Order and result messages for pathology information systems

Implementation guideline HL7 version 2.4 Order and result messages for pathology information systems PATHOLOGY, LABORATORY Date August 22, 2013 ID 13022 Author Heitmann Consulting and Services Dr. K.U. Heitmann Reviewers Nictiz Drs. T. van Stijn Nictiz Drs. C.E. Hülsmann www.nictiz.nl

Index H-1 Introduction 4 1.1. Original author 4 1.2. Revision 4 1.3. Review 4 1.4. Translation 4 1.5. Status 4 1.6. Document history 5 H-2 Exchange format and workflow overview 6 2.1. Version of the HL7 protocol 6 2.2. Workflow overview 6 H-3 Order to the pathology laboratory 8 3.1. Process 8 3.2. Specification of message composition (segments) 8 3.3. MSH segment 9 3.4. PID segment 9 3.5. PV1 segment 15 3.6. ORC segment 16 3.7. OBR segment 18 3.8. SAC segment 20 3.9. OBX segment 20 H-4 Order confirmation of receipt 26 4.1. Variant 1 26 4.2. Variant 2 26 4.3. Variant 3 26 4.4. MSA segment 27 4.5. SAC segment 27 August 22, 2013 Order and result messages for pathology information systems

H-5 Pathology laboratory results 32 5.1. Specification of message composition (segments) 32 5.2. MSH segment 32 5.3. PID segment 33 5.4. PV1 segment 35 5.5. ORC segment 35 5.6. OBR segment 35 5.7. OBX segment 38 H-6 Confirmation of receiving result message 41 H-7 Appendix I 42 7.1. Communication 42 7.2. MLLP 42 7.3. U-DPS attributes concerning the HL7 connection 42 H-8 Appendix II 43 8.1. Concepts 43 August 22, 2013 Order and result messages for pathology information systems

H-1 Introduction This document describes the HL7 version 2.4 messages used to order a study to be executed on tissue, cellular material or an autopsy on a non-living person. An order message is sent to the pathology laboratory. In addition, this document describes the result messages as a response to the described order messages. The document is based on earlier versions of two documents by Tieto Healthcare Netherlands BV: [1] Documentatie koppelingen U-DPS ZIS: HL7 ORU koppeling versie 2.4, document version 1.0, 24 December 2008 and [2] Documentatie HL7 koppelingen: ORM koppeling versie NL 2.4, document version 1.1.1, 24 November 2010 These documents as well as the current document are based on the following document that is owned bij the HL7 Netherlands Foundation: Implementatie Gids HL7 Versie 2.4 NL (Implementation guideline HL7 version 2.4 NL) In that document, the following chapters have mainly served as a source for the present document: [3] Chapter 2: Control [4] Chapter 3: Patient Administration [5] Chapter 4: Order Entry [6] Chapter 7: Observation Reporting 1.1. Original author Fons Geerts, Tieto Healthcare Netherlands BV 1.2. Revision Dr. K.U. Heitmann (Heitmann Consulting and Services) 1.3. Review Drs. T. van Stijn (Nictiz) Drs. C.E. Hülsman (Nictiz) 1.4. Translation This document has been translated from Dutch into English by Drs. C.E. Hülsmann. The purpose of translation is serving all software vendors that operate nationally and or internationally, developing software for the Dutch market. 1.5. Status Final August 22, 2013 Order and result messages for pathology information systems 4

1.6. Document history Version Date (ymd) Description Author 1.0 2008-12-24 Original document title: HL7 ORU koppeling versie 2.4 [1] 1.1.1 2010-11-24 Original document title: ORM koppeling versie NL 2.4 [2] 2.0 2012-04-12 Revision and merge of the first two ducuments, changes to version 2.4 and new message types/trigger events 2.1 2012-04-20 Addition of report number and sample number in the confirmation message and making LOINC codes compulsory where possible. 2.2 2012-04-25 Addition to Specimen Source, adjustments made because of incoming comments 2.3 2012-04-29 More comments and clarifications from earlier versions, reporting protocol and ACK messages elaborated, correction of typing mistakes Fons Geerts Fons Geerts Dr. K. Heitmann Dr. K. Heitmann Dr. K. Heitmann Dr. K. Heitmann 2.4 2012-05-04 Correction of typing mistake OML event Dr. K. Heitmann 2.5 2012-08-01 Several changes after review by NICTIZ, mainly of semantic or syntactic nature 2.6 2012-11-11 Change of message type name ORU; addition of OBR-31 Reason for study 2.7 2012-11-28 Adjustment of Abstract Syntax Message for messages (addition of symbols) Dr. A. Huisman (MedicalPHIT for RIVM) Dr. K. Heitmann Dr. K. Heitmann 2.8 2013-02-08 Document review and lay-out change Drs. C.E. Hülsmann 2.9 2013-02-13 Addition of the SAC segment in OML^O21 after receiving vendor feedback February 8th 2013 3.0 2013-06-06 Additional code for Reason for study, revision of the SAC segment, additional code for OBX-3 (additional note on material), examples 3.1 2013-06-30 Translation from Dutch into English, adjustment of note PID-3, update of par. 3.1: use of BSN is compulsory Dr. K. Heitmann Dr. K. Heitmann Drs. C.E. Hülsmann August 22, 2013 Order and result messages for pathology information systems 5

H-2 Exchange format and workflow overview 2.1. Version of the HL7 protocol U-DPS uses the HL7 protocol version 2.4 NL. The BSN is the Dutch national identification number called Burgerservicenummer, also used in the healthcare sector to identify a person. Whether or not this BSN has to be delivered to the receiving oranizations, depends on the urge of the representatives of these organizations. In most cases, these organizations are Hospitals, the receiver of the messages being the Hospital Information System (HIS). The HL7 Netherlands Foundation has served as the main advisor for the specifications in this document. However, this foundation does not own any specific guidelines on the composition of an order message for a pathology laboratory. For this reason, this document emphasizes the use of the OBX segment as part of the message as far as the Kind of material and Clinical information is concerned. 2.2. Workflow overview Diagram 1 is an overview of all involved actors (application roles) and the HL7 v2.4 messages that are involved. Diagram 1: Interactions between a lab order placer (original order initiator) and lab order filler (original order executor, in this case the pathology laboratory) August 22, 2013 Order and result messages for pathology information systems 6

A requesting system (order placer) sends requests for studies (orders) on tissue, cellular material or an autopsy on a non-living person to the pathology laboratory (order filler) by sending a Lab Order Message OML^O21 (Message Type OML, Trigger event O21). After receiving the request, the pathology laboratory can reply by sending a Lab Order Response ORL^O22 (asynchronous). The pathology laboratory can send the study result using an Unsolicited Laboratory Observation Message ORU^R01. In order to confirm the receipt of the study results, the order placer then sends an acknowledgement message (ACK^R01) (synchronous). In the following chapters the composition of the mentioned messages will be further elaborated as well as the segments that are used in this document. Note: The Lab Order Message OML^O21 is a new message since version 2.4 and replaces the old ORM message. It is merely the same as the OMG message with some extensions. August 22, 2013 Order and result messages for pathology information systems 7

H-3 Order to the pathology laboratory In order to support the requests for study of tissue, cellular material or executing an autopsy on a non-living person that are sent to the pathology laboratory, U-DPS supports a system for electronic ordering. This system is using the HL7 protocol. From now on in this document the U-DPS system is mentioned when referring to the system that receives the order (order filler), where this can also be another information system at the pathology department. 3.1. Process The order placer, e.g. an HIS, sends an order and U-DPS confirms receiving the order by sending a return message. The laboratory can already inform the order placer about the study report number and the sample number in this return message. However, in this stage informing the order placer about these numbers is optional. The study is executed at the pathology laboratory, and after that, when closing it, the order placer is informed about the study results and the order number. Placing the order is done by an authorized healthcare provider (HCP) and has to be interpreted as an official order to perform a study. The code and name of the requesting HCP are used in the pathology study report. Also, the order message is a source for patient information concerning his name and address, a description of the material type and clinical information, that is available in the study result report. Use of the BSN in digital communication in healthcare is compulsory. For this reason, using the 2.4 version of this protocol is a necessity. 3.2. Specification of message compostion (segments) The Lab Order Message OML^O21 uses the following HL7 v2.4 segments: Segment MSH PID PV1 { } ORC [ ] OBR Description Message header Patient identification Patient visit Order communication Observation Request [ { SAC } ] Specimen Container Details [ { OBX } ] Observation/Result (Legend: Abstract Message Syntax, [ ] optional, { } one or more recurrences) August 22, 2013 Order and result messages for pathology information systems 8

3.3. MSH segment Table 1: HL7 Attribute Table - MSH - Message Header SEQ LEN DT OPT RP/# TBL# ITEM # ELEMENT NAME U-DPS 1 1 ST R 00001 Field Separator 2 4 ST R 00002 Encoding Characters ^~& 3 180 HD O 0361 00003 Sending Application Contents agreed on by all parties concerned 4 180 HD O 0362 00004 Sending Facility Contents agreed on by all parties concerned 5 180 HD O 0361 00005 Receiving Application Contents agreed on by all parties concerned 6 180 HD O 0362 00006 Receiving Facility Contents agreed on by all parties concerned 7 26 TS R 00007 Date/Time Of Message Format: YYYYMMDDhhmmss 8 40 ST O 00008 Security 9 13 CM R 0076/ 0003 00009 Message Type OML^O21 note MSH9 10 20 ST R 00010 Message Control ID 11 3 PT R 00011 Processing ID P 12 60 VID R 0104 00012 Version ID 2.4 13 15 NM O 00013 Sequence Number 14 180 ST O 00014 Continuation Pointer 15 2 ID O 0155 00015 Accept Acknowledgment Type 16 2 ID O 0155 00016 Application Acknowledgment Type 17 3 ID O 0399 00017 Country Code 18 16 ID O Y 0211 00692 Character Set 19 250 CE O 00693 Principal Language Of Message 20 20 ID O 0356 01317 Alternate Character Set Handling Scheme 21 10 ID O Y 0449 01598 Conformance Statement ID Note MSH9: Element 9 in the MSH segment (Message type), in short MSH-9, has the following value: OML^O21. In the response message Lab Order Response ORL^O22 (see chapter H-5 in this document) the value is: ORL^O22. And so on. 3.4. PID segment Table 2: HL7 Attribute Table PID Patient identification SEQ LEN DT OPT RP/# TBL# ITEM# ELEMENT NAME U-DPS 1 4 SI O 00104 Set ID - PID 2 20 CX B 00105 Patient ID August 22, 2013 Order and result messages for pathology information systems 9

3 250 CX R Y 00106 Patient Identifier List Patient number note PID3 4 20 CX B Y 00107 Alternate Patient ID - PID 5 250 XPN R Y 00108 Patient Name Patient name note PID5 6 250 XPN O Y 00109 Mother s Maiden Name 7 26 TS O 00110 Date/Time of Birth Date of birth 8 1 IS O 0001 00111 Administrative Sex Gender 9 250 XPN B Y 00112 Patient Alias 10 250 CE O Y 0005 00113 Race 11 250 XAD O Y 00114 Patient Address Patient address information note PID11 12 4 IS B 0289 00115 County Code 13 250 XTN O Y 00116 Phone Number - Home 14 250 XTN O Y 00117 Phone Number - Business 15 250 CE O 0296 00118 Primary Language 16 250 CE O 0002 00119 Marital Status 17 250 CE O 0006 00120 Religion 18 250 CX O 00121 Patient Account Number 19 16 ST B 00122 SSN Number - Patient 20 25 DLN O 00123 Driver's License Number - Patient 21 250 CX O Y 00124 Mother's Identifier 22 250 CE O Y 0189 00125 Ethnic Group 23 250 ST O 00126 Birth Place 24 1 ID O 0136 00127 Multiple Birth Indicator 25 2 NM O 00128 Birth Order 26 250 CE O Y 0171 00129 Citizenship 27 250 CE O 0172 00130 Veterans Military Status 28 250 CE B 0212 00739 Nationality 29 26 TS O 00740 Patient Death Date and Time 30 1 ID O 0136 00741 Patient Death Indicator 31 1 ID O 0136 01535 Identity Unknown Indicator 32 20 IS O Y 0445 01536 Identity Reliability Code 33 26 TS O 01537 Last Update Date/Time 34 40 HD O 01538 Last Update Facility 35 250 CE C 0446 01539 Species Code 36 250 CE C 0447 01540 Breed Code 37 80 ST O 01541 Strain 38 250 CE O 2 0429 01542 Production Class Code Note PID3: Patient identifier list (PID-3) Only the ADT message HL7 v2.4 has the possibility to include the BSN, in a recurring PID-03 (sub-)segment, e.g.: August 22, 2013 Order and result messages for pathology information systems 10

PID 1 43123456^^^LOCAL^PI ~055123456^^^NLMINBIZA^NNNLD Onwel^Jolanda... The first sub sub segment is the local patient number, the second is the BSN. Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ < assigning authority (HD)> ^ <identifier type code (ID)> ^ < assigning facility (HD) ^ <effective date (DT)> ^ <expiration date (DT)> Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)> Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)> Examples BSN 066123456^^^NLMINBIZA^NNNLD^^20090101 Official identity document (passport/identity card) AA1234567^^^NLMINBIZA^PPN^^20080101 Driver s license 1234567890^^^NLRDW^DL^^20090107 Immigration document 12345678^^^NLIND^CZ^^20090701 When using the BSN and the official identity document, stating the date of verification can be necessary. The effective date component can be used to do so. Attention: The formal meaning of effective date is the starting date of the identifier, meaning that from that moment on the identifier is valid. In this case the component effective date is given a different meaning. Table 3: User-defined Table 0363 - Assigning Authority Code Description Dutch application NLMINBIZA NLMINJUS NLVWS NLIND NLRDW CIBG Prismant Vektis NL Ministerie van Binnenlandse Zaken (Ministry of Internal Affairs) NL Ministerie van Justitie (Ministry of Justice) NL Ministerie van Volksgezondheid, Welzijn en Sport (Ministry of Health, Wellbeing and Sports) NL Immigratie en Naturalisatie Dienst (Immigration Services) NL Rijksdienst voor het Wegverkeer (National road traffic service) NL Centraal Informatiepunt Beroepen Gezondheidszorg (Dutch Central Information office for Healthcare professions) NL Onder andere voor de Landelijke Medische Registratie (LMR) (a.o. for national medical registration) NL Centrum voor informatie en standaardisatie voor de zorgverzekeraars Burgerservicenummer (BSN) Reisdocument (paspoort/identiteitskaart) (BSN, passport/official identity document) Vreemdelingendocument (Immigration document) Rijbewijs (Driver s license) Zorgverlener Identificatienummer UZI (Unique Healthcare Provider Identification number) August 22, 2013 Order and result messages for pathology information systems 11

LOCAL <AGB code> (Centre for information and standardization for healthcare insurance companies) Lokaal gedefinieerd (Locally defined) AGB code van de instelling die het patiëntnummer heeft uitgereikt (AGB code of the organization that issued the patient number) Compulsory in case of exchange of healthcare information across institution borders Table 4: HL7 Table 0203 - Identifier type Code Description Dutch application AM American Express AN Account number DBC identification number BA Bank Account Number To be used for a giro or bank account number. The concerned bank has to be mentioned in the field Assigning Authority. Attention: this was BANK and GIRO in IG 2.3. BR BRN Birth registry number Breed Registry Number CZ Citizenship Card Immigration document as meant by the Dutch identification law WID (Wet op de identificatieplicht) DI Diner s Club card DL Driver s license number e.g. concerning the Dutch identification law WID ( Wet op de identificatieplicht ) DN Doctor number DR Donor Registration Number The Dutch Donorregistratienummer is meant. DS EI EN FI GI GN Discover Card Employee number Employer number Facility ID Guarantor internal identifier Guarantor external identifier HC Health Card Number The Dutch Zorgpasnummer is meant. JHN LN LR MA MC MCN Jurisdictional health number (Canada) License number Local Registry ID Medicaid number Medicare number Microchip Number MR Medical record number Dutch Medisch dossiernummer is meant MS NE NH NI MasterCard National employer identifier National Health Plan Identifier National unique individual identifier NNNLD National Person Identifier where the xxx is the ISO table 3166 3-character (alphabetic) country code NNNLD BSN August 22, 2013 Order and result messages for pathology information systems 12

NPI National provider identifier The Dutch UZI number PEN Pension Number PI Patient internal identifier Patient number within the organization PN Person number PPN Passport number Passport number, but also in general an official identity document (e.g. in accordance with the Dutch identification law WID: Wet op de identificatieplicht PRN Provider number PT Patient external identifier To be used for e.g. regional patient number, or the patient number in another healthcare institution. RR RRI SL SR SS U UPIN VN VS WC WCN XX Railroad Retirement number Regional registry ID State license State registry ID Social Security number Unspecified Medicare/HCFA s Universal Physician Identification numbers Visit number VISA WIC identifier Workers Comp Number Organization identifier Note PID5: Components: In Version 2.3, replaces the PN data type. <family name (FN)> ^ <given name (ST)> ^ <second and further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)> ^ <name assembly order (ID)> U-DPS: < second and further given names or initials thereof> contains the Dutch voorletters (initials) Subcomponents of family name: <surname (ST)> & <own surname prefix (ST)> & <own surname (ST)> & <surname prefix from partner/spouse (ST)> & <surname from partner/spouse (ST)> U-DPS: naamvrouw = <own surname> naamman (echtgenoot van) = <surname from partner/spouse> In HL7 version 2.3 the field PID-9 Patient alias was still used to communicate several different parts of the name. In this version however, the datatype XPN is extensive enough to communicate all parts of the Legal name. Note PID11: Components: In Version 2.3 and later, replaces the AD data type. <street August 22, 2013 Order and result messages for pathology information systems 13

address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code (ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)> ^ <county/parish code (IS)> ^ <census tract (IS)> ^ <address representation code (ID)> ^ <address validity range (DR)> Subcomponents of street address: <street address (ST)> & <street name (ST)> & <dwelling number (ST)> This field contains all the patient s addresses. The first address in this field has to be the address that is used to correspond with the patient. The field is filled as specified in Table 5. U-DPS does not use all the data in this element. Table 5: HL7 Adress Type componenten en sub-componenten Component Sub component Usage in The Netherlands Street address As of version 2.4 street address is a complex datatype. Different parts of the address can be filled in into the various sub components. Street address Street name Dwelling number Street name and dwelling number should be in this field as a composition, for reasons of backwards compatibility. Straatnaam Huisnummer, some implementations are known where dwelling number and street name are combined in the field Street name. Other designation City State Zip or postal code Country Address type Other geographic designation County/parish code Census tract Address representation code Address validity range Huisnummertoevoeging, additional information to specify the precise dwelling. Woonplaats N.A. Postcode, in case of a Dutch postal code no spaces should be entered: e.g. 2316XA Country in which the specified address is. The first address should have the value M (mailing). Other addresses can be specified, e.g. home address ( H ), or temporary address or residence ( C ). N.A. N.A. N.A. N.A. Starting date and end date of validity of the address can be specified using this field. This could be of use for temporary addresses. Date range start date/time Date range end date/time Starting date of validity of the address Last moment in time when the address is still valid (valid up to and including). Examples: PID 0112159^^^^PI~203444906^^^^NNNLD Reubsaet- Geurts&""&Geurts&""&Reubsaet^A^^^^^L 19151201 F Aelserhof 1^^Elsloo Lb^^6181 LB^NL 046-4378238 P N "" N PID 1234567^^^^PI~122298222^^^^NNNLD Broek van der Gruiter de&de&gruiter&van der&broek^l.^^^^^l 19200101 V Postweg August 22, 2013 Order and result messages for pathology information systems 14

14&Postweg&14^^Tilburg^^5000KL^^M^^^^^20080220&20080420~Logeerstraat 34&Logeerstraat&34^^Best^^7800YY^^C^^^^^20080220&20080227 040-1234567 N 3.5. PV1 segment Table 6: HL7 Attribute Table - PV1 Patient visit SEQ LEN DT OPT RP/# TBL# ITEM# ELEMENT NAME U-DPS 1 4 SI O 00131 Set ID - PV1 2 1 IS R 0004 00132 Patient Class Indication meaning inpatient or outpatient values: see Table 7 3 80 PL O 00133 Assigned Patient Location Department 4 2 IS O 0007 00134 Admission Type 5 250 CX O 00135 Preadmit Number 6 80 PL O 00136 Prior Patient Location 7 250 XCN O Y 0010 00137 Attending Doctor 8 250 XCN O Y 0010 00138 Referring Doctor 9 250 XCN B Y 0010 00139 Consulting Doctor 10 3 IS O 0069 00140 Hospital Service 11 80 PL O 00141 Temporary Location 12 2 IS O 0087 00142 Preadmit Test Indicator 13 2 IS O 0092 00143 Re-admission Indicator 14 6 CWE O 0023 00144 Admit Source 15 2 IS O Y 0009 00145 Ambulatory Status 16 2 IS O 0099 00146 VIP Indicator 17 250 XCN O Y 0010 00147 Admitting Doctor 18 2 IS O 0018 00148 Patient Type 19 250 CX O 00149 Visit Number Case of illness, in case this is used by the HIS (SAP) 20 50 FC O Y 0064 00150 Financial Class Financial Class 21 2 IS O 0032 00151 Charge Price Indicator Charge Price Indicator 22 2 IS O 0045 00152 Courtesy Code Courtesy Code 23 2 IS O 0046 00153 Credit Rating Credit Rating 24 2 IS O Y 0044 00154 Contract Code Contract Code 25 8 DT O Y 00155 Contract Effective Date Contract Effective Date 26 12 NM O Y 00156 Contract Amount Contract Amount 27 3 NM O Y 00157 Contract Period Contract Period 28 2 IS O 0073 00158 Interest Code Interest Code 29 1 IS O 0110 00159 Transfer to Bad Debt Code 30 8 DT O 00160 Transfer to Bad Debt Date Transfer to Bad Debt Code Transfer to Bad Debt Date 31 10 IS O 0021 00161 Bad Debt Agency Code Bad Debt Agency Code 32 12 NM O 00162 Bad Debt Transfer Amount 33 12 NM O 00163 Bad Debt Recovery Amount Bad Debt Transfer Amount Bad Debt Recovery Amount August 22, 2013 Order and result messages for pathology information systems 15

34 1 IS O 0111 00164 Delete Account Indicator Delete Account Indicator 35 8 DT O 00165 Delete Account Date Delete Account Date 36 3 IS O 0112 00166 Discharge Disposition Discharge Disposition 37 25 CM O 0113 00167 Discharged to Location Discharged to Location 38 250 CE O 0114 00168 Diet Type Diet Type 39 2 IS O 0115 00169 Servicing Facility Servicing Facility 40 1 IS B 0116 00170 Bed Status Bed Status 41 2 IS O 0117 00171 Account Status Account Status 42 80 PL O 00172 Pending Location Pending Location 43 80 PL O 00173 Prior Temporary Location Prior Temporary Location 44 26 TS O 00174 Admit Date/Time Admit Date/Time 45 26 TS O Y 00175 Discharge Date/Time Discharge Date/Time 46 12 NM O 00176 Current Patient Balance Current Patient Balance 47 12 NM O 00177 Total Charges Total Charges 48 12 NM O 00178 Total Adjustments Total Adjustments 49 12 NM O 00179 Total Payments Total Payments 50 250 CX O 0203 00180 Alternate Visit ID Alternate Visit ID 51 1 IS O 0326 01226 Visit Indicator Visit Indicator 52 250 XCN B Y 0010 01274 Other Healthcare Provider Other Healthcare Provider Table 7: possible values for PV1-2 Code Beschrijving I O P K D B klinisch (inpatient) Poliklinisch (outpatient) Preadmit (Preadmit) MedKeuring (medical test) Dag (day) PolBev (Obstetrics) 3.6. ORC segment Table 8: HL7 Attribute Table ORC Common Order SEQ LEN DT OPT RP/# TBL# ITEM# ELEMENT NAME U-DPS 1 2 ID R N 0119 00215 Order Control Order status note ORC1 2 22 EI C 00216 Placer Order Number Placer order number, delivered by the sending system 3 22 EI C 00217 Filler Order Number Filler order number, PA number note ORC3 4 22 EI O 00218 Placer Group Number August 22, 2013 Order and result messages for pathology information systems 16

5 2 ID O N 0038 00219 Order Status 6 1 ID O 0121 00220 Response Flag 7 200 TQ O Y 00221 Quantity/Timing Used to specify the priority note ORC7 8 200 CM O 00222 Parent 9 26 TS O 00223 Date/Time of Transaction Date/time when the order is registered in the ordering system. note ORC9 10 120 XCN O Y 00224 Entered By 11 120 XCN O Y 00225 Verified By 12 120 XCN O Y 00226 Ordering Provider Ordering Provider (coded) note ORC12 13 80 PL O 00227 Enterer s Location Location (coded) note ORC13 14 250 XTN O Y/2 00228 Call Back Phone Number 15 26 TS O 00229 Order Effective Date/Time 16 250 CE O 00230 Order Control Code Reason 17 250 CE O 00231 Entering Organization 18 250 CE O 00232 Entering Device 19 120 XCN O Y 00233 Action By 20 250 CE O 0339 01310 Advanced Beneficiary Notice Code 21 250 XON O Y 01311 Ordering Facility Name 22 250 XAD O Y 01312 Ordering Facility Address 23 250 XTN O Y 01313 Ordering Facility Phone Number 24 250 XAD O Y 01314 Ordering Provider Address 25 250 CWE O N 01473 Order Status Modifier Note ORC1: Of all available codes that can be delivered using this element, U-DPS uses the codes: NW, CA and CR. Table 9: possible values for ORC-1 Code Description NW CA or CR nieuwe order (new order) verwijderen order (cancel order) Cancelling the order can currently only be indicated if the order has not yet been incorporated into a report. August 22, 2013 Order and result messages for pathology information systems 17

Note ORC3: The filler order number ( rapportnummer ) will be the unique laboratory order number indicating the registered study. The used format is: <type of study><year> <serial number> type of study can contain: B, C, S, T or M. Year: only the last two digits of the year in which the material is received. Serial number: a pathology/anatomy (PA) number (unique for each laboratory) and possibly a version indicator: A, B, C, D... Examples: T09-00001 Histologie C09-00001 Cytologie S09-00001 Obductie B09-00001 Cervixcytologie This study report number is only issued when the received order is being processed. This can be at the moment of confirming the order (when processing the order starts), or later, when the report after performing the study is finished. Note ORC7: ORC-7 sub field 6 can contain a character that may cause the priority of the study to be risen. In other words: should the study be performed in emergency, or should it not. U-DPS reacts on the character S. Caused by this S, the field soortaanvraag (kind of order) will contain the value spoed (emergency). All other values lead to a normal priority: normaal. The information is also part of the OBR-27 sub field 6. Note ORC9: Date-time on which the order is entered into the ordering system of the ordering application. Should this field be empty, then the date of de MSH segment can be used as a source. Note ORC12: The ordering provider number that is delivered by the HIS, is converted into an order placer code in U-DPS. When a result is issued, the ordering provider number as known in the HIS will be provided by U-DPS. Note ORC13: In case registering a location code is a necessity, the code will be incorporated into the U-DPS report. 3.7. OBR segment Table 10: HL7 Attribute Table OBR Observation Request SEQ LEN DT OPT RP/# TBL# ITEM # ELEMENT NAME U-DPS 1 4 SI O 00237 Set ID - OBR 2 22 EI C 00216 Placer Order Number Placer order number, delivered by the sending August 22, 2013 Order and result messages for pathology information systems 18

system 3 22 EI C 00217 Filler Order Number + Filler order number, PA number 4 250 CE R 00238 Universal Service ID Type of study note OBR4 5 2 ID B 00239 Priority - OBR 6 26 TS B 00240 Requested Date/Time 7 26 TS C 00241 Observation Date/Time # 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 60 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST O 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 0163 0369 00249 Specimen Source * 16 120 XCN O Y 00226 Ordering Provider See ORC segment 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer Field 1 19 60 ST O 00252 Placer Field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng - Date/Time + 23 40 CM O 00256 Charge to Practice + 24 10 ID O 0074 00257 Diagnostic Serv Sect ID Hospital/institution optional: location of requestor (coded) 25 1 ID C 0123 00258 Result Status + 26 200 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 150 XCN O Y/5 00260 Result Copies To Receivers of copies of the result report 29 200 CM O 00261 Parent 30 20 ID O 0124 00262 Transportation Mode (code and name to be filled in) 31 250 CE O Y 00263 Reason for Study note OBR31 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + August 22, 2013 Order and result messages for pathology information systems 19

37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector s Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Note OBR4: The sending system can use this field for terms like one of the following: Histologie (Histology) Cytologie (Cytology) Obductie (Autopsy) Cervixcytologie (Cervixcytology) In practice, the pathology department will often decide by itself on the study to be performed. Note OBR31: The reason for study (request) can be specified here. This is optional. For now only one of the following values is permitted: 3.8. SAC segment BVO-DDK (bowel cancer screening) BVO-DDK-NOTP (bowel cancer screening, only for study, it is not permitted to redistribute the information to third parties, e.g. ColonIS) SAC segment specification see paragraph 4.5. 3.9. OBX segment Table 11: HL7 Attribute Table OBX Observation SEQ LEN DT OPT RP/# TBL# ITEM# ELEMENT NAME U-DPS 1 4 SI O 00569 Set ID - OBX Serial number of the OBX segment 2 2 ID C 0125 00570 Value Type FT 3 250 CE R 00571 Observation Identifier note OBX3 4 20 ST C 00572 Observation Sub-ID August 22, 2013 Order and result messages for pathology information systems 20