Patient Sync Integration Guide. Patient Demographic Synchronization Patient Appointment Schedules Synchronization Patient Context

Transcription

1 Patient Demographic Synchronization Patient Appointment Schedules Synchronization Patient Context August 24, 2010

2 Table of Contents SLUTIN VERVIEW...3 VERVIEW...3 PATIENT DEMGRAPHICS SYNCHRNIZATIN...3 PATIENT APPINTMENT SCHEDULES SYNCHRNIZATIN...3 PATIENT CNTEXT...3 PATIENT DEMGRAPHICS SYNCHRNIZATIN VERVIEW...4 PATIENT APPINTMENT SCHEDULE SYNCHRNIZATIN VERVIEW...6 CNNECTIVITY PTINS AND REQUIREMENTS...8 CNNECTIVITY PTINS...8 CNNECTIVITY REQUIREMENTS...8 Secure HTTP (HTTP/SSL) over Internet...8 Mailbox...8 Persistent...8 HTTP over IPSec VPN...8 Mailbox...8 Persistent...9 Secure FTP (FTP/SSL) over Internet...9 FTP over IPSec VPN...9 Lower Layer Protocol (LLP) over IPSec VPN...9 AS2 Connector...10 WebSphere MQ...10 Covisint Scout...10 PATIENT DEMGRAPHICS MESSAGING PTINS AND REQUIREMENTS...11 MESSAGE VERSIN...11 HL7 ADT STANDARD...11 ADT Events...11 HL7 ADT^A01 Message Structure v Supported ADT Segments...12 Supported Acknowledgements...12 PATIENT DEMGRAPHICS ADT SEGMENTS/FIELDS...13 SAMPLE HL7 ADT V PATIENT APPINTMENT SCHEDULE MESSAGING PTINS AND REQUIREMENTS...26 MESSAGE VERSIN...26 HL7 SIU STANDARD...26 SIU Events...26 HL7 SIU^S12 Message Structure v Supported SIU Segments...27 Page Page 11

3 Supported Acknowledgements...27 PATIENT APPINTMENT SCHEDULE SIU SEGMENTS/FIELDS...28 SAMPLE HL7 SIU V TRANSMISSIN LEVEL HL7 ACK/NACK SEGMENTS/FIELDS...38 ERRR CDES AND MESSAGES...39 PATIENT CNTEXT...40 Page Page 22

4 Solution verview verview The purpose of this document is to describe the scope of the Covisint Patient Sync solution which is used to push patient demographics and patient appointment schedules, which are initiated in a PMS system, to an Application Provider. And to describe the Patient Context solution which is used to provide the Application Provider with a Patient Identifier when a user federates to an application. Patient Demographics Synchronization nce the initial load of patient records for a practice is completed, the PMS systems will send real-time Add and Update HL7 ADT messages to Covisint. The patient synchronization solution allows PMS systems to send patient demographic messages on behalf of physician practices to Covisint, which will then be forwarded on to any application for which the physician is signed up. Patient Appointment Schedules Synchronization PMS systems will send real-time HL7 SIU messages to Covisint. The patient synchronization solution allows PMS systems to send Appointment Schedule data on behalf of physician practices to Covisint, which will then be forwarded on to any application through received HL7 Schedule Information Unsolicited (SIU) transactions. Patient Context Patient Context is a federation extension that is used to send a Patient Identifier to an Application Provider when a user federates to an Application Provider s application. nce the application has the Patient Identifier, it can then be used to retrieve a specific patient record that was obtained using Patient Synch Page Page 33

5 Patient Demographics Synchronization verview Covisint Environment Start Create/Update Patient 1 Practice PMS HL7 ADT Demographic Message w/patient_ Views Patient In Patient Search Portlet on Sponsor s portal HL7 ACK 6 2 Messaging Hub 3 Route w/trading Partner and format requirements Sponsor s Portal 4 5 Lookup Destination and Format 6 Add/Update Patient Mapping, Translation, And Routing Trading Partner Profiles Patient Sync Database User 7 HL7 ADT w/ Trading Partner And Patient Ack/Nack 8 Application Provider Environment Views Patient Record In Application Provider s Application HL7 Messaging Engine 11 9 Practice 10 Lookup w/ Trading Partner Add/Update Patient Practice Crosswalk Finish Target Application Practice Datastore Figure 1: Patient Demographics Synchronization Process Page Page 44

6 1. Practice Management System: (PMS) Sends Demographic Message When the user adds or updates patient demographic information in the PMS system, a real-time HL7 ADT message is sent to the Covisint Messaging Hub. 2. Covisint Returns HL7 Transmission Level ACK Message Upon receipt, Covisint returns an acknowledgement message back to the PMS system. 3. Trading Partner Profile Lookup Covisint retrieves trading partner information (e.g., routing rules, transformation requirements). 4. Message Routed by Trading Partner Covisint routes the message to the trading partner that uniquely identifies the source practice. 5. Patient Synchronization Database Add/Update Covisint stores patient demographic and appointments information discretely by practice domain. 6. User Views Patient in Sponsor s Portal Portlet Users can access patient demographic information, from the message via the Sponsor s portal (e.g., Patient Search portlet, Patient Synchronization Status portlet). 7. Covisint Sends Demographic Message to Application Provider An HL7 ADT message is sent to the Application Provider per the Application Provider s mapping requirements 8. Application Provider Returns ACK Application Provider returns acknowledgement to Covisint. 9. Application Provider Trading Partner Crosswalk Application Provider performs trading partner crosswalk to their internal practice. 10. Application Provider Add/Update Application Provider adds/updates the patient information in their application. 11. User Views Patient Record in Application Provider s Application When the user accesses the Application Provider s application, the patient record has been pre-populated, or updated. No user action is required to create/update the patient record in the application. Page Page 55

7 Patient Appointment Schedule Synchronization verview Figure 2: Patient Appointment Schedule Synchronization Process Page Page 66

8 1. Practice Management System: (PMS) Sends Appointment Schedule Message When the user adds or updates appointment schedule information in the PMS system, a real-time HL7 SIU message is sent to the Covisint Messaging Hub. 2. Covisint Returns HL7 Transmission Level ACK Message Upon receipt, Covisint returns an acknowledgement message back to the PMS system. 3. Trading Partner Profile Lookup Covisint retrieves trading partner information (e.g., routing rules, transformation requirements). 4. Message Routed by Trading Partner Covisint routes the message to the trading partner that uniquely identifies the source practice. 5. Patient Synchronization Database Add/Update Covisint stores appointment schedules discretely by practice domain. 6. User Views Appointment Schedule in Sponsor s Portal Portlet Users can access appointment schedule, from the Sponsor s portal. 7. Covisint Sends Appointment Schedule Message to Application Provider An HL7 SIU message is sent to the Application Provider per the Application Provider s mapping requirements 8. Application Provider Returns ACK Application Provider returns acknowledgement to Covisint. 9. Application Provider Trading Partner Crosswalk Application Provider performs trading partner crosswalk to their internal practice. 10. Application Provider Add/Update Application Provider adds/updates the appointment schedule in their application. 11. User Views Appointment Schedule in Application Provider s Application When the user accesses the Application Provider s application, the appointment schedule has been pre-populated, or updated. No user action is required to create/update the appointment schedule in the application. Page Page 77

9 Connectivity ptions and Requirements Connectivity ptions Secure HTTP (HTTP/SSL) over Internet HTTP over IPSec VPN Secure FTP (FTP/SSL) over Internet FTP over IPSec VPN LLP over IPSec VPN AS2 Connector WebSphere MQ Covisint Scout (Installable agent) Connectivity Requirements The following describes solutions for setting up connectivity with Covisint Connect. Page Page 88 Secure HTTP (HTTP/SSL) over Internet Mailbox Connect to the Covisint messaging hub using unidirectional TCP/IP link over the public Internet. Application Provider sends (PST) and retrieves (GET) from Covisint mailbox No network setup required. Production URL: i. ii. Staging (test) URL: iii. iv. Covisint perations will provide username/password for both test and production. Persistent Connect to Covisint using a TCP/IP link over the public Internet. Covisint sends (PST) to Application Provider. Firewall must be opened for the IP/URL on port 443 that the customer provides. Production URL: i. Staging (test) URL: ii. Covisint perations will provide username/password for both test and production. HTTP over IPSec VPN Mailbox Connect to the Covisint messaging hub using unidirectional TCP/IP link over a VPN tunnel. Application Provider sends (PST) and retrieves (GET) from Covisint mailbox No network setup required. Production URL: v.

10 vi. Staging (test) URL: vii. viii. Covisint perations will provide username/password for both test and production. Persistent Connect to Covisint using a TCP/IP link over a VPN tunnel. Covisint sends (PST) to Application Provider. Firewall must be opened for the IP/URL on port 443 that the customer provides. Production URL: iii. Staging (test) URL: iv. Covisint perations will provide username/password for both test and production. Secure FTP (FTP/SSL) over Internet To use the FTP Connector, you should have prior knowledge of FTP commands and how to use them Connect to Covisint messaging hub using standard FTP client software and TCP/IP communications. Network setup required (open firewall for specific IP and port). Available in two methods i. Mailbox (push-pull) Application Provider sends (PUT) and retrieves (GET) from Covisint mailbox. ii. Persistent (push) - Covisint sends (PST) to Application Provider. Pre-Prod IP address: i ii. Ports 21, 990 and range through Production IP address: i ii. Ports 21, 990 and range through Covisint perations will provide username/password for both test and production. FTP over IPSec VPN To use the FTP Connector, you should have prior knowledge of FTP commands and how to use them. Connect to Covisint messaging hub using standard FTP client software and TCP/IP communications over a VPN tunnel. Available in two methods: i. Mailbox (push-pull) Application Provider sends (PUT) and retrieves (GET) from Covisint mailbox. ii. Persistent (push) - Covisint sends (PST) to Application Provider. Public Internet IP Addresses for messaging i. Production: ii. Staging: Firewall access required. Lower Layer Protocol (LLP) over IPSec VPN Standard for transmitting HL7 messages via TCP/IP Network setup required (open firewall for specific IP and port) and VPN i. Provide IPSec VPN Tunnel application to Network team Page Page 99

11 ii. iii. Network team will provide port number to use specific to the IP address Persistent connections: Request network team to permit persistent connection for the IP address. Network team will need to configure the IP address on the load balancer and firewall to allow this. therwise, Covisint default behavior is to close idle connections after one hour. Application Provider sends to Covisint with sync ack. Covisint sends to Application Provider with sync ack, if applicable. AS2 Connector Transmits HL7 messages as MIME/SMIME messages. Encryption and digital signature are both optional. Following are the modes for sending a message: i. Signed only ii. iii. Encrypted only No signature, No encryption The messages are sent in a MIME message. This option is not recommended for secure transmission using AS2 protocol. NTE: Signed and encrypted recommended Message Disposition Notification (MDN): The MDN is an acknowledgement receipt sent by the receiver that indicates a secure and successful receipt of the message. Firewall must be opened for the outbound channel IP/URL that the customer provides. Inbound access is already permitted. Inbound URLs v. Production: vi. Test: AS2 Certificate Required. Covisint operations will provide username/password for both test and production. WebSphere MQ WebSphere MQ is a popular system for messaging across multiple platforms, including Windows, Linux, IBM mainframe and midrange, and Unix. There are two parts to message queuing: i. Messages are collections of binary or character (for instance ASCII or EBCDIC) data that have some meaning to a participating program. As in other communications protocols, storage, routing, and delivery information is added to the message before transmission and stripped from the message prior to delivery to the receiving application. ii. Message queues are objects that store messages in an application. Production i. mq.covisint.com ii. Internet IP: : 1414, 443 Test i. mq2.stg.covisint.com ii. Internet IP: Port 1414 Firewall access required. Covisint Scout Scout is a lightweight secure software agent that will be installed on your local machine and configured by Covisint. Makes integration simple and fast with a proven solution. Additional information is located at: Page Page 10 10

12 Patient Demographics Messaging ptions and Requirements Message Version HL7 v2.3 HL7 ADT Standard ADT Events ADT^A01 - Admit/visit notification ADT^A04 - Register a patient ADT^A08 - Update patient information ADT^A28 - Add person information ADT^A31 - Update person information NTE: The events listed above all use the ADT^A01 message structure. HL7 ADT^A01 Message Structure v2.3 Segment PT/REQ Iteration Response Grammar: Group Control Comment MSH R 1:1 Message Header EVN R 1:1 Event Type R 1:1 PATIENT P R 1:1 Patient Identification [ PD1 ] 0:1 Additional Demographics Where [ ] shows segment is optional [ { NK1 } ] 0:S Next to Kin Information Where { } shows multiple iteration R 1:1 PATIENT_VISIT PV1 R 1:1 Patient Visit [ PV2 ] 0:1 Patient Visit Additional Info. Not used for processing [ { DB1 } ] 0:S Disability Information Not used for processing [ { BX } ] 0:S bservation/result Not used for processing [ { AL1 } ] 0:S Allergy Information Not used for processing [ { DG1 } ] 0:S Diagnosis Information Not used for processing [ DRG ] 0:1 Diagnosis Related Group Not used for processing [ { 0:S PRCEDURE PR1 R 1:1 Procedures Not used for processing [{RL}] 0:S Role Not used for processing } ] Not used for processing [ { GT1 } ] 0:S Guarantor [ { 0:S INSURANCE IN1 R 1:1 Insurance [ IN2 ] 0:1 Insurance Additional Info Not used for processing Page Page 11 11

13 [ IN3 ] 0:1 Insurance Add'l Info - Cert Not used for processing } ] Not used for processing [ ACC ] 0:1 Accident Information Not used for processing [ UB1 ] 0:1 Universal Bill Information Not used for processing [ UB2 ] 0:1 Universal Bill 92 Information Not used for processing Supported ADT Segments MSH, EVN, P, PD1, NK1, PV1, PV2, DB1, BX, AL1, DG1, DRG, PR1, RL, GT1, IN1, IN2, IN3, ACC, UB1, UB2 Supported Acknowledgements Ack_General, riginal Mode Page Page 12 12

14 Patient Demographics ADT Segments/Fields Covisint Standard External Interface HL7 v2.3 Ref Segment Length Table 1 Segment MSH Message Header R N Page Page External Interface r/o/c/b Rep# Description Item Section Data Structure 2 MSH.1 1 R Field Separator ST 3 MSH.2 4 R Encoding Characters ST ^~\& 4 MSH Sending Application HD 5 MSH Sending Facility HD 6 MSH Receiving Application HD 7 MSH C Receiving Facility HD 8 MSH.7 26 R Date / Time of Message TS 9 MSH.8 40 Security ST 10 MSH.9 7 R Message Type CM_MSG Required Value Formatted as YYYYMMDDHHMMSS 11 MSH R 'ADT' 'A01', 'A04', 'A08', 'A28', 12 MSH R or,'a31' 13 MSH R Message Control ST 14 MSH.11 3 R Processing PT 'P' 15 MSH R Version '2.3' 16 MSH Sequence Number NM 17 MSH Continuation Pointer ST 18 MSH Accept Acknowledgement Type MSH Application Acknowledgement Type MSH.17 2 Country Code MSH Y Character Set Principal Language of 22 MSH Message CE Segment EVN 23 Event Type R N 24 EVN R Event Type Code EVN.2 26 R Recorded Date/Time TS 26 EVN.3 26 Date/Time Planned Event TS 27 EVN Event Reason Code EVN perator CN 29 EVN.6 26 N Event occurred TS 30 Segment P Patient Identification R N

15 31 P.1 4 Set - Patient SI 32 P.2 20 Patient (External ) CX 33 P.3 20 R Y Patient (Internal ) CX 34 P.3.1 R (ST) ST 35 P.3.2 check digit ST code identifying the check 36 P digit scheme employed 37 P.3.4 assigning authority HD 38 P namespace IS 39 P universal ST 40 P universal type 41 P.3.8 identifier type code IS 42 P.3.9 assigning facility HD 43 P namespace IS 44 P universal ST 45 P universal type 46 P.4 20 Y Alternate Patient CX 47 P.5 48 R Y Patient Name XPN 48 P.5.1 R family name ST 49 P.5.2 R given name ST 50 P.5.3 middle initial or name ST 51 P.5.4 suffix (e.g., JR or III) ST 52 P.5.5 prefix (e.g., DR) ST 53 P.5.6 degree (e.g., MD) ST 54 P name type code 55 P.6 48 Mother's Maiden Name XPN 56 P.7 26 C Date of Birth TS 57 P C Sex IS 58 P.9 48 Y Patient Alias XPN 59 P Race IS 60 P Y Patient Address XAD 61 P.11.1 street address ST 62 P.11.2 other designation ST 63 P.11.3 City ST 64 P.11.4 state or province ST 65 P.11.5 C zip or postal code ST 66 P.11.6 Country 67 P address type other geographic 68 P.11.8 designation ST First Instance of the P.3.1 will be the Noneditable Unique Patient from the source PMS system Page Page 14 14

16 69 P.11.9 county/parish code IS 70 P census tract IS 71 P.12 4 County Code IS 72 P Y Phone Number - Home TN Phone Number - 73 P Y Business TN 74 P Primary Language CE 75 P Marital Status IS 76 P Religion IS 77 P Patient Account Number CX 78 P SSN Number - Patient ST 79 P Driver's License Number DLN 80 P Y Mother's Identifier CX 81 P Ethnic Group IS 82 P Birth Place ST 83 P Multiple Birth Indicator P.25 2 Birth rder NM 85 P Citizenship IS 86 P Veterans Military Status CE 87 P Nationality Code CE Patient Death Date and 88 P Time TS 89 P Patient Death Indicator Segment PD1 Formatted as (999) Formatted as (999) Formatted as or Patient Demographic Information Y 91 PD Y Living Dependency IS 92 PD Living Arrangement IS 93 PD Y Patient Primary Facility XN 94 PD1.3.1 organization name ST organization name type 95 PD code 96 PD1.3.3 number (NM) 97 PD1.3.4 check digit NM 98 PD code identifying the check digit scheme employed 99 PD1.3.6 assigning authority HD 100 PD identifier type code 101 PD1.3.8 assigning facility HD Patient Primary Care 102 PD C Y Provider Name & No XCN 103 PD1.4.1 number (ST) ST 104 PD1.4.2 family name ST Page Page 15 15

17 105 PD1.4.3 given name ST 106 PD1.4.4 middle initial or name ST 107 PD1.4.5 suffix (e.g., JR or III) ST 108 PD1.4.6 prefix (e.g., DR) ST 109 PD1.4.7 degree (e.g., MD) ST 110 PD source table IS 111 PD1.4.9 assigning authority HD 112 PD name type 113 PD identifier check digit ST 114 PD code identifying the check digit scheme employed 115 PD identifier type code IS 116 PD assigning facility HD 117 PD Student Indicator IS 118 PD Handicap IS 119 PD Living Will IS 120 PD rgan Donor IS 121 PD Separate Bill PD Y Duplicate Patient CX 123 PD ST 124 PD check digit ST 125 PD code identifying the check digit scheme employed 126 PD assigning authority HD 127 PD identifier type code IS 128 PD assigning facility HD 129 PD Publicity Indicator CE 130 PD Y Protection Indicator 1283 Segment NK1 131 Next of Kin Y 132 NK1.1 4 R Set - NK SI 133 NK C Y Name XPN 134 NK1.2.1 family name ST 135 NK1.2.2 given name ST 136 NK1.2.3 middle initial or name ST 137 NK1.2.4 suffix (e.g., JR or III) ST 138 NK1.2.5 prefix (e.g., DR) ST 139 NK1.2.6 degree (e.g., MD) ST 140 NK name type code Name Representation 141 NK code 142 NK Relationship CE Page Page 16 16

18 143 NK identifier 144 NK1.3.2 text ST 145 NK1.3.3 name of coding system ST 146 NK1.3.4 alternate identifier 147 NK1.3.5 alternate text ST name of alternate coding 148 NK1.3.6 system ST 149 NK Y Address XAD 150 NK1.4.1 street address ST 151 NK1.4.2 other designation ST 152 NK1.4.3 city ST 153 NK1.4.4 state or province ST 154 NK1.4.5 zip or postal code ST 155 NK1.4.6 country 156 NK address type other geographic 157 NK1.4.8 designation ST 158 NK1.4.9 county/parish code IS 159 NK census tract IS 160 NK Y Phone Number XTN 161 NK1.5.1 telecommunication number TN telecommunication use 162 NK code telecommunication 163 NK equipment type () 164 NK address ST 165 NK1.5.5 Country Code NM 166 NK1.5.6 Area/city code NM 167 NK1.5.7 Phone number NM 168 NK1.5.8 Extension NM 169 NK1.5.9 any text ST 170 NK Y Business Phone Number XTN 171 NK1.6.1 telecommunication number TN telecommunication use 172 NK code telecommunication 173 NK equipment type () 174 NK address ST 175 NK1.6.5 Country Code NM 176 NK1.6.6 Area/city code NM 177 NK1.6.7 Phone number NM 178 NK1.6.8 Extension NM 179 NK1.6.9 any text ST 180 NK Contact Role CE 181 NK1.8 8 Start Date DT Formatted as (999) Formatted as (999) Page Page 17 17

19 182 NK NK NK NK Page Page End Date DT Next of Kin / Associated Parties Job Title ST Next of Kin / Associated Parties Job Code/Class JCC Next of Kin / Associated Parties Employee Number CX 186 NK ST 187 NK check digit ST 188 NK code identifying the check digit scheme employed 189 NK assigning authority HD 190 NK identifier type code IS 191 NK assigning facility HD 192 NK Y rganization Name XN 193 NK organization name ST organization name type 194 NK code IS 195 NK number (NM) NM 196 NK check digit ST 197 NK code identifying the check digit scheme employed 198 NK assigning authority HD 199 NK identifier type code IS 200 NK assigning facility HD 201 NK Marital Status IS 202 NK Sex IS 203 NK Date/Time of Birth TS 204 NK time of an event ST 205 NK degree of precision ST 206 NK Y Living Dependency IS 207 NK Y Ambulatory Status IS 208 NK Y Citizenship IS 209 NK Primary Language CE 210 NK identifier 211 NK text ST 212 NK name of coding system ST 213 NK alternate identifier 214 NK alternate text ST 215 NK name of alternate coding system ST 216 NK Living Arrangement IS 217 NK Publicity Indicator CE 218 NK Protection Indicator NK Student Indicator IS

20 220 NK NK Religion IS Mother's Maiden Name XPN 222 NK family name ST 223 NK given name ST 224 NK middle initial or name ST 225 NK suffix (e.g., JR or III) ST 226 NK prefix (e.g., DR) ST 227 NK degree (e.g., MD) ST 228 NK name type code Name Representation 229 NK code 230 NK Nationality CE 231 NK identifier 232 NK text ST 233 NK name of coding system ST 234 NK alternate identifier 235 NK alternate text ST 236 NK name of alternate coding system ST 237 NK Ethnic Group IS 238 NK Y Contact Reason CE 239 NK identifier 240 NK text ST 241 NK name of coding system ST 242 NK alternate identifier 243 NK alternate text ST name of alternate coding 244 NK system ST 245 NK Y Contact Person's Name XPN 246 NK family name ST 247 NK given name ST 248 NK middle initial or name ST 249 NK suffix (e.g., JR or III) ST 250 NK prefix (e.g., DR) ST 251 NK degree (e.g., MD) ST 252 NK name type code 253 NK Name Representation code Contact Person's 254 NK Y Telephone Number XTN 255 NK telecommunication number TN telecommunication use 256 NK code telecommunication 257 NK equipment type () 258 NK address ST Formatted as (999) Page Page 19 19

21 259 NK Country Code NM 260 NK Area/city code NM 261 NK Phone number NM 262 NK Extension NM 263 NK any text ST 264 NK Y Contact Person's Address XAD 265 NK street address ST 266 NK other designation ST 267 NK city ST 268 NK state or province ST 269 NK zip or postal code ST 270 NK country 271 NK address type other geographic 272 NK designation ST 273 NK county/parish code IS 274 NK census tract IS Next of Kin/Associated 275 NK Y Party's Identifiers CX 276 NK ST 277 NK check digit ST 278 NK code identifying the check digit scheme employed 279 NK assigning authority HD 280 NK identifier type code IS 281 NK assigning facility HD 282 NK Job Status IS 283 NK Race IS 284 NK Handicap IS 285 NK Contact Person Social Security Number ST Segment PV1 286 Patient Visit R N 287 PV1.1 4 Set - Patient Visit SI 288 PV R Patient Class PV Assigned Patient Location PL 290 PV Admission Type PV Preadmit Number CX 292 PV Prior Patient Location PL 293 PV Y Attending Doctor XCN Formatted as or E - Emergency I - Inpatient - utpatient P - Preadmit R - Recurring Patient B - bstetrics Page Page 20 20

22 294 PV Y Referring Doctor XCN 295 PV Y Consulting Doctor XCN 296 PV Hospital Service PV Temporary Location PL 298 PV Preadmit Test Indicator PV Readmission Indicator PV Admit Source PV Y Ambulatory Status IS 302 PV VIP Indicator PV Y Admitting Doctor XCN 304 PV Patient Type PV Visit Number CX 306 PV Y Financial Class FC 307 PV Charge Price Indicator PV Courtesy Code PV Credit Rating PV Y Contract Code PV Y Contract Effective Date DT 312 PV Y Contract Amount NM 313 PV Y Contract Period NM 314 PV Interest Code PV Transfer to Bad Debt Code PV Transfer to Bad Debt Date DT 317 PV Bad Debt Agency Code PV Bad Debt Transfer Amount NM 319 PV Bad Debt Recovery Amount NM 320 PV Delete Account Indicator PV Delete Account Date DT 322 PV Discharge Disposition PV Discharged to Location CM_DLD 324 PV Diet Type PV Servicing Facility PV Bed Status IS 327 PV Account Status PV Pending Location PL 329 PV Prior Temporary Location PL 330 PV Admit Date/Time TS 331 PV Discharge Date/Time TS 332 PV Current Patient Balance NM 333 PV Total Charges NM 334 PV Total Adjustments NM Page Page 21 21

23 335 PV Total Payments NM 336 PV Alternate Visit CX 337 PV Visit Indicator IS 338 PV Y ther Healthcare Provider XCN Segment GT1 339 Guarantor Y 340 GT1.1 4 Set - GT SI 341 GT Y Guarantor Number CX 342 GT R Y Guarantor Name XPN 343 GT Y Guarantor Spouse Name XPN 344 GT Y Guarantor Address XAD 345 GT Y Guarantor Ph Num- Home XTN Guarantor Ph Num- 346 GT Y Business XTN Guarantor Date/Time of 347 GT Birth TS 348 GT Guarantor Sex IS 349 GT Guarantor Type IS 350 GT Guarantor Relationship IS 351 GT Guarantor SSN ST 352 GT Guarantor Date - Begin DT 353 GT Guarantor Date - End DT 354 GT Guarantor Priority NM 355 GT Y Guarantor Employer Name XPN 356 GT Y Guarantor Employer Address XAD 357 GT Y Guarantor Employ Phone Number XTN Guarantor Employee 358 GT Y Number CX Guarantor Employment 359 GT Status IS 360 GT Y Guarantor rganization XN Guarantor Billing Hold 361 GT Flag GT Guarantor Credit Rating Code CE 363 GT Guarantor Death Date And Time TS 364 GT Guarantor Death Flag GT Guarantor Charge Adjustment Code CE 366 GT Guarantor Household Annual Income CP 367 GT Guarantor Household Size NM 368 GT Y Guarantor Employer Number CX 369 GT Guarantor Marital Status Code IS Formatted as (999) Formatted as (999) Formatted as or Formatted as (999) Page Page 22 22

24 370 GT Guarantor Hire Effective Date DT 371 GT Employment Stop Date DT 372 GT Living Dependency IS 373 GT Ambulatory Status IS 374 GT Citizenship IS 375 GT Primary Language CE 376 GT Living Arrangement IS 377 GT Publicity Indicator CE 378 GT Protection Indicator GT Student Indicator IS 380 GT Religion IS 381 GT Mother s Maiden Name XPN 382 GT Nationality Code CE 383 GT Ethnic Group IS 384 GT Y Contact Person's Name XPN Contact Person s 385 GT Y Telephone Number XTN 386 GT Contact Reason CE 387 GT Contact Relationship Code IS 388 GT Job Title ST 389 GT Job Code/Class JCC Guarantor Employer's 390 GT Y rganization Name XN 391 GT Handicap IS 392 GT Job Status IS 393 GT Guarantor Financial Class FC 394 GT Guarantor Race IS 395 Segment IN1 Insurance Segment Y 3 Iterations 396 IN1.1 4 Set - Insurance SI 397 IN R Insurance Plan 368 CE 398 IN Y Insurance Company CX 399 IN R Y Insurance Company Name XN 400 IN Y Insurance Company Address XAD 401 IN Y Insurance Co. Contact Person XPN 402 IN Y Insurance Co Phone Number XTN 403 IN1.8 25* Group Number ST 404 IN Y Group Name XN Insured's group employer 405 IN Y CX Formatted as (999) Formatted as (999) IN1.8 Group Number field lengths has been extended to 25 characters Page Page 23 23

25 406 IN Y Insured's Group Emp Name XN 407 IN Plan Effective Date DT 408 IN Plan Expiration Date DT 409 IN Authorization Information CM_AUI 410 IN Plan Type IS 411 IN R Y Name of Insured XPN Insured's Relationship to 412 IN Patient IS 413 IN R Insured's Date of Birth TS 414 IN Y Insured's Address XAD 415 IN Assignment of Benefits IS 416 IN Coordination of Benefits IS Coordination of Ben. 417 IN Priority ST 418 IN Notice of Admission Code IN Notice of Admission Date DT 420 IN Rpt of Eligibility Code IN Rpt of Eligibility Date DT 422 IN Release Information Code IS 423 IN Pre-Admit Cert (PAC) ST 424 IN Verification Date/Time TS 425 IN Verification By XPN 426 IN Type of Agreement Code IS 427 IN Billing Status IS 428 IN Lifetime Reserve Days NM Delay before lifetime 429 IN reserve days NM 430 IN Company Plan Code IS 431 IN * R Policy Number ST 432 IN Policy Deductible CP 433 IN Policy Limit - Amount CP 434 IN Policy Limit - Days NM 435 IN Room Rate - Semi-Private CP 436 IN Room Rate - Private CP Insured's Employment 437 IN Status CE 438 IN Insured's Sex IS Insured's Employer 439 IN Y Address XAD 440 IN Verification Status ST 441 IN Prior Insurance Plan IS 442 IN Coverage Type IS Page Page 24 24

26 443 IN Handicap IS 444 IN Y Insured's Number CX Sample HL7 ADT^A08 v2.3 Note: ADT^A08 is the default message that will be sent to an Application Provider unless another option is specified. MSH ^~\& PATACCT ABC Hospital^ ^CV CVISINT ADT^A P 2.3 EVN A P MILLER^JAMES M W P BX 71^^ATWD^K^ (555) M PD1 53^BARLW^M^ELISABETH^MD N 1 N NK1 1 MILLER^JDI 01^SPUSE (313) ^SPUSE PV1 1 ER 1020^BLXHAM^BRANDN^D^D ER ^BLXHAM^BRANDN^D^D E S GT MILLER^JAMES P BX 71^^ATWD^K^74827 (999) M IN ^BCBS-TN: BCBS F TENNESSEE (PP) 9037^BCBS-TN: BCBS F TENNESSEE (PP) BCBS-TN: BCBS F TENNESSEE (PP) P BX ^^CHATTANGA^TN^37401 ^ (800) SETSER^VICTRIA^ ABC F NTE: Carriage Return (CR) Hex decimal value of [0D ] must be used for segment terminator. Page Page 25 25

27 Patient Appointment Schedule Messaging ptions and Requirements Message Version HL7 v2.3 HL7 SIU Standard SIU Events SIU^S12 - Notification of new appointment booking SIU^S13 - Notification of appointment rescheduling SIU^S14 - Notification of appointment modification SIU^S15 - Notification of appointment cancellation SIU^S17- Notification of appointment deletion NTE: The events listed above all use the SIU^S12 message structure. HL7 SIU^S12 Message Structure v2.3 Segment PT/REQ Iteratio n MSH R 1:1 Message Header Response Grammar: Group Control Comment SCH R 1:1 Schedule Activity Information [ { NTE } ] 0:S Notes and comments segment Not used for processing { R 1:S PATIENT P R 1:1 Patient Identification 0:1 PATIENT_VISIT [ PV1] 0:1 Patient Visit [ PV2 ] 0:1 Patient Visit Additional Info. Not used for processing [ { BX } ] 0:S bservation/result Not used for processing [ { DG1 } ] 0:S Diagnosis Information Not used for processing } { R 1:S RESURCES RGS R 1:1 Resource Group } ] } ] [ { 0:S SERVICE Not used for processing AIS R 1:1 Appointment Information Not used for processing Service [{NTE}] 0:S Notes and comments segment Not used for processing [ { 0:S GENERAL_RES URCE AIG R 1:1 Appointment Information - General Resource Not used for processing Not used for processing [{NTE}] 0:S Notes and comments segment Not used for processing [ { 0:S LCATIN_RES Not used for processing Page Page 26 26

28 } ] } ] } AIL R 1:1 Appointment Information - Location Resource URCE Not used for processing [{NTE}] 0:S Notes and comments segment Not used for processing [ { 0:S PERSNNEL_RES URCE AIP R 1:1 Appointment Information - Personnel Resource Not used for processing Not used for processing [{NTE}] 0:S Notes and comments segment Not used for processing Supported SIU Segments MSH, SCH, NTE, P, PV1, PV2, BX, DG1, RGS, AIS, AIG Supported Acknowledgements Ack_General, riginal Mode Page Page 27 27

29 Patient Appointment Schedule SIU Segments/Fields Patient Appointment Schedules - SIU Segments/Fields Standard External Interface HL7 v2.3 Ref Segment Length Table External Interface r/o/c/b Rep# Description Item Section Segment MSH Message 1 Header R N Page Page Data Structure 2 MSH.1 1 R Field Separator ST Required Value 3 MSH.2 4 R Encoding Characters ST ^~\& 4 MSH Sending Application HD 5 MSH Sending Facility HD 6 MSH Receiving Application HD 7 MSH Receiving Facility HD 8 MSH.7 26 R Date / Time of Message TS Formatted as YYYYMMDDHHMMSS 9 MSH.8 40 Security ST 10 MSH.9 7 R Message Type CM_MSG 11 MSH R 'SIU' 12 MSH R 13 MSH R Message Control ST 14 MSH.11 3 R Processing PT 'P' 15 MSH R Version '2.3' 16 MSH Sequence Number NM 17 MSH Continuation Pointer ST 18 MSH Accept Acknowledgement Type MSH Application Acknowledgement Type MSH.17 2 Country Code MSH Y Character Set MSH Principal Language of Message CE 23 Segment SCH Patient Identification R N 24 SCH.1 75 R Placer Appointment EI 25 SCH.1.1 R entity Identifier ST 26 SCH namespace IS 27 SCH universal ST universal 28 SCH type 29 SCH.2 75 C Filler Appointment EI 30 SCH.2.1 R entity Identifier ST 31 SCH namespace IS 32 SCH universal ST 33 SCH universal type 34 SCH.3 5 C ccurrence Number NM 35 SCH.4 75 Placer Group Number EI 'S12', 'S13', 'S14', 'S15', or,'s17'

30 36 SCH Schedule CE 37 SCH R Event Reason CE 38 SCH.6.1 R Identifier 39 SCH.6.2 Test ST 40 SCH.6.3 Name of Coding System ST 41 SCH.6.4 Alternative Identifier 42 SCH.6.5. Alternative Text ST 43 SCH.6.6 Name of Alternative coding system ST 44 SCH Appointment Reason CE 45 SCH Appointment Type CE 46 SCH.9 20 Appointment Duration NM 47 SCH Appointment Duration Units CE 48 SCH R Y Appointment Timing Quantity TQ 49 SCH.11.1 quantity CQ 50 SCH.11.2 interval CM 51 SCH.11.3 duration ST 52 SCH.11.4 R start date/time TS 53 SCH.11.5 end date/time TS 54 SCH.11.6 Priority ST 55 SCH.11.7 condition ST 56 SCH.11.8 Text TX 57 SCH.11.9 conjunction ST order 58 SCH sequencing CM 59 SCH Placer Contact Person XCN 60 SCH Placer Contact Phone Number XTN 61 SCH Placer Contact Address XAD 62 SCH Placer Contact Location PL 63 SCH R Filler Contact Person XCN SCH R Id Number ST SCH SCH.16.3 SCH.16.4 SCH.16.5 R family name ST R given name ST middle initial or name ST suffix (e.g., JR or III) ST 69 SCH.16.6 prefix (e.g., DR) ST 70 SCH.16.7 degree (e.g., MD) ST 71 SCH Source table ST 72 SCH.16.9 Assigning authority HD 73 SCH name type code 74 SCH Identifier check digit ST SCH Code identifying the check digit scheme employed 76 SCH Identifier type code IS Formatted as (999) If this info is not available default to 0 If this info is not available default to UNKNWN If this info is not available default to UNKNWN Page Page 29 29

31 77 SCH Assigning facility HD Filler Contact Phone 78 SCH Number XTN 79 SCH Filler Contact Address XAD 80 SCH Filler Contact Location PL 81 SCH R Entered by Person XCN SCH R Id Number ST SCH SCH.20.3 R family name ST 84 R given name ST SCH.20.4 middle initial or 85 name ST SCH.20.5 suffix (e.g., JR or 86 III) ST 87 SCH.20.6 prefix (e.g., DR) ST 88 SCH.20.7 degree (e.g., MD) ST 89 SCH Source table ST 90 SCH.20.9 Assigning authority HD 91 SCH name type code SCH Identifier check 92 digit ST SCH Code identifying the check digit scheme employed 94 SCH Identifier type code IS 95 SCH Assigning facility HD 96 SCH Y Entered by Phone Number XTN 97 SCH Entered by Location PL 98 SCH Parent Placer Appointment EI 99 SCH Parent Filler Appointment EI 100 SCH Filler Status Code CE 101 Segment NTE Notes and Comments Y 102 NTE.1 4 Set Notes and Comments SI 103 NTE.2 8 Source of Comment NTE Y Comment FT 105 Segment P Patient Identification R N 106 P.1 4 Set - Patient SI 107 P.2 20 Patient (External ) CX 108 P.3 20 R Y Patient (Internal ) CX 109 P.3.1 R (ST) ST 110 P.3.2 check digit ST Formatted as (999) If this info is not available default to 0 If this info is not available default to UNKNWN If this info is not available default to UNKNWN Formatted as (999) First Instance of the P.3.1 MUST be the Non-editable Unique Patient from the source PMS system). Page Page 30 30

32 111 P code identifying the check digit scheme employed 112 P.3.4 assigning authority HD 113 P namespace IS 114 P universal ST 115 P universal type 116 P.3.8 identifier type code IS 117 P.3.9 assigning facility HD 118 P namespace IS 119 P universal ST 120 P universal type 121 P.4 20 Y Alternate Patient CX 122 P.5 48 R Y Patient Name XPN 123 P.5.1 R family name ST 124 P.5.2 R given name ST 125 P.5.3 middle initial or name ST 126 P.5.4 suffix (e.g., JR or III) ST 127 P.5.5 prefix (e.g., DR) ST 128 P.5.6 degree (e.g., MD) ST 129 P name type code 130 P.6 48 Mother's Maiden Name XPN 131 P.7 26 Date of Birth TS 132 P Sex IS 133 P.9 48 Y Patient Alias XPN 134 P Race IS 135 P Y Patient Address XAD 136 P.11.1 street address ST 137 P.11.2 other designation ST 138 P.11.3 City ST 139 P.11.4 state or province ST 140 P.11.5 zip or postal code ST 141 P.11.6 Country 142 P address type 143 P.11.8 other geographic designation ST 144 P.11.9 county/parish code IS 145 P census tract IS 146 P.12 4 County Code IS 147 P Y Phone Number - Home TN 147 P Y Phone Number - Business TN 149 P Primary Language CE 150 P Marital Status IS 151 P Religion IS 152 P Patient Account Number CX 153 P SSN Number - Patient ST 154 P Driver's License Number DLN 155 P Y Mother's Identifier CX 156 P Ethnic Group IS 157 P Birth Place ST Formatted as (999) Formatted as (999) Formatted as Page Page 31 31

33 158 P Multiple Birth Indicator P.25 2 Birth rder NM 160 P Y Citizenship IS 161 P Veterans Military Status CE 162 P Nationality Code CE 163 P Patient Death Date and Time TS 164 P Patient Death Indicator Segment PV1 Patient Visit N 166 PV1.1 4 Set - Patient Visit SI 167 PV R Patient Class PV Assigned Patient Location PL 169 PV Admission Type PV Preadmit Number CX 171 PV Prior Patient Location PL 172 PV Y Attending Doctor XCN 173 PV Y Referring Doctor XCN 174 PV Y Consulting Doctor XCN 175 PV Hospital Service PV Temporary Location PL 177 PV Preadmit Test Indicator PV Readmission Indicator PV Admit Source PV Y Ambulatory Status IS 181 PV VIP Indicator PV Y Admitting Doctor XCN 183 PV Patient Type PV Visit Number CX 185 PV Y Financial Class FC 186 PV Charge Price Indicator PV Courtesy Code PV Credit Rating PV Y Contract Code PV Y Contract Effective Date DT 191 PV Y Contract Amount NM 192 PV Y Contract Period NM 193 PV Interest Code PV Transfer to Bad Debt Code PV Transfer to Bad Debt Date DT 196 PV Bad Debt Agency Code PV Bad Debt Transfer Amount NM 198 PV Bad Debt Recovery Amount NM 199 PV Delete Account Indicator PV Delete Account Date DT 201 PV Discharge Disposition E - Emergency I - Inpatient - utpatient P - Preadmit R - Recurring Patient B - bstetrics Page Page 32 32

34 202 PV Discharged to Location CM 203 PV Diet Type PV Servicing Facility PV Bed Status IS 206 PV Account Status PV Pending Location PL 208 PV Prior Temporary Location PL 209 PV Admit Date/Time TS 210 PV Discharge Date/Time TS 211 PV Current Patient Balance NM 212 PV Total Charges NM 213 PV Total Adjustments NM 214 PV Total Payments NM 215 PV Alternate Visit CX 216 PV Visit Indicator IS 217 PV Y ther Healthcare Provider XCN 218 Segment PV2 - Patient Visit Additional Information N 219 PV C Prior Pending Location PL 220 PV Accommodation Code CE 221 PV Admit Reason CE 222 PV Transfer Reason CE 223 PV Y Patient Valuables ST 224 PV Patient Valuables Location ST 225 PV Visit User Code IS 226 PV Expected Admit Date/Time TS 227 PV Expected Discharge Date/Time TS 228 PV Estimated Length of Inpatient Stay NM 229 PV Actual Length of Inpatient Stay NM 230 PV Visit Description ST 231 PV Referral Source Code XCN 232 PV Previous Service Date DT 233 PV Employment Illness Related Indicator PV Purge Status Code IS 235 PV Purge Status Date DT 236 PV Special Program Code IS 237 PV Retention Indicator PV Expected Number of Insurance Plans NM 239 PV Visit Publicity Code IS 240 PV Visit Protection Indicator PV Y Clinic rganization Name XN 242 PV Patient Status Code IS 243 PV Visit Priority Code IS 244 PV Previous Treatment Date DT 245 PV Expected Discharge Disposition IS 246 PV Signature on File Date DT Page Page 33 33