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HL7 |
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HL7 provide a framework (and related
standards) for the exchange,
integration, sharing, and retrieval of
electronic health information. These
standards define how information is
packaged and communicated from one party
to another, setting the language,
structure and data types required for
seamless integration between systems.
HL7 standards support clinical practice
and the management, delivery, and
evaluation of health services, and are
recognized as the most commonly used in
the world.
http://www.hl7.org
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PATIENT DEMOGRAPHICS (ADT) |
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The HL7 ADT message contains patient
demographic information for HL7
communication as well as provides the
some important info about trigger events
(like patient admission, discharge,
transfer, registration etc.) Among these
the most important segments in ADT
message are the PID ( Patient
Identification) segment, the PV1
(Patient Visit) segment and occasionally
the IN1 (Insurance) segment. ADT
messages are more frequent in HL7
processing and are the most widely used
used of all messaging.
51 types of ADT messages are used for
triggering various events. Some of the
most used are:
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ADT-A01 - patient admit |
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ADT-A02 - patient transfer |
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ADT-A03 - patient discharge |
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ADT-A04 - patient
registration |
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ADT-A05 - patient
pre-admission |
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ADT-A08 - patient
information update |
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ADT-A11 - cancel patient
admit |
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ADT-A12 - cancel patient
transfer |
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ADT-A13 - cancel patient
discharge |
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PATIENT SCHEDULE (SIU) |
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The Patient Schedule list option is very
similar to the patient search option but
here the generated list of patients
contains their schedule information.
Scheduling patients for the various
investigations is the key function of a
Radiology facility and the Schedule
module provides various options to
handle this. The Schedule module is the
crux of the whole RIS system and
understanding the various features built
into it is very vital to using RIS.
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RADIOLOGY ORDER (ORM) |
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The general order message is transmitted
using HL7 ORM-O01 message function. It
should be noted that there is only one
type of ORM message - the ORM - O01
message.
New orders, cancellations, information
updates, discontinuation etc. are the
trigger events for ORM - O01message. The
most extensively used message type in
HL7 standard is the ORM message.
Get to know how Corepoint Health enables
customer HL7 initiatives.
The order is defined as a “request for
service” that is sent between
applications, or in few cases within a
single application (an application can
send orders to itself). The ORM is made
of segments and groups of segments, each
of which may be required, optional,
repeatable, or a combination of these
(HL7 cardinality.
The ORM - O01 message with segments and
groups of segments will include the
following:
Segment / Group |
Name |
Optional / Repeatable? |
MSH |
Message header |
Required |
NTE |
Notes and comments |
Optional, Repeatable |
Patient Group - Optional group
(Required for new orders
pertaining to a patient only) |
PID |
Patient identification |
Required |
PID1 |
Patient demographics |
Optional |
NTE-1 |
Notes and comments |
Optional, Repeatable |
Patient Visit Group - Optional
group, part of Patient Group |
PV1 |
Patient visit |
Required |
PV2 |
Patient visit - additional info |
Optional |
Insurance Group - Optional and
repeatable group, part of
Patient Group |
IN1 |
Insurance |
Required |
IN2 |
Insurance additional info |
Optional |
IN3 |
Insurance additional info
certification |
Optional |
Patient Group continued |
GT1 |
Guarantor |
Optional |
AL1 |
Patient allergy information |
Optional, Repeatable |
Order Group - Repeatable group |
ORC |
Common order |
Required |
Order Detail Group - Optional
group, part of Order Group |
OBR |
Observation request |
Required |
NTE-2 |
Notes and comments |
Optional, Repeatable |
DG1 |
Diagnosis |
Optional, Repeatable |
Observation Group - Optional and
Repeatable, part of Order Detail
Group |
OBX |
Observation |
Required |
NTE-3 |
Notes and comments |
Optional, Repeatable |
Order Group continued |
CTI |
Clinical trial identification |
Optional |
BLG |
Billing |
Optional |
Similar to the ADT messages, ORM
messages also have a PID segment for
patient identification information.
Difference is that in ORM message, this
segment is only necessary in the case of
new orders and only if the new order
pertains to a particular patient. Only
if both the conditions are met will the
PID segment be included in the message.
Another segment that has a unique
function in the ORM message is the OBX
(Observation) segment in comparison to
its use in other message types, such as
ORU (Observational Report - Unsolicited)
message. In the ORM message, the OBX
segment forms the integral part of an
optional and repeatable group called
Observation group. The OBX segment
carries the clinical information that
might be required by the recipient
system to interpret the observation that
is made, rather than just information
about observations and results (as in
ORU message). |
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LAB. ORDER (ORM) |
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BILL CHARGES (DFT) |
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The DFT message is mainly used for
financial transaction that is sent to a
billing system and facilitates
accounting. The message will contain
information like ancillary charges or
patient deposit, and is sent between the
DSS/Order Filler and the Charge
Processor. The DSS/Order Filler will
check if the procedure had been
completed.
Trigger events include:
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Procedure ordered |
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Procedure scheduled |
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Procedure completed |
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Report events for
professional fees (future defined)
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REPORT (ORU) |
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ORU message or HL7 ORU – R01 transmits
observations and results from the
producing system/filler (LIS, EKG
system) to the ordering system/placer (i.e
HIS, physician office application). Any
data producing system also transmits
result data from producing system to a
medical record system or else to another
system that is not part of the original
order process. Clinical trials
registration, medical reporting for
drugs and devices etc. are other
functions of ORU messages.
Types of observations in ORU systems:
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The entire lab results |
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The imaging study reports |
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EKG pulmonary function
study report |
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Patient condition or
relevant data (vital signs, symptoms, allergies, notes
etc.) |
The ORU message is a well structured
report in which the observations are
individually separated to different
entities and then into fields. ORU
messages do not contain images; they use
different data types but mostly text,
numbers and codes.
The OBR and OBX are more significant
in ORU message due to their functions:
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The OBR segment is
used in all ORU messages as a report header, and
contains important information about the order being
fulfilled (i.e. order number, request date/time,
observation date/time, ordering provider, etc.). This
segment is part of a group that can be used more than
once for each observation result that is reported in the
message. |
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The OBX segment
transmits the actual clinical observation results as a
single observation or observation fragment. OBX segments
can also be used more than once in the message, and may
be followed by one or more NTE segments to provide
additional notes and comments about the observation. |
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LAB RESULT (ORU) |
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healthcare projects dealing with medical information
systems, medical billing, HL7 Engines, medical
reports, document archiving, mammography tracking
systems, and Heallthcare EDI.
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IMMUNIZATION REGISTRY |
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The Immunization Information System (IIS)
is a versatile tool to augment and
sustain high vaccination coverage. This
is done by consolidating vaccination
records of children and adults from
variety of providers, forecasting the
next dose, past due and the next due
which will support the reminder and
recall of vaccination notices for each
individual. It also makes available
official vaccination forms and
vaccination outreach assessments. This
is in line with the national health
objective of increasing upto 95% the
proportion of children aged <6 years who
have data in the fully operational
population based IIS. These are
catchment area children less than 6
years of age with 2 or more immunization
administered according to ACIP
recommendations.
The children are entered into the IIS at
birth, especially in a population based
IIS, this is done through the electronic
birth records. The IIS record is
initiated by a health provider at the
time of child’s first immunization. If
the IIS enters the data of all children
in a given area and providers report
immunization information, it will be
able to provide single data source for
all community immunization partners.
This helps in providing effective
immunization strategies like reminder,
recall, AFIX and WIC linkage. The same
IIS can be used for adult immunization
coverage also.
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MEDICAL DOCUMENT MANAGEMENT (MDM) |
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The management of medical records by
transmitting new or updated documents or
by transmitting important status
information and updating records can be
easily done using HL7 MDM. Trigger
events and messages can be one of the
two categories: either they convey the
status of the document, or they produce
the status of the document and contain
the document contents. MDM messages are
generated in relation to an order or
independently of them.
The HL7 MDM has 11 different trigger
events for the MDM message type as a
standard. The commonly used MDM message
is MDM T02 because it acts like an ORU
or Result message. The MDM T-02 message
notifies a system of creation of a
document and includes the document
contents.
An important part of the MDM message is
the OBX segment. It contains document
contents, because it is used to separate
the body contents where headings or
other separations may occur. Allthe MDM
message will have the same structure
except the OBX segment. When the message
type contains document content then it
is quite longer, many may also have
repeating OBX segments based on how much
of data has to be transmitted.
The
HL7 MDM message helps manage medical
records by transmitting new or updated
documents, or by transmitting important
status information and/or updates for
the record. Trigger events and messages
can be one of two categories: they can
either describe the status of the
document, or they can describe the
status of the document AND contain the
document contents. MDM messages can be
created in relation to an order or
independently of them.
There are 11 different trigger events
for the MDM message type provided in the
HL7 standard. The most commonly used MDM
message is the MDM-T02 (Original
document notification and content)
because it acts like an ORU (Result)
message. By definition, the MDM-T02
message notifies a system of creation of
a document and includes the document
contents.
The OBX segment is an important part of
MDM messages that contain document
contents, because it is used to separate
the body contents along places where
headings or other separations might
occur. All MDM messages have the same
message structure with the exception of
the OBX segment. Message types that
contain document contents are
significantly longer, and may have
repeating OBX segments depending on how
much data needs to be conveyed.
The segments in the MDM-T02, T04, T06,
T08 and T10 (which all contain document
contents) are as follows:
Segment / Group
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Name
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Optional / Repeatable?
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MSH
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Message header
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Required |
EVN
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Event type
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Required |
PID
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Patient identification
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Required |
PV1
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Patient visit
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Required |
TXA
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Document notification segment
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Required |
OBX
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Observation segment
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Required,
Repeatable |
The segments in the MDM-T01, T03, T05,
T07, T9 and T11 (which do not contain
document contents) are as follows:
Segment / Group
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Name
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Optional / Repeatable?
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MSH
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Message header
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Required |
EVN
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Event type
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Required |
PID
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Patient identification
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Required |
PV1
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Patient visit
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Required |
TXA
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Document notification segment
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Required |
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HOSPITAL INTERFACE WORKFLOWS |
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Hospital workflow usually is taken up
largely by patient information and the
daily routine involving patient
admission, discharge and emergency cases
along with clinical results, radiology
analysis, consultation records and
billing. A synchronized and
comprehensive software solution for
medical systems, simplifies and
facilitates the workflow in hospitals
and clinics, right from patient
registration to billing. This results in
cost savings by providing hospital
personnel with seamless access to
patient information from the hospital
information system and streamlining
hospital interface workflows.
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RADIOLOGY INTERFACE WORKFLOWS |
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The following diagram clearly illustrates the standard workflow of operations in a typical setup.
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CDA |
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The HL7 Clinical Document Architecture (CDA)
is a XML – based markup standard which
specifies the encoding, structure and
semantics of clinical documents for
exchange. The ANSI – certified standard
CDA is from Health Level Seven
(HL7.org). The Release 1.0 was published
in November, 2000 and 2.0 was published
with HL7 2005 Normative Edition.
The specific syntax and framework for
clinical documents is supplied by CDA.
Every clinical document will have the
following six characteristics:
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Persistence |
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Stewardship |
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Authentication potential |
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Relevant Context |
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Completeness |
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Human readability |
The feature of CDA is that it can
contain any type of clinical content.
The Discharge Summary, Imaging Report,
Admission, Pathology Report and so on
makes up a CDA document. CDA uses an XML
format even though it allows non-XML
body (pdf, word, jpg and so on) for
normal implementations. CDA was
developed using the HL7 Development
Framework (HDF) and operates on HL7
Reference Information Model (RIM) and
the HL7 Version 3 data types. The
highlight of CDA is that it specifies
that a document must consist of textual
part (ensuring human interpretation of
the document contents) and optional
structured parts (software processing).
The coding systems like SNOMED and LOINC
is used to represent the concepts in the
structured part.
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CCR |
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Continuity of Care Record (CCR) is a
health record standard specification
developed jointly by ASTM International,
the Massachusetts Medical Society (MMS),
the Healthcare Information and
Management Systems Society (HIMSS), the
American Academy of Family Physicians (AAFP),
the American Academy of Pediatrics (AAP),
and other health informatics vendors.
The CCR standard is a patient health
summary standard. It is a way to create
flexible documents that contain the most
relevant and timely core health
information about a patient, and to send
these electronically from one caregiver
to another. It contains various sections
such as patient demographics, insurance
information, diagnoses and problem list,
medications, allergies and care plan.
These represent a "snapshot" of a
patient's health data that can be useful
or possibly lifesaving, if available at
the time of clinical encounter. The ASTM
CCR standard is designed to permit easy
creation by a physician using an
electronic health record (EHR) system at
the end of an encounter.
Because it is expressed in the standard
data interchange language known as XML,
a CCR can potentially be created, read
and interpreted by any EHR or EMR
software application. A CCR can also be
exported in other formats, such as PDF
and Office Open XML (Microsoft Word 2007
format).
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EMD HL7 SDK |
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HL7 provide a framework (and related
standards) for the exchange,
integration, sharing, and retrieval of
electronic health information. These
standards define how information is
packaged and communicated from one party
to another, setting the language,
structure and data types required for
seamless integration between systems.
HL7 standards support clinical practice
and the management, delivery, and
evaluation of health services, and are
recognized as the most commonly used in
the world.
http://www.hl7.org
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