1. HL7 Overview

2. Learning Objectives Define “HL7”
Understand the basic structure of HL7 messages
Understand typical usage of HL7 messages
Understand common message content and workflow

3. Table of Contents
Terminology
Introduction
Overview
Summary

4. Terminology

5. Terminology
Message Types are messages that reference a group of related actions (example: ADT)
Trigger Events are specific actions that are associated with the generation of a message (example: ADT_A01)
Segments are logical groups of data elements or “fields” (example: PID)

6. Introduction

7. Introduction
Health care organizations often operate numerous information systems and integrate them via data transfer interfaces
HL7 (Health Level 7) is the name of the organization and the predominant messaging standard for exchanging key sets of administrative and clinical data in the healthcare enterprise
The cross-departmental usage of HL7 leads to the use of some generic labels
Example: Diagnostic Service Section ID (~AE Title) and Universal Service ID (Procedure Code)

8. Introduction
Departmental system databases typically store a combination of redundant and unique data
The most common redundant data are patient IDs and demographics
Health care organizations usually assign primary responsibility for correctly identifying patients to a single department that manages the data in a single system

9. Introduction
The department(s) with primary responsibility for patient ID usually use(s) a system commonly referred to as a Healthcare Information System (HIS)
Typical HIS functions are registration/admitting, and billing
Order entry, claims, clinical viewing, decision support, and other functions may or may not be supported by the HIS
The HIS is regarded as the master system

10. Overview

11. HL7 Overview What is HL7? What is a “Message?”
“Health Level Seven develops specifications, the most widely used being a messaging standard that enables disparate healthcare applications to exchange keys sets of clinical and administrative data.”1
What is a “Message?”
A message is a basic communication unit containing information that models a real world event
How does one read a Message?
A message is structured like an organizational chart
Message
Segment
Fields
Component
Common HL7 Message Types, Segments, and Fields based on HL7 Standards
1 – About Health Level Seven
Source:

12. HL7 Message Structure Message has User User User User Segments Fields
contains
The HL7 (Health Level 7) communications standard defines the following terms:
ADT = An HL7 message type wherein the “trigger event” is an Admission, Discharge, Transfer of a patient. Associated events include pre-registration, registration, admission, discharge, transfer, patient demographic updates and patient merges. ADT messages are commonly referred to by name or as patient demographic messages
ORM = An HL7 message type wherein the “trigger event” is either the placement or fulfillment of a request for medical examination (order), an order status change, an order change request or an order cancellation. ORM messages are commonly referred to as order messages.
ORU = An HL7 message type wherein the “trigger event” is the submission of a report; whether preliminary, final, addendum or revision. ORU messages are commonly referred to as result or report messages.
comprised of
User
User
Components

13. Message Types
ADT is an (A)dmit, (D)ischarge, and (T)ransfer message that is “triggered” by a patient admission, discharge, or transfer
ORM is an (Or)der (M)essage which includes new orders, order status changes, and order cancels
ORU is a Report/Result Message
Example:
<11>MSH|^~\&|IMAGING|PSJMC|TDSresults|PSJMC| ||ORM^O01|783744|P|2.3<13>
Message type-ADT for patient management, ORM for orders, ORU for results
ADT trigger events A01 and A04 establish patients; A02 transfer; A03 discharge
ORM trigger event O01 for order entry
ORU trigger event R01 for results

14. Message Segments PID is a Patient Identifier Segment
<11>MSH|^~\&|IMAGING|PSJMD|TDS|PSJMD| ||ORM^O01|785465|P|2.3<13>
PID|| | ^^^PSJ||ESCARDA^NARVARO|| |M|||1234 SOMEWHERE AVE^^^CA^ || | |||| | <13>
PV1||I|4S^S460|||||FEB^SINATRA^FRANK^E^^^MD^8888||||||||||IP|||||||||||||||||||||||||| <13>
ORC|SN||100A ||IP|N|1^^^ ^^S|| |^INTERFACE^HIS||FEB^SINATRA^FRANK^E^^^MD^8888<13>
OBR|||100A |9025^CT PELVIS 72193^MWA||| ||||||--..|||FEB^SINATRA^FRANK^E^^^MD^8888||58944|||| ||CT|||1^^^ ^^S|ST1^TAPAIN^STEVEN^^^^MD^0275~SLP^POLISH^JOSEPH^L^^^MD^9828<13>
NTE|1||CT UROGRAM ,PT GOING TO OR 1230 TODAY<13>
<28><13>
PID is a Patient Identifier Segment
PV1 is a Patient Visit Segment
ORC is the top level Order Information Segment
OBR is the Order Detail Segment
NTE is the Notes and Comments Segment
OBX is the Report/Result Segment in an ORU Message

15. Typical Message Content and Functions
HL7 specifies requirements for SEQs/components but this does not confer an obligation to process this data
Conversely, a target application may require data that is not HL7 required
HL7 sometimes requires codified data

16. Typical Message Work Flow
ADT-establish patient, visit, update demographics, update visit
Example: ADT_A04, A06, A08, A03
ORM-order with account (PID-18) vs. visit (PV1-19), order response, result
Example: ORM_O01, ORR_O02, ORU_R01
ORU by definition is unsolicited-does not have to be in response to an order

17. “Data Flow” Process HL7 Message Type Exam Status
*Table represents typical HL7 data flow – actual message types vary by organization
Process
HL7 Message Type
Exam Status
Patient admitted
ADT01
N/A
Patient demographic change
ADT08
Patient merge
ADT18 or 34
Radiology procedure ordered/scheduled
ORMNW
S(cheduled)
Ordered procedure modified
ORMXO
Image acquisition at modality begins
I(n progress)
Procedure completed by technologist
ORMSC
C(omplete)
Report dictated by radiologist
D(ictated)
Preliminary report transcribed
ORU
P(reliminary)
Final report signed
F(inal)
Radiology procedure canceled
ORMCA
X(canceled)

18. HL7 Message Fields Common Fields Order and Report Fields
PID-02 MPI number
PID-03 MRN
PID-05 Patient name
PID-07 DOB
PID-08 Sex
PID-18 Patient Account No.
PID-19 SSN
PV1-07 Attending MD
PV1-17 Admitting MD
Order and Report Fields
ORC-02 or OBR-02 Order Number
ORC-03 or OBR-03 Accession No.
ORC-12 Ordering MD
OBR-04 Exam Code and Exam Description
OBR-07 Order Date and Time
OBR-24 Resource Name
OBR-25 Order/Exam Status
OBX-05 Result Text

19. Summary

20. Summary HL7 is a messaging protocol
Message types, trigger events, and segments are identified with 3 character labels; fields are identified by position (SEQ) in segments.
Data placement, basic structure, message types, and event definitions should be consistent in HL7 messaging

21. Summary
Due to variations in healthcare business requirements and supported functionality of different information systems there are many variations in HL7 conformance
Variation in HL7 data content is present at the message, segment and field level
Variation is also present in workflow

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