HL7 Interface Specifications Merge AIMS 8.3

HL7 Interface Specifications Merge AIMS 8.3 Merge Healthcare 900 Walnut Ridge Drive Hartland, WI 53029 USA 877.44.MERGE

2012 Merge Healthcare. The information contained herein is confidential and is the sole property of Merge Healthcare. None of the information may be reproduced, copied, and/or re-distributed electronically, manually, or otherwise to any person without advance written permission from Merge Healthcare, except as may be expressly authorized by contracts or other agreements between Merge Healthcare and its customer. Merge Healthcare and AMICAS are registered trademarks and VERICIS, RadSuite, Abraxas, and iconnect are also trademarks of Merge Healthcare. Other trademarks or service marks referred to herein are the property of their respective owners. Doc # Revision Date Description AIMS-1068 1 10/15/12 Initial release for 8.3.

Contents Inbound Interfaces Communication......................................................... 1 HL7 Version Support..................................................... 1 Inbound Interface Functionality............................................. 1 Admit/ Discharge- ADT................................................... 2 Supported ADT Event Types........................................... 2 s...................................................... 4 Scheduling - SIU....................................................... 14 Supported SIU Event Types........................................... 14 s..................................................... 15 Lab Results - ORU..................................................... 25 Supported ORU Event Types............................................. 25 s..................................................... 25 Outbound Interfaces Communication........................................................ 29 HL7 Version Support.................................................... 29 Charge Utilization - DFT................................................. 29 Charge Utilization Interface Functionality................................. 30 s..................................................... 30 DFT^P03 Message Template.......................................... 32 Charge Utilization Message Example.................................... 32 Post Case - ORU....................................................... 33 Post Case Interface Functionality....................................... 33 s..................................................... 33 ORU^R01 Message Template......................................... 36 Post-Case Message Example.......................................... 37 Clinical Data - Outbound................................................. 38 Clinical Data Interface Functionality..................................... 38 s..................................................... 38 Clinical Data Message Template....................................... 64 Clinical Data Message Example........................................ 69 i

Merge AIMS 8.3 HL7 Interface Specification ii

1 Chapter 1 Inbound Interfaces The Merge Healthcare Anesthesia Information Management System (AIMS) supports three types of inbound interfaces: ADT, Scheduling, and Lab Results. This portion of the document defines the interface specifications that support the transmission of data from the HIS system to the AIMS system. The specific HL7 events supported by the AIMS system as well as the fields to which the data are assigned within the application are defined. Communication Protocol: TCP Streaming Sockets (WinSock2 TCP Socket) Port Number: The AIMS system accepts all inbound connections through one configurable port. Acknowledgement Sent: Commit-level MSA structure HL7 Version Support The Merge Healthcare AIMS system currently supports HL7 versions 2.1 to 2.4 for all inbound ADT, SIU, and ORU messages. Inbound Interface Functionality HL7 messages can be routed from various hospital systems into the HIS HL7 engine on multiple sockets, and then into the HL7 Inbound Interface on a single socket connection. Conversely, multiple senders can send directly to the interface using the same destination IP address and port number, where no HL7 engine is available. The interface accepts unsolicited HL7 messages over a TCP streaming socket and returns a commit-level HL7 ACK on the same socket. Application-level ACK and custom error messages are not supported (for example: delayed acknowledgement on a different socket). The HL7 Inbound Interface is unidirectional. HL7 event types will control the behavior of the message processing. The message handling logic will follow different paths depending upon the particular message's event type. Messages with event types not configured for processing will be discarded. The Interface will decide which logical path to follow based upon the event type of the message found in the HL7 message header segment (MSH: 9). The parser will then find the various data elements within the segments of the message and send the information into SQL 1

Merge AIMS 8.3 HL7 Interface Specification Server. A message lacking the system's required fields will not be processed into the database. The HL7 Inbound Interface can be configured to populate the various fields in the SQL Server database from virtually any HL7 message element. The base configuration has been adequate for most installations, but adjustments to the base mappings can be made to suit a particular situation. Actual configuration settings will be negotiated between the HIS department and the Merge Healthcare development team during implementation. Admit/ Discharge- ADT The ADT information is used to update the patient demographic and visit information in the AIMS system database. This information can be viewed and/or updated manually through the AIMS PAE and AIMS Anesthesia products. Any changes to the patient's demographic and/or visit information recorded through the HIS system will automatically update the database such that the data will be available through AIMS PAE and AIMS Anesthesia. These are some of the benefits of having an ADT interface: Patient demographics and visit information will be available to the OR in a timely fashion Updates to patient information are available immediately Supported ADT Event Types The Merge Healthcare AIMS system currently supports these ADT event types to: Create new patient record Update patient record Merge patient records Trigger Event Definition Action ADT^A01 Admit a Patient If patient record does not exist in the AIMS system, it is created. ADT^A02 Transfer a Patient If patient record exists, it is updated; otherwise, the record is created. ADT^A04 Register a Patient If patient record exists, it is updated; otherwise, the record is created. ADT^A05 Pre-Admit If patient record exists, it is updated; otherwise, the record is created. ADT^A06 ADT^A07 Transfer an Outpatient to Inpatient Change Inpatient to Outpatient If patient record exists, it is updated; otherwise, the record is created If patient record exists, it is updated; otherwise, the record is created 2

Chapter 1 Inbound Interfaces Trigger Event Definition Action ADT^A08 Update Patient Information If patient record exists, it is updated; otherwise, the record is created. ADT^A13 Cancel Discharge If patient record exists, it is updated; otherwise, the record is created. ADT^A18 Merge Patient Information This merge event is non-specific and is retained in HL7 for backwards compatibility. It is supported by the system; however, exact functionality is determined on an individual basis with accounts ADT^A34 Merge Patient - Internal ID (MRN) If prior MRN is found in our system, it will be changed to the "surviving" MRN, or merged with the "surviving" MRN if that already exists. ADT^A35 ADT^A36 Merge Patient Information - Account Number Merge Patient Information If prior Account is found in our system, it will be changed to the "surviving" Account, or merged with the "surviving" Account if that already exists. If prior MRN is found in our system, it will be changed to the "surviving" MRN, or merged with the "surviving" MRN if that already exists. ADT^A40 Merge Patient - Internal ID (MRN) If prior MRN is found in our system, it will be changed to the "surviving" MRN, or merged with the "surviving" MRN if that already exists. ADT^A41 ADT^A42 Merge Patient Information - Account Number Merge Visit - Visit Number If prior Account is found in our system, it will be changed to the "surviving" Account, or merged with the "surviving" Account if that already exists. Visit number update ADT^A44 Move Account Account will be moved to, or created on, the specified MRN ADT^A45 Move Visit Visit number update ADT^A47 Change MRN If prior MRN is found in our system, it will be changed to the "surviving" MRN, or merged with the "surviving" MRN if that already exists. 3

Merge AIMS 8.3 HL7 Interface Specification Trigger Event Definition Action ADT^A49 Change Account Number If prior Account is found in our system, it will be changed to the "surviving" Account, or merged with the "surviving" Account if that already exists. ADT^A50 Change Visit Number Visit number update ADT^P01 Add Patient Account If patient record exists, it is updated; otherwise, the record is created. ADT^A60 Add/Update/Delete Patient Allergy Properly drug-framework codified patient allergies will be updated in the patient record. s The Merge Healthcare AIMS system currently supports these segments for HL7 ADT messages: 1. MSH Message Header 2. PID Patient Identification 3. PV1 Patient Visit 4. DG1 Diagnosis 5. IN1 Insurance Info 6. OBX Observation 7. NTE Notes and s 8. ORC Common Order 9. RXE Pharmacy/Treatment Encoded Order 10. RXR Pharmacy/Treatment Route 11. MRG Patient Merge 12. AL1 Patient Allergy 13. IAM Patient Allergy (A60) 4

Chapter 1 Inbound Interfaces Within each supported segment, the system can capture and process these elements: Table 1-1: MSH Definition MSH 1 R Field Separator MSH 2 R Encoding Characters Literal "^~\&" MSH 3 O Sending Application MSH 4 O Sending Facility MSH 9 1 R Message Type ADT MSH 9 2 R Trigger Event A01-A60 MSH 10 R Message Control ID Unique Message ID MSH 12 R HL7 Version 2.1 to 2.4 Table 1-2: PID Definition PID 2 O External ID PID 3 1 R Patient MRN PID 5 1 R Patient Last Name PID 5 2 R Patient First Name PID 5 3 O Patient Middle Name PID 7 O Patient Date of Birth Format: YYYYMMDD PID 8 O Patient Sex PID 18 R Patient Account Number PID 19 O Patient SSN Number Format: XXX-XX- XXXX 5

Merge AIMS 8.3 HL7 Interface Specification Table 1-3: PV1 Definition PV1 2 O Patient Class I, O, U (Inpatient, Outpatient, Unknown) PV1 3 4 O Patient Facility PV1 5 O Pre-admit Number Prior T Account Number PV1 10 O Hospital Service PV1 17 1 O Admitting Doctor ID PV1 17 2 O Admitting Doctor Last Name PV1 17 3 O Admitting Doctor First Name PV1 17 7 O Admitting Doctor Degree PV1 19 1 O Patient Visit Number PV1 44 O Admit Date/Time Format: YYYYMMDDHHmm PV1 50 O Alternate Visit ID Prior T Account Number Table 1-4: DG1 Definition DG1 1 O Set ID DG1 2 O Diagnosis Coding Method I9, etc. DG1 3 1 O Diagnosis Code/ Identifier DG1 4 O Diagnosis Description DG1 5 O Diagnosis Date/Time Format: YYYYMMDDHHmm DG1 6 O Diagnosis Type A,W, F (Admitting, Working, Final) 6

Chapter 1 Inbound Interfaces Table 1-5: IN1 Definition IN1 2 1 O Insurance Plan ID IN1 4 1 O Insurance Company Name Table 1-6: OBX Definition for Height/Weight OBX 3 1 O Observation Identifier Indicator (Height, Weight, etc) OBX 5 1 O Observation Value Patient Height or Weight OBX 6 1 O Observation Units Recognized height units include cm, centimeter(s), mm, millimeter(s), m, meter(s), ft, foot, feet; otherwise inches is assumed. Recognized weight units include kg, kilo(s), kilogram(s), oz, ounce(s); otherwise pounds is assumed. Table 1-7: OBX Definition for Surgical History OBX 3 1 R Observation Identifier External key such as SURG_HX; mapped in System Config utility. OBX 5 1 R Observation Value Procedure name or description OBX 7 1 O Reference Range Anesthesia Type; mapped in System Config utility 7

Merge AIMS 8.3 HL7 Interface Specification Table 1-7: OBX Definition for Surgical History (Continued) OBX 8 1 O Abnormal Flags "Y" for complications checkbox; other flags ignored. OBX 11 1 O Observation Result Status OBX 14 1 O Observation datetime OBX 15 1 and 3 C Producer's ID and Name of coding system "D" Delete will remove item. "F" Final or "C" Correction (or any other value) will add or update the item. Surgical procedure date: "yyyymmddhhmm" or "yyyymmdd" Internal ID from source system and name of source system. itionally required, necessary to process deletes. Table 1-8: OBX Definition for Family History of Anesthesia OBX 3 1 R Observation Identifier External key matching None Problems No Problems Unknown As mapped in System Config utility. 8

Chapter 1 Inbound Interfaces Table 1-9: OBX Definition for NPO Status OBX 3 1 R Observation Identifier Either of two values (Date-time value or Since Midnight checkbox) mapped in System Config utility. OBX 5 1 C Observation Value If Identifier matches to checkbox, then Value field indicates checkbox state (T, True, F False) OBX 14 1 C Observation datetime If Identifier matches to date-time, NPO since this date-time Table 1-10: OBX Definition for PreOp or PostOp Vital Signs OBX 3 1 R Observation Identifier Group identifier indicating PreOp or Post-Op, as mapped in System Config utility OBX 4 R Observation Sub-Id Identifies the particular measurements, including: Blood Pressure Temperature Temperature Mode Pulse Respiration SpO2 Room Air Percent Oxygen The Identifiers are mapped in System Config utility. 9

Merge AIMS 8.3 HL7 Interface Specification Table 1-10: OBX Definition for PreOp or PostOp Vital Signs (Continued) OBX 5 1 R Observation Value Value of the specific measurement; numeric except for Temperature Mode and Room Air OBX 6 1 C Units Required for Temperature (F or C) OBX 14 1 R Observation datetime Vitals timestamp; the single latest timestamp per set is saved in AIMS. Table 1-11: OBX Definition for Medical History OBX 3 1 R Observation Identifier Identifies the particular ition as mapped in the System Config utility. OBX 5 1 O Observation Value See note below OBX 11 1 R Observation Result Status OBX 14 1 R Observation datetime "D" Delete will remove item. "F" Final or "C" Correction (or any other value) will add or update the item. Timestamp Table 1-12: OBX Definition for Timed Events OBX 3 1 R Observation Identifier Identifies the particular Event as mapped in the System Config utility. OBX 5 1 O Observation Value Can optionally be used instead of OBX- 14 for event datetime OBX 14 1 R Event date-time Timestamp of event 10

Chapter 1 Inbound Interfaces The patient s medication profile of Home and Current medications is sent in a RDE^O11 message. The MSH, PID, and PV1 segments are described above. Each medication must be sent in a separate message, with a single ORC and RXE segment. Table 1-13: NTE Definition for Surgical History NTE 3 O Surgical History item Table 1-14: NTE Definition for Family History of Anesthesia NTE 3 O Family History Table 1-15: NTE Definition for NPO Status NTE 3 O NPO (25 character max) Table 1-16: NTE Definition for PreOp or PostOp Vital Signs NTE 3 O Physiologic Status Table 1-17: NTE Definition for Medical History NTE 3 O ition Note regarding medical history Value field: The value field is not explicitly required. If all possible medical history items have multiple-choice style answers (T/F, Y/N, selection lists), then it is possible to combine OBX-3 and OBX-5 into a composite identifier, and map those to groups of conditions in PAE. For example, a question "Do You Smoke?" with Y/N answers could map to a PAE "Smoker" and "Non-smoker" conditions. However, if any medical history items have free-response answers, then it is recommended to map the Value field as the comment associated with the individual question. For example, a question "Who is your cardiologist?" with a text response would map to a PAE "Cardiologist" condition and its associated comment field. Examples: OBX 3 TX NURAASS12^NURSM1^Do you now/did you ever smoke? Y F 201206281413 OBX 4 TX NURAASS12^NURSMH1^Qty. 1:1 pack/day F 201206281413 11

Merge AIMS 8.3 HL7 Interface Specification Table 1-18: ORC Definition for Home/Current Medications ORC 2 1 C Order Identifier Used as the Source ID; necessary to process deletes ORC 5 1 C Order Status "D" or other configured value will remove item with matching ID, Source, and Source ID ORC 9 1 C Documentation Datetime Updates are only processed if newer than existing data ORC 10 1 C User Name Free text, can also be configured to RXE-13 ORC 21 1 C Ordering Facility Name Used as Source; necessary to process deletes Table 1-19: RXE Definition for Home/Current Medications RXE 1 1-2 O Frequency Free text RXE 2 1 R Medication Identifier RXE 2 2 R Medication Description RXE 2 3 R Identifier Type RXE 4 1 O Dose Amount Free text RXE 5 1 O Dose Units Concatenated with Dose Amount RXE 7 1 O Free text RXE 18 1 O Last Taken Free text Table 1-20: RXR Definition for Home/Current Medications RXR 1 2 O Route Free text 12

Chapter 1 Inbound Interfaces Table 1-21: MRG Definition MRG 2 R Prior Patient ID Prior MRN MRG 3 R Prior Account Number Prior Account Number Table 1-22: AL1 Definition AL1 2 1 R Allergen Type Code "DA" (Drug Allergy), "FA" (Food Allergy) AL1 3 1 R Allergen Code/ID AL1 3 2 R Allergen Code/Text AL1 3 3 R Allergen Code/Type AL1 3 4 O Alternate Identifier AL1 3 6 O Allergy Source System AL1 5 O Allergic Reaction Table 1-23: IAM Definition IAM 2 1 R Allergen Type Code "DA" (Drug Allergy), "FA" (Food Allergy) IAM 3 1 R Allergen Code/ID IAM 3 2 R Allergen Code/Text IAM 3 3 R Allergen Code/Type IAM 5 O Allergic Reaction IAM 6 1 O Allergy Action/ Identifier IAM 7 1 C Allergy Unique Identifier IAM 7 2 C Allergy Source System 13

Merge AIMS 8.3 HL7 Interface Specification Table 1-23: IAM Definition IAM 9 1 O Sensitivity to Causative Agent code "IN" Intolerance Any other value for a true allergy IAM 17 1 O Allergy Clinical Status Code Scheduling - SIU The SIU information is used to update the scheduling information in the AIMS system database. This information can be viewed and/or updated manually through the AIMS PAE and AIMS Anesthesia products. Any updates to the surgical procedure scheduling recorded through hospital scheduling system will automatically update the AIMS system database such that the data will be available through AIMS PAE and AIMS Anesthesia. These are some of the benefits of having a scheduling interface: Procedure scheduling information will be available to the OR in a timely fashion Updates to scheduling information are available almost immediately It will eliminate the need to manually enter procedure, scheduling and patient demographics within the system Supported SIU Event Types The Merge Healthcare AIMS system currently supports these SIU event types for: New scheduled surgery appointment (also known as a "Case") Scheduled appointment update Scheduled appointment cancellation Trigger Event Definition Action SIU^S12 New Appointment (Surgical Procedure) Case record is created. This includes patient information. If patient record exists, it will be attached and updated as needed. SIU^S13 Reschedule Surgery If case record exists, it is updated; otherwise, the record is created. SIU^S14 Change Surgical Appointment Details If case exists, it is updated; otherwise, the record is created. SIU^S15 Cancel Surgery Case is canceled 14

Chapter 1 Inbound Interfaces s The Merge Healthcare AIMS system currently supports these segments for HL7 SIU messages: 1. MSH Message Header 2. SCH Appointment Identification 3. PID Patient Identification 4. PV1 Patient Visit 5. OBX Event Timestamps 6. NTE Notes and s 7. ORC Common Order 8. RXE Pharmacy/Treatment Encoded Order 9. RXR Pharmacy/Treatment Route 10. AIS Surgical Procedure Information 11. AIL Operating Room Location (Scheduled Date/Time) 12. AIP Hospital personnel Within each supported segment, the system can capture and process these elements: Table 1-24: MSH Definition MSH 1 R Field Separator MSH 2 R Encoding Characters Literal "^~\&" MSH 3 O Sending Application MSH 4 O Sending Facility MSH 9 1 R Message Type SIU MSH 9 2 R Trigger Event S12-15 MSH 10 R Message Control ID Unique Message ID MSH 12 R HL7 Version 2.1 to 2.4 Table 1-25: SCH Definition SCH 2 1 R Filler Appointment ID Medical Procedure Appointment ID 15

Merge AIMS 8.3 HL7 Interface Specification Table 1-26: PID Definition PID 2 O External ID PID 3 1 R Patient MRN PID 5 1 R Patient Last Name PID 5 2 R Patient First Name PID 5 3 O Patient Middle Name PID 7 O Patient Date of Birth Format: YYYYMMDD PID 8 O Patient Sex PID 18 R Patient Account Number PID 19 O Patient SSN Number Format: XXX-XX- XXXX Table 1-27: PV1 Definition PV1 2 O Patient Class I, O, U (Inpatient, Outpatient, Unknown) PV1 3 4 O Patient Facility PV1 5 O Pre-admit Number Prior T Account Number PV1 10 O Hospital Service PV1 17 1 O Admitting Doctor ID PV1 17 2 O Admitting Doctor Last Name PV1 17 3 O Admitting Doctor First Name PV1 17 7 O Admitting Doctor Degree PV1 19 1 O Patient Visit Number PV1 44 O Admit Date/Time Format: YYYYMMDDHHmm PV1 50 O Alternate Visit ID Prior T Account Number 16

Chapter 1 Inbound Interfaces Table 1-28: OBX Definition for Height/Weight OBX 6 1 O Observation Units Recognized height units include cm, centimeter(s), mm, millimeter(s), m, meter(s), ft, foot, feet; otherwise inches is assumed. Recognized weight units include kg, kilo(s), kilogram(s), oz, ounce(s); otherwise pounds is assumed. Table 1-29: OBX Definition for Surgical History OBX 3 1 R Observation Identifier External key such as SURG_HX; mapped in System Config utility. OBX 5 1 R Observation Value Procedure name or description OBX 7 1 O Reference Range Anesthesia Type; mapped in System Config utility 17

Merge AIMS 8.3 HL7 Interface Specification Table 1-29: OBX Definition for Surgical History (Continued) OBX 8 1 O Abnormal Flags "Y" for complications checkbox; other flags ignored. OBX 11 1 O Observation Result Status OBX 14 1 O Observation datetime OBX 15 1 and 3 C Producer's ID and Name of coding system "D" Delete will remove item. "F" Final or "C" Correction (or any other value) will add or update the item. Surgical procedure date: "yyyymmddhhmm" or "yyyymmdd" Internal ID from source system and name of source system. itionally required, necessary to process deletes. Table 1-30: OBX Definition for Family History of Anesthesia OBX 3 1 R Observation Identifier External key matching None Problems No Problems Unknown As mapped in System Config utility. 18

Chapter 1 Inbound Interfaces Table 1-31: OBX Definition for NPO Status OBX 3 1 R Observation Identifier Either of two values (Date-time value or Since Midnight checkbox) mapped in System Config utility. OBX 5 1 C Observation Value If Identifier matches to checkbox, then Value field indicates checkbox state (T, True, F False) OBX 11 1 C Observation datetime If Identifier matches to date-time, NPO since this date-time 19

Merge AIMS 8.3 HL7 Interface Specification Table 1-32: OBX Definition for PreOp or PostOp Vital Signs OBX 3 1 R Observation Identifier Group identifier indicating PreOp or Post-Op, as mapped in System Config utility OBX 4 R Observation Sub-Id Identifies the particular measurements, including: Blood Pressure Temperature Temperature Mode Pulse Respiration SpO2 Room Air Percent Oxygen The Identifiers are mapped in System Config utility. OBX 5 1 R Observation Value Value of the specific measurement; numeric except for Temperature Mode and Room Air OBX 6 1 C Units Required for Temperature (F or C) OBX 14 1 R Observation datetime Vitals timestamp; the single latest timestamp per set is saved in AIMS. 20

Chapter 1 Inbound Interfaces Table 1-33: OBX Definition for Medical History OBX 3 1 R Observation Identifier Identifies the particular ition as mapped in the System Config utility. OBX 5 1 O Observation Value See note below OBX 11 1 R Observation Result Status OBX 14 1 R Observation datetime "D" Delete will remove item. "F" Final or "C" Correction (or any other value) will add or update the item. Timestamp Table 1-34: OBX Definition for Timed Events OBX 3 1 R Observation Identifier Identifies the particular Event as mapped in the System Config utility. OBX 5 1 O Observation Value Can optionally be used instead of OBX- 14 for event datetime OBX 14 1 R Event date-time Timestamp of event The patient s medication profile of Home and Current medications is sent in a RDE^O11 message. The MSH, PID, and PV1 segments are described above. Each medication must be sent in a separate message, with a single ORC and RXE segment. Table 1-35: NTE Definition for Surgical History NTE 3 O Surgical History item Table 1-36: NTE Definition for Family History of Anesthesia NTE 3 O Family History 21

Merge AIMS 8.3 HL7 Interface Specification Table 1-37: NTE Definition for NPO Status NTE 3 O NPO (25 character max) Table 1-38: NTE Definition for PreOp or PostOp Vital Signs NTE 3 O Physiologic Status Table 1-39: NTE Definition for Medical History NTE 3 O ition Note regarding medical history Value field: The value field is not explicitly required. If all possible medical history items have multiple-choice style answers (T/F, Y/N, selection lists), then it is possible to combine OBX-3 and OBX-5 into a composite identifier, and map those to groups of conditions in PAE. For example, a question "Do You Smoke?" with Y/N answers could map to a PAE "Smoker" and "Non-smoker" conditions. However, if any medical history items have free-response answers, then it is recommended to map the Value field as the comment associated with the individual question. For example, a question "Who is your cardiologist?" with a text response would map to a PAE "Cardiologist" condition and its associated comment field. Examples: OBX 3 TX NURAASS12^NURSM1^Do you now/did you ever smoke? Y F 201206281413 OBX 4 TX NURAASS12^NURSMH1^Qty. 1:1 pack/day F 201206281413 22

Chapter 1 Inbound Interfaces Table 1-40: ORC Definition for Home/Current Medications ORC 2 1 C Order Identifier Used as the Source ID; necessary to process deletes ORC 5 1 C Order Status "D" or other configured value will remove item with matching ID, Source, and Source ID ORC 9 1 C Documentation Datetime Updates are only processed if newer than existing data ORC 10 1 C User Name Free text, can also be configured to RXE-13 ORC 21 1 C Ordering Facility Name Used as Source; necessary to process deletes Table 1-41: RXE Definition for Home/Current Medications RXE 1 1-2 O Frequency Free text RXE 2 1 R Medication Identifier RXE 2 2 R Medication Description RXE 2 3 R Identifier Type RXE 4 1 O Dose Amount Free text RXE 5 1 O Dose Units Concatenated with Dose Amount RXE 7 1 O Free text RXE 18 1 O Last Taken Free text Table 1-42: RXR Definition for Home/Current Medications RXR 1 2 O Route Free text 23

Merge AIMS 8.3 HL7 Interface Specification The first AIS segment becomes the primary procedure. Any subsequent AIS segments will become Additional scheduled procedures for the case. There is no limit on the number of additional procedures for a case. Table 1-43: AIS Definition AIS 3 4 R Universal Service ID - Code AIS 3 5 O Universal Service ID - Text Medical Procedure Type ID Medical Procedure Type Text Table 1-44: AIL Definition AIL 3 2 R Location ID (Room) Medical Procedure Location/Room AIL 6 1 R Start Date/Time Procedure Date and Time Format: YYYYMMDDHHmm Multiple staff are supported, in that there can be multiple surgeons, multiple CRNAs, multiple Anesthesiologists, multiple nurses, etc., but the system will determine their role in the case based upon the database setting for that clinician. Typically, only the surgeon is sent across on the schedule; but other team members can be sent as well. Table 1-45: AIP Definition AIP 3 1 R Personnel ID Medical Procedure Staff ID 24

Chapter 1 Inbound Interfaces Lab Results - ORU The Lab Result information will be sent from the hospital's lab system and stored in the AIMS system database. This information can be viewed in the AIMS PAE and AIMS Anesthesia products. Any changes to the patient's lab result information recorded through either the LIS or the HIS system will automatically update the database such that the data will be available through AIMS PAE and AIMS Anesthesia. These are some of the benefits of having a lab results interface: Patient lab results information will be available to the clinician Updates to patient lab results information are available immediately Supported ORU Event Types The Merge Healthcare AIMS system currently supports these ORU event types to: Populate the lab results Update lab results based on Date/Time of observation for each visit Trigger Event Definition Action ORU^R01 Unsolicited Lab Result If matching Patient account and lab test type are found in the database, lab results will be added to the patient record. s The Merge Healthcare AIMS system currently supports these segments for HL7 ORU messages: 1. MSH Message Header 2. PID Patient Identification 3. OBR Observation Request Information (Date/Time, etc) 4. OBX Observation (Lab Results) 5. NTE s 25

Merge AIMS 8.3 HL7 Interface Specification Within each supported segment, the Merge Healthcare AIMS system can capture and process these elements: Table 1-46: MSH Definition MSH 1 R Field Separator MSH 2 R Encoding Characters Literal "^~\&" MSH 3 O Sending Application MSH 4 O Sending Facility MSH 9 1 R Message Type ORU MSH 9 2 R Trigger Event R01 MSH 10 R Message Control ID Unique Message ID MSH 12 R HL7 Version 2.1 to 2.4 Table 1-47: PID Definition PID 2 O External ID PID 3 1 R Patient MRN PID 5 1 R Patient Last Name PID 5 2 R Patient First Name PID 5 3 O Patient Middle Name PID 7 O Patient Date of Birth Format: YYYYMMDD PID 8 O Patient Sex PID 18 R Patient Account Number PID 19 O Patient SSN Number Format: XXX-XX- XXXX Table 1-48: OBR Definition OBR 7 R Observation Date/ Time Lab Result Date and Time Format: YYYYMMDDHHmm 26

Chapter 1 Inbound Interfaces Table 1-49: OBX Definition OBX 1 R Set ID OBX 2 R Value Type Only "ST" and "NM" will be processed OBX 3 1 R Observation Identifier Lab Results Lab Type OBX 5 1 R Observation Value Lab Results Observation Value OBX 6 1 O Observation Units OBX 7 O Reference Range OBX 8 O Abnormal Flag Table 1-50: NTE Definition NTE 3 O Lab Results Observation s 27

Merge AIMS 8.3 HL7 Interface Specification 28

2 Chapter 2 Outbound Interfaces The Merge Healthcare AIMS system supports three outbound interfaces: Clinical Data, Charge Utilization, and the Post Case interface. This portion of the document defines the interface specifications that support the transmission of data from the AIMS system to the client s interface engine for further processing, or directly to the HIS system(s). Communication Protocol: TCP Streaming Sockets Target IP address and Port Number: Configurable Acknowledgement Received: MSA message structure - commit level acknowledgement (same socket) HL7 Version Support Clinical Data Interface: HL7 Version 2.4 Charge Utilization Interface: HL7 Version 2.3 Post Case Interface: HL7 Version 2.3.1 Charge Utilization - DFT This interface is designed to provide information regarding the items and quantities of drugs and supplies used during an anesthesia procedure. These are some of the benefits of having a Charge Utilization interface: Billing system, pharmacy and/or materials management will know what was used during an anesthesia case immediately upon close of case. Manual paperwork for charging is eliminated. Auditing report is available. 29

Merge AIMS 8.3 HL7 Interface Specification Charge Utilization Interface Functionality The HL7 Charge Utilization Interface runs as a Windows service, and communicates with the database via the AIMS system web service, over HTTPS. It polls the database for new utilization data, and sends out HL7 DFT^P03 messages if new data is found. At the close of an anesthesia case, the system parses out the case data sent in from the AIMS Anesthesia client machine in the OR where the case ran. Some of that parsed data will be entered into the three utilization tables in the SQL database. This will trigger the outbound interface to send out the utilization messages for that case. The three utilization types are: OR Drugs IV Bag Solutions Supply Items The outbound interface can be configured to send out any or all of the three utilization types. There will be one HL7 transaction per item type per case. The case utilization data is grouped and aggregated by charge code and Product ID. Overall utilization quantities are calculated for each combination of charge code and Product ID for that anesthesia case. If five different drugs were given during that case, five HL7 transactions are produced - regardless of how many individual syringes were used to deliver those drugs. There will be one HL7 transaction per drug, showing the total usage quantity of that drug. The financial transaction is completed after the HL7 ACK message is received, at which time the transaction is posted back to the database where the utilization records involved with that transaction are marked with an Export Date/Time. s The Merge Healthcare AIMS system supports these segments for HL7 DFT messages: 1. MSH Message Header 2. PID Patient Identification 3. PV1 Patient Visit 4. FT1 Financial Transaction Within each supported segment, the Merge Healthcare AIMS system can process and export these elements: Table 2-1: MSH Definition MSH 1 Field Separator MSH 2 Encoding Characters Literal "^~\&" MSH 3 Sending Application Literal "MERGEAIMS" 30

Chapter 2 Outbound Interfaces Table 2-1: MSH Definition MSH 4 Sending Facility Sending facility for multifacility customers, or Default for single-facility customers MSH 9 1 Message Type Literal "DFT" MSH 9 2 Trigger Event Literal "P03" MSH 10 Message Control ID [msg_control_id] MSH 11 Processing ID Literal "P" MSH 12 HL7 Version Literal "2.3" MSH 15 Accept Ack Type Literal "AL" MSH 16 Application Ack Type Literal "NE" Table 2-2: PID Definition PID 3 1 Patient MRN [patient_mrn] PID 5 1 Patient Last Name [patient_last_name] PID 5 2 Patient First Name [patient_first_name] PID 18 Patient Account Number [patient_account_number] Table 2-3: PV1 Definition PV1 2 Patient Class [patient_class] PV1 3 1 Patient Facility [use_location] -- OR Name PV1 19 1 Patient Visit Number [visit_number] Table 2-4: FT1 Definition FT1 2 Transaction ID [transaction_id] FT1 4 1 Use Date [use_date] -- Date/Time of use FT1 5 Posting Date [posting_date] FT1 6 Debit/Credit Indicator [debit_credit] -- "D" or "C" (Configurable) FT1 7 1 Charge Code [charge_code] -- Hospital Charge Code 31

Merge AIMS 8.3 HL7 Interface Specification Table 2-4: FT1 Definition (Continued) FT1 7 2 Product Name [product_name] FT1 7 4 Product ID [product_id] FT1 8 1 NDC Quantity N4[product_ndc]ML[amoun t_delivered] FT1 10 7 Quantity [quantity] -- Billable Quantity FT1 16 1 Department Code [department_code] FT1 20 1 Staff ID [staff_id] FT1 20 2 Staff Last Name [staff_lastname] FT1 20 3 Staff First Name [staff_firstname] FT1 25 1 Procedure Code [procedure_code] DFT^P03 Message Template MSH ^~\& MERGEAIMS [sending_facility] [target_app] [target_facility] [message_date_ti me] DFT^P03 [msg_control_id] P 2.3 AL NE USA EVN P03 [message_date_time] PID [patient_mrn]^^^[patient_facility] [patient_last_name]^[patient_first_name]^[patient_mid dle_name] [patient_account_number] PV1 [patient_class] [use_location] [visit_number] FT1 [transaction_id] [use_date] [posting_date] [debit_credit] [charge_code]^[product_name]^ ^[product_id] N4[product_ndc]ML[amount_delivered] [quantity] [department_code] [staff_id]^[staff_lastname]^[staff_firstname] [procedure_code] Charge Utilization Message Example MSH ^~\& MERGEAIMS Default DataGateSimulator FDBMain 20100915120430 DFT^P03 2 0100915120427170 P 2.3 AL NE USA EVN P03 20100915120430 PID MRNU07.420^^^ KOPTAN_07.420^ASHTON^ ANU07.420 PV1 I OR 01 VN07.420 FT1 I0af36e13-a22d-46e1-bc6a- 821c8853a644 20100820112327 20100915120430 CH 54354^Morphine 500mg / 500mL NS^^N409998768098ML500^ 1 FDBMainPharm ^^ 32

Chapter 2 Outbound Interfaces Post Case - ORU This interface is designed to provide information indicating various aspects of an anesthesia procedure. The outbound message is triggered upon close-of-case. Here is one of the benefits of having a Post Case interface: Destination system will be appraised of various case aspects immediately upon close of case. Post Case Interface Functionality The HL7 Post-Case Interface runs as a Windows service, and communicates with the system database via the AIMS system web service, over HTTPS. It polls the database for newlyclosed anesthesia cases, and sends out an HL7 ORU R01 message for any cases closed since the previous polling interval (generally set at 1 minute). At the close of an anesthesia case, the system parses out the case data sent to the server from the AIMS Anesthesia client machine in the OR where the case ran. The case data are parsed out and stored in the relational database (SQL Server). The final action of close-ofcase processing is the triggering of the outbound Post-Case HL7 transaction. This is achieved via a database trigger populating a polling table. Any open transactions will be found in this 'ClosedCasePolling' table. There will be one HL7 transaction per case. The Post-Case interface service will poll the database for any open transactions (which it has not yet processed). Cases will be processed in the order in which they were closed. s The Merge Healthcare AIMS system currently supports these segments for HL7 ORU messages: 1. MSH Message Header 2. PID Patient Identification 3. OBR Observation Request Information 4. OBX Observation Within each supported segment, the Merge Healthcare AIMS system can process and export these elements: Table 2-5: MSH Definition MSH 1 Field Separator MSH 2 Encoding Characters Literal "^~\&" MSH 3 Sending Application Literal "MERGEAIMS" MSH 5 Receiving Application DestApp 33

Merge AIMS 8.3 HL7 Interface Specification Table 2-5: MSH Definition MSH 7 Message Date/Time [message_date_time] MSH 9 1 Message Type Literal "ORU" MSH 9 2 Trigger Event Literal "R01" MSH 10 Message Control ID [msg_control_id] MSH 11 Processing ID Literal "P" MSH 12 HL7 Version Literal "2.3.1" MSH 15 Accept Ack Type Literal "AL" MSH 16 Application Ack Type Literal "NE" MSH 17 Country Code Literal "USA" Table 2-6: PID Definition PID 3 1 Patient MRN CX:5 = "AN" MRN CX:5 = "MR" Case number CX:5 = "CASE" SS# CX:5 = "SS" PID 5 1 Patient Last Name [patient_last_name] PID 5 2 Patient First Name [patient_first_name] PID 5 3 Patient Middle Name [patient_middle_name] PID 7 Patient Date of Birth [patient_dob] PID 8 Patient Sex [patient_sex] PID 18 1 Patient Account Number [patient_account_number] PID 19 Patient Social Sec Number [patient_ss] Table 2-7: OBR Definition OBR 3 Observation Identifier [filler_appt_id] OBR 4 1 Universal Service ID Literal "5000.8" OBR 4 2 Universal Service Text Literal "ANESTHESIA" OBR 4 3 Name of Coding System Literal "AS4" 34

Chapter 2 Outbound Interfaces Table 2-8: OBX Definition OBX 1 Set ID [setid] -- Identifies Give Instance of OBX OBX 2 Value Type HL7 Data Type found in OBX-5 OBX 3 1 Observation Identifier/ID Indicates which element of the case data this particular OBX contains. OBX 3 2 Observation Identifier/Text Text version of the ID in OBX-3 OBX 5 1 Observation Value Actual Information: Date/ Time, procedure type, etc. OBX 11 Observation Result Status Literal "F" NOTE: If a particular event did not occur during the case, such as no PREOPSTART event ever happened, then the OBX segment which would ordinarily have represented that event will not be present in the HL7 message. Therefore, the SET ID of the OBX will not be a reliable means of locating a particular piece of information for parsing out. Instead, the code found in OBX:3.1, or OBX:3.2 must be used to locate which OBX instance contains the needed information from OBX:5 The default indicators are as follows: PRIMARYPROCEDURE = 1 ANESTHESIATYPE = 2 ASACLASS = 3 PREOPSTART = 4 INROOMSTART = 5 ANESTHESIASTART = 6 INCISIONSTART = 7 INCISIONEND = 8 INCISIONMINUTES = 9 INROOMEND = 10 ANESTHESIAEND = 11 PACUEND = 12 The preceding codes can be reconfigured to match codes or descriptions in your system, but the meaning of the information they represent must be carefully preserved if such reconfiguration is considered. 35

Merge AIMS 8.3 HL7 Interface Specification ANESTHESIA TYPE: The anesthesia types used will be limited to those found in the system database. No mapping to other systems is currently available. Any desired mapping of anesthesia types must be done within the receiving system. ORU^R01 Message Template MSH ^~\& MERGEAIMS DestApp [message_date_time] ORU^R01 [msg_control_id] P 2.3.1 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^^mr~[filler_appt_id]^^^^case~[patient_accoun t]^^^^an [patient_last_name]^[patient_first_name]^[patient_middle_name] [patient_dob] [pa tient_sex] [patient_account]^^^^an [patient_ss] OBR 1 [filler_appt_id] 5000.8^ANESTHESIA^AS4 OBX [setid] CE 1^PRIMARYPROCEDURE^99PSD ^[value]^99ps F OBX [setid] CE 2^ANESTHESIATYPE^99PSD [value_id]^[value]^99ds F OBX [setid] CE 3^ASACLASS^99PSD [value_id]^[value]^99ds F OBX [setid] TS 4^PREOPSTART^99PSD [value] F OBX [setid] TS 5^INROOMSTART^99PSD [value] F OBX [setid] TS 6^ANESTHESIASTARTTIME^99PSD [value] F OBX [setid] TS 7^INCISIONSTART^99PSD [value] F OBX [setid] TS 8^INCISIONEND^99PSD [value] F OBX [setid] NM 9^INCISIONMINUTES^99PSD [value] Min F OBX [setid] TS 10^INROOMEND^99PSD [value] F OBX [setid] TS 11^ANESTHESIASTOPTIME^99PSD [value] F OBX [setid] TS 12^PACUEND^99PSD [value] F 36

Chapter 2 Outbound Interfaces Post-Case Message Example MSH ^~\& MERGEAIMS DestApp 20050628141450 ORU^R01 20050628444 P 2.3.1 AL N E USA PID 1 444-44- 4444^^^^SSN~FMRN100^^^^MR~444^^^^CASE~FACCT100^^^^AN LASTNAME^FIRSTNA ME^MID OBR 1 444 5000.8^ANESTHESIA^AS4 OBX 1 CE 1^PRIMARYPROCEDURE^99PSD 1 ^PROC_ID3^99PS F OBX 2 CE 2^ANESTHESIATYPE^99PSD 1 EPIGEN^Epidural and General^99DS F OBX 3 CE 3^ASACLASS^99PSD 1 ^IV^99DS F OBX 4 TS 6^ANESTHESIASTARTTIME^99PSD 1 20050628135606 F OBX 5 TS 11^ANESTHESIASTOPTIME^99PSD 1 20050628135915 F OBX 6 TS 7^INCISIONSTART^99PSD 1 20050628135755 F OBX 7 TS 8^INCISIONEND^99PSD 1 20050628135757 F OBX 8 TS 5^INROOMSTART^99PSD 1 20050628135719 F OBX 9 TS 10^INROOMEND^99PSD 1 20050628135811 F OBX 10 TS 4^PREOPSTART^99PSD 1 20050628135610 F OBX 11 TS 12^PACUEND^99PSD 1 20050628135922 F OBX 12 NM 9^INCISIONMINUTES^99PSD 1 1 Min F 37

Merge AIMS 8.3 HL7 Interface Specification Clinical Data - Outbound This interface is designed to share discrete clinical information documented in the PreAnesthesia Evaluation (PAE) and in the anesthesia record. The outbound messages are triggered differently depending on the data: Allergies can be documented in either the PAE or the Anesthesia record, and are sent when saved (real-time). Timed events (Patient In Room, Procedure Start, etc) are documented in the anesthesia record, and are sent when saved (real-time). This supports a shared intraoperative workflow between anesthesia and nursing. Other data documented in the PAE are sent when the PAE is signed and/or Finalized. Other data documented in the anesthesia record are sent when the record is signed and closed, including closing an appended case. The clinical data interface is intended to support shared workflows and shared discrete data. Combined with the inbound clinical data interface, duplicate data entry is minimized (ie, data entered by Nursing within the Nursing system becomes available in the Anesthesia system, and data entered by Anesthesia becomes available within the Nursing system). Patient safety is enhanced by sharing codified allergy and medication lists. Clinical Data Interface Functionality The HL7 Clinical Data Interface runs as a Windows service, and communicates with the system database via the AIMS system web service, over HTTPS. It polls the database for updated records, and sends out the appropriate HL7 messages for any data since the previous polling interval (generally set at 1 minute). Any open transactions will be found in the 'Outbound Clinical Data Polling' table. There may be multiple transactions per case (per patient). The Outbound interface service will poll the database for any open transactions (which it has not yet processed). s The Merge Healthcare AIMS system currently supports these segments for HL7 ORU messages: 1. MSH Message Header All 2. PID Patient Identification All 3. PV1 Patient Visit All 38

Chapter 2 Outbound Interfaces 4. OBR Observation Request Information NPO Status 5. OBX Observation Medical history conditions Family anesthesia history Surgical history PreOp vital signs PostOp (PACU) vital signs Timed events Fluid outputs & balance Anesthesia type & ASA 6. AL1 or IAM Patient Allergy and Adverse Reaction information Allergies 6. DG1 Diagnosis ICD-9 coding 7. PR1 Procedures Surgical procedures & times CPT coding 8. ORC Common Order Medications delivered Infusions delivered 9. RXE and RXR Pharmacy Encoded Order Pharmacy Route Medications delivered Infusions delivered 10. RXC Pharmacy Component Order Infusions delivered (base solution and additives) 11. NTE Notes and s Various Within each supported segment, the Merge Healthcare AIMS system can process and export these elements: Table 2-9: MSH Definition MSH 1 Field Separator MSH 2 Encoding Characters Literal "^~\&" MSH 3 Sending Application Literal "MERGEAIMS" MSH 4 Sending Facility Sending facility for multifacility customers, or "Default" for single-facility customers MSH 5 Receiving Application "CLINICALHIS" or other literal value MSH 7 Message Date/Time [message_date_time] 39

Merge AIMS 8.3 HL7 Interface Specification Table 2-9: MSH Definition (Continued) MSH 9 1 Message Type Configured literal (such as "ORU"), or for Allergies "ADT" MSH 9 2 Trigger Event Configured literal (such as "R01") or for Allergies: "A08" or "A60" MSH 10 Message Control ID [msg_control_id] MSH 11 Processing ID Literal "P" MSH 12 HL7 Version Literal "2.4" MSH 15 Accept Ack Type Literal "AL" MSH 16 Application Ack Type Literal "NE" MSH 17 Country Code Literal "USA" Table 2-10: PID Definition PID 3 1 Patient MRN Account Number CX:5 = "AN" MRN CX:5 = "MR" Case number CX:5 = "CASE" SS# CX:5 = "SS" Note: Can also be configured similar to Charge Interface PID 5 1 Patient Last Name [patient_last_name] PID 5 2 Patient First Name [patient_first_name] PID 5 3 Patient Middle Name [patient_middle_name] PID 7 Patient Date of Birth [patient_dob] PID 8 Patient Sex [patient_sex] PID 18 1 Patient Account Number [patient_account_number] PID 19 Patient Social Sec Number [patient_ss] 40

Chapter 2 Outbound Interfaces Table 2-11: PV1 Definition PV1 2 Patient Class [patient_class] PV1 19 1 Patient Visit Number [visit_number] Table 2-12: OBR Definition (optionally included in any messages using OBX segments) OBR 3 Observation Identifier [filler_appt_id] OBR 4 1 Universal Service ID Literal "5000.8" or other configured value OBR 4 2 Universal Service Text Literal "ANESTHESIA" or other configured value OBR 4 3 Name of Coding System Literal "AS4" or other configured value Table 2-13: OBX Definition (message structure defined here. See table below for values specific to each type of data) OBX 1 Set ID [setid] OBX 2 Value Type [value_type] OBX 3 1 Observation Identifier/ID [observation_id] OBX 3 2 Observation Identifier/Text [observation_text] OBX 3 3 Observation Coding System [observation_name_of_codi ng_system] OBX 4 Observation Sub-ID [observation_sub_id] OBX 5 Observation Value [value] OBX 6 Units [value_units] OBX 7 Reference Range [references_range] OBX 8 Abnormal Flags [abnormal_flags] OBX 11 Observation Result Status [observation_result_status] OBX 14 Observation Date-Time [observation_date_time] OBX 15 1 Producer's ID Identifier [source_id] OBX 15 3 Producer's ID Coding System [source] OBX 16 Responsible Observer XCN structure as defined below [responsible_observer] 41

Merge AIMS 8.3 HL7 Interface Specification Table 2-14: NTE Definition (comments) NTE 1 Set ID [setid] NTE 3 [comment] Table 2-15: XCN Definition (staff identifier data structure) Sequence 1 ID number Interface ID 2 Family name Last name 3 Given name First name 4 Second and further given names or initials Middle name 5 Suffix (e.g., JR or III) Suffix 6 Prefix (e.g., DR) Prefix 7 Degree (e.g., MD) Credentials The following tables show how the OBX segments may be populated with the data applicable to each message type. Table 2-16: NPO Status - a set of 2 OBX segments; the first is always included, and the second is included only if the date-time is documented. Field [setid] [value_type] [observation_id] [observation_text] [observation_name_of_coding_system] [observation_sub_id] [value] [value_units] [references_range] Content 1 for Since Midnight checkbox 2 for NPO date-time Set ID 1: CE Set ID 2: TS Set ID 1: NPOSINCEMIDNIGHT or other mapped value Set ID 2: NPO or other mapped value Set ID 1: NPO since midnight (checkbox) Set ID 2: NPO since the specified time Literal "MergeAIMS" Set ID 1: True or False Set ID 2: NPO date-time 42

Chapter 2 Outbound Interfaces Table 2-16: NPO Status - a set of 2 OBX segments; the first is always included, and the second is included only if the date-time is documented. (Continued) Field [abnormal_flags] [observation_result_status] [observation_date_time] [source_id] [source] [responsible_observer] NTE comment segment Content Literal "F" Set ID 1: Last Saved date-time Set ID 2: Patient's NPO date-time Included following each/both segments, when comment is present Table 2-17: Medical history conditions - zero to many OBX segments, one per each condition in the PAE. Note that deleted (= inactive) are also included. Field [setid] [value_type] [observation_id] [observation_text] [observation_name_of_coding_system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [observation_result_status] [observation_date_time] [source_id] [source] Content Incremented counter CE ition mapped identifier; will be is not mapped Print Description Literal "MergeAIMS" "True" if active "False" if inactive or deleted "F" if active "D" if inactive or deleted Last Updated date-time 43

Merge AIMS 8.3 HL7 Interface Specification Table 2-17: Medical history conditions - zero to many OBX segments, one per each condition in the PAE. Note that deleted (= inactive) are also included. Field [responsible_observer] NTE comment segment Content XCN structure of saved-by staff, or Username if staff not available (eg, data received from external system) Included when a comment is present Table 2-18: Family anesthesia history - one OBX segment Field Content [setid] 1 [value_type] [observation_id] [observation_text] [observation_name_of_coding_system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [observation_result_status] [observation_date_time] [source_id] [source] [responsible_observer] NTE comment segment CE Mapped identifier One of four possible values: "PROBLEMS", "NO PROBLEMS", "NO HISTORY", or "UNKNOWN" Literal "MergeAIMS" One of four possible values: "PROBLEMS", "NO PROBLEMS", "NO HISTORY", or "UNKNOWN" "F" Final Last Updated date-time XCN structure of saved-by staff, or Username if staff not available (eg, data received from external system) Included when a comment is present Table 2-19: Surgical history - zero to many OBX segments, one per surgical history row Field [setid] [value_type] Content Incremented counter TX 44

Chapter 2 Outbound Interfaces Table 2-19: Surgical history - zero to many OBX segments, one per surgical history row Field [observation_id] [observation_text] [observation_name_of_coding_system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [observation_result_status] [observation_date_time] [source_id] [source] [responsible_observer] NTE comment segment Content Mapped identifier for Surgical History Description of surgery Literal "MergeAIMS" Description of surgery Mapped identifier for anesthesia type, or SWKey if no mapping present. T or F from the "Perioperative complications?" checkbox "F" Final Date of surgery. If documented as year-only, will be sent as January 1st ("2002" = "20020101000000"). unless result was received from external system unless result was received from external system XCN structure of saved-by staff, or Username if staff not available (eg, data received from external system) Included when a comment is present Table 2-20: PreOp and PostOp (PACU) vital signs - a collection of OBX segments, one per measurement Field [setid] [value_type] [observation_id] [observation_text] Content Incremented counter NM Numeric value except for: BLOODPRESSURE = TX TEMPERATUREMODE = TX PATIENTONROOMAIR = CE PATIENTONOXYGEN = CE Mapped ID such as PREOP_VITALS or POSTOP_VITALS "PreOp Vital Signs" or "PACU Vital Signs" 45

Merge AIMS 8.3 HL7 Interface Specification Table 2-20: PreOp and PostOp (PACU) vital signs - a collection of OBX segments, one per measurement (Continued) Field [observation_name_of_coding_system] [observation_sub_id] [value] Content Literal "MergeAIMS" HEIGHT WEIGHT HEIGHT and WEIGHT are literal (not mapped). All others are "Mapped IDs corresponding to the following:" SYSTOLIC DIASTOLIC BLOODPRESSURE TEMPERATURE TEMPERATUREMODE PULSERATE RESPIRATIONRATE SPO2 PATIENTONROOMAIR PATIENTONOXYGEN OXYGENSETTING Numeric value except for: BLOODPRESSURE = Systolic/Diastolic as a combined field "120/80" TEMPERATUREMODE = string value "Oral" PATIENTONROOMAIR = True or False PATIENTONOXYGEN = True or False 46

Chapter 2 Outbound Interfaces Table 2-20: PreOp and PostOp (PACU) vital signs - a collection of OBX segments, one per measurement (Continued) Field [value_units] [references_range] [abnormal_flags] [observation_result_status] [observation_date_time] [source_id] [source] [responsible_observer] NTE comment segment Content Configurable for HEIGHT Configurable for WEIGHT mmhg for SYSTOLIC mmhg for DIASTOLIC mmhg for BLOODPRESSURE Configurable for TEMPERATURE for TEMPERATUREMODE BPM for PULSERATE BPM for RESPIRATIONRATE % for SPO2 for PATIENTONROOMAIR for PATIENTONOXYGEN % or L/min for OXYGENSETTING "F" (Final) Date time of the collection of vitals (single value shared for all measurements) Included when a comment is present (single NTE after the collection of OBXs) Table 2-21: Timed events - zero to many OBX segments, one per event Field [setid] [value_type] [observation_id] [observation_text] [observation_name_of_coding_system] [observation_sub_id] Content Incremented counter TS Mapped identifier; if not mapped Display name of event Literal "MergeAIMS" 47

Merge AIMS 8.3 HL7 Interface Specification Table 2-21: Timed events - zero to many OBX segments, one per event Field [value] [value_units] [references_range] [abnormal_flags] [observation_result_status] [observation_date_time] [source_id] [source] [responsible_observer] Content Date-time of event "F" (Final) Date-time of event Table 2-22: Fluid outputs & balance - one to many OBX segments, one per output plus one for fluid balance Field [setid] [value_type] [observation_id] [observation_text] [observation_name_of_coding_system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [observation_result_status] [observation_date_time] [source_id] [source] [responsible_observer] Content Incremented counter NM SWKey of output fluid NETBALANCE for fluid balance Display name of output fluid "Net perioperative fluid balance" Literal "MergeAIMS" Numeric balance (sum of input infusions and fluids, minus sum of output fluids; can be negative) "ml" "F" (Final) 48

Chapter 2 Outbound Interfaces Table 2-23: Anesthesia type & ASA - one to many OBX segments, one for ASA class plus one for each anesthesia type documented. Field [setid] [value_type] [observation_id] [observation_text] [observation_name_of_coding_system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [observation_result_status] [observation_date_time] [source_id] [source] [responsible_observer] Content Incremented counter CE ASA ATYP for primary anesthesia type AATYP for additional types "ASA Class" "Anesthesia Type (Primary)" "Additional Anesthesia Type" Literal "MergeAIMS" for ASA Mapped identifier for anesthesia type, or SWKey if no mapping present. ASA Physical Status description, typically roman numeral I through V or IE through VE where E indicates an emergency surgery CE structure with mapped identifier, anesthesia type display name, and "MergeAIMS" "F" (Final) The patient's medication profile of Home and Current medications (documented in PAE; this is not the anesthesia-delivered medications) is sent in RDE^O11 messages. The MSH, PID, and 49

Merge AIMS 8.3 HL7 Interface Specification PV1 segments are described above. Each medication is sent in a separate message, with a single ORC, RXE, and RXR segment. Table 2-24: Definition for Home/Current Medications ORC 2 1 Placer Order Number Row ID from database (GUID) ORC 5 1 Order Status "IP" (In Process) ORC 9 1 Date/Time of Transaction Documentation date-time ORC 10 1 Entered By XCN structure of saved-by staff, or Username if staff not available (eg, data received from external system) ORC 21 1 Ordering Facility Name "DOCUSYS" if entered by Anesthesia; other value if data received from external system ORC 21 3 Ordering Facility ID Numeric ID if entered by Anesthesia; other value if data received from external system Table 2-25: RXE Definition for Home/Current Medications RXE 1 1-2 Quantity/Timing Frequency (split at first space " " character) RXE 2 1 Give Code - Identifier Identifier (varies based on installed Drug Information Framework) FDB = Drug Name ID Multum = D Number Micromedex = Generic Formulation Code RXE 2 2 Give Code - Description Name of medication RXE 2 3 Give Code - Identifier Type Varies based on installed Drug Information Framework: FDB = "DNID" Multum = "DNUM" Micromedex = "GFC" 50

Chapter 2 Outbound Interfaces Table 2-25: RXE Definition for Home/Current Medications (Continued) RXE 2 4 Give Code - Alternate Identifier RXE 2 6 Give Code - Alternate Identifier Type Identifier (varies based on installed Drug Information Framework) FDB = Dispensable Drug ID Multum = Synonym ID Micromedex = but may include the NDC if data received from external system Varies based on installed Drug Information Framework: FDB = "MEDID" Multum = "SYN" Micromedex = "NDC" RXE 3 1 Give Amount Dose field (up to first space " " character) Note: Not guaranteed numeric. RXE 5 1 Give Units Dose field (after first space " " character) RXE 7 1 Administration Instructions RXE 18 1 Date-Time of most recent refill or dose Last Taken Note: This comes from a text field, so it generally won't be a well-formatted date and may be null. Table 2-26: RXR Definition for Home/Current Medications RXR 1 2 Route - text Route 51

Merge AIMS 8.3 HL7 Interface Specification The patient's medication profile of anesthesia-delivered medications is sent in an ORM^O01 message. The MSH, PID, and PV1 segments are described above. Each delivery is sent in an ORC, RXE, and RXR segment group. Multiple deliveries are included in a single message. Table 2-27: ORC Definition for Delivered Medications ORC 2 1 Placer Order Number Row ID from database (GUID) ORC 5 1 Order Status "CM" = completed ORC 7 1 Quantity/Timing "1" = a single delivery ORC 9 1 Date/Time of Transaction Date-time of delivery ORC 12 Ordering Provider XCN structure of staff ORC 21 1 Ordering Facility Name Source system = "MergeAIMS" ORC 21 3 Ordering Facility ID Source ID = Row ID from database (GUID) Table 2-28: RXE Definition for Delivered Medications RXE 2 1 Give Code - Identifier Charge Code as configured in AIMS Formulary RXE 2 2 Give Code - Description Primary display name of medication RXE 2 3 Give Code - Identifier Type "CHARGECODE" RXE 2 4 Give Code - Alternate Identifier Identifier (varies based on installed Drug Information Framework) FDB = Routed Medication ID Multum = Synonym ID Micromedex = Generic Formulation Code RXE 2 5 Give Code - Alternate Text Mapped Drug Name from Drug Information Framework, as configured in AIMS Formulary 52

Chapter 2 Outbound Interfaces Table 2-28: RXE Definition for Delivered Medications (Continued) RXE 2 6 Give Code - Alternate Identifier Type Varies based on installed Drug Information Framework: FDB = "RMID" Multum = "SYN" Micromedex = "GFC" RXE 3 1 Give Amount Delivery amount Note: Will be 0 for "By Each" medications. RXE 5 1 Give Units Delivery units; typically a drug weight unit such as "mg" RXE 7 1 Administration Instructions RXE 18 1 Date-Time of most recent refill or dose RXE 23 1 Give Rate Amount RXE 24 1 Give Rate Units RXE 25 1 Give Strength Alternate delivery amount. If a "By Each" type of medication, this is the quantity; otherwise this is the delivery volume. RXE 26 1 Give Strength Units Alternate units; "Each" or "ml" RXE 31 1 Supplementary Code - ID NDC number, as configured in AIMS Formulary RXE 31 2 Supplementary Code - Text NDC Description as configured in AIMS Formulary RXE 31 3 Supplementary Code - Identifier type RXE 31 4 Supplementary Code - Alternate ID RXE 31 5 Supplementary Code - Alternate Text RXE 31 6 Supplementary Code - Alternate Identifier type "NDC" Billing NDC, as configured in AIMS Formulary NDC Description as configured in AIMS Formulary "BILLINGNDC" 53

Merge AIMS 8.3 HL7 Interface Specification Table 2-29: RXR Definition for Delivered Medications RXR 1 1 Route - ID Route of delivery SWKey RXR 1 2 Route - text Route of delivery name The patient's medication profile of anesthesia-delivered infusions (plain fluids and drug infusions) is sent in an ORM^O01 message. The MSH, PID, and PV1 segments are described above. Each delivery is sent in an ORC, RXE, RXC (if additives present), and RXR segment group. Multiple deliveries are included in a single Message. For infusions documented by rate, each change of rate is treated as a separate delivery. Table 2-30: ORC Definition for Delivered Infusions ORC 2 1 Placer Order Number Row ID from database (GUID) ORC 5 1 Order Status "CM" = completed ORC 7 All Quantity/Timing TQ structure, defined below ORC 9 1 Date/Time of Transaction Date-time of delivery, or end time if rate-based. ORC 12 Ordering Provider XCN structure of staff ORC 21 1 Ordering Facility Name Source system = "MergeAIMS" ORC 21 3 Ordering Facility ID Source ID = Row ID from database (GUID) Table 2-31: RXE Definition for Delivered Infusions RXE 2 1-6 Give Code If the infusion is a plain fluid, then RXE-2 (subfields 1-6) is similar to medication delivery, above. If the infusion includes drug additives, then RXE-2 is and the RXC segment contains the detailed infusion definition. RXE 3 1 Give Amount Delivery volume RXE 5 1 Give Units Volume units, "ml" RXE 7 1 Administration Instructions Infusion final disposition, such as "Completed" or "Transferred" 54

Chapter 2 Outbound Interfaces Table 2-31: RXE Definition for Delivered Infusions (Continued) RXE 18 1 Date-Time of most recent refill or dose RXE 23 1 Give Rate Amount if documented as a volume; Rate value if documented as a rate RXE 24 1 Give Rate Units if documented as a volume; "ml/hr" if documented as a rate RXE 25 1 Give Strength RXE 26 1 Give Strength Units RXE 31 1 Supplementary Code - ID NDC number, as configured in AIMS Formulary (for infusion, not additive) RXE 31 2 Supplementary Code - Text NDC Description as configured in AIMS Formulary RXE 31 3 Supplementary Code - Identifier type RXE 31 4 Supplementary Code - Alternate ID RXE 31 5 Supplementary Code - Alternate Text RXE 31 6 Supplementary Code - Alternate Identifier type "NDC" Billing NDC, as configured in AIMS Formulary NDC Description as configured in AIMS Formulary "BILLINGNDC" Table 2-32: RXC Definition for Delivered Infusions - repeated for base solution and additive(s) RXC 1 1 Rx Component Type "B" for base solution; "A" for additive(s) RXC 2 1-6 Component Code Component (base solution or additive) identifiers, similar to RXE-2 for medication deliveries 55

Merge AIMS 8.3 HL7 Interface Specification Table 2-32: RXC Definition for Delivered Infusions - repeated for base solution and additive(s) RXC 3 1 Component Amount Infusion initial volume for base solution (bag volume); Additive initial amount (amount of additive in bag) RXC 4 1 Component Units Volume units, "ml" for base solution Additive units, typically a drug weight unit such as "mg" RXC 5 1 Component Strength for base solution; Original concentration of additive (before it was diluted into infusion) RXC 6 1 Component Strength Units for base solution; Original concentration units for additive RXC 7 1 Supplementary Code NDC information for component (base solution or additive), similar to RXE- 31 Table 2-33: RXR Definition for Delivered Infusions RXR 1 1 Route - ID Route of delivery SWKey RXR 1 2 Route - text Route of delivery name Table 2-34: TQ Definition (Timing/Quantity data structure for infusions) Sequence 1 Quantity "1" one delivery 2 Interval if documented as a volume "C" if documented as a rate 3 Duration if documented as a volume "M" and the duration in minutes if documented as a rate (ex: "M60") 56

Chapter 2 Outbound Interfaces Table 2-34: TQ Definition (Timing/Quantity data structure for infusions) Sequence 4 Start date-time if documented as a volume Rate start time if documented as a rate 5 End date-time Delivery time if documented as a volume Rate end time if documented as a rate Diagnosis codes can be documented in the PAE and also in AIMS Anesthesia. Procedure coding can only be documented in AIMS Anesthesia. Coding data are sent when the PAE is signed and when the Anesthesia record is signed. Coding data consists of 1) zero to many DG1 diagnosis segments, 2) zero to many PR1 surgical procedure segments, and 3) zero to many PR1 procedure coding segments, which include both surgeon-performed and personally-performed procedures. Table 2-35: DG1 Definition for Diagnosis Code(s) DG1 1 Set ID Incremented counter DG1 3 1 Diagnosis Code/ Identifier Diagnosis code (number) DG1 3 2 Diagnosis Code/ Text Diagnosis description DG1 3 3 Diagnosis Code/ Identifier Type "I9" = ICD-9 DG1 5 Diagnosis Date/Time PAE: when the PAE was signed AIMS Anesthesia: when the code was documented DG1 6 Diagnosis Type "W" = Working DG1 15 Diagnosis Priority "0" = not ranked DG1 16 Diagnosing Clinician XCN structure of staff who signed the anesthesia record; if record not yet signed (PAE signing trigger event) then this will be the PAE signer. 57

Merge AIMS 8.3 HL7 Interface Specification Table 2-35: DG1 Definition for Diagnosis Code(s) (Continued) DG1 17 Diagnosis Classification "D" = Diagnosis DG1 19 Attestation Date/Time PAE: when the PAE was signed AIMS Anesthesia: when the record was signed Note: Associated with DG1-16. Either the anesthesia record signer/ signed time, or if that's not signed yet then it's the PAE signer/signed time. Table 2-36: PR1 Definition for Procedure Code(s) personally performed by Anesthesia staff PR1 1 Set ID Incremented counter PR1 3 1 Procedure Code/ Identifier Procedure code (number) PR1 3 2 Procedure Code/ Text Procedure description PR1 3 3 Procedure Code/ Identifier Type "C4" = CPT-4 PR1 5 Procedure Date/Time When the code was documented PR1 6 Procedure Functional Type "I" Personally performed procedures (codes for IV, catheter, etc) PR1 7 Procedure Minutes PR1 8 Anesthesiologist PR1 9 Anesthesia Code PR1 10 Anesthesia Minutes PR1 11 Surgeon PR1 12 Procedure Practitioner XCN structure of Linked staff member, if documented PR1 14 Procedure Priority Procedure codes are not ranked PR1 15 Associated Diagnosis Code PR1 16 Procedure Code Modifier 58

Chapter 2 Outbound Interfaces Table 2-37: PR1 Definition for Procedure Code(s) not personally performed PR1 1 Set ID Incremented counter PR1 3 1 Procedure Code/ Identifier Procedure code (number) PR1 3 2 Procedure Code/ Text Procedure description PR1 3 3 Procedure Code/ Identifier Type "C4" = CPT-4 PR1 5 Procedure Date/Time Individual procedure start time if code linked to actual procedure, otherwise the overall Incision Start Time PR1 6 Procedure Functional Type "P" Procedure for Treatment (codes for the surgery) PR1 7 Procedure Minutes Individual procedure time if code linked to actual procedure, otherwise the overall Incision Time. This is a duration (number of minutes, can be a decimal value) not a timestamp. PR1 8 Anesthesiologist XCN structure of Anesthesia staff who signed the record PR1 9 1 Anesthesia Code/ Identifier Anesthesia crosswalk code (number) PR1 9 2 Anesthesia Code/ Text Anesthesia crosswalk description PR1 9 3 Anesthesia Code/ Identifier Type "XWALK" Crosswalk PR1 10 Anesthesia Minutes Anesthesia Time duration (total for case) PR1 11 Surgeon XCN structure of Surgeon linked to code, if documented; otherwise primary surgeon for the case PR1 12 Procedure Practitioner Same as PR1-11 Surgeon PR1 14 Procedure Priority Procedure codes are not ranked 59

Merge AIMS 8.3 HL7 Interface Specification Table 2-37: PR1 Definition for Procedure Code(s) not personally performed (Continued) PR1 15 1 Associated Diagnosis Code/ Identifier PR1 15 2 Associated Diagnosis Code/ Description PR1 15 3 Associated Diagnosis Code/ Identifier Type Linked diagnosis code, if documented (either linked to same actual procedure as this CPT code, or the first "linked code" among the diagnosis codes) PR1-15 is if none found. Linked diagnosis description "I9" ICD-9 PR1 16 (can repeat) 1 Procedure Code Modifier/ Identifier Modifier code(s) PR1 16 2 Procedure Code Modifier/ Description PR1 16 3 Procedure Code Modifier/ Identifier type Modifier description(s) "CPTM" CPT Modifier The anesthesia record may cover a single surgery, or can document multiple "actual" surgical procedures (there can also be multiple scheduled procedures, but those are not relevant here). Each surgical procedure will be sent as a PR1 segment within an ORU^R01 message. Table 2-38: PR1 Definition for Surgical Procedure(s) PR1 1 Set ID Incremented counter PR1 3 1 Procedure Code/ Identifier Hospital scheduling code if scheduled if added by anesthesia user PR1 3 2 Procedure Code/ Text Procedure description PR1 3 3 Procedure Code/ Identifier Type PR1 3 4 Procedure Code/ Alt Identifier "ScheduledProcedure" if scheduled "MergeAIMS" if added by anesthesia user CPT code, if linked to actual procedure (otherwise for subfields 4-6) PR1 3 5 Procedure Code/ Alt Text CPT description 60

Chapter 2 Outbound Interfaces Table 2-38: PR1 Definition for Surgical Procedure(s) (Continued) PR1 3 6 Procedure Code/ Alt Identifier Type "C4" = CPT-4 PR1 5 Procedure Date/Time Procedure Start time. Same as Incision Start time if only one procedure. PR1 6 Procedure Functional Type "P" = Procedure PR1 7 Procedure Minutes Procedure duration in minutes. Same as Incision Time duration if only one procedure. PR1 8 Anesthesiologist PR1 9 Anesthesia Code PR1 10 Anesthesia Minutes PR1 11 Surgeon XCN structure of primary surgeon PR1 12 Procedure Practitioner PR1 14 Procedure Priority Procedure rank (1, 2, etc) PR1 15 1 Associated Diagnosis Code/ Identifier PR1 15 2 Associated Diagnosis Code/ Description PR1 15 3 Associated Diagnosis Code/ Identifier Type Diagnosis code, if linked to actual procedure (otherwise ) Linked diagnosis description "I9" ICD-9 PR1 16 (can repeat) 1 Procedure Code Modifier/ Identifier Modifier code(s, if any) for CPT in PR1-3.4 PR1 16 2 Procedure Code Modifier/ Description PR1 16 3 Procedure Code Modifier/ Identifier type Modifier description(s) "CPTM" CPT Modifier Allergy messages are sent whenever the AIMS user updates the patient allergy profile. Either of two message styles are supported: an ADT^A08 with AL1 segments, or an ADT^A60 with IAM segments. 61

Merge AIMS 8.3 HL7 Interface Specification For the AL1 style, only active (non-deleted) allergies are included. For the IAM style, both active and deleted allergies are included. Table 2-39: AL1 Definition AL1 1 1 Set ID Incremented counter AL1 2 1 Allergen Type Code Configured value such as "DA" (Drug Allergy) AL1 3 1 Allergen Code/ID Substance identifier (ID from Drug Information Framework) "-1" if No Known Drug Allergies AL1 3 2 Allergen Code/Text Substance description "NKDA" if No Known Drug Allergies AL1 3 3 Allergen Code/Type Configured value, as appropriate based on Drug Information Framework AL1 3 5 Allergen Code/ Alternate Text (free text) AL1 5 1, can repeat Allergic Reaction Reaction(s) AL1 7 1 Sensitivity Code "IN" or other configured value if allergy is marked as an Intolerance "AL" for allergies Table 2-40: IAM Definition IAM 1 1 Set ID Incremented counter IAM 2 1 Allergen Type Code Configured value such as "DA" (Drug Allergy) IAM 3 1 Allergen Code/ID Substance identifier (ID from Drug Information Framework) "-1" if No Known Drug Allergies IAM 3 2 Allergen Code/Text Substance description "NKDA" if No Known Drug Allergies 62

Chapter 2 Outbound Interfaces Table 2-40: IAM Definition (Continued) IAM 3 3 Allergen Code/Type Configured value, as appropriate based on Drug Information Framework IAM 3 5 Allergen Code/ Alternate Text (free text) IAM 5 1 (can repeat) Allergic Reaction Reaction(s) IAM 6 1 Allergy Action "U" Update for active allergies "D" Delete for inactive allergies IAM 7 1 Allergy Unique Identifier Source ID from external system if originally documented externally Numeric identifier if documented by AIMS user IAM 7 2 Allergy Source System Source Name from external system if originally documented externally "DOCUSYS" if documented by AIMS user IAM 9 1 Sensitivity to Causative Agent code "IN" or other configured value if allergy is marked as an Intolerance "AL" for allergies IAM 17 1 Allergy Clinical Status Code C Confirmed or verified D Doubt raised E Erroneous I Confirmed but inactive P Pending S Suspect U Unconfirmed 63

Merge AIMS 8.3 HL7 Interface Specification Clinical Data Message Template Template for NPO Status Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ADT^A08 [msg_control_id] P 2.4 AL NE USA EVN [message_date_time] PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] OBR 1 [filler_appt_id] 5000.8^ANESTHESIA^AS4 OBX [setid] [value_type] [observation_id]^[observation_text]^[observation_name_of_coding_ system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [obs ervation_result_status] [observation_date_time] [source_id]^^[source] [responsible_observer ] NTE Template for Medical History itions Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORU^R01 [msg_control_id] P 2.4 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] OBR 1 [filler_appt_id] 5000.8^ANESTHESIA^AS4 OBX [setid] [value_type] [observation_id]^[observation_text]^[observation_name_of_coding_ system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [obs ervation_result_status] [observation_date_time] [source_id]^^[source] [responsible_observer ] NTE Template for Family Anesthesia History Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORU^R01 [msg_control_id] P 2.4 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] 64

Chapter 2 Outbound Interfaces PV1 [patient_class] [visit_number] OBR 1 [filler_appt_id] 5000.8^ANESTHESIA^AS4 OBX [setid] [value_type] [observation_id]^[observation_text]^[observation_name_of_coding_ system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [obs ervation_result_status] [observation_date_time] [source_id]^^[source] [responsible_observer ] NTE Template for Surgical History Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORU^R01 [msg_control_id] P 2.4 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] OBR 1 [filler_appt_id] 5000.8^ANESTHESIA^AS4 OBX [setid] [value_type] [observation_id]^[observation_text]^[observation_name_of_coding_ system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [obs ervation_result_status] [observation_date_time] [source_id]^^[source] [responsible_observer ] NTE Template for Vital Signs Messages MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORU^R01 [msg_control_id] P 2.4 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] OBR 1 [filler_appt_id] 5000.8^ANESTHESIA^AS4 OBX [setid] [value_type] [observation_id]^[observation_text]^[observation_name_of_coding_ system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [obs ervation_result_status] [observation_date_time] [source_id]^^[source] [responsible_observer ] NTE Template for Timed Events Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORU^R01 [msg_control_id] P 2.4 AL NE USA 65

Merge AIMS 8.3 HL7 Interface Specification PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] OBR 1 [filler_appt_id] 5000.8^ANESTHESIA^AS4 OBX [setid] [value_type] [observation_id]^[observation_text]^[observation_name_of_coding_ system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [obs ervation_result_status] [observation_date_time] [source_id]^^[source] [responsible_observer ] Template for Fluid Output & Balance Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORU^R01 [msg_control_id] P 2.4 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] OBR 1 [filler_appt_id] 5000.8^ANESTHESIA^AS4 OBX [setid] [value_type] [observation_id]^[observation_text]^[observation_name_of_coding_ system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [obs ervation_result_status] [observation_date_time] [source_id]^^[source] [responsible_observer ] Template for Anesthesia Types and ASA Class Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORU^R01 [msg_control_id] P 2.4 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] OBR 1 [filler_appt_id] 5000.8^ANESTHESIA^AS4 OBX [setid] [value_type] [observation_id]^[observation_text]^[observation_name_of_coding_ system] [observation_sub_id] [value] [value_units] [references_range] [abnormal_flags] [obs ervation_result_status] [observation_date_time] [source_id]^^[source] [responsible_observer ] Template for Home/Current Medications Messages MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] RDE^O11 [msg_control_id] P 2.4 AL NE USA 66

Chapter 2 Outbound Interfaces PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] ORC [order_identifier] [order_status] [order_date_time] [user_name] [source]^^[sour ce_id] RXE [frequency_quantity]^[frequency_interval] [medication_identifier]^[medication_descriptio n]^[medication_identifier_type]^[medication_alt_identifier]^^[medication_alt_identifier_type] [d ose_amount] [dose_units] [comment] [last_taken] RXR ^[route_of_administration] Template for Delivered Medications Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORM^O01 [msg_control_id] P 2.4 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] ORC [order_identifier] [order_status] [quantity_timing] [order_date_time] [user_name] [ord ering_provider] [source]^^[source_id] RXE [medication_identifier] [dose_amount] [dose_units] [comment] [last_taken] [rat e_amount] [rate_units] [alt_dose_amount] [alt_dose_units] [supplementary_code] RXR [route_of_administration_identifier]^[route_of_administration] Template for Delivered Infusions Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORM^O01 [msg_control_id] P 2.4 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] ORC [order_identifier] [order_status] [quantity_timing] [order_date_time] [user_name] [ord ering_provider] [source]^^[source_id] RXE [medication_identifier] [dose_amount] [dose_units] [comment] [last_taken] [rat e_amount] [rate_units] [alt_dose_amount] [alt_dose_units] [supplementary_code] RXR [route_of_administration_identifier]^[route_of_administration] RXC [component_type] [component_code] [component_amount] [component_units] [compon ent_strength] [component_strength_units] [supplementary_code] 67

Merge AIMS 8.3 HL7 Interface Specification Template for Coding Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORU^R01 [msg_control_id] P 2.4 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] DG1 [setid] [diagnosis_code] [diagnosis_date_time] [diagnosis_type] [diagnosis_priority] [diagnosing_clinician] [diagnosis_classification] [attestation_date] PR1 [setid] [procedure_code] [procedure_date_time] [procedure_type] [procedure_minutes] [ anesthesiologist] [anesthesia_code] [anesthesia_minutes] [surgeon] [procedure_practitioner] [procedure_priority] [associated_diagnosis_code] [procedure_code_modifier] Template for Surgical Procedures Message MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] ORU^R01 [msg_control_id] P 2.4 AL NE USA PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] PR1 [setid] [procedure_code] [procedure_date_time] [procedure_type] [procedure_minutes] [ anesthesiologist] [anesthesia_code] [anesthesia_minutes] [surgeon] [procedure_practitioner] [procedure_priority] [associated_diagnosis_code] [procedure_code_modifier] Template for Allergy Message (AL1) MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] [msg_type] [msg_control_id] P 2.4 AL NE USA EVN [message_date_time] PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] AL1 [setid] [allergy_category] [allergen_id]^[allergen_description]^[allergen_type]^^[allergen_c omment] [allergy_reaction] [allergy_sensitivity_code] 68

Chapter 2 Outbound Interfaces Template for Allergy Message (A60-IAM) MSH ^~\& MERGEAIMS [sending_facility] CLINICALHIS [patient_facility] [message_date _time] [msg_type] [msg_control_id] P 2.4 AL NE USA EVN [message_date_time] PID 1 [patient_ss]^^^^ssn~[patient_mrn]^^^[patient_facility]^mr~[filler_appt_id]^^^[patient_f acility]^case~[patient_account_number]^^^[patient_facility]^an [patient_last_name]^[patient _first_name]^[patient_middle_name] [patient_dob] [patient_sex] [patient_account_num ber]^^^[patient_facility]^an [patient_ss] PV1 [patient_class] [visit_number] IAM [setid] [allergy_category] [allergen_id]^[allergen_description]^[allergen_type]^^[allergen_c omment] [allergy_reaction] [allergy_action] [allergy_source_id]^[allergy_source] [allergy_sen sitivity_code] [allergy_status] Clinical Data Message Example Sample NPO Status Message MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012073639 ADT^A08 20121012 073638436 P 2.4 AL NE USA EVN 20121012073639 PID 1 111111111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FA C1^AN LONGER^AMY^J 19710809000000 F AN01.93^^^FAC1^AN 111111111 PV1 O VN01.93 OBR 1 FA01.93 5000.8^ANESTHESIA^AS4 OBX 1 CE NPOSINCEMIDNIGHT^NPO since midnight (checkbox)^mergeaims True F 20121011145625 ^^ NTE 1 Had a snack at 8pm OBX 2 TS NPO^NPO since the specified time^mergeaims 20121010200000 F 20121010200000 ^^ NTE 1 Had a snack at 8pm? Sample Medical History itions Message MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012073639 ORU^R01 20121012 073638045 P 2.4 AL NE USA PID 1 111111111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FA C1^AN LONGER^AMY^J 19710809000000 F AN01.93^^^FAC1^AN 111111111 PV1 O VN01.93 69

Merge AIMS 8.3 HL7 Interface Specification OBR 1 FA01.93 5000.8^ANESTHESIA^AS4 OBX 1 CE SMOKER^Current Smoker^MergeAIMS True F 20121011110000 ^^ BettySmith OBX 2 CE DIABETES^Diabetes^MergeAIMS True F 20121011110000 ^^ BettySmith OBX 3 CE ^Patient s usual blood pressure: ^MergeAIMS True F 20121011145900 ^^ AMD08031^Test^Anesthesiologist^H.^^^AMD^ NTE 1 180/120 OBX 4 CE SMOKINGHX^Past history of smoking^mergeaims True F 20121011110000 ^^ BettySmith NTE 1 Since age 17. OBX 5 CE ^Hypertension^MergeAIMS True F 20121011145900 ^^ AMD08031^Test^Ane sthesiologist^h.^^^amd^ OBX 6 CE ^Steroid use^mergeaims False D 20121011145400 ^^ AMD08031^Test^Anesthesiologist^H.^^^A MD^ OBX 7 CE DIABETESTYPEII^Adult-onset (Type II)^MergeAIMS True F 20121011110000 ^^ BettySmith NTE 1 Adult Onset at age 40. OBX 8 CE ^Hyperparathyroidism^MergeAIMS False D 20121011145400 ^^ AMD08031^ Test^Anesthesiologist^H.^^^AMD^ OBX 9 CE HYPERTENSIONMALIGNANT^Malignant^MergeAIMS True F 201210111100 00 ^^ BettySmith? Sample Family Anesthesia History Message MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012073639 ORU^R01 20121012 073638126 P 2.4 AL NE USA PID 1 111111111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FA C1^AN LONGER^AMY^J 19710809000000 F AN01.93^^^FAC1^AN 111111111 PV1 O VN01.93 OBR 1 FA01.93 5000.8^ANESTHESIA^AS4 OBX 1 CE FAMHXPROBLEMS^PROBLEMS^MergeAIMS PROBLEMS F 201210111453 22 ^^ AMD08031^Test^Anesthesiologist^H.^^^AMD^ NTE 1 Mother had difficult airway and postop N&V.? Sample Surgical History Message MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012073639 ORU^R01 20121012 073638709 P 2.4 AL NE USA 70

Chapter 2 Outbound Interfaces PID 1 111111111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FA C1^AN LONGER^AMY^J 19710809000000 F AN01.93^^^FAC1^AN 111111111 PV1 O VN01.93 OBR 1 FA01.93 5000.8^ANESTHESIA^AS4 OBX 1 TX SURG_HX^ACL Repair^MergeAIMS ACL Repair MAC T F 20110412000000 31^^MEDITECH AMD08031^Test^Anesthesiologist^H.^ ^^AMD^ NTE 1 Right knee OBX 2 TX SURG_HX^Cataract Removal^MergeAIMS Cataract Removal GENERAL_MASK F F 20090222000000 32^^MEDITECH AMD08031^Test^Anes thesiologist^h.^^^amd^ NTE 1 Both eyes.? Sample Vital Signs Messages (PreOp and PostOp) MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012073639 ORU^R01 20121012 073638590 P 2.4 AL NE USA PID 1 111111111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FA C1^AN LONGER^AMY^J 19710809000000 F AN01.93^^^FAC1^AN 111111111 PV1 O VN01.93 OBR 1 FA01.93 5000.8^ANESTHESIA^AS4 OBX 1 NM PREOP_VITALS^PreOp Vital Signs^MergeAIMS HEIGHT 68 IN F 20121011145624 ^^ OBX 2 NM PREOP_VITALS^PreOp Vital Signs^MergeAIMS WEIGHT 125 LB F 20121011145624 ^^ OBX 3 NM PREOP_VITALS^PreOp Vital Signs^MergeAIMS SYSTOLIC 150 mmhg F 20121011145624 ^^ OBX 4 NM PREOP_VITALS^PreOp Vital Signs^MergeAIMS DIASTOLIC 95 mmhg F 20121011145624 ^^ OBX 5 TX PREOP_VITALS^PreOp Vital Signs^MergeAIMS BLOODPRESSURE 150/ 95 mmhg F 20121011145624 ^^ OBX 6 NM PREOP_VITALS^PreOp Vital Signs^MergeAIMS TEMPERATURE 98.6 F F 20121011145624 ^^ OBX 7 TX PREOP_VITALS^PreOp Vital Signs^MergeAIMS TEMPERATUREMODE Oral F 20121011145624 ^^ OBX 8 NM PREOP_VITALS^PreOp Vital Signs^MergeAIMS PULSERATE 62 BPM F 20121011145624 ^^ OBX 9 NM PREOP_VITALS^PreOp Vital Signs^MergeAIMS RESPRATE 16 BPM F 20121011145624 ^^ OBX 10 NM PREOP_VITALS^PreOp Vital Signs^MergeAIMS SPO2 99 % F 20121011145624 ^^ 71

Merge AIMS 8.3 HL7 Interface Specification OBX 11 CE PREOP_VITALS^PreOp Vital Signs^MergeAIMS ROOMAIR False F 20121011145624 ^^ OBX 12 CE PREOP_VITALS^PreOp Vital Signs^MergeAIMS ONOXYGEN True F 20121011145624 ^^ OBX 13 NM PREOP_VITALS^PreOp Vital Signs^MergeAIMS OXYGENSETTING 2 L/ Min F 20121011145624 ^^ NTE 1 Taken in POHA.? MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012110659 ORU^R01 20121012 110658469 P 2.4 AL NE USA PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NGER^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 OBR 1 FA01.93 5000.8^ANESTHESIA^AS4 OBX 1 NM POSTOP_VITALS^PACU Vital Signs^MergeAIMS HEIGHT 68 IN F 20121012110200 ^^ OBX 2 NM POSTOP_VITALS^PACU Vital Signs^MergeAIMS WEIGHT 125 LB F 20121012110200 ^^ OBX 3 NM POSTOP_VITALS^PACU Vital Signs^MergeAIMS SYSTOLIC 188 mmhg F 20121012110200 ^^ OBX 4 NM POSTOP_VITALS^PACU Vital Signs^MergeAIMS DIASTOLIC 121 mmhg F 20121012110200 ^^ OBX 5 TX POSTOP_VITALS^PACU Vital Signs^MergeAIMS BLOODPRESSURE 188/ 121 mmhg F 20121012110200 ^^ OBX 6 NM POSTOP_VITALS^PACU Vital Signs^MergeAIMS TEMPERATURE 99.2 F F 20121012110200 ^^ OBX 7 TX POSTOP_VITALS^PACU Vital Signs^MergeAIMS TEMPERATUREMODE F 20121012110200 ^^ OBX 8 NM POSTOP_VITALS^PACU Vital Signs^MergeAIMS PULSERATE 55 BPM F 20121012110200 ^^ OBX 9 NM POSTOP_VITALS^PACU Vital Signs^MergeAIMS RESPRATE 15 BPM F 20121012110200 ^^ OBX 10 NM POSTOP_VITALS^PACU Vital Signs^MergeAIMS SPO2 98 % F 20121012110200 ^^ OBX 11 CE POSTOP_VITALS^PACU Vital Signs^MergeAIMS ROOMAIR False F 20121012110200 ^^ OBX 12 CE POSTOP_VITALS^PACU Vital Signs^MergeAIMS ONOXYGEN False F 20121012110200 ^^ NTE 1 taken on admit to PACU? 72

Chapter 2 Outbound Interfaces Sample Timed Events Message MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012110659 ORU^R01 20121012 110658571 P 2.4 AL NE USA PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NGER^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 OBR 1 FA01.93 5000.8^ANESTHESIA^AS4 OBX 1 TS OR.IN^In Room Time^MergeAIMS 20121012095551 F 20121012095551 ^^ OBX 2 TS ^Anesthesia Start Time^MergeAIMS 20121012095551 F 20121012095551 ^^ OBX 3 TS ^%STAFF% - Doing Case^MergeAIMS 20121012095551 F 20121012095551 ^^ OBX 4 TS ^%STAFF% - Medical Direction/ Supervision^MergeAIMS 20121012095551 F 20121012095551 ^^ OBX 5 TS ^Monitoring Begun^MergeAIMS 20121012095552 F 20121012095552 ^^ OBX 6 TS PR.START^Surgery Begun^MergeAIMS 20121012095600 F 20121012095600 ^^ OBX 7 TS ^Prep Finished^MergeAIMS 20121012095600 F 20121012095600 ^^ OBX 8 TS ^Induction Begun^MergeAIMS 20121012095600 F 20121012095600 ^^ OBX 9 TS ^Induction Finished^MergeAIMS 20121012095636 F 20121012095636 ^^ OBX 10 TS ^Prep Begun^MergeAIMS 20121012095636 F 20121012095636 ^^ OBX 11 TS PR.STOP^Surgery Finished^MergeAIMS 20121012104432 F 20121012104432 ^^ OBX 12 TS ^Dressing On^MergeAIMS 20121012104442 F 20121012104442 ^^ OBX 13 TS ^Emergence Finished^MergeAIMS 20121012104443 F 20121012104443 ^^ OBX 14 TS ^Monitoring Finished^MergeAIMS 20121012110612 F 20121012110612 ^^ OBX 15 TS OR.OUT^To Recovery^MergeAIMS 20121012110612 F 20121012110612 ^^? Sample Fluid Output & Balance Message MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012110659 ORU^R01 20121012 110658178 P 2.4 AL NE USA PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NGER^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 73

Merge AIMS 8.3 HL7 Interface Specification OBR 1 FA01.93 5000.8^ANESTHESIA^AS4 OBX 1 NM EBL^Estimated Blood Loss^MergeAIMS 20 ml F 20121012101341 ^^ OBX 2 NM NETBALANCE^Net perioperative fluid balance^mergeaims 241.12 ml F ^^? Sample Anesthesia Types and ASA Class Message MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012110658 ORU^R01 20121012 110658021 P 2.4 AL NE USA PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NGER^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 OBR 1 FA01.93 5000.8^ANESTHESIA^AS4 OBX 1 CE ASA^ASA Class^MergeAIMS II F ^^ OBX 2 CE ATYP^Anesthesia Type (Primary)^MergeAIMS GENERAL GENERAL^General Endotracheal Anesthesia^MergeAIMS^^^ F ^^ OBX 3 CE AATYP^Additional Anesthesia Type^MergeAIMS REGIONAL REGIONAL^Regional^MergeAIMS^^^ F ^^? Sample Home/Current Medications Messages (Micromedex) MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012110553 RDE^O11 20121012 110552491 P 2.4 AL NE USA PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NGER^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 ORC 393cbb0d-b112-4d18-a23bb6e6969f27f2 IP 20121011145800 AMD08031^Test^Anesthesiologist^H.^^^AMD^ Cl inical HIS^^0000381 RXE Q4H^ 117382^ONDANSETRON 2 MG/ML 2 ML VIAL^GFC^00143989105^^NDC 4 MG 10/11/2012 8am RXR ^IV PUSH? MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012110553 RDE^O11 20121012 110552531 P 2.4 AL NE USA PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NGER^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 74

Chapter 2 Outbound Interfaces ORC d68b6fb6-fec2-43ba-82b0- f388080a1d1c IP 20121012104700 AMD08031^Test^Anesthesiologist^H.^^^AMD^ D OCUSYS^^58 RXE as^needed 112655^Clopidogrel Hydrogen Sulfate^GFC^^^NDC 75 MG RXR ^Oral? Sample Delivered Medications Message (Micromedex) MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012110659 ORM^O01 20121012 110658344 P 2.4 AL NE USA PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NGER^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 ORC 356340b8-7f44-42dd-a453- ea9073af89e5 CM 1 20121012095000 50012^White^Jonathan^Ron^^^AMD^ Merge AIMS^^356340b8-7f44-42dd-a453-ea9073af89e5 RXE 330541^Ampicillin^CHARGECODE^100195^AMPICILLIN SODIUM POWDER FOR SOLUTION (Injection (^GFC 1000 mg 10 ml 0069-0029-18^Pfizer Laboratories^NDC^00069002918^Pfizer Laboratories^BILLINGNDC RXR IV^IV ORC 3121ec95-29f6-46ee-9d4dad401f2a796e CM 1 20121012095823 SG9191^Green^Sam^^Jr^^CRNA^ MergeAIM S^^3121ec95-29f6-46ee-9d4d-ad401f2a796e RXE 3330123^FentaNYL 2 ml^chargecode^104349^fentanyl CITRATE INJECTABLE (Injection (systemic))^gfc 50 mcg 1 ml 0409-9093-32^Hospira, Inc.^NDC^00409909332^Hospira, Inc.^BILLINGNDC RXR IV^IV ORC df4daaa1-2a6a-4a2a-9b07- ead51017a203 CM 1 20121012095900 SG9191^Green^Sam^^Jr^^CRNA^ MergeAI MS^^df4daaa1-2a6a-4a2a-9b07-ead51017a203 RXE 330685^Propofol^CHARGECODE^103285^PROPOFOL EMULSION (Intravenous)^GFC 200 mg 20 ml 0703-2856-04^Teva Parenteral Medicines, Inc^NDC^00703285604^Teva Parenteral Medicines, Inc^BILLINGNDC RXR IV^IV ORC d30c8f69-0db5-4304-b7a0-3384870268f3 CM 1 20121012100000 SG9191^Green^Sam^^Jr^^CRNA^ MergeAIM S^^d30c8f69-0db5-4304-b7a0-3384870268f3 RXE 330558^Rocuronium^CHARGECODE^111553^ROCURONIUM BROMIDE KIT (Injection (systemic))^gfc 40 mg 4 ml ^^NDC^^^BILLINGNDC RXR IV^IV 75

Merge AIMS 8.3 HL7 Interface Specification ORC 8f4a16ae-7a57-4094-b3be- 396e9a86b32e CM 1 20121012100000 SG9191^Green^Sam^^Jr^^CRNA^ MergeAI MS^^8f4a16ae-7a57-4094-b3be-396e9a86b32e RXE 3300025^Afrin Nasal Spray 0.05%^CHARGECODE^106919^OXYMETAZOLINE HYDROCHLORIDE SPRAY (Nasal (systemic^gfc 0 1 Each ^^NDC^^^BILLINGNDC RXR NASAL^Nasal ORC c5597814-e2be-4654-9f2aa4ce56587162 CM 1 20121012101500 SG9191^Green^Sam^^Jr^^CRNA^ MergeAI MS^^c5597814-e2be-4654-9f2a-a4ce56587162 RXE 3330123^FentaNYL 2 ml^chargecode^104349^fentanyl CITRATE INJECTABLE (Injection (systemic))^gfc 50 mcg 1 ml 0409-9093-32^Hospira, Inc.^NDC^00409909332^Hospira, Inc.^BILLINGNDC RXR IV^IV? Sample Delivered Infusions Message (Micromedex) MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012110659 ORM^O01 20121012 110658261 P 2.4 AL NE USA PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NGER^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 ORC 9fd44c40-4d33-4ee9-bf53-10dabf912bd7 CM 1^C^M18^20121012100200^20121012102000^ 20121012102000 SG 9191^Green^Sam^^Jr^^CRNA^ MergeAIMS^^9fd44c40-4d33-4ee9-bf53-10dabf912bd7 RXE 31.89 ml Discontinued 106.29 ml/hr 00264-1482-55^Dopamine in Dextrose 5% Injection, B Braun^NDC^00264148255^Dopamine in Dextrose 5% Injection, B Braun^BILLINGNDC RXR IV^IV RXC B 330914^D5W^CHARGECODE^101084^DEXTROSE SOLUTION (Intravenous)^GFC 250 ml 00264-1482-55^Dopamine in Dextrose 5% Injection, B Braun^NDC^00264148255^Dopamine in Dextrose 5% Injection, B Braun^BILLINGNDC RXC A 3305681^DOPamine^CHARGECODE^101262^DOPAMINE HYDROCHLORIDE INJECTABLE (Intravenous)^GFC 400 mg 80 mg/ml ^^NDC^^^BILLINGNDC ORC d5de0969-f482-469a-92dcbb2127f1f14b CM 1^C^M33^20121012102000^20121012105300^ 20121012105300 SG9 191^Green^Sam^^Jr^^CRNA^ MergeAIMS^^d5de0969-f482-469a-92dc-bb2127f1f14b RXE 29.23 ml Discontinued 53.15 ml/hr 00264-1482-55^Dopamine in Dextrose 5% Injection, B Braun^NDC^00264148255^Dopamine in Dextrose 5% Injection, B Braun^BILLINGNDC RXR IV^IV 76

Chapter 2 Outbound Interfaces RXC B 330914^D5W^CHARGECODE^101084^DEXTROSE SOLUTION (Intravenous)^GFC 250 ml 00264-1482-55^Dopamine in Dextrose 5% Injection, B Braun^NDC^00264148255^Dopamine in Dextrose 5% Injection, B Braun^BILLINGNDC RXC A 3305681^DOPamine^CHARGECODE^101262^DOPAMINE HYDROCHLORIDE INJECTABLE (Intravenous)^GFC 400 mg 80 mg/ml ^^NDC^^^BILLINGNDC ORC 9e62af2d-941b-4065-8dacfd7f83406c44 CM 1^^^^20121012095500^ 20121012095500 SG9191^Green^Sam^^Jr^^ CRNA^ MergeAIMS^^9e62af2d-941b-4065-8dac-fd7f83406c44 RXE 330011^Lactated Ringers (1,000 ml) IV ^CHARGECODE^102142^LACTATED RINGER S SOLUTION SOLUTION (Intravenous)^GFC 50 ml Transferred 0338-0117-04^Baxter Healthcare Corporation^NDC^00338011704^Baxter Healthcare Corporation^BILLINGNDC RXR IV^IV ORC 87035ed9-c2ec-4038-b2c2-032e39c4becd CM 1^^^^20121012100000^ 20121012100000 SG9191^Green^Sam^^Jr^^ CRNA^ MergeAIMS^^87035ed9-c2ec-4038-b2c2-032e39c4becd RXE 330011^Lactated Ringers (1,000 ml) IV ^CHARGECODE^102142^LACTATED RINGER S SOLUTION SOLUTION (Intravenous)^GFC 100 ml Transferred 0338-0117-04^Baxter Healthcare Corporation^NDC^00338011704^Baxter Healthcare Corporation^BILLINGNDC RXR IV^IV ORC be0bd2c6-f0e1-450a-8b5bb6e96842c374 CM 1^^^^20121012102557^ 20121012102557 SG9191^Green^Sam^^Jr^^ CRNA^ MergeAIMS^^be0bd2c6-f0e1-450a-8b5b-b6e96842c374 RXE 330011^Lactated Ringers (1,000 ml) IV ^CHARGECODE^102142^LACTATED RINGER S SOLUTION SOLUTION (Intravenous)^GFC 50 ml Transferred 0338-0117-04^Baxter Healthcare Corporation^NDC^00338011704^Baxter Healthcare Corporation^BILLINGNDC RXR IV^IV? Sample Coding Message (PAE Diagnosis Coding) MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012073638 ORU^R01 20121012 073637870 P 2.4 AL NE USA PID 1 111111111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FA C1^AN LONGER^AMY^J 19710809000000 F AN01.93^^^FAC1^AN 111111111 PV1 O VN01.93 DG1 1 401.0^MALIGNANT ESSENTIAL HYPERTENSION^I9^^^ 20121012073600 W 0 AMD08031^Test^Anesthesiologist^H.^^^ AMD^ D 20121012073600 DG1 2 250.02^TYPE II OR UNSPECIFIED TYPE DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION, UNCONTROLLED^I9^^^ 20121012073600 W 0 AMD08031^Test^Anesthesiologist^H.^^ ^AMD^ D 20121012073600 77

Merge AIMS 8.3 HL7 Interface Specification? Sample Coding Message (Complete Coding from Anesthesia Record) MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012172054 ORU^R01 20121012 172052745 P 2.4 AL NE USA PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NG_01.93^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 DG1 1 844.1^SPRAIN OF MEDIAL COLLATERAL LIGAMENT OF KNEE^I9^^^ 20121012100156 W 0 AMD08031^Test^Anesthesiologist^H.^^^AMD^ D 20 121012172009 DG1 2 401.0^MALIGNANT ESSENTIAL HYPERTENSION^I9^^^ 20121012095549 W 0 AMD08031^Test^Anesthesiologist^H.^^^ AMD^ D 20121012172009 DG1 3 250.02^TYPE II OR UNSPECIFIED TYPE DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION, UNCONTROLLED^I9^^^ 20121012095549 W 0 AMD08031^Test^Anesthesiologist^H.^^ ^AMD^ D 20121012172009 PR1 1 22556^ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); THORACIC^C4^^^ 20121012100243 P 41.82 AMD08031^Test^Anesthesiologist^H.^^^AMD^ 00626^ANESTHESIA FOR PROCEDURES ON THE THORACIC SPINE AND CORD, VIA AN ANTERIOR TRANSTHORACIC APPROACH; UTILIZING 1 LUNG VENTILATION^XWALK^^^ 68.21 FT9876^Thornton^Frank^^^^MD^ FT9876^Thornton^Frank^ ^^^MD^ PR1 2 22585^ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)^C4^^^ 20121012095600 P 48.53 AMD08031^Test^Anesthesiologist^H.^^^A MD^ -00003^*** NOT A PRIMARY PROCEDURE CODE ***^XWALK^^^ 68.21 FT9876^Thornton^Frank^^^^MD^ FT9876^Thornton^Frank^^^^MD^ PR1 3 22585^ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)^C4^^^ 20121012095600 P 48.53 AMD08031^Test^Anesthesiologist^H.^^^A MD^ -00003^*** NOT A PRIMARY PROCEDURE CODE ***^XWALK^^^ 68.21 FT9876^Thornton^Frank^^^^MD^ FT9876^Thornton^Frank^^^^MD^ PR1 4 4048F^DOCUMENTATION THAT ADMINISTRATION OF PROPHYLACTIC PARENTERAL ANTIBIOTIC WAS INITIATED WITHIN 1 HOUR (IF FLUOROQUINOLONE OR VANCOMYCIN, 2 HOURS) PRIOR TO SURGICAL INCISION (OR START OF PROCEDURE WHEN NO INCISION IS REQUIRED) AS ORDERED (PERI 2)^C4^^^ 20121012095600 P 48.53 AMD08031^Test^Anesthesiologist^H.^^^AMD^ ^^XWAL K^^^ 68.21 SG9191^Green^Sam^^Jr^^CRNA^ SG9191^Green^Sam^^Jr^^CRNA^ 78

Chapter 2 Outbound Interfaces PR1 5 27658^REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON^C4^^^ 20121012095600 P 6.25 AMD08031^Test^Anesthesiologist^H.^^^AMD^ 01 470^ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, AND FASCIA OF LOWER LEG, ANKLE, AND FOOT; NOT OTHERWISE SPECIFIED^XWALK^^^ 68.21 FT9876^Thornton^Frank^^^^MD^ FT9876^Thornton^Frank^^^ ^MD^ 844.1^SPRAIN OF MEDIAL COLLATERAL LIGAMENT OF KNEE^I9^^^ 51^MULTIPLE PROCEDURES^CPTM^^^ PR1 6 36620^ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE PROCEDURE); PERCUTANEOUS^C4^^^ 20121012171913 I ^^^^^^^ ^^^^^^^ 50012^White^Jonathan^Ron ^^^AMD^ PR1 7 99135^ANESTHESIA COMPLICATED BY UTILIZATION OF CONTROLLED HYPOTENSION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY ANESTHESIA PROCEDURE)^C4^^^ 20121012095600 P 48.53 AMD08031^Test^Anesthesiologist^H.^^^A MD^ 68.21 FT9876^Thornton^Frank^^^^MD^ FT9876^Thornton^Frank^^^^MD^? Sample Surgical Procedures Message MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012173041 ORU^R01 20121012 173040581 P 2.4 AL NE USA PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NG_01.93^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 PR1 1 27658^REPAIR, FLEXOR TENDON, LEG; PRIMARY, W/O Graft^ScheduledProcedure^27658^REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON^C4 20121012095600 P 6.25 FT9876^Thornton^Frank^^^^MD^ 2 844.1^SPRAI N OF MEDIAL COLLATERAL LIGAMENT OF KNEE^I9^^^ 51^MULTIPLE PROCEDURES^CPTM^^^ PR1 2 22812^SPINAL FUSION, 8+ VERT, ANTERIOR^ScheduledProcedure^22556^ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); THORACIC^C4 20121012100243 P 41.82 FT9876^Thornton^Frank^^^^MD^ 1? Sample Allergy Message (AL1, Micromedex) MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012105800 ADT^A08 20121012 105800529 P 2.4 AL NE USA EVN 20121012105800 PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NGER^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 79

Merge AIMS 8.3 HL7 Interface Specification PV1 O VN01.93 AL1 1 Drug 7700060^CEFAZOLIN^MDX^^ N&V AL AL1 1 Drug 7700697^HYDROCODONE^MDX^^ Headache IN AL1 1 Drug 7702923^PENICILLIN^MDX^^Difficulty breathing, according to mother Anaphylaxis AL AL1 1 Drug 7705145^EGGS^MDX^^ Anaphylaxis AL? Sample Allergy Message (A60-IAM, Micromedex) MSH ^~\& MERGEAIMS Default CLINICALHIS FAC1 20121012110107 ADT^A60 20121012 110107032 P 2.4 AL NE USA EVN 20121012110107 PID 1 111-11- 1111^^^^SSN~MRN01.93^^^FAC1^MR~FA01.93^^^FAC1^CASE~AN01.93^^^FAC1^AN LO NGER^AMY^J 19810809000000 F AN01.93^^^FAC1^AN 111-11-1111 PV1 O VN01.93 IAM 1 DA 7700060^CEFAZOLIN^MDX^^ N&V U 238^DOCUSYS AL C IAM 1 DA 7700697^HYDROCODONE^MDX^^ Headache U 242^DOCUSYS IN U IAM 1 DA 7702923^PENICILLIN^MDX^^Difficulty breathing, according to mother Anaphylaxis U ^ AL U IAM 1 DA 7700223^ACETAMINOPHEN^MDX^^ D 241^DOCUSYS AL I IAM 1 DA 7705145^EGGS^MDX^^ Anaphylaxis U 239^DOCUSYS AL C? 80