S02 ATTACHMENT D.6 - RADIOLOGY_AND_CLINICAL_SPECIALTY_WORKFLOW.pdf

Profiles for HL7 Messages from VistA to Commercial PACS

(Radiology and Clinical Specialty Workflow)

Including Business and Functional Requirements

1 May 2013

Revision 1.2.16

Revision History

Date Revision Description Author

11/14/2011 1.2.11 Initial Version Peter Kuzmak

1/26/2012 1.2.12 Changes after first WPR Peter Kuzmak

2/17/2011 1.2.13 Changes after second eWPR Peter Kuzmak

2/21/2012 1.2.14 Reworked FORWARD code Peter Kuzmak

3/1/2012 1.2.15 Reviewed ORU report messages Peter Kuzmak

5/10/2013 1.2.16 Added PV1-11 Temporary Location Peter Kuzmak

Profiles for VistA HL7 Messages i

Table of Contents

5TForeword 5T ........................................................................................................................... xi

5TOrganization of This Document 5T .................................................................................... xii

5TChanges for Version 1.2.8 5T ............................................................................................. xiii

5TIntroduction: Basic Data Sets 5T ...................................................................................... xiv

5T0.15T 5TBasic Patient Data Set 5T .......................................................................... xiv 5T0.25T 5TBasic Visit Data Set 5T .............................................................................. xv 5T0.35T 5TBasic Order Data Set 5T ........................................................................... xvi 5T0.45T 5TBasic Report Data Set 5T .......................................................................... xix

5TTerminology 5T.................................................................................................................... xxi

5T15T 5TPatient Registration Profile5T

5T1.15T 5TUse Case 5T 5T1.1.1 5T 5TScope5T 5T1.1.2 5T 5TActors and Roles 5T

5T1.25T 5TInteractions 5T 5T1.35T 5TDynamic Definition 5T

5T1.3.1 5T 5TPatient Registration Message (ADT) 5T 5T1.3.1.1 5T 5TADT Message Received – MRN Not Found 5T 5T1.3.1.2 5T 5TADT Received for Existing MRN (Non-Update, Non-Merge) 5T 5T1.3.1.3 5T 5TADT Received for Sensitive/Employee Patient 5T 5T1.3.1.4 5T 5TADT Received – More than 1 Value for Same Identifier 5T

5T1.3.2 5T 5TAcknowledgment Message (ACK) 5T 5T1.3.2.1 5T 5TOriginal Mode ACK To Be Returned 5T 5T1.3.2.2 5T 5TERR Segment To Be Sent for AE and AR Conditions 5T 5T1.3.2.3 5T 5TIncorrect Message Type, Trigger Event, Version ID, or Processing Code to Cause Reject 5T 5T1.3.2.4 5T 5TIncorrect Receiving Application or Receiving Facility to Cause Error 5T .. 4

5T1.45T 5TStatic Definition – Message Level 5T 5T1.4.1 5T 5TPatient Registration Message 5T

5T1.4.2 5T 5TAcknowledgment Message 5T 5T1.55T 5TStatic Definition – Segment Level 5T

5T1.5.1 5T 5TMSH Segment 5T 5T1.5.2 5T 5TEVN Segment 5T

5T1.5.3 5T 5TPID Segment 5T 5T1.5.4 5T 5TPV1 Segment 5T 5T1.5.5 5T 5TROL Segment 5T

5T1.5.6 5T 5TDG1 Segment 5T 5T1.5.7 5T 5TOBX Segment 5T

5T1.5.8 5T 5TAL1 Segment 5T 5T1.5.9 5T 5TMSA Segment 5T 5T1.5.10 5T 5TERR Segment 5T ii

5T1.65T 5TStatic Definition – Field Level 5T

5T1.6.1 5T 5TMSH Segment Fields 5T 5TMSH-1-Field Separator 5T 5TMSH-2-Encoding Characters 5T 5TMSH-3-Sending Application 5T 5TMSH-4-Sending Facility5T 5TMSH-5-Receiving Application 5T 5TMSH-6-Receiving Facility5 T 5TMSH-7-Date/Time of Message 5T 5TMSH-9-Message Type 5T 5TMSH-10-Message Control ID 5T 5TMSH-11-Processing ID 5T 5TMSH-12-Version ID 5T

5TMSH-17-Country Code 5T 5T1.6.2 5T 5TEVN Segment Fields 5T

5TEVN-1-Event Type Code 5T 5TEVN-2-Recorded Date/Time 5T 5TEVN-6-Event Occurred 5T

5T1.6.3 5T 5TPID Segment Fields 5T 5TPID-2-Patient ID 5T 5TPID-3-Patient Identifier List 5T 5TPID-4-Alternate Patient ID5T 5TPID-5-Patient Name 5T 5TPID-7-Date/Time of Birth 5T 5TPID-8-Sex 5T 5TPID-10-Race5T

5TPID-11-Patient Address 5T 5TPID-13-Phone Number – Home5T 5TPID-14-Phone Number – Business 5T 5TPID-19-SSN Number – Patient 5T 5TPID-22-Ethnic Group 5T

5T1.6.4 5T 5TPV1 Segment Fields 5T 5TPV1-2-Patient Class 5T

5TPV1-3-Assigned Patient Location 5T 5TPV1-7-Attending Doctor 5T 5TPV1-8-Referring Doctor 5T 5TPV1-10-Hospital Service 5T 5TPV1-15-Ambulatory Status 5T

5TPV1-16-VIP Indicator 5T 5TPV1-19-Visit 5T

5TPV1-44-Admit Date/Time 5T 5T1.6.5 5T 5TROL Segment Fields 5T

5TROL-1-Role Instance ID 5T 5TROL-2-Action Code 5T 5TROL-3-Role5T 5TROL-4-Role Person 5T iii

5TROL-12-Phone5T 5T1.6.6 5T 5TDG1 Segment Fields 5T

5TDG1-1-Set ID5T 5TDG1-3-Diagnosis Code 5T 5TDG1-6-Diagnosis Type 5T

5T1.6.7 5T 5TOBX Segment Fields 5T 5TOBX-1-Set ID 5T 5TOBX-2-Value Type 5T 5TOBX-3-Observation Identifier 5T 5TOBX-5-Observation Value 5T 5TOBX-6-Units 5T 5TOBX-11-Observation Result Status5T

5T1.6.85T 5TAL1 Segment Fields 5T 5TAL1-1-Set ID5T 5TAL1-2-Allergy Type 5T 5TAL1-3-Allergy Code/Mnemonic/Description 5T 5TAL1-5-Allergy Reaction 5T 5TAL1-6-Identification Date 5T

5T1.6.9 5T 5TMSA Segment Fields 5T 5TMSA-1-Acknowledgment Code 5T 5TMSA-2-Message Control ID 5T 5TMSA-3-Text Message5T 5TMSA-6-Error Condition 5T

5T1.6.10 5T 5TERR Segment Fields 5T 5TERR-1-Error Code and Location 5T

5T25T 5TPatient Update Profile 5T

5T2.15T 5TUse Case 5T 5T2.1.1 5T 5TScope5T 5T2.1.2 5T 5TActors and Roles 5T

5T2.25T 5TInteractions 5T

5T2.35T 5TDynamic Definition 5T 5T2.3.1 5T 5TPatient Update Message (ADT) 5T

5T2.3.1.1 5T 5TUpdate Received for Existing MRN (Non-Demo, Non-Merge) 5T

5T2.3.1.2 5T 5TUpdate Received for MRN Not on File (Non-Demo, Non-Merge) 5T 5T2.3.1.3 5T 5TUpdate Received for Existing MRN (Update Demographics) 5T 5T2.3.1.4 5T 5TUpdate Received for MRN Not on File (Update Demographics) 5T 5T2.3.1.5 5T 5TUpdate Received for Existing MRN (Merge) 5T

5T2.3.1.6 5T 5TUpdate Received for MRN Not on File (Merge) 5T 5T2.3.1.7 5T 5TUpdate Received for Existing MRN (Change ID) 5T 5T2.3.1.8 5T 5TUpdate Received for MRN Not on File (Change ID) 5T 5T2.3.1.9 5T 5TUpdate Received – More than 1 Value for Same Identifier 5T 5T2.3.1.10 5T 5TUpdate Received for Sensitive/Employee Patient 5T

5T2.3.2 5T 5TAcknowledgment Message (ACK) 5T 5T2.3.2.1 5T 5TOriginal Mode ACK To Be Returned 5T

5T2.3.2.2 5T 5TERR Segment To Be Sent for AE and AR Conditions 5T iv

5T2.3.2.3 5T 5TIncorrect Message Type, Trigger Event, Version ID, or Processing Code to Cause Reject 5T 5T2.3.2.4 5T 5TIncorrect Receiving Application or Receiving Facility to Cause Error 5T 38

5T2.45T 5TStatic Definition – Message Level 5T 5T2.4.1 5T 5TPatient Update Message: Transfer 5T 5T2.4.2 5T 5TPatient Update Message: Discharge 5T 5T2.4.3 5T 5TPatient Update Message: Update Patient Information 5T 5T2.4.4 5T 5TPatient Update Message: Merge Patient Identifier List 5T 5T2.4.5 5T 5TPatient Update Message: Change Patient Identifier List 5T 5T2.4.6 5T 5TPatient Update Message: Cancel Admit 5T 5T2.4.7 5T 5TPatient Update Message: Cancel Transfer 5T 5T2.4.8 5T 5TPatient Update Message: Cancel Discharge 5T 5T2.4.9 5T 5TAcknowledgment Message 5T

5T2.55T 5TStatic Definition – Segment Level 5T 5T2.5.1 5T 5TMSH Segment 5T 5T2.5.2 5T 5TEVN Segment 5T 5T2.5.3 5T 5TPID Segment 5T 5T2.5.4 5T 5TMRG Segment 5T 5T2.5.5 5T 5TPV1 Segment 5T 5T2.5.6 5T 5TROL Segment 5T 5T2.5.7 5T 5TDG1 Segment 5T 5T2.5.8 5T 5TOBX Segment 5T 5T2.5.9 5T 5TAL1 Segment 5T 5T2.5.10 5T 5TMSA Segment 5T 5T2.5.11 5T 5TERR Segment 5T

5T2.65T 5TStatic Definition – Field Level 5T

5T2.6.1 5T 5TMSH Segment Fields 5T 5TMSH-1-Field Separator 5T 5TMSH-2-Encoding Characters 5T 5TMSH-3-Sending Application 5T 5TMSH-4-Sending Facility5T 5TMSH-5-Receiving Application5T 5TMSH-6-Receiving Facility5 T

5TMSH-7-Date/Time of Message 5T 5TMSH-9-Message Type 5T 5TMSH-10-Message Control ID 5T 5TMSH-11-Processing ID 5T 5TMSH-12-Version ID 5T

5TMSH-17-Country Code 5T 5T2.6.2 5T 5TEVN Segment Fields 5T

5TEVN-1-Event Type Code 5T 5TEVN-2-Recorded Date/Time 5T 5TEVN-6-Event Occurred 5T

5T2.6.3 5T 5TPID Segment Fields 5T 5TPID-2-Patient ID 5T 5TPID-3-Patient Identifier List 5T v

5TPID-4-Alternate Patient ID5T 5TPID-5-Patient Name 5T 5TPID-7-Date/Time of Birth 5T 5TPID-8-Sex 5T 5TPID-10-Race5T 5TPID-11-Patient Address 5T 5TPID-13-Phone Number – Home5T 5TPID-14-Phone Number – Business 5T 5TPID-19-SSN Number – Patient 5T 5TPID-22-Ethnic Group 5T

5T2.6.4 5T 5TMRG Segment Fields 5T 5TMRG-1-Prior Patient Identifier List 5T

5T2.6.5 5T 5TPV1 Segment Fields 5T 5TPV1-2-Patient Class 5T 5TPV1-3-Assigned Patient Location 5T 5TPV1-7-Attending Doctor 5T 5TPV1-8-Referring Doctor 5T 5TPV1-10-Hospital Service 5T 5TPV1-15-Ambulatory Status 5T 5TPV1-16-VIP Indicator 5T 5TPV1-19-Visit 5T 5TPV1-44-Admit Date/Time 5T 5TPV1-45-Discharge Date/Time 5T

5T2.6.6 5T 5TROL Segment Fields 5T 5TROL-1-Role Instance ID 5T

5TROL-2-Action Code 5T 5TROL-3-Role5T 5TROL-4-Role Person 5T 5TROL-12-Phone5T

5T2.6.7 5T 5TDG1 Segment Fields 5T 5TDG1-1-Set ID5T 5TDG1-3-Diagnosis Code 5T 5TDG1-6-Diagnosis Type 5T

5T2.6.8 5T 5TOBX Segment Fields 5T 5TOBX-2-Value Type 5T 5TOBX-3-Observation Identifier 5T 5TOBX-5-Observation Value 5T 5TOBX-6-Units 5T

5TOBX-11-Observation Result Status5T 5T2.6.9 5T 5TAL1 Segment Fields 5T

5TAL1-1-Set ID5T 5TAL1-2-Allergy Type 5T

5TAL1-3-Allergy Code/Mnemonic/Description 5T 5TAL1-5-Allergy Reaction 5T 5TAL1-6-Identification Date 5T

5T2.6.105T 5TMSA Segment Fields 5T vi

5TMSA-1-Acknowledgment Code 5T

5TMSA-2-Message Control ID 5T 5TMSA-3-Text Message5T 5TMSA-6-Error Condition 5T

5T2.6.11 5T 5TERR Segment Fields 5T

5T35T 5TOrder Entry/Update Profile5T

5T3.15T 5TUse Case 5T 5T3.1.1 5T 5TScope5T 5T3.1.2 5T 5TActors and Roles 5T

5T3.25T 5TInteractions 5T 5T3.35T 5TDynamic Definition 5T

5T3.3.1 5T 5TOrder Message (ORM) 5T 5T3.3.1.1 5T 5TNew Order – Case, Study Instance UID and MRN Not Found 5T

5T3.3.1.2 5T 5TNew Order – Case and Study Instance UID Not Found, MRN Found 5T . 73 5T3.3.1.3 5T 5TNew Order – Case and Study Instance UID Found, MRN Does Not

Match 5T 5T3.3.1.4 5T 5TNew Study for Existing Order – Case and MRN Found, Study Instance

UID Does Not Match 5T 5T3.3.1.5 5T 5TNew Order – Case, Study Instance UID and Matching MRN Found, Orderable Item Code Does Not Match 5T 5T3.3.1.6 5T 5TOrder Cancellation – Case and Matching MRN Found 5T 5T3.3.1.7 5T 5TOrder Cancellation – Case Found, MRN and/or Study Instance UID Do

Not Match 5T 5T3.3.1.8 5T 5TOrder Cancellation – Case Found, DOB, Sex or Name Do Not Match 5T 75 5T3.3.1.9 5T 5TOrder Cancellation – Case and Matching MRN Not Found 5T

5T3.3.1.10 5T 5TPatient Examined – Case and Matching MRN Found 5T 5T3.3.1.11 5T 5TPatient Examined – Case Not Found 5T 5T3.3.1.12 5T 5TPatient Examined – Case Found, MRN and/or Study Instance UID Do

Not Match 5T 5T3.3.1.13 5T 5TPatient Examined – Case Found, DOB, Sex or Name Do Not Match5T .. 76 5T3.3.1.14 5T 5TPatient Examined – Case and Matching MRN Found, Orderable Item

Code Does Not Match 5T 5T3.3.1.15 5T 5TNew or Updated Order – Study Instance UID To Be Assigned from

ZDS Segment 5T 5T3.3.1.16 5T 5TNew Order –VistA Code To Be Stored, CPT Code May Be Stored 5T 5T3.3.1.17 5T 5TOrder Received and Filed for Pregnant Patient 5T 5T3.3.1.18 5T 5TOrder Received and Filed for Sensitive/Employee Patient 5T 5T3.3.1.19 5T 5TOrder or Order Update Received – More than 1 Value for Same

Identifier 5T 5T3.3.2 5T 5TAcknowledgment Message (ACK) 5T

5T3.3.2.1 5T 5TOriginal Mode ACK To Be Returned 5T 5T3.3.2.2 5T 5TERR Segment To Be Sent for AE and AR Conditions 5T 5T3.3.2.3 5T 5TIncorrect Message Type, Trigger Event, Version ID, or Processing Code to Cause Reject 5T 5T3.3.2.4 5T 5TIncorrect Receiving Application or Receiving Facility to Cause Error 5T 78

5T3.45T 5TStatic Definition – Message Level 5T vii

5T3.4.1 5T 5TOrder Message 5T 5T3.4.2 5T 5TAcknowledgment Message 5T

5T3.55T 5TStatic Definition – Segment Level 5T 5T3.5.1 5T 5TMSH Segment 5T 5T3.5.2 5T 5TPID Segment 5T 5T3.5.3 5T 5TPV1 Segment 5T 5T3.5.4 5T 5TORC Segment 5T 5T3.5.5 5T 5TOBR Segment 5T 5T3.5.6 5T 5TZDS Segment 5T 5T3.5.7 5T 5TOBX Segment 5T 5T3.5.8 5T 5TMSA Segment 5T 5T3.5.9 5T 5TERR Segment 5T

5T3.65T 5TStatic Definition – Field Level 5T 5T3.6.1 5T 5TMSH Segment Fields 5T

5TMSH-1-Field Separator 5T 5TMSH-2-Encoding Characters 5T 5TMSH-3-Sending Application 5T 5TMSH-4-Sending Facility5T 5TMSH-5-Receiving Application 5T 5TMSH-6-Receiving Facility5 T 5TMSH-7-Date/Time of Message 5T 5TMSH-9-Message Type 5T 5TMSH-10-Message Control ID 5T 5TMSH-11-Processing ID 5T 5TMSH-12-Version ID 5T

5TMSH-17-Country Code 5T 5T3.6.2 5T 5TPID Segment Fields 5T

5TPID-2-Patient ID 5T 5TPID-3-Patient Identifier List 5T 5TPID-4-Alternate Patient ID5T 5TPID-5-Patient Name 5T 5TPID-7-Date/Time of Birth 5T 5TPID-8-Sex 5T

5TPID-10-Race5T 5TPID-11-Patient Address 5T 5TPID-13-Phone Number – Home5T 5TPID-14-Phone Number – Business 5T 5TPID-19-SSN Number – Patient 5T

5TPID-22-Ethnic Group 5T 5T3.6.3 5T 5TPV1 Segment Fields 5T

5TPV1-2-Patient Class 5T 5TPV1-3-Assigned Patient Location 5T

5TPV1-7-Attending Doctor 5T 5TPV1-8-Referring Doctor 5T 5TPV1-11-Temporary Location 5T 5TPV1-10-Hospital Service 5T viii

5TPV1-15-Ambulatory Status 5T

5TPV1-16-VIP Indicator 5T 5TPV1-19-Visit 5T

5T3.6.4 5T 5TORC Segment Fields 5T 5TORC-1-Order Control 5T 5TORC-2-Placer Order Number 5T 5TORC-3-Filler Order Number 5T 5TORC-5-Order Status 5T 5TORC-7-Quantity/Timing5T 5TORC-8-Parent 5T 5TORC-9-Date/Time of Transaction 5T 5TORC-10-Entered By5T 5TORC-12-Ordering Provider 5T

5TORC-13-Enterer’s Location 5T 5TORC-14-Call Back Phone Number 5T 5TORC-15-Order Effective Date/Time (Clinical Specialties only) 5T 5TORC-17-Entering Organization5T

5T3.6.5 5T 5TOBR Segment Fields 5T 5TOBR-1-Set ID 5T 5TOBR-2-Placer Order Number 5T 5TOBR-3-Filler Order Number 5T 5TOBR-4-Universal Service Identifier5T 5TOBR-5-Priority5T 5TOBR-15-Specimen Source 5T 5TOBR-16-Ordering Provider 5T 5TOBR-17-Order Callback Phone Number 5T

5TOBR-18-Placer Field 1 5T 5TOBR-19-Placer Field 2 5T 5TOBR-20-Filler Field 1 5T 5TOBR-21-Filler Field 2 5T 5TOBR-24-Diagnostic Service Section ID 5T 5TOBR-27-Quantity/Timing5T 5TOBR-28-Result Copies To (Clinical Specialties only) 5T

5TOBR-29-Parent 5T 5TOBR-30-Transportation Mode5T 5TOBR-31-Reason for Study5 T 5TOBR-36-Scheduled date/time (Clinical Specialties only) 5T

5T3.6.6 5T 5TZDS Segment Fields 5T

5TZDS-1-Study Instance UID 5T 5T3.6.7 5T 5TOBX Segment Fields 5T

5TOBX-2-Value Type 5T 5TOBX-3-Observation Identifier 5T 5TOBX-5-Observation Value 5T 5TOBX-6-Units 5T 5TOBX-11-Observation Result Status5T

5T3.6.8 5T 5TMSA Segment Fields 5T ix

5T3.6.9 5T 5TERR Segment Fields 5T

5T45T 5TReport Transmission & Storage Profile 5T

5T4.15T 5TUse Case 5T 5T4.1.1 5T 5TScope5T 5T4.1.2 5T 5TActors and Roles 5T

5T4.25T 5TInteractions 5T 5T4.35T 5TDynamic Definition 5 T

5T4.3.1 5T 5TReport Message (ORU) 5T 5T4.3.1.1 5T 5TVistA Is System of Legal Record 5T 5T4.3.1.2 5T 5TReport Received by PACS – Case and MRN Found, No Previous

Report on File 5T 5T4.3.1.3 5T 5TReport Received by PACS – Case and MRN Found, Previous Report

Already on File 5T 5T4.3.1.4 5T 5TReport Received by PACS – Case and MRN Not Found 5T

5T4.3.2 5T 5TAcknowledgment Message (ACK) 5T 5T4.3.2.1 5T 5TOriginal Mode ACK To Be Returned 5T 5T4.3.2.2 5T 5TERR Segment To Be Sent for AE and AR Conditions 5T 5T4.3.2.3 5T 5TIncorrect Message Type, Trigger Event, Version ID, or Processing Code to Cause Reject 5T 5T4.3.2.4 5T 5TIncorrect Receiving Application or Receiving Facility to Cause Error 5T

5T4.45T 5TStatic Definition – Message Level 5T

5T4.4.1 5T 5TReport Message 5T 5T4.4.2 5T 5TAcknowledgment Message 5T

5T4.55T 5TStatic Definition – Segment Level 5T 5T4.5.1 5T 5TMSH Segment 5T 5T4.5.2 5T 5TPID Segment 5T 5T4.5.35T 5TOBR Segment 5T 5T4.5.4 5T 5TOBX Segment 5T 5T4.5.5 5T 5TMSA Segment 5T

5T4.5.6 5T 5TERR Segment 5T 5T4.65T 5TStatic Definition – Field Level 5T

5T4.6.1 5T 5TMSH Segment Fields 5T

5TMSH-1-Field Separator 5T 5TMSH-2-Encoding Characters 5T 5TMSH-3-Sending Application 5T 5TMSH-4-Sending Facility5T

5TMSH-5-Receiving Application 5T 5TMSH-6-Receiving Facility5 T 5TMSH-7-Date/Time of Message 5T 5TMSH-9-Message Type5T 5TMSH-10-Message Control ID 5T

5TMSH-11-Processing ID 5T 5TMSH-12-Version ID 5T

5TMSH-17-Country Code 5T x

5T4.6.2 5T 5TPID Segment Fields 5T

5T4.6.3 5T 5TOBR Segment Fields 5T 5TOBR-1-Set ID 5T 5TOBR-2-Placer Order Number 5T 5TOBR-3-Filler Order Number 5T 5TOBR-4-Universal Service Identifier 5T 5TOBR-7-Observation Date/Time 5T 5TOBR-15-Specimen Source 5T 5TOBR-16-Ordering Provider 5T 5TOBR-17-Order Callback Phone Number 5T 5TOBR-18-Placer Field 1 5T 5TOBR-19-Placer Field 2 5T 5TOBR-20-Filler Field 1 5T

5TOBR-21-Filler Field 2 5T 5TOBR-22-Results Rpt/Status Chng – Date/Time5T 5TOBR-25-Status 5T 5TOBR-28-Result Copies To (Clinical Specialties only) 5T 5TOBR-29-Parent 5T 5TOBR-32-Principal Result Interpreter 5T 5TOBR-33-Assistant Result Interpreter 5T 5TOBR-35-Transcriptionist 5T

5T4.6.4 5T 5TOBX Segment Fields 5T 5TOBX-2-Value Type 5T 5TOBX-3-Observation Identifier 5T 5TOBX-5-Observation Value 5T 5TOBX-6-Units 5T

5TOBX-11-Observation Result Status5T 5T4.6.5 5T 5TFields Used in the MSA Segment 5T 5T4.6.6 5T 5TFields Used in the ERR Segment 5T xi

Foreword

The Health Level Seven (HL7) Standard has been used by the VA's Radiology Package for communicating order and report information for over two decades. Digital imaging became the standard of care in radiology over a decade ago.

Over the last decade there has been tremendous growth of digital imaging applications in the clinical specialties. The VA has played a major role in this advancement, with its

DICOM interface to the CPRS Consult Request Tracking Package. Capabilities that were only a dream a decade ago are now mandatory. The following Integrating the

Healthcare Enterprise (IHE) domains have come into existence: Anatomic Pathology, Dentistry, Eye Care, Endoscopy, Laboratory. Interfacing multiple systems in the clinical specialties, numerous modalities as well as PACS, is now a requirement. This HL7 message specification is to support the PACS in the clinical specialties.

This document is an enhancement of the existing Profiles for HL7 Messages from VistA to Commercial PACS (Radiology) specification to include the profiles for the clinical specialty messages that are sent from the VistA medical center system to commercial

Picture Archiving and Communication Systems (PACS). This is an IHE-conformant

HL7 interface that provides order entry, result reporting, and ADT information. VA will be sending HL7 Version 2.3.1 messages, as required by IHE. However, a number of

HL7 Version 2.4 structures will be pre-adopted: for example, the ROL segment, which can accommodate multiple telephone numbers for clinicians. The purpose of this messaging is to support DICOM Modality Worklist functionality on PACS, indicate

DICOM mapping of received order data into stored and forwarded IOD instances, and to allow storage of VistA reports on PACS.

This document serves two purposes. It identifies the VistA HIS data elements that will be handled by the new interface, as well as the HL7 and DICOM fields that contain those data elements. It also defines the functional business requirements of this interface, including the various conditions that can occur during operation and the expected behavior of the PACS under the possible circumstances.

Specifications in this document are organized into conformance profiles covering order messaging. The methodology used is that of the Conformance section (2.12) of Chapter

2 of HL7 Version 2.5. The order messages used are intended to support the Scheduled

Workflow (SWF) profile of the Integrating the Healthcare Enterprise (IHE) Radiology

Technical Framework (Rad-TF), Cardiology Technical Framework (CAR-TF) and Eye

Care Technical Framework ( EYE CARE-TF), while the ADT update messages used are intended to support the SWF profile.

xii

Organization of This Document

The 0TIntroduction 0T to this document contains four tables that group the key elements that are communicated by the HL7 interface. These 0TBasic Data Sets 0T include elements relating to 5Tpatients 5T, 5Tvisits5T, 5Torders 5T, and 5Treports5T. Within the tables are the names of the elements in the VistA system, the names of the corresponding HL7 elements, and the names and tags of the corresponding DICOM elements. These tables will be referred to throughout the document.

Following the Introduction, three HL7 profiles are presented. Each of these profiles is divided into sections as prescribed by the Conformance section of the HL7 Standard:

Use case, including actors and roles

Interactions, showing the message sent and expected processing within the communications portion of the interface

Dynamic definition, which contains the business and functional requirements for message processing

Message level static definition, showing the segment structure of the HL7 message used for the profile

Segment level static definition, showing the elements used in each segment

Field level static definition, describing how field elements (and, where applicable, subelements) are populated, including values for enterprise-wide controlled vocabularies

The sections listed above conform to the conventions used in the discussion of HL7

Conformance Profiles in the Health Level Seven Standard, Version 2.5, Section 2.12.

IHE Radiology support is provided by the following HL7 messages:

Message Trigger Event(s) Order

Code(s) Profile VistA IHE

Actor Destination IHE Actor

Transaction

ADT A01, A04 Scheduled Workflow

ADT DSS/Order Filler

Patient Registration (1)

ADT A02, A03, A08,

A11, A12, A13, A40, A47

Patient Information Reconciliation

DSS/Order Filler

Image Manager

Patient Update (12)

ORM O01 NW Scheduled Workflow

DSS/Order Filler

Image Manager

Procedure Scheduled (4)

ORM O01 XO, CA Scheduled Workflow

DSS/Order Filler

Image Manager

Procedure Update (13)

Note: The current VA Radiology package does not support the transmission of multiple Scheduled Procedure Steps in a single HL7 message.

xiii

Changes for Version 1.2.8

The following changes are introduced in Version 1.2.8 of this specification.

1. The logic for populating PV1-19-Visit Number has been modified to reflect the actual values produced by VistA Radiology/Imaging HL7 utilities.

2. The documented values of Fields OBR-18-Placer Field 1, OBR-19-Placer

Field 2, OBR-20-Filler Field 1, and OBR-21-Filler Field 2 now match what is produced by the VistA Radiology Package.

xiv

0BIntroduction: Basic Data Sets

The following basic data sets will be referred to throughout these profiles. These tables list the patient-related, order-related, and message-related elements that will be transmitted, stored, and/or used by interfaced systems.

0.1 5BBasic Patient Data Set

The following are the elements of the Basic Patient Data Set. All mapped DICOM fields, if they were provided and listed below, must be preserved in the PACS generated

DICOM Modality Worklist (C-FIND) SOP class, as well as in all C-STORE storage SOP classes that are used to store and forward Instances by PACS.

VistA Data Description

HL7 DICOM

Site Number-DFN PID-2-Patient ID, concatenated by hyphen

(0010,1000) Other

Patient IDs, second value (PID-2.1)

Social Security

Number (SSN)

PID-3-Patient Identifier List

Following IHE, the identifier in PID-3 in all HL7 transactions is single valued.

In the VA, the value of PID-3.1 is the

SSN.

In this document, the term Medical

Record Number (MRN) will refer to the value of the PID-3.1 field.

PID-19-SSN Number-Patient [HL7 recommends populating this field for backward compatibility]

(0010,0020) Patient ID

(PID-3.1)

(0010,0021) Issuer of

Patient ID (PID-3.4)

ICN [Integration

Control Number]

PID-4-Alternate Patient ID (0010,1000) Other

Patient IDs, first value

(PID-4.1)

Name PID-5-Patient Name (0010,0010) Patient’s

Name xv

Description

HL7 DICOM

Sex PID-8-Sex (0010,0040) Patient’s

Sex

Race PID-10-Race (0010,2160) Ethnic

Group

DOB PID-7-Date/Time of Birth

[may be as imprecise as YYYY; is

NOT zero filled]

(0010,0030) Patient’s

Birth Date

(0010,0032) Patient’s

Birth Time

Patient Size OBX instance containing HEIGHT in

OBX-3.2-Text

(0010,1020) Patient’s

Size (height in meters)

Patient Weight OBX instance containing WEIGHT in

OBX-3.2-Text

(0010,1030) Patient’s

Weight (weight in kg)

Address PID-11-Patient Address (0010,1040) Patient’s

Address

0.2 6BBasic Visit Data Set

The following are the elements of the Basic Visit Data Set. All mapped DICOM fields, if they were provided and listed below, must be preserved in the PACS generated DICOM

Modality Worklist (C-FIND) SOP class, as well as in all C-STORE storage SOP classes that are used to store and forward Instances by PACS. Superscript P

MWL

P is used if only the

Modality Worklist applies.

Description

HL7 DICOM

Category of Exam

[inpatient, outpatient, etc.]

PV1-2-Patient Class (0038,4000) Visit

Comments

Room-Bed PV1-3-Assigned Patient

Location (inpatient)

(0038,0300) Current

Patient Location

Clinic, Emergency

Department

PV1-11-Temporary Patient

Location (outpatient)

(0038,0300) Current

Patient Location

Attending Physician PV1-7-Attending Doctor [also carried in an occurrence of the

ROL segment]

(0008,1050) Performing

Physician’s Name xvi

Description

HL7 DICOM

Ordering Physician PV1-8-Referring Doctor [also carried in an occurrence of the

ROL segment]

(0008,0090) Referring

Physician’s Name

Allergies OBX instance containing

ALLERGIES in OBX-3.2-Text

(0010,2110) Allergies

Pregnancy Status PV1-15-Ambulatory Status

(value B6 indicates that patient is pregnant)

(0010,21C0) Pregnancy

Status

Patient Sensitivity

(employee, flagged sensitive, etc.)

PV1-16-VIP Indicator (0040,3001)

Confidentiality Constraint on Patient Data

Description

(0040,1008)P

MWL

Confidentiality Code

Admission ID PV1-19-Visit Number (0038,0010) Admission

ID

Date/Time of Admission PV1-44-Admit Date and Time (0038,0020) Admitting

Date and

(0038,0021) Admitting

Time

Date/Time of Discharge PV1-45-Discharge Date and

Time

(0038,0030) Discharge

Date and

(0038,0032) Discharge

Time

0.3 7BBasic Order Data Set

The following are the elements of the Basic Order Data Set. All mapped DICOM elements, if they were provided and listed below, must be preserved either in the PACS generated DICOM Modality Worklist (C-FIND) SOP class and/or in all C-STORE storage SOP classes that are used to store and forward Instances by PACS. Superscript

P

MWL

P is used if only the Modality Worklist SOP class applies.

VistA Data Description HL7 DICOM

Order set ORC-8-Parent Not used for clinical specialties xvii

Location/Institution (Contains institution and location where imaging is performed)

OBR-21-Filler Field 2 (0040,0011)P

MWL

P Scheduled

Procedure Step Location

(0008,0080) Institution

Name

(0008,0082) Institution

Code Sequence

Ordering Provider OBR-16-Ordering

Provider

(0032,1032) Requesting

Physician

Callback Phone Number OBR-17-Order

Callback Phone

Number

(0040,2010)P

MWL

P Order

Callback Phone Number

Full Accession Number (exam date concatenated with the Case

Number: ‘MMDDYY-nnnnn’, or

Station Number concatenated with the exam date concatenated with the Case Number: ‘SSS-

MMDDYY-nnnnn’)

OBR-18-Placer Field 1 Full Accession Number:

(0008,0050) Accession

Number

Case Number OBR-19-Placer Field 2 Case Number only

(‘nnnnn’):

(0020,0010) Study ID

(0040,0100)P

MWL

P Scheduled

Procedure Step Sequence

>(0040,1001)P

MWL

P

Requested Procedure ID

Procedure (orderable item codes

– CPT code and text)

OBR-4-Universal

Service ID

CPT-4 code and text:

(0032,1064) P

MWL

PRequested

Procedure Code Sequence

Sequence

> (0008,0100) Code Value

> (0008,0102) Coding

Scheme Designator

> (0008,0104) Code

Meaning xviii

Request Urgency ORC-7.6-Priority:

S = STAT (with highest priority)

A = ASAP (fill after

Stat orders)

R = ROUTINE (the default)

(0040,1003)P

MWL

P Requested

Procedure Priority

The HL7 values shown in the previous column are to be mapped to DICOM values as follows:

HL7 DICOM

S STAT

A HIGH

R ROUTINE

Modifiers – procedure and CPT OBX instance containing

MODIFIERS in

OBX-3.2-Text -3

Types:

‘M’ - Procedure modifiers (local)

‘C4’ - CPT modifiers

(national)

(0032,1060)P

MWL

P Requested

Procedure Description:

applicable modifiers concatenated and optionally appended with laterality indicator

Modality OBR-24 (Diagnostic

Service Section ID)

(0008,0060) Modality

(0040,0100)P

MWL

P Scheduled

Procedure Step Sequence

> (0008,0060) Modality

Scheduled Date/Time ORC-7.4.1-Time (in

Component OBR-27.4-

Start Date/Time of

Field OBR-27-

Quantity/Timing)

OBR-27.4.1- Time (in

Component OBR-27.4-

Start Date/Time of

Field OBR-27-

Quantity/Timing)

(0032,1000)P

MWL

P Scheduled

Study Start Date

(0032,1001)P

MWL

P Scheduled

Study Start Time

(0040,0100)P

MWL

P Scheduled

Procedure Step Sequence

> (0040,0002)P

MWL

P

Scheduled Procecure Step

Start Date

> (0040,0003)P

MWL

P

Scheduled Procedure Step

Start Time xix

History (unlimited text) OBX instance containing HISTORY in OBX-3.2-Text

For backward compatibility, the following element may be populated:

(0010,21B0) Additional

Patient History

Reason for Study OBR-31-Reason for

Study

Should be displayed for

Modality Worklist and stored in DICOM header in the following elements:

(0040,1002) Reason for the

Requested Procedure AND

(0040,1400) Requested

Procedure Comments

(0032,1030) Reason for

Study

Technologist’s Comment OBX instance containing TECH

COMMENT in OBX-

3.2-Text

(0032,4000) Study

Comment

Study Instance UID ZDS-1.1-Study

Instance UID

Value sent in HL7 message

MUST be used by PACS.

(0020,000D) Study

Instance UID

0.4 8BBasic Report Data Set

The following are the elements of the Basic Report Data Set. This is not a normative mapping for Report data. PACS is responsible for its own storage of report data, but if the PACS owns a transcription system, the context identified by the given DICOM tags must be stored in the appropriate outgoing HL7 ORU^R01 messages (which are not a part of this specification).

xx

Description

HL7 DICOM

Report Status OBR-25-Result Status (4008,0210) Interpretation

Type ID – CS: [REPORT, AMENDMENT]

Report Status – Codes: F for final and R for released not verified

OBR-25-Result Status (4008,0212) Interpretation

Status ID – CS:

[TRANSCRIBED,

APPROVED]

Date/Time of Transaction OBR-22-Results Rpt/Status

Chg – Date/Time if OBR-

18 = ‘R’

(4008,0108) Interpretation

Transcription Date

(4008,0109) Interpretation

Transcription Time

Impression Text OBX instance containing

IMPRESSION in OBX-

3.2-Text

(4008,0300) Impressions

Report Text OBX instance containing

REPORT in OBX-3.2-Text

(4008,010B) Interpretation

Text

Diagnostic Code OBX instance containing

DIAGNOSTIC CODE in

OBX-3.2-Text

(4008,0117) Interpretation

Diagnosis Code Sequence

Primary Interpreting

Resident

OBR-33-Assistant Result

Interpreter

(4008,010C) Interpretation

Author

Verifying Physician OBR-32-Principal Result

Interpreter

(4008,0114) Physician

Approving Interpretation xxi

Terminology

The term file, when used as a proper term, shall be understood to mean a VA File

Manager file on the local VistA system, unless this document explicitly indicates otherwise. Likewise, the term table, when used as a proper term, shall be understood to mean a table (HL7-defined or user-defined) cited in the Health Level Seven Standard.

In the static definition portions of the profile, the following abbreviations are employed in the Usage column. Note the constraints on the HL7 definitions of CE and X: the conformant receiving application shall NOT raise an error if such fields are populated.

Value Description Comment

R Required A conforming sending application shall populate all “R” elements with a non-empty value. A conforming receiving application shall process (save/print/archive/etc.) or ignore the information conveyed by required elements. A conforming receiving application must not raise an error due to the presence of a required element, but may raise an error due to the absence of a required element.

RE Required but may be empty The element may be missing from the message, but must be sent by the sending application if there is relevant data. A conforming sending application must be 11Tcapable11T of providing all "RE" elements. If the conforming sending application knows the required values for the element, then it must send that element. If the conforming sending application does not know the required values, then that element will be omitted.

Receiving applications will be expected to process

(save/print/archive/etc.) or ignore data contained in the element, but must be able to successfully process the message if the element is omitted (no error message should be generated because the element is missing).

C Conditional This usage has an associated condition predicate.

11TIf the predicate is satisfied:

A conformant sending application must always send the element. A conformant receiving application must process or ignore data in the element. It may raise an error if the element is not present.

11TIf the predicate is NOT satisfied:

A conformant sending application must NOT send the element.

A conformant receiving application must NOT raise an error if the condition predicate is false, whether the element is present or not.

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Value Description Comment

CE Conditional but it may be empty This usage has an associated condition predicate.

11TIf the predicate is satisfied:

If the conforming sending application knows the required values for the element, then the application must send the element. If the conforming sending application does not know the values required for this element, then the element shall be omitted. The conforming sending application must be 11Tcapable11T of knowing the element (when the predicate is true) for all ‘CE’ elements.

If the element is present, the conformant receiving application shall process (display/print/archive/etc.) or ignore the values of that element. If the element is not present, the conformant receiving application shall 11Tnot 11T raise an error due to the presence or absence of the element.

11TIf the predicate is not satisfied:

A conformant sending application must NOT send the element.

A conformant receiving application must NOT raise an error if the condition predicate is false, whether the element is present or not.

B Retained for backward compatibility

A conforming sending application may populate this element.

However, this element has been deprecated in the HL7 Standard and may be withdrawn from a future version of the Standard. A future version of this Profile may withdraw support for this field.

A conforming receiving application shall process

(save/print/archive/etc.) or ignore the information conveyed. A conforming receiving application must not raise an error due to the presence or absence of a deprecated element.

X Not supported For conformant sending applications, the element will not be sent. Conformant receiving applications shall ignore the element whether it is sent or not.

1 1BPatient Registration Profile

1.1 9BUse Case

1.1.1 33BScope

The Patient Registration transaction conveys the patient demographic and visit information that was captured at the point of encounter. This transaction is used both for inpatients (i.e., those who are assigned a bed at the facility) and outpatients (i.e., those who are not assigned a bed at the facility). It is implemented only for PACS that assert support for the Modality Worklist Service Class Provider.

1.1.2 34BActors and Roles

Actor: VistA Imaging

Role: Receives patient registration notification from VistA Patient Information

Management System. Transmits appropriate demographic and encounter information to associated imaging systems including commercial Picture Archiving and Communication

Systems (PACS).

Actor: PACS

Role: Receives and stores patient demographic and encounter information for use in building the Modality Worklist (MWL) when orders are received from VistA Radiology.

1.2 10BInteractions

The actors in this use case shall perform the behaviors shown in the following activity diagram.

1.3 11BDynamic Definition

Vista and PACS shall generate and process HL7 messages according to the following functional and business requirements.

1.3.1 35BPatient Registration Message (ADT)

VistA Imaging shall transmit an ADT message to PACS upon patient registration.

If PACS accepts ADT messages, it shall process the message in conformance with the following requirements.

1.3.1.1 136BADT Message Received – MRN Not Found

When PACS receives an ADT registration message for a patient for which it does not find an MRN in its system, PACS will create a new patient record and will extract from the HL7 message, and will store in its system, the information contained in the 0TBasic Patient Data Set 0T (see Section 5T0.15T above) and the 0TBasic Visit

Data Set0T (see Section 0.2 above).

1.3.1.2 137BADT Received for Existing MRN (Non-Update, Non-Merge)

When PACS receives an ADT registration message for a patient for which it finds an MRN in its system, PACS will verify that name, sex, and DOB exactly match what is already in its system: if so, PACS will extract from the HL7 message, and will store in its system, the information contained in the 0TBasic Patient Data Set 0T

(see Section 5T0.1 5T above) and the 0TBasic Visit Data Set 0T (see Section 0.2 above); if not, PACS will put the message onto a reconciliation queue and notify the sending system of the anomaly(ies) via an HL7 application acknowledgment containing a value of AE (application error) in field MSA-1-acknowledgment code and a fully populated occurrence of ERR-1-error code and location, as described in Section

1.6.10 below, including code 204 (unknown key identifier) in component 4.

1.3.1.3 138BADT Received for Sensitive/Employee Patient

When PACS receives an ADT registration message for a patient whose VIP

Indicator value in PV1-16 is set to E (employee) or S (sensitive), PACS shall safeguard the identity of the patient using VA rules for suppressing patient name and other identifying information.

1.3.1.4 139BADT Received – More than 1 Value for Same Identifier

When PACS receives an ADT registration message containing more than one value for the MRN, PACS will notify the sending system of the anomaly(ies) via an HL7 application acknowledgment and will not update any patient record. The application acknowledgment shall contain a value of AE (application error) in field MSA-1-acknowledgment code and a fully populated occurrence of ERR-1-error code and location, as described in Section 1.6.10 below, including code 207

(application internal error) in component 4. PACS is responsible for notifying support staff and users of anomalies as needed.

1.3.2 36BAcknowledgment Message (ACK)

1.3.2.1 140BOriginal Mode ACK To Be Returned

If PACS accepts ADT registration messages, it shall return an original mode ACK application acknowledgment, as defined in the HL7 Standard and prescribed by the IHE Radiology Technical Framework. The trigger event of the acknowledgment message shall be equal to the trigger event of the message that was received.

1.3.2.2 141BERR Segment To Be Sent for AE and AR Conditions

When an error is determined to have occurred, PACS shall return the acknowledgment code AE (Application Error) or AR (Application Reject) as appropriate, and shall populate Field ERR-1-error code and location with the relevant error information including the appropriate error code from HL7 Table

0357. See Section 1.6.10 for more information on populating ERR-1-error code and location.

1.3.2.3 142BIncorrect Message Type, Trigger Event, Version ID, or Processing Code to Cause Reject

If the value received in MSH-9.1-message type, MSH-9.2-trigger event, MSH-11-processing code, or MSH-12-version ID is invalid, the value AR (application reject) shall be returned in MSA-1-acknowledgment code, and the appropriate value from HL7 Table 0357 shall be returned in ERR-1-error code and location.

See Section 1.6.10 for more information on populating ERR-1-error code and location.

1.3.2.4 143BIncorrect Receiving Application or Receiving Facility to Cause Error

If the value received in MSH-5-receiving application or MSH-6-receiving facility is invalid, the value AE (application error) shall be returned in MSA-1-acknowledgment code, and the value 103 (table value not found) shall be returned in ERR-1-error code and location. See Section 1.6.10 for more information on populating ERR-1-error code and location.

1.4 12BStatic Definition – Message Level

HL7 messages shall be populated and processed according to the following abstract message definitions.

1.4.1 37BPatient Registration Message

Segment ADT Message Usage Cardinality HL7 Chapter

MSH Message Header R [1..1] 2

EVN Event Type R [1..1] 3

PID Patient Identification R [1..1] 3

[ PD1 ] Additional Demographics X [0..0] 3

[ { NK1 } ] Next of Kin / Associated Parties X [0..0] 3

PV1 Patient Visit R [1..1] 3

[ PV2 ] Patient Visit – Additional Info. X [0..0] 3

[ { ROL } ] Role RE [0..2] 12

[ { DB1 } ] Disability Information X [0..0] 3

[ { OBX } ] Observation / Result R [2..2] 7

[ { AL1 } ] Allergy Information RE [0..99] 3

[ { DG1 } ] Diagnosis Information RE [0..1] 6

[ DRG ] Diagnosis Related Group X [0..0] 6

[ { PR1 Procedures X [0..0] 6

[ { ROL } ] Role X [0..0] 12

[ { GT1 } ] Guarantor X [0..0] 6

[ { IN1 Insurance X [0..0] 6

[ IN2 ] Insurance Additional Info. X [0..0] 6

[ { IN3 } ] Insurance Additional Info. – Cert. X [0..0] 6

[ ACC ] Accident Information X [0..0] 6

[ UB1 ] Universal Bill Information X [0..0] 6

[ UB2 ] Universal Bill 92 Information X [0..0] 6

1.4.2 38BAcknowledgment Message

Segment ACK Message Usage Cardinality HL7 Chapter

MSH Message Header R [1..1] 2

MSA Message Acknowledgment R [1..1] 2

[ ERR ] Error RE [0..1] 2

1.5 13BStatic Definition – Segment Level

Fields in HL7 messages shall be populated and processed according to the following

Segment Attribute Tables.

1.5.1 39BMSH Segment

Refer to Section 1.6.1, 0TMSH Segment Fields 0T, for a detailed explanation of the fields used in this segment.

Seq Len DT Usage Cardinality TBL# Item # Element Name

1 1 ST R [1..1] 00001 Field Separator

2 4 ST R [1..1] 00002 Encoding Characters

3 180 HD R [1..1] 0361 00003 Sending Application

4 180 HD R [1..1] 0362 00004 Sending Facility

5 180 HD R [1..1] 0361 00005 Receiving Application

6 180 HD R [1..1] 0362 00006 Receiving Facility

7 26 TS R [1..1] 00007 Date/Time of Message

8 40 ST X [0..0] 00008 Security

9 13 CM R [1..1] 0076

00009 Message Type

10 20 ST R [1..1] 00010 Message Control ID

11 3 PT R [1..1] 00011 Processing ID

12 60 VID R [1..1] 0104 00012 Version ID

13 15 NM X [0..0] 00013 Sequence Number

14 180 ST X [0..0] 00014 Continuation Pointer

15 2 ID X [0..0] 0155 00015 Accept Acknowledgment Type

16 2 ID X [0..0] 0155 00016 Application Acknowledgment Type

17 3 ID R [1..1] 00017 Country Code

18 16 ID X [0..0] 0211 00692 Character Set

19 250 CE X [0..0] 00693 Principal Language of Message

20 20 ID X [0..0] 0356 01317 Alternate Character Set Handling Scheme

21 10 ID X [0..0] 01598 Conformance Statement ID

1.5.2 40BEVN Segment

The following is a listing of all the fields defined for the EVN Segment in HL7. Refer to

Section 1.6.2, 0TEVN Segment Fields 0T, for a more detailed explanation of the fields used by

VistA.

1 3 ID R [1..1] 0003 00099 Event Type Code

2 26 TS R [1..1] 00100 Recorded Date/Time

3 26 TS X [0..0] 00101 Date/Time Planned Event

4 3 IS X [0..0] 0062 00102 Event Reason Code

5 60 XCN X [0..0] 0188 00103 Operator ID

6 26 TS RE [0..1] 01278 Event Occurred

7 180 HD X [0..0] 01534 Event Facility

1.5.3 41BPID Segment

The following is a listing of all the fields defined for the PID Segment in HL7. Refer to

Section 1.6.3, PID Segment Fields, for a more detailed explanation of the fields used by

1 4 SI X [0..0] 00104 Set ID - PID

2 20 CX R [1..1] 00105 Patient ID

3 250 CX R [1..1] 00106 Patient Identifier List

4 20 CX R [1..1] 00107 Alternate Patient ID - PID

5 250 XPN R [1..1] 00108 Patient Name

6 250 XPN X [0..0] 00109 Mother’s Maiden Name

7 26 TS RE [0..1] 00110 Date/Time of Birth

8 1 IS RE [0..1] 0001 00111 Sex

9 250 XPN X [0..0] 00112 Patient Alias

10 250 CE RE [0..1] 0005 00113 Race

11 250 XAD RE [0..1] 00114 Patient Address

12 4 IS X [0..0] 0289 00115 County Code

13 250 XTN RE [0..1] 00116 Phone Number - Home

14 250 XTN RE [0..1] 00117 Phone Number - Business

15 250 CE X [0..0] 0296 00118 Primary Language

16 250 CE X [0..0] 0002 00119 Marital Status

17 250 CE X [0..0] 0006 00120 Religion

18 250 CX X [0..0] 00121 Patient Account Number

19 16 ST R [1..1] 00122 SSN Number - Patient

20 25 DLN X [0..0] 00123 Driver's License Number - Patient

21 250 CX X [0..0] 00124 Mother's Identifier

22 250 CE RE [0..1] 0189 00125 Ethnic Group

23 250 ST X [0..0] 00126 Birth Place

24 1 ID X [0..0] 0136 00127 Multiple Birth Indicator

25 2 NM X [0..0] 00128 Birth Order

26 250 CE X [0..0] 0171 00129 Citizenship

27 250 CE X [0..0] 0172 00130 Veterans Military Status

28 250 CE X [0..0] 0212 00739 Nationality

29 26 TS X [0..0] 00740 Patient Death Date and Time

30 1 ID X [0..0] 0136 00741 Patient Death Indicator

31 1 ID X [0..0] 0136 01535 Identity Unknown Indicator

32 20 IS X [0..0] 0445 01536 Identity Reliability Code

33 26 TS X [0..0] 01537 Last Update Date/Time

34 40 HD X [0..0] 01538 Last Update Facility

35 250 CE X [0..0] 0446 01539 Species Code

36 250 CE X [0..0] 0447 01540 Breed Code

37 80 ST X [0..0] 01541 Strain

38 250 CE X [0..0] 0429 01542 Production Class Code

1.5.4 42BPV1 Segment

The following is a listing of all the fields defined for the PV1 Segment in HL7. Refer to

Section 1.6.4, 0TPV1 Segment Fields 0T, for a more detailed explanation of the fields used by

1 4 SI X [0..0] 00131 Set ID - PV1

2 1 IS R [1..1] 0004 00132 Patient Class

3 80 PL C [0..1] 00133 Assigned Patient Location

4 2 IS X [0..0] 0007 00134 Admission Type

5 250 CX X [0..0] 00135 Preadmit Number

6 80 PL X [0..0] 00136 Prior Patient Location

7 250 XCN CE [0..1] 0010 00137 Attending Doctor

8 250 XCN RE [0..1] 0010 00138 Referring Doctor

9 250 XCN X [0..0] 0010 00139 Consulting Doctor

10 30 IS C [0..1] 0069 00140 Hospital Service

11 80 PL X [0..0] 00141 Temporary Location

12 2 IS X [0..0] 0087 00142 Preadmit Test Indicator

13 2 IS X [0..0] 0092 00143 Re-admission Indicator

14 6 IS X [0..0] 0023 00144 Admit Source

15 2 IS RE [0..2] 0009 00145 Ambulatory Status

16 2 IS RE [0..1] 0099 00146 VIP Indicator

17 250 XCN X [0..0] 0010 00147 Admitting Doctor

18 2 IS X [0..0] 0018 00148 Patient Type

19 250 CX RE [0..1] 00149 Visit Number

20 50 FC X [0..0] 0064 00150 Financial Class

21 2 IS X [0..0] 0032 00151 Charge Price Indicator

22 2 IS X [0..0] 0045 00152 Courtesy Code

23 2 IS X [0..0] 0046 00153 Credit Rating

24 2 IS X [0..0] 0044 00154 Contract Code

25 8 DT X [0..0] 00155 Contract Effective Date

26 12 NM X [0..0] 00156 Contract Amount

27 3 NM X [0..0] 00157 Contract Period

28 2 IS X [0..0] 0073 00158 Interest Code

29 1 IS X [0..0] 0110 00159 Transfer to Bad Debt Code

30 8 DT X [0..0] 00160 Transfer to Bad Debt Date

31 10 IS X [0..0] 0021 00161 Bad Debt Agency Code

32 12 NM X [0..0] 00162 Bad Debt Transfer Amount

33 12 NM X [0..0] 00163 Bad Debt Recovery Amount

34 1 IS X [0..0] 0111 00164 Delete Account Indicator

35 8 DT X [0..0] 00165 Delete Account Date

36 3 IS X [0..0] 0112 00166 Discharge Disposition

37 25 CM X [0..0] 0113 00167 Discharged to Location

38 250 CE X [0..0] 0114 00168 Diet Type

39 2 IS X [0..0] 0115 00169 Servicing Facility

40 1 IS X [0..0] 0116 00170 Bed Status

41 2 IS X [0..0] 0117 00171 Account Status

42 80 PL X [0..0] 00172 Pending Location

43 80 PL X [0..0] 00173 Prior Temporary Location

44 26 TS RE [0..1] 00174 Admit Date/Time

45 26 TS X [0..0] 00175 Discharge Date/Time

46 12 NM X [0..0] 00176 Current Patient Balance

47 12 NM X [0..0] 00177 Total Charges

48 12 NM X [0..0] 00178 Total Adjustments

49 12 NM X [0..0] 00179 Total Payments

50 250 CX X [0..0] 0203 00180 Alternate Visit ID

51 1 IS X [0..0] 0326 01226 Visit Indicator

52 250 XCN X [0..0] 0010 01274 Other Healthcare Provider

1.5.5 43BROL Segment

The ROL Segment is used to give more complete information about the patient’s referring and attending physicians than is permitted by the PV1 Segment. Specifically, the ROL Segment allows for the transmission of multiple callback numbers for each physician.

The following is a listing of all the fields defined for the ROL Segment in HL7. Refer to

Section 1.6.5, 0TROL Segment Fields 0T, for a more detailed explanation of the fields used by

1 60 EI R [1..1] 01206 Role Instance ID

2 2 ID R [1..1] 0287 00816 Action Code

3 250 CE R [1..1] 0443 01197 Role-ROL

4 250 XCN R [1..1] 01198 Role Person

5 26 TS X [0..0] 01199 Role Begin Date/Time

6 26 TS X [0..0] 01200 Role End Date/Time

7 250 CE X [0..0] 01201 Role Duration

8 250 CE X [0..0] 01205 Role Action Reason

9 250 CE X [0..0] 01510 Provider Type

10 250 CE X [0..0] 0406 01461 Organization Unit Type

11 250 XAD X [0..0] 00679 Office/Home Address

12 250 XTN RE [0..8] 00678 Phone

1.5.6 44BDG1 Segment

The following is a listing of all the fields defined for the DG1 Segment in HL7. Refer to

Section 1.6.6, 0TDG1 Segment Fields 0T, for a more detailed explanation of the fields used by

1 4 SI R [1..1] 00375 Set ID - DG1

2 2 ID X [0..0] 0053 00376 Diagnosis Coding Method

3 250 CE R [1..1] 0051 00377 Diagnosis Code - DG1

4 40 ST X [0..0] 00378 Diagnosis Description

5 26 TS X [0..0] 00379 Diagnosis Date/Time

6 2 IS RE [0..1] 0052 00380 Diagnosis Type

7 250 CE X [0..0] 0118 00381 Major Diagnostic Category

8 250 CE X [0..0] 0055 00382 Diagnostic Related Group

9 1 ID X [0..0] 0136 00383 DRG Approval Indicator

10 2 IS X [0..0] 0056 00384 DRG Grouper Review Code

11 250 CE X [0..0] 0083 00385 Outlier Type

12 3 NM X [0..0] 00386 Outlier Days

13 12 CP X [0..0] 00387 Outlier Cost

14 4 ST X [0..0] 00388 Grouper Version And Type

15 2 ID X [0..0] 0359 00389 Diagnosis Priority

16 250 XCN X [0..0] 00390 Diagnosing Clinician

17 3 IS X [0..0] 0228 00766 Diagnosis Classification

18 1 ID X [0..0] 0136 00767 Confidential Indicator

19 26 TS X [0..0] 00768 Attestation Date/Time

1.5.7 45BOBX Segment

In the ADT registration message, the OBX Segment is used to communicate height and weight of the patient. The following is a listing of all the fields defined for the OBX

Segment in HL7. Refer to Section 1.6.7, 0TOBX Segment Fields 0T, for a more detailed explanation of the fields used by VistA.

1 4 SI R [1..1] 00569 Set ID – OBX

2 2 ID R [1..1] 0125 00570 Value Type

3 250 CE R [1..1] 00571 Observation Identifier

4 20 ST X [0..0] 00572 Observation Sub-ID

5 65536P

R [1..1] 00573 Observation Value

6 250 CE R [1..1] 00574 Units

7 60 ST X [0..0] 00575 Reference Range

8 5 IS X [0..0] 0078 00576 Abnormal Flags

9 5 NM X [0..0] 00577 Probability

10 2 ID X [0..0] 00578 Nature of Abnormal Test

11 1 ID R [1..1] 0085 00579 Observation Result Status

12 26 TS X [0..0] 00580 Date Last Observation Normal Value

13 20 ST X [0..0] 00581 User Defined Access Checks

14 26 TS X [0..0] 00582 Date/Time of the Observation

15 250 CE X [0..0] 00583 Producer’s ID

16 250 XCN X [0..0] 00584 Responsible Observer

17 250 CE X [0..0] 00936 Observation Method

18 22 EI X [0..0] 01479 Equipment…