form as a series of OBX segments that immediately follow the order segment ST O N N OBR-14 Specimen received date and time Identifies the date and time a diagnostic service receives the specimen TS R Y N Example: OBR-15 Specimen source Identifies the site where the specimen should be obtained or where the service should be performed. CM O N N Valid codes for the specimen source code subcomponent are defined in HL7 table Valid codes for the body site code subcomponent are defined in HL7 table 0163 OBR-16 Ordering provider Identifies the individual that requested the order or prescription XCN O * N N OBR-17 Order callback Identifies the telephone XTN O N N N 37 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

38 Seq Name Value Type Req d Length Card Used? Disp? phone number number to call for clarification of a request or other information regarding the order; identical to the value populated in ORC-14 Callback Phone Number (2) OBR-18 OBR-19 Example: (555) Placer field #1 Contains free-form text entered by the placer Placer field #2 Contains free-form text entered by the placer ST O N N ST O N N OBR-20 Filler 1 Contains free-form text entered by the filler OBR-21 Filler 2 Contains free-form text entered by the filler ST O N N ST O N N OBR-22 Result reported date and time Identifies the date and time when the results are entered in a report or when the status value in the ORC- 5 - Order Status field was changed. When other applications (such as office or clinical database applications) query the radiology application for results that have not yet been transmitted, the information in this field may be used to control processing in the exchange. Usually, the ordering service would want only those results for which the reporting date and time is greater than the date and time the inquiring application last received results TS R Y N Example: OBR-23 Charge to Contains the charge to the CM O N N 38 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

39 Seq Name Value Type Req d Length Card Used? Disp? practice ordering entity for the studies performed, when applicable. The first subcomponent is a dollar amount identified by the filler; the second subcomponent is a charge code identified by the filler OBR-24 Diagnostic serv sect ID Specifies the code in HL7 table 0074 that identifies where the observation was performed ID O N N Examples: AU for Audiology RAD for Radiology OBR-25 Test status Specifies the code in HL7 table 0123 that identifies the status of results for the order ID R Y OBR-25 O for Order received; specimen not yet received I for No results available; specimen received; procedure incomplete S for No results available; procedure scheduled but not performed yet A for Some, but not all results are available P for Preliminary: a verified early result is available, but final results are not yet obtained C for Correction to results R for Results stored, but not yet verified F for Final results are stored and verified; can only be changed with a corrected result X for No results available; 39 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

40 Seq Name Value Type Req d Length Card Used? Disp? order cancelled Y for No order on record for this test Z for No record of the patient OBR-26 Parent result Identifies the OBX segment of a parent s result in situations such as toxicology tests CM O N N OBR-27 Quantity and timing Specifies the priority, quantity, frequency, and timing of an order request; similar to the ORC-7 field TQ O * N N OBR-28 Result copies to Identifies other individuals who are to receive copies of the result XCN O N (5) N N OBR-29 Parent Associates a child order request with its parent order request; similar to the ORC-8 field CM O N N OBR-30 Transportation mode Specifies the code in HL7 table 0124 that identifies how the patient should be transported ID O N N CART for Cart or gurney PORT for The examining device is transported to the patient s location WALK for Patient walks to diagnostic service WHLC for Wheelchair OBR-31 Reason for study Specifies the code or text using the conventions for coded fields as documented in Chapter 2 of the HL7 specification CE O * N N OBR-32 Principle result interpreter Identifies the individual who interpreted the observation and is responsible for the CM O N N 40 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

41 Seq Name Value Type Req d Length Card Used? Disp? contents of the report OBR-33 Assistant result interpreter Identifies the clinical observer who assisted with interpreting the observation CM O * N N OBR-34 Technician Identifies the performing technician CM O * N N OBR-35 Transcriptionist Identifies the transcriber of the report CM O * N N OBR-36 Scheduled date and time Identifies the date and time the filler scheduled an observation TS O N N Example: OBR-37 Number of sample containers Identifies the number of containers for a given sample NM O N N OBR-38 Transport logistics of collected sample Identifies the means by which a sample reaches the diagnostic service provider, such as a transport van or public postal service CE O * N N OBR-39 Collector s comment Contains additional comments related to the sample CE O * N N OBR-40 Transport arrangement responsibility Identifies the individual responsible for arranging transport to the planned diagnostic service, such as Requester, Provider, or Patient CE O N N OBR-41 Transport arranged Specifies the code in HL7 table 0224 that identifies whether or not transportation has been arranged ID O N N A for Arranged N for Not arranged 41 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

42 Seq Name Value Type Req d Length Card Used? Disp? U for Unknown OBR-42 Escort required Specifies the code in HL7 table 0225 that identifies whether or not an escort is required for the patient R for Required N for Not required U for Unknown ID O N N OBR-43 Planned patient transport comment Contains a code or freeform comments on special requirements for the transportation of the patient CE O * N N 42 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n

43 Observation Result (OBX) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report and is designed to carry information about observations in report messages. The OBX segment is required and may repeat. OBX example with an imaging site: OBX 1 TX Identifier^ObservationName^NameOfCodingSystem 5.5 meq/l H Status LP^Imaging Partners^123 SomeDrive^AnyTown^CA^95835^MedicalDirector^(555) OBX example without an imaging site: OBX 1 TX Identifier^ObservationName^NameOfCodingSystem 5.5 meq/l H Status OBX example with an Attachment: OBX 1 ED 1 ^PDFReport^PDF^Base64^JVBERi0xLjUNJeLjz9MNCjE4IDAgb2JqDTw8L0xpb mvhcml6zwqgms9midiy Seq Name Value Type Req d Length Card Used? Disp? OBX-0 OBX-1 Segment type Sequence number OBX ST R N N SI R N N OBX-2 Value type Contains the format of the observation value If the value is CE then the result must be a coded entry If the value is TX or ST then the results are bulk text If the value is ED, then the results will appear as an attached image CE, ST, NM, TX, ED, SN R N N OBX-3 Observation identifier Contains a unique identifier for the observation, such as Local Observation Identifiers Names and Codes (LOINC) CE R Y OBX-3 43 P a g e H L 7 R e s u l t s S p e c i f i c a t i o n