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2007/01/08-09 IHE-Japan Technical Committee

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1 2007/01/08-09 IHE-Japan Technical Committee
Japanese Extension for Transactions based on HL7 in IHE Radiology Domain 2007/01/08-09 IHE-Japan Technical Committee

2 Japanese Extensions for HL7 Transaction
Background Why IHE-J needs extensions for HL7 transactions ? More detail order information is needed Patient arrival is important event Support for medical billing system is required Why HL7 V2.5 is needed ? Expression power V2.3.1 is poor Detail description of order information Expression of information for medical billing To keep consistency of HL7 version with other domain LAB domain, Cardiology domain and so on 2007/01/08 Japanese Extensions for HL7 Transaction

3 Japanese Extensions for Transaction
X Japanese extension for SWF integration profile X Affected Existing Transactions 2007/01/08 Japanese Extensions for HL7 Transaction

4 Scheduled Workflow Diagram
ADT DSS/Order Filler Order Placer Pt. Registration [RAD-1]↓ Patient Update [RAD-12]↓ ←Placer Order Management [RAD-2] →Filler Order Management [RAD-3] →Appointment Notification [RAD-48] →Patient Accepted Notification [RAD-X] →Order Performed Notification [RAD-Y] ↓Pt. Registration [RAD-1] ↓Patient Update [RAD-12] Performed Procedure Step Manager Evidence Creator ↓ Procedure Scheduled [RAD-4] ↑ Image Availability Query [RAD-11] ↓ Procedure Updated [RAD-13] ↑ Performed Work Status Update[RAD-42] ↑ Instance Availability Notification [RAD-49] ↑ Modality PS in Progress [RAD-6] ↑ Modality PS Completed [RAD-7] ↑ Creator PS in Progress [RAD-20] ↑ Creator PS Completed [RAD-21] ↓ Creator PS in Progress [RAD-20] ↓ Creator PS Completed [RAD-21] Image Manager Archive Storage Commitment [RAD-10]↓ ↓ Creator Images Storage [RAD-18] Image Display ↓ Query Images [RAD-14] ↓ Retrieve Images [RAD-16] → Modality PS in Progress [RAD-6] → Modality PS Completed [RAD-7] → Creator PS in Progress [RAD-20] → Creator PS Completed [RAD-21] Acquisition Modality ← Modality PS in Progress [RAD-6] ← Modality PS Completed [RAD-7] ← Query Modality Worklist [RAD-5] Storage Commitment [RAD-10]↓ ↑ Modality Image Stored [RAD-8] 2007/01/08 Japanese Extensions for HL7 Transaction

5 Parts of Scheduled Workflow Diagram
ADT Pt. Registration [RAD-1]↓ Patient Update [RAD-12]↓ ↓Pt. Registration [RAD-1] ↓Patient Update [RAD-12] ←Placer Order Management [RAD-2] →Filler Order Management [RAD-3] →Appointment Notification [RAD-48] →Patient Accepted Notification [RAD-X] →Order Performed Notification [RAD-Y] DSS/Order Filler Order Placer ↓ Procedure Scheduled [RAD-4] ↑ Image Availability Query [RAD-11] ↓ Procedure Updated [RAD-13] ↑ Performed Work Status Update[RAD-42] ↑ Instance Availability Notification [RAD-49] Bold Modified Bold + Underline New Plane Optional Plane Unchanged Image Manager Archive 2007/01/08 Japanese Extensions for HL7 Transaction

6 X.7.0.1 Japanese extension for SWF integration profile
2 New Transactions ! Patient Accepted Notification [RAD-X] This is used for the patient arrival notice. In Japan, it is important that the system detects the patient arrival to the radiology department. To lock order modification, to know where the patient is ORU message is used for this transaction Order Performed Notification [RAD-Y] This is used for the information transfer for medical billing system as performed procedure information. Method for examinations, additional billing, material (film, drug, instrument etc) This transaction is usually used instead of RAD-3 OMI message is used for this transaction 2007/01/08 Japanese Extensions for HL7 Transaction

7 X.7.0.2 Affected Existing Transactions(1/2)
[RAD-1] Register Patient A08 is only event that is used in IHE-J [RAD-2] Placer Order Management OMG message is used instead of ORM Detail information is set in ORC segment by using JJ1017 Code (Japanese master code for Radiology) [RAD-3] Filler Order Management This transaction is optional RAD-Y should be used instead of This transaction 2007/01/08 Japanese Extensions for HL7 Transaction

8 X.7.0.2 Affected Existing Transactions(2/2)
[RAD-4] Procedure Scheduled This transaction is used between DSS/OF and IM/RM OMI message is used from DSS/OF to IM/RM ORI used for reply from IM/RM to DSS/OF ORM message is not used [RAD-12] Patient Update A08 is only event that is used in IHE-J [RAD-13] Procedure Update 2007/01/08 Japanese Extensions for HL7 Transaction

9 Japanese Extensions for HL7 Transaction
2007/01/08 Japanese Extensions for HL7 Transaction

10 Japanese Extensions for HL7 Transaction
X Use of Start Block Control Characters like 0b X Use of HL7 Messages X Use of HL7 Message Segments X Data Type 2007/01/08 Japanese Extensions for HL7 Transaction

11 X.7.0.3 Use of Start Block Control Characters like 0b
An implementation example describes a case which uses a start block character ahead of MSH segment. However, this example is for the case where the physical layer is RS232C, and this is not proper to the case where the lower layer is TCP/IP. It is normal that implementation of HL7 in Japan does not append these start block character like 0x0b. 2007/01/08 Japanese Extensions for HL7 Transaction

12 Japanese Extensions for HL7 Transaction
X Use of HL7 Messages (1) Use of ADT/ACK Messages The consistency of patient information between Order Placer, DSS/Order Filler and Image Manager/Image Archive (2) Use of OMG/ORG Messages OMG messages are used for transmission of the requested messages for radiology exam from HIS to RIS. And ORG messages are used for the reply. (3) Use of OMI/ORI Messages The exam and procedure information between systems in the radiology department is transmitted by using OMI message. And ORI messages are used for the reply. (4) Use of ORU/ACK Messages ORU messages are used for the patient arrival and ACK message is used for the reply. 2007/01/08 Japanese Extensions for HL7 Transaction

13 X.7.0.5 Use of HL7 Message Segments(1/4)
(1) MSH Segment MSH segment is required for each message of requested order. (2) EVN Segment The EVN Segment is used for backward compatibility. (3) PID Segment According to HL7 V2.5, PID segment in OMG message is optional. But IHE-J requests PID segment in each order information for one patient. (4) PV1 Segment According to HL7 V2.5, PV1 segment in OMG message is optional. But the PV1 segment is used for distinction between outpatient and inpatient. 2007/01/08 Japanese Extensions for HL7 Transaction

14 X.7.0.5 Use of HL7 Message Segments(2/4)
(5) PV2 Segment IHE-J does not use PV2 segment. (6) AL1 Segment Basically the allergy information is described in OBX segment as patient profile. The allergy information is used as contraindication information for radiology exam. So it should be described in OBX segment with other contraindication information (e.g. Lab result information). The reason of this is that all contraindication information should be kept in one place (OBX segment) in the message. (7) TQ1 Segment According to HL7 V2.5, TQ1 segment in OMG message is optional. But the TQ1 segment is used for priority of message. So TQ1 segment is required. 2007/01/08 Japanese Extensions for HL7 Transaction

15 X.7.0.5 Use of HL7 Message Segments(3/4)
(8) TQ2 Segment IHE-J does not use TQ2 segment. (9) DSC Segment IHE-J does not use DSC segment. (10) ZE1 Segment (Billing Segment) It is difficult to put billing information as performed procedure information in segment structure according to HL7 V2.5 standard. ZE1 segment is defined to transmit billing information. Some items are described in the ZE1 segment, procedures, drugs, instrument, additional billing items, films and practitioners. 2007/01/08 Japanese Extensions for HL7 Transaction

16 X.7.0.5 Use of HL7 Message Segments(4/4)
(11) ZE2 Segment (Radiation Dose Segment) In Japan, the exposure information usually has been transmitted from RIS to HIS. But it is difficult to describe the exposure information in standard HL7 V2.5 message structure. ZE2 segment is defined to describe exposure information. The exposure information is usually transmitted from modality to RIS by using DICOM MPPS. That information is described in HL7 message structure by using ZE2 segment. 2007/01/08 Japanese Extensions for HL7 Transaction

17 Japanese Extensions for HL7 Transaction
X Data Type new data type “ZRD” This is used to describe amount of quantities like medicine, film, film segment, etc. For example, the number of sheets of film taken in an examination is specified with ZRD. 2007/01/08 Japanese Extensions for HL7 Transaction

18 Japanese Extensions for HL7 Transaction
2007/01/08 Japanese Extensions for HL7 Transaction

19 Japanese Extensions for HL7 Transaction
Discussion Points 2007/01/08 Japanese Extensions for HL7 Transaction


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