HL7 Overview

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

Table of Contents Terminology Introduction Overview Summary

Terminology

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)

Introduction

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)

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

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

Overview

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 http://www.hl7.org 1 – About Health Level Seven Source: http://www.hl7.ie/about_us.asp

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

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|20030926000401||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

Message Segments PID is a Patient Identifier Segment <11>MSH|^~\&|IMAGING|PSJMD|TDS|PSJMD|20030926133719||ORM^O01|785465|P|2.3<13> PID||01000083270000160771229|555-55-555^^^PSJ||ESCARDA^NARVARO||19000606|M|||1234 SOMEWHERE AVE^^^CA^90001-0000||213-456-7890|312-987-6543||||60771229|55555555<13> PV1||I|4S^S460|||||FEB^SINATRA^FRANK^E^^^MD^8888||||||||||IP||||||||||||||||||||||||||200102240414<13> ORC|SN||100A-01011800||IP|N|1^^^200102241201^^S||200309261015|^INTERFACE^HIS||FEB^SINATRA^FRANK^E^^^MD^8888<13> OBR|||100A-01011800|9025^CT PELVIS 72193^MWA||| 200102241201||||||--..|||FEB^SINATRA^FRANK^E^^^MD^8888||58944|||| 200102240414||CT|||1^^^200102240414^^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

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

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

“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)

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

Summary

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

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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