1. 17.09.1998CH4 Modifications San Diego 1 Proposal for Improving the Consistency of Chapter 4 (Order Entry) Prof. Dr. Joachim Dudeck Institut fuer Medizinische Informatik Justus-Liebig-Universitaet Gießen E-Mail: jwd@uni-giessen.de

2. 17.09.1998CH4 Modifications San Diego 2 Improving the Consistency of HL7 1. Problem - Missing Definitions 2. Proposals for Consistent Definitions 3. ORM / ORR - General Order Message 4. Specific Order Entry Messages 5. Diet Orders 6. Supply Orders 7. Pharmacy / Treatment Orders 8. Other Messages

3. 17.09.1998CH4 Modifications San Diego 3 1. Problem - Missing Definitions A Communications Standard should be easy implementable But in HL7 the most important message control parameters < Message Types < Trigger Events < Action Control Codes are not consistently used in different parts of the standard due to a lack of clear and unequivocal definitions

4. 17.09.1998CH4 Modifications San Diego 4 2. Proposals for Consistent Definitions Message Type –The Message Type defines the structure of the message –One Message Type should be allocated to one specific sequence of mandatory and / or optional segments. –If the cardinality, the sequence or the optionality of segments is changed - a new message type had to be introduced

5. 17.09.1998CH4 Modifications San Diego 5 2. Proposals for Consistent Definitions Trigger Event –defines the event, the change occurred in the environment which initiates the transmission of the message (i.e. admission or discharge of a patient, delivering of a new order) –defines on a message level the action(s) to be carried out in the target system after having received the message

6. 17.09.1998CH4 Modifications San Diego 6 Message Structure Identifier –introduced in version 2.3.1 to identify unambiguously the message structure –the inconsistencies in the message type definitions could be overcome without changing the standard to seriously

7. 17.09.1998CH4 Modifications San Diego 7 2. Proposals for Consistent Definitions Action Code / Message Control Code –define the action to be carried out in the receiving system on a data / segment level –have to be used if this action can not be defined on the message level, i.e. if a message consists of repeatable segments which can initiate different actions (add, update, delete) –required in particular in repeatable segments

8. 17.09.1998CH4 Modifications San Diego 8 3. ORM/ORR - General Order Message ORM / ORR Messages –Several Order Detail Segments can occur in these messages like OBR, RQD, RQ1, RXO, ODS and ODT –Messages can also be transmitted without any Order Detail Segments –The currently used Event Types O01 and O02 do not transmit any additional information –The structure of a ORM /ORR message can therefore not be recognized neither from the message type nor from the event code

9. 17.09.1998CH4 Modifications San Diego 9 3. ORM/ORR - General Order Message Proposal for restructuring ORM / ORR Messages ORM / ORR messages should be used –with the OBR segment only –applying the following Trigger Events < ONWNew Order < OMMOrder Modification (including cancel) < OCMOrder Control Message –with the Message Structure Identifier ORM_O01 and ORR_O02

10. 17.09.1998CH4 Modifications San Diego 10 3. ORM/ORR - General Order Message

11. 17.09.1998CH4 Modifications San Diego 11 3. ORM/ORR - General Order Message

12. 17.09.1998CH4 Modifications San Diego 12 3. ORM/ORR - General Order Message

13. 17.09.1998CH4 Modifications San Diego 13 4. Specific Order Entry Messages Further Order Entry Message Types OMD/ORDDiet Order (Segments ODS / ODT) OMS/ORSSupply Orders (Segment RQD) OMN/ORNNonstock Supply Orders (Segments RQD, RQ1) RDO/RROPharmacy / Treatment Order Message (Segment RXO) RDE/RREalready defined

14. 17.09.1998CH4 Modifications San Diego 14 5. Diet Orders

15. 17.09.1998CH4 Modifications San Diego 15 5. Diet Orders

16. 17.09.1998CH4 Modifications San Diego 16 5. Diet Orders

17. 17.09.1998CH4 Modifications San Diego 17 Further Order Entry Message Types OMD/ORDDiet Order (Segments ODS / ODT) OMS/ORSSupply Orders (Segment RQD) OMN/ORNNonstock Supply Orders (Segments RQD, RQ1) RDO/RROPharmacy / Treatment Order Message (Segment RXO) RDE/RREalready correctly defined

18. 17.09.1998CH4 Modifications San Diego 18 6. Supply Orders

19. 17.09.1998CH4 Modifications San Diego 19 6. Supply Orders

20. 17.09.1998CH4 Modifications San Diego 20 6. Supply Orders

21. 17.09.1998CH4 Modifications San Diego 21 6. Supply Orders Supply Messages –the RQ1 Segment - Nonstock requisition details is an optional Segment –It is therefore not necessary to distinguish between stock and non-stock supply messages –One Supply Order Message would be sufficient (OMS / ORS)

22. 17.09.1998CH4 Modifications San Diego 22 Further Order Entry Message Types OMD/ORDDiet Order (Segments ODS / ODT) OMS/ORSSupply Orders (Segment RQD) OMN/ORNNonstock Supply Orders (Segments RQD, RQ1) RDO/RROPharmacy / Treatment Order Message (Segment RXO) RDE/RREalready defined

23. 17.09.1998CH4 Modifications San Diego 23 7. Pharmacy / Treatment Orders

24. 17.09.1998CH4 Modifications San Diego 24 8. Other Messages Vaccine Administration Data Message TypesTrigger Events VXQ Query Vacc.Rec V01 VXX Response mult. V02 VXR Response single V03 VXU Unsolic. Update V04 Message Type and Trigger Event carry the same information

25. 17.09.1998CH4 Modifications San Diego 25 8. Other Messages Clinical Trials and Product Experiences Message Type and Event Type definitions are already used according to the new definitions