VA770-17-R-0423-008.pdf

Attachment 2:

Package Insert Printing Interface

Control Document

Version 1.0 ● February 15, 2017

Department of Veteran Affairs

VA CMOP

3480 East Britannia Drive, Suite 100

Tucson, AZ 85706

Tel: 520-295-3406

Package Insert Printing Interface Control Document

VA CMOP

Version: 1.1 Revision Date: August 22, 2010

Executive Sponsor

Bill Falbe

William.falbe@va.gov

615-225-4574

Signature Date

Technology Sponsor

Phil Burkhalter Phil.burkhalter@va.gov 520-295-3406

Project Manager

Mark Ivey Ricard.ivey@va.gov 615-225-5546

Security Officer

David Stratton David.stratton@va.gov 520-295-3458 mailto:William.falbe@va.gov mailto:Phil.burkhalter@va.gov mailto:Ricard.ivey@va.gov mailto:David.stratton@va.gov

Table of Contents 1 Introduction

1.1 Purpose

1.2 Scope

1.3 System Identification

2 Interface Definition

2.1 System Overview

2.2 Operations

2.3 Data Transfer

2.4 Transaction Types

2.5 Precedence and Criticality

2.6 Communications Methods

2.7 Performance Requirements

2.8 Security

3 Appendix A – TRN Message

3.1 FHS – File Header Segment – Required segment

3.2 BHS – Batch Header Segment – Required segment

3.3 ORC – Common Order Segment – Required segment

3.4 NTE|2 – Refill Instructions Text – Required segment

3.5 NTE|3 – Non Refill Instructions Text Segment– Required segment

3.6 NTE|4 – Co-pay Instructions Text Segment – Required segment

3.7 MSH – Message Header Segment – Required segment

3.8 PID – Patient Identification Segment – Required segment

3.9 NTE|8 – Additional Patient Street Address Information Segment – Optional segment

3.10 ZML – Multi-Rx Label Segment – Optional segment

3.11 ZSL – Suspense Label Segment – Optional segment

3.12 ORC – Common Order Segment – Required segment (HL7 2.3.1)

3.13 RXE – Pharmacy/Treatment Encoded Order Segment – Required segment

3.14 NTE|7 – Additional Medication Instructions Segment – Optional segment

3.15 ZR1 – Rx Order Additional Information Segment – Required segment

3.16 NTE|11– Special Medication Instructions Segment – Optional segment

3.17 BTS – Batch Trailer Segment – Required segment

3.18 Batch Transmission Acknowledgement/Non-Acknowledgement (.TAC)

3.19 MSA – Message Acknowledgement Segment – Required segment

3.20 CMOP Production Transmission Acknowledgment/Non Acknowledgement (.TAC)

3.21 9.8.1 MSH – Message Header Segment – Required segment

3.22 MSA – Message Acknowledgement Segment – Required segment

Document History Paper copies are valid only on the day they are printed. Contact the author if you are in any doubt about the accuracy of this document.

Revision History

Revision Number

Revision Date

Summary of Changes Author

1.1 9/29/2010

Deleted: 1.4 Operational Agreement, 2.2 Interface Overview,

2.6 Data Exchanges, 6.1 Data Structure, and 6.2 Data

Elements.

Added: Appendix A – TRN Messages

Reference Documents

Please see the following documents for more information:

Document Name Version Author

Distribution List

This document has been distributed to:

Name Position Company Action

Introduction

This interface control document describes the interface between a VA CMOP and an external manifesting and prescription document printing companies.

Purpose

This Interface Control Document (ICD) presents the software interface requirements between the VA CMOP System and an external contractor system. The purpose of the Interface Control Document is to specify interface requirements to be met by the participating systems. It describes the concept of operations for the interface, defines the message structure and protocols which govern the interchange of data, and identifies the communication paths along which the data is expected to flow.

Scope

This Interface Control Document specifies the interface(s) between the VA CMOP System and an external contractor system. Upon formal approval for each participating system, this ICD shall be incorporated into the requirements baseline for each system. This document provides details on the functional, performance, operational and design requirements for the interface between VA CMOP System and an external contractor system. This document describes the file parameters and record layouts for the data that the VA CMOP System and an external contractor system use. This data is used in conjunction with other datasets to create the VA CMOP datasets. It is intended for all parties requiring such information, including software developers, system designers and testers responsible for implementing the interface.

System Identification

This Interface Control Document describes the interface between VA CMOP System and an external contractor system.

The VA CMOP system collects and distributes data to authorized external vendors. In this interface, VA CMOP system provides real time data feed to the external vendor system. The external vendor system uses this data to print supporting Rx documentation, i.e.: refill order forms, non refill instruction sheets, Patient Medication Inserts, Med Guides, Change of Address forms, Co-Pay slips, medication warnings and other documents as required by the VA CMOP system.

The external vendor system will utilize the data to print the required documents and stuff them into the mail package.

Interface Definition

System Overview

This interface specification defines the connection, data transmission, data formats and processing rules between the VA CMOP system and a single external system in order to transmit the data needed to allow the external vendor to print patient prescription documents and insert them into the package’s outer pocket.

The network connection will be constant connection between the two systems. The VA will configure a network shared drive with folders that will contain the different folders and files used to transmit data between the two systems.

At a minimum the VA will create two primary folders named INBOX and OUTBOX. The INBOX folder will have three sub folders named DOWNLOADHISTORY, PROCESSINGINCOMPLETE, TEMP. The OUTBOX folder will have three sub folders named DOWNLOADHISTORY, PROCESSINGINCOMPLETE, TEMP.

The VA will place all files going to the external vendor’s system for processing in the root of the INBOX folder. As the external vendor system starts to process a file from the INBOX folder, it will move the file to the INBOX/TEMP folder for processing. If the external vendor system can’t complete processing the file, the external vendor system will leave the file in the TEMP folder. If the external vendor system can’t process the file or encounters an error in the file, the file will be moved to the INBOX/PROCESSINGINCOMPLETE folder. If the external vendor can process the file, it will move the file to the INBOX/DOWNLOADHISTORY folder.

The external vendor system will use the OUTBOX folder to place files for the VA CMOP system to process. As the VA system begins to process a file, it will move the file to the TEMP folder. At the completion of processing the file, it will be moved to the DOWNLOADHISTORY folder. If processing fails the file will remain in the TEMP folder. If an error is encountered while processing the file, it will be moved to the PROCESSINGINCOMPLETE folder.

VA will be responsible for monitoring the INBOX/TEMP, INBOX/PROCESSINGINCOMPLETE, OUTBOX/TEMP and the OUTBOX/PROCESSINGINCOMPLETE folders for problem files and resolving issues associated with these files. VA will also be responsible for archiving and deleting files in the INBOX/DOWNLOADHISTORY and the OUTBOX/DOWNLOADHISTORY folders.

The VA system is comprised of the CMOP manual packing operation and the CMOP database system. The CMOP manual packing operation will package the patient’s prescription order that will contain from one to many prescriptions and products. As the last prescription is scanned and placed in the package, the packing operator will be provided with a mailing label that has the patient’s mailing address and a CMOP generated package id.

Once the packaging operator seals the package closed and puts the mailing label on the package, they will scan the package id barcode. This completes the manual packaging operation. The scan of the package id barcode will trigger the CMOP Production system to create a folder with a title that matches the package id. Once the new folder has been created, the VA software will create up to three file types based on file extension. The file extension determines the data in the file and what documents print based on the data. The file with an extension of TRN will contain all the patient and medical center information necessary to create the patient refill, non-refill, co-pay and label warning documents for all prescriptions in the package. The file with the extension of PDF will contain the data needed to print the medication guides. There will be a PDF file for each prescription that has a required med guide document. Not all prescriptions require a med guide so this file type is optional. The files with an extension of PMI will contain the data needed to print the Patient Medication Inserts. Not all prescriptions require a PMI so this file is also optional based on the prescriptions contained in the package.

At the external vendor site, there will be a process that monitors for the files from the VA. The vendor will allow all files to age for at least two minutes before attempting to process the files. The vendor will utilize the files in the processing and packaging of the package. The vendor system will use the TRN file for data such as the Medical Center return address, phone number and billing codes. The TRN file will also contain all necessary data to print the patient refill, non-refill and Co-Pay documents. See Appendix A for the data segments, format and data definitions.

Operations

As each patient package is packed at the VA CMOP, the packing operator is required to scan all prescription packages unique barcode to verify all prescriptions placed into the package below to the patient order being processed at that time. As the last prescription label is scanned the packing operator is provided with a patient mailing label generated by the VA CMOP packing software. The patient mailing label has the medical center return address and the patient’s mailing address and a unique (in the VA CMOP system) package identification number

(package id) printed in barcode format. The package id is created by the VA CMOP system and is printed in barcode format 128. The packing operator is required to scan this barcode to complete the packing operation.

As the final package id scan is completed by the packing operator, the packing software will create a folder in a specific folder on the shared VA/Vendor server. The folder will be named the same as the VA package id. The packing software will create separate files in the folder that will contain the data needed for the external vendor to print the required supporting documentation. Each file will be identified by the package id and a file extension. The file extension will designate the type of data contained in the file. All files will be created in standard ASCII format.

The table below lists the file extensions and purpose of the file, system creator and system consumer of the file.

Extension Purpose Creator Consumer PMI Contains data needed to print the PMI VA CMOP Vendor MED Contains the data needed to print the Med Guides VA CMOP Vendor TRN Contains all the patient data needed to print the refill, non-refill, co-pay, change of address and warning label documents

VA CMOP Vendor

ACK Contains the acknowledgement for the TRN file Vendor VA CMOP

Data Transfer

The external vendor will be required to connect to the VA CMOP System via a VA provided site-to-site Virtual Private Network (VPN). In order to establish the VA VPN connection the vendor will be required to meet VA security and privacy regulations. See the VA Security and Privacy documents.

The Site-to-Site VPN provides a secure encrypted connection between the VA CMOP and the external vendor system. The VPN provides the ability to create file shares on servers in order to share files used to transfer data between the two systems.

VA will provide the secure server can control access to the server. VA will provide the required security policies and procedures on the shared server. VA will create two folders to be used to transfer data between to the two systems. A folder named INBOX will be used for the VA to store files containing information needed by the external vendor system in order to print and place in the patient package. A folder named OUTBOX will be used for the external vendor to store files with confirmation data and shipping data files for the VA CMOP System to use to update the VA database with the shipping tracking and costing information.

The receiving system will monitor the appropriate folder for receiving data files and as new files are added, will wait a minimum of two minutes to allow the file to complete building before accessing the file. When the receiving system is ready to consume the file, it will copy the original file to a backup folder for archiving and to a temporary processing folder. When the receiving system has consumed the data in the file, the file will be deleted from the temporary processing folder.

Transaction Types

There are five transaction types used by this interface. See the appropriate appendix for the transaction segments, segment formats and data definitions.

a. Patient and medical center data transaction messages

b. Acknowledgement messages

c. Patient Med Guide transactions messages

d. Patient Medication Insert transaction messages

Precedence and Criticality

Both the VA CMOP and Vendor’s systems will monitor for issues with processing of data. Issues will be reported via email to the VA CMOP Help Desk distribution group using the email address of VHANCMOPHelpDesk@va.gov. In addition the vendor will establish an email group to receive email notifications of problems detected. Both VA CMOP and the vendor will monitor for problems reported via email.

Communications Methods

Communications will be via a secure Site-to-Site connection that will provide dedicated, encrypted connectivity between the two systems. All data transferred between the two systems will be across this connection.

Problems detected either by the automated processes or a user will be reported to both the VA CMOP Help Desk and the Vendor’s help email groups.

Performance Requirements

Both systems will place files into the appropriate InBox or OutBox folder as the processing activity is completed.

Each system will monitor for files by extension type. As a message for a system is placed in the appropriate folder, the receiving system will allow the file to age for at least two minutes, but no more than five minutes to allow the file creation to complete. Acknowledgement messages will be generated by the receiving station as the file is consumed and the data committed to storage on the receiving system.

Security

This interface governs the transfer of data that is governed by HIPAA and Privacy Policy and Laws. Data is protected while in transit on the VA approved Site-to-Site VPN. Data governed by HIPAA and Privacy Laws and Policy must be transferred via the secure connection. If data must be transmitted via another protocol such as email, the emails and the data contained in the email and attachments must be encrypted using an approved VA PKI certificate. The VA will issue PKI certificates to the vendor for this purpose.

Security, privacy and HIPAA violations must be reported to the VA CMOP Security and Privacy offices when discovered.

mailto:VHANCMOPHelpDesk@va.gov

Appendix A – TRN Message

Data sent in the Transmission file are part of the permanent prescription dispensing record. The data elements will not be modified edit or deleted by the receiving station. The data may be supplemented with new data as necessary by the processing system. Only data that has been archived to permanent storage may be deleted by the processing system.

The following conventions are used in this message specification.

Braces, { . . . }, indicate one or more repetitions of the enclosed group of segments. (Of course, the group may contain only a single segment.)

Brackets, [ . . . ], show that the enclosed group of segments is optional. If a group of segments is optional and may repeat it should be enclosed in brackets and braces, { [ . . . ] }.

Note: [{...}] and {[...]} are equivalent.

FHS

BHS

ORC

{NTE|2}

{NTE|3}

{NTE|4}

{MSH

PID

[NTE|8]

{[ZML]}

{[ZSL]}

ORC

RXE

{[NTE|7]}

ZR1

[NTE|11]}

BTS

FTS

This group of segments can be repeated between the first ORC

This group of segments can be repeated between the first ORC

FHS – File Header Segment – Required segment

Field Name Seq# Len DT R/O Rep Tbl Desc File Field Separator 1 1 ST R N HL7 recommended field separator.

File Encoding Characters 2 4 ST R N HL7 recommended encoding characters.

File Sending Application 3 15 ST R N The name of the application creating the batch.

File Sending Facility 4 20 ST R N The name of the sending medical center.

File Receiving Facility 6 20 ST R N The name of the receiving station.

File Creation Date/Time 7 26 TS R N The date and time the batch was created on the sending station system.

File Control ID 11 20 ST R N This field will be the file name. The file name is the packageid number concatenated with the file extension.

EXAMPLE:

FHS|^~\&|CHCS|MEDICAL CENTER NAME||CMOP CHARLESTON|20010928120135||||573013240530.TRN

BHS – Batch Header Segment – Required segment

Batch Field Separator 1 1 ST R N HL7 recommended field separator.

Batch Encoding Characters 2 3 ST R N HL7 recommended encoding characters.

Batch Sending Application 3 15 ST R N The name of the application creating the batch.

Batch Receiving Application 5 15 ST R N The name of the sending medical center.

Batch Creation Date/Time 7 26 TS R N The date and time the batch was created on the sending station system.

Batch Name/ID/Type 9 20 ST O N RAR^RAR

Batch Comment 10 80 ST O N Controlled Substance Flag. This field will be set to CS for a Controlled substance transmission. It will be null if not a Controlled substance transmission.

Batch Control ID 11 20 ST R N This is the package id.

EXAMPLE:

Non Controlled Substance Transmission BHS|^~\&|Outside Agency Application Name||VA CMOP||20011109144013||RAR^RAR||573013240530

Controlled Substance Transmission BHS|^~\&|Outside Agency Application Name||VA CMOP||20011109144013||RAR^RAR|CS|573-013240530

ORC – Common Order Segment – Required segment

Field Name Seq# Len DT R/O Rep Qty Tbl Desc Order Control 1 2 ID R N 0119 This will always be a new order, NW

Order Facility Name 21 60 XON O Y This field will contain the pharmacy division name and unique pharmacy division number.

Ordering Facility Address 22 106 XAD O Y This field contains the return mailing address for the sending pharmacy division.

Ordering Facility Phone Number 23 48 XTN O Y This is the phone number for the sending pharmacy division.

EXAMPLE:

ORC|NW||||||||||||||||||||^^^^^^^573GG&INVERNESS CBOC&573|PO BOX 147038^^GAINESVILLE^FL^32614- 7038|(800) 349-9457

NTE|2 – Refill Instructions Text – Required segment

Set ID = 2 1 1 ST R N Set id for the segment

Refill Instructions Text 2 100 FT R

This is the standard free text refill instructions that will print for all refillable prescriptions in the patch. For backwards compatibility, this segment will always be present. If no data for the segment, the segment will be formatted with at least three spaces.

[NTE] The Set ID field will identify the NTE segment (2=Refill Instructions; 3=Non-refill Instructions Narrative; 4=Copayment Narrative). The Comment field will contain the respective information.

EXAMPLE:

NTE|2|Prescriptions (Rx’s) are NOT automatically NTE|2|refilled. To request refills:

NTE|2|

NTE|2|(1) Call our TOLL FREE # -> 1-888-820-0230.

NTE|2| Have your Social Security & Rx #’s ready

NTE|2| OR

NTE|2|(2) Sign and mail your refill request(s).

NTE|2| Use the return address label provided.

NTE|2|

NTE|2|Order your refills as soon as possible, AT NTE|2|LEAST 14 DAYS before you run out.

NTE|2|

NTE|2|ALL refills are MAILED. Please do NOT come NTE|2|to the clinic for Rx refills.

NTE|3 – Non Refill Instructions Text Segment– Required segment

Set ID = 3 1 1 ST R N Set id for the segment

Refill Instructions Text 2 100 FT R

This is the standard free text non-refillable instructions that will print for all non-refillable prescriptions in the batch For backwards compatibility, this segment will always be present.

If no data for the segment, the segment will be formatted with at least three spaces.

EXAMPLE:

NTE|3| ** If NO REFILLS remain OR your Rx has NTE|3| EXPIRED (too old) ** discuss this with NTE|3| your VA PROVIDER at your next appt.

NTE|3|

NTE|3| If you will run out of medicine BEFORE NTE|3| your next appt, call (941) 939-3939 to NTE|3| make or change an appt.

NTE|4 – Co-pay Instructions Text Segment – Required segment

Set ID = 4 1 1 ST R N Set id for the segment

Refill Instructions Text 2 100 FT R

This is the standard free text co-pay instructions that will print for all prescriptions in the batch that have a co-pay charge. For backwards compatibility, this segment will always be present. If no data for the segment, the segment will be formatted with at least three spaces.

EXAMPLE:

NTE|4| Questions about your bill? Please call NTE|4| 1-888-820-0230 Ext. 4004 (TOLL FREE)

MSH – Message Header Segment – Required segment

Field Separator 1 1 ST R N HL7 recommended field separator.

Encoding Characters 2 4 ST R N HL7 recommended encoding characters.

Sending Application 3 15 ST R N The name of the application creating the batch. In the VA this will always be ‘VistA’.

Receiving Application 5 30 ST R N This is the application receiving the data. Where VA is the Dispensing Agency it will be ‘VistA’.

Message Creation Date/Time 7 26 TS R N

Date and time the message was created on the sending Station system.

Message Type 9 7 C R N 0076 The type of message being sent. This will always be ‘ORM^O01’.

Message Control ID 10 20 ST R N

This is a number that uniquely identifies this message from all other messages. The format of the message number is station number-transmission number-order number.

Processing ID 11 1 ID R N 0103 This will always be a P.

Version ID 12 8 ID R N 0104 This will always be 2.3.1 Accept Ack Type 15 2 ID R N 0155 This will always be NE Application Ack Type 16 2 ID R N 0155 This will always be NE

[MSH-5] Receiving Application is the name of the dispensing application.

[MSH-10] Message Control ID is the number that uniquely identifies the message. It is returned in MSA-2.

EXAMPLE:

MSH|^~\&|SENDING AGENCY NAME||VistA||20010925202704||ORM^O01|573-013240530-

1794|P|2.3.1|||AL|AL

PID – Patient Identification Segment – Required segment

Field Name Seq# Len DT R/O Rep Qty Desc

Patient ID 3 20 C R N Patient SSN^Check Digit^Check Digit Scheme.

Check digit scheme will be M11. HL7 P 2-15

Patient Name 5 48 PN R N The name of the patient. Format will be ^LAST

NAME^FIRST NAME^MIDDLE

INITIAL^SUFFIX.

Patient Address 11 106 AD R Y 3 The patient’s mailing address. See HL7 specification, 3.3.2.11 for format.

Patient Phone Number 13 40 TN O N The patient’s contact phone number.

Primary Language 15 60 CE O N

Patient’s primary language field is used to determine the language used to print the patient PMIS. ISO Table 639 defines the language codes.

(Appendix C)

Patient Account Number 18 250 CX O N

This field contains the unique VA Internal Control Number (ICN) and checksum value. Format will be ICN^checksum. The Checksum is provided by the VistA system. Receiving station is not required to compute the checksum for validating the data.

[PID-3] This is the patient’s SSN, check digit and check digit scheme. Refer to HL7 Version 2.3.1 page 2-15.

[PID-15] Patient’s primary language field is used to determine the language used to print the patient PMI data, medication information, etc.

[PID-18] Patient Account Number field is used to uniquely identify the patient. The number is guaranteed to be unique across the VA system. A checksum value is provided with the field, the receiving station is not required to compute checksums on this data element. Nor will the checksum be stored within the receiving stations database.

EXAMPLE:

PID|||11111111111^1^M11||^MOUSE^MICKEY^^||||||100 MOUSE LANE^APT

#3^CHARLESTON^SC^29405||(843) 745-4124||ENG|||1234567^345

NTE|8 – Additional Patient Street Address Information Segment – Optional segment

This segment is multi-functional. It is used to carry additional street lines for the patient address if there are more than two street lines in the address. It is also used to indicate that the patient address is a temporary address. When used as a temporary address indicator, the expiration date will indicate when the address is due to expire. If the patient’s mailing label is scheduled to print after the expiration date, the entire patient order will be automatically cancelled back to the medical center with a cancel reason of ‘Temp Address Expired’.

The check for address expiration is to be made before the patient order is released to the system for processing. If the patient address will expire prior to the package being mailed, the entire patient order will be automatically cancelled back to the medical center. The cancel reason will be ‘ADD – Expired address correct & resubmit”

Field Name Seq# Len DT R/O Rep Qty Tbl Desc Set Id = 8 1 4 ST R N Temporary Address 2 1 NM R N 1 means this is a temporary addrss Temporary Until 3 8 DT R N Expiration Date. Format: YYYYMMDD

Additional Street Address 4 35 ST R 2 Additional Street Address. This field may Repeat twice.

Example of Patient Data with Temporary Address Information:

PID|||999999999^1^M11||STEELE^JAMES E.||||||107 OAK RD.^APT#3^LIMA^OH^48132 (or 48132-9999)

NTE|8|1\F\20041015\F\Street Address line 3\R\Street Address line 4\R\Street Address line 5

Example of Patient Data with NO Temporary Address Information:

PID|||999999999^1^M11||STEELE^JAMES E.||||||107 OAK RD.^APT#3^LIMA^OH^48132

NTE|8||\F\\F\Street Address line 3\R\Street Address line 4\R\Street Address line 5

ZML – Multi-Rx Label Segment – Optional segment

Drug Name 1 40 ST R N The free text drug name. (VA PRINT NAME) Number of Refills 2 3 NM R N Total number of remaining refills Expiration Date 3 26 TS R N Prescription expiration date.

Rx Number 4 20 ST R N This is the prescription number as assigned by the originating pharmacy.

Barcode

5 20 ST R N

This field is used by the VA pharmacy system to produce a barcode value that is recognized on the medical system.

This barcode is used to enter the next refill.

[ZML] This segment is repetitive. It repeats for all the drugs for the patient

ZML|FELODIPINE 10MG SA TAB|1|20011209|200002833|573-7291313

ZML|LEVOTHYROXINE NA (SYNTHROID) 0.1MG TAB|1|20011209|200012872|573-8048381

ZSL – Suspense Label Segment – Optional segment

Drug Name 1 40 ST R N The free text drug name. (VA PRINT NAME) Suspense Date 2 26 TS R N The date the fill is suspended for processing.

Rx Number 3 20 ST R N This is the prescription number as assigned by the originating pharmacy.

[ZSL] This segment is repetitive. It repeats for all suspended Rx’s for the patient.

ZSL|FELODIPINE 10MG SA TAB|20011209|200002833

ORC – Common Order Segment – Required segment (HL7 2.3.1)

Order Control 1 2 ID R N 0119 This will always be a new order. NW

Placer Order Number 2 75 CM R N This is the Rx Index. See Key Terms for the definition of the Rx Index.

Placer Group Number 4 22 EI R N

This field is two parts. The first part is the number of Rx’s in the patient order, the second number is the Sequence number of this Rx in the patient order.

Example: this patient order has five Rx’s in it, this Rx is the second Rx in the order so this field will be 5^2.

Quantity Timing 7 200 TQ R N This field contains duration of the fill.

Start date of the fill End date of the fill = Start date + days supply

Entered By 10 80 XCN R N The entering clerks id number.

Ordering Provider 12 80 XCN R N The name of the ordering provider.

Order Effective Date 15 26 TS R N The effective date of the order.

ORC|NW|573-200002833F-4||5^2|||^^^20010925^20011224|||10111||^STEPHENS^ REBECCA^S|||20001227

RXE – Pharmacy/Treatment Encoded Order Segment – Required segment

Quantity/Timing 1 200 TQ R N Quantity Requested

Give Code 2 100 CE R N 0292 This is a composite field that contains the unique VA product ID^VA Print Name^L

Give Amount – Minimum 3 20 NM R N Quantity Requested

Give Units 5 60 CE R N

This field contains the units for the Give Amount as encoded by the pharmacy or treatment application. Example: TAB, CAP, GM, OZ etc.

Provider’s Administration Instructions

7 200 CE R N

This field will contain the first 80 characters of the provider’s instructions (SIG)

Number of Refills 12 60 NM R N This field contains the total original number of refills.

Pharmacist Verifier ID 14 20 ST R N

This is the pharmacist’s id number on the sending station system. For the VA it will be the pharmacist’s Local ID (DUZ) number.

Prescription Number 15 20 ST R N

This is the Rx Index number as assigned by the originating pharmacy. This number has to match the Placer Order Number field on the preceding ORC Segment.

Number of Refills Remaining 16 20 NM R N Number of refills remaining for this prescription.

D/T of Most Recent Refill 18 26 TS R N Date of the most recent fill dispensed.

EXAMPLE:

RXE|45|L0139^LEVOTHYROXINE NA (SYNTHROID) 0.1MG TAB^L|45||TAB||^TAKE 1 TABLET(S) BY

MOUTH EVERY MORNING |||||0||10111|200012872|0||20010925

ADDITIONAL FIELD NOTES:

[RXE-1] Quantity Requested [RXE-2] Give Code identifies the substance ordered as encoded by the Pharmacy. The components, in order, are the VA Product ID, VA Product Name.

[RXE-3] Give Amount - Minimum is a required field but it will not be used in OP Version 2.0. It will always be a null value (“”).

[RXE-5] Give Units identifies the units for the give amount as encoded by the VA National Drug File.

[RXE-7] Providers Administration Instructions (SIG). This field is limited to 80 characters. Only the second component of this field is used.

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)> Definition: This field contains the ordering provider’s instructions to the patient or the provider administering he drug or treatment. If coded, a user-defined table must be used; if free text (describing a custom V, mixture, or salve, for example), place the text in the second component, e.g., |^this is a free text administration instruction|.

[RXE-12] Number of Refills - Definition: This field contains the total original number of refills. Outpatient only.

[RXE-14] Pharmacist Verifier ID identifies the pharmacist who verified the order. The first component is the DFN pointer in the NEW PERSON file (#200) of VISTA and the second component is the name.

[RXE-15] Prescription Number is the external Outpatient prescription number.

[RXE-16] Number of Refills Remaining - Definition: Number of refills remaining. This field is conditional because it is required when a prescription is dispensed to an outpatient. It is not relevant to inpatient treatment orders.

[RXE-18] D/T of Last Refill identifies the last date the patient received this particular drug (i.e., Last Dispense Date).

NTE|7 – Additional Medication Instructions Segment – Optional segment

Set ID = 7 1 4 ST R N

Rx Number 2 20 FT R N

This is the Rx Number of the prescription for this NTE|7 segment.

This field is used to match the correct NTE|7 segment to the correct prescription.

Language Flag 3 2 ST R N

This flag indicates the primary language of the patient. All printed documentation sent to the patient will be printed in this language. All SIG text will be displayed to the verifying Pharmacist in English on the Pharmacy Verification screens.

ISO Table 639 will be used for the language code/flag. (Appendix C contains ISO Table 639)

Segment Sequence Number 4 2 NT R N This is the segment sequence number. It is used to insure the text is printed in the correct sequence.

Patient Medication Instructions 5 100 FT R N This is field is limited to 100 characters.

ADDITIONAL FIELD NOTES:

The NTE|7 segment carries SIG information when the RXE-7 field exceeds 80 characters. The NTE|7 segment may repeat as many times as necessary to complete the SIG. If the patient’s primary language flag is not English, both the primary language and the English version of the SIG will be transmitted with the patient data. The SIG will be sent in English first and then in the primary language.

The segment sequence number is used to determine the sequence of the NTE|7 segments and not the SIG continuations. The first NTE|7 segment will always be number 1 for each language. If the patient has a primary language other than English, the NTE|7 segments will always be ordered so that the English version is sent first then the primary language.

The patient’s primary language code will be used to print the SIG and warning labels on the patient documentation. These data elements will display in English on the pharmacy verification screens at the time of verification or review of these data elements in other electronic processes.

In the example the RXE segment is added for continuity purposes.

EXAMPLE:

RXE|0-400797-1|||||||||||30||^^L|||||11|20040413|11|||20050414|20040413|400797||||TAKE 2 TABLET(S) BY

MOUTH EVERY DAY FOR 7 DAYS, THEN TAKE 3 TABLET(S) EVERY DAY

NTE|7|400797|ENG|1|THEN TAKE 1 TABLET TWICE A DAY FOR 3 DAYS, THEN TAKE 2

TABLET(S) FOR PAIN

NTE|7|400797|SPA|1|TOMAR DOS TABLETA(S) POR BOCA DIARIAMENTE POR 7 DIAS, LUEGO

TOMAR TRE

NTE|7|400797|SPA|2|TABLETA(S) DIARIAMENTE LUEGO TOMAR UNO TABLETA TWICE A

DAY POR 3 DIAS, LUEGO

NTE|7|400797|SPA|3|TOMAR QD PARA DOLOR

ZR1 – Rx Order Additional Information Segment – Required segment

Rx Number 1 20 ST R N

This is the Rx Index number as assigned by the originating pharmacy. This number has to match the Prescription Number field on the preceding RXE segment.

Rx Patient Status 2 20 CE R N The patient’s status.

Renewable 3 1 ST O N

A flag indicating whether this prescription is renewable. A 1 in this field indicates that the prescription is renewable. Null means the prescription is not renewable.

Copayment 4 1 ST O N

A flag indicating whether this patient will be charged a co-pay for this prescription.

A 1 means a co-pay charge is due. Null means no co-pay charge is due.

Safety Cap 5 1 ST O N A flag to indicate the patient’s preference for a safety cap. A 1 will indicate safety cap, null will be no safety cap.

Refill Text 6 8 ST R N This is the free text. It will be formatted as refill number of maximum refills.

Example: (1of10)

Clinic 7 40 ST R N The free text name of the clinic where the prescription originated. (DoD Group Pharmacy)

Days Supply 8 3 NM R N The days supply for the prescription.

Rx Barcode Value 9 20 ST R N

This field is used by the VA pharmacy system to produce a barcode value that is recognized on the medical system. This barcode is used to enter the next refill.

Barcode Data—Institution ID—Internal entry number from prescription file. (DoD

– Letters RX then number “RX12345”.

Drug Warning 10 35 ST O R 5 APP B

This field contains the record number of the corresponding drug warning from the VADrug Warning table. See Appendix B for a list of these warnings.

Mail Flag 11 2 ST O N 0 = Regular Mail, 1 = Registered mail.

Other codes may be added at a future date.

Rx Expiration Date 12 26 TS R N The date the prescription expires.

PMIS Data 13 10 ST O N

This is the record number for the PMI sheet that will print with the prescription.

This data element is used to reference the correct PMI data record from the First Data Bank tables.

PMI Print Flag 14 1 NM O N

This flag is used to determine if the PMI sheet should be printed. If the flag is set to 1, the PMI will print.

Print Refill Slip 15 1 NM O N

This flag is used to determine if a refill slip is printed and mailed. If the flag is set to 1, the refill slip is not printed. If the flag is null or zero, the refill slip will be printed and mailed.

Contract Product Price 16 9 NM O N This is the VA contract price per dispense unit for the product requested. This field is only used by the VA CMOP when sending data to an external Direct to Patient Vendor. This value will not be used when sending data from the CMOP CDB to the CMOP Production systems.

Contract Number 17 20 ST O N

This is the VA contract number for the item from the VA NAC or VA PBM database. This field is only used by the VA CMOP when sending data to an external Direct to Patient Vendor. This value will not be used when sending data from the CMOP CDB to the CMOP Production systems.

Contract Item Number 18 20 ST O N

This is the Item number from the Contract.

This field is required when sending orders to a VA CMOP Direct to Patient Vendor for filling and processing. This field is only used by the VA CMOP when sending data to an external Direct to Patient Vendor. This value will not be used when sending data from the CMOP CDB to the CMOP Production systems.

Vendor SKU 19 10 ST O N

This is the DTP SKU for the item. This field is only used by the VA CMOP when sending data to an external Direct to Patient Vendor. This value will not be used when sending data from the CMOP CDB to the CMOP Production systems.

Billing CMOP 20 5 ST O N

This is the CMOP Station Number. This field is used for billing back to the appropriate CMOP. This field is only used by the VA CMOP when sending data to an external Direct to Patient Vendor. This value will not be used when sending data from the CMOP CDB to the CMOP Production systems.

EXAMPLE:

ZR1|200012872|ONSC|1|1|0|(1of1)|INVERNESS/PC,LAB|45|573- 8048381|1~2~3||20020101|15.02|1234512|N123P45|X12345X123

The drug warning data element on the ZR1 segment is being phased out by the VA. The VA is moving to using industry standard drug warning labels. During the phase out period, drug warnings will be received in this data element or on the NTE|11 segment described below. Software that utilizes the drug warnings must be capable of pulling the data from either field. If the NTE|11 segment is received and there is data on the ZR1 segment in the drug warning field, the data from the NTE|11 segment will be used.

NTE|11– Special Medication Instructions Segment – Optional segment

The NTE|11 segment carries special medication information as entered by the medical center. If he language flag is set to a language other than English, the NTE|11 segments will transmit in both languages. The primary language will be used for printing on the documentation that is sent to the patient. If the primary language is not English, the English version of the warning labels will be displayed on the pharmacist’s verification screens during the verification process. The English version of the warnings will always be transmitted first. A maximum of five warnings will be transmitted for a prescription. The sequence the warnings are received is based on the warning labels priority.

Set ID = 11 1 4 ST R N

Rx Number 2 20 FT R N This is the prescription number. This number must match the data in the ZR1 segment, sequence number 1 Field.

Language Flag 3 2 ST R N

This field indicates the language for printing the warnings ISO Table 639 is used for the language codes.

(Appendix C)

Record Number 4 10 ST R N This is the record number from the tables. When using First Data Bank, this number is the record number for the warning in their tables.

Patient Medication Instructions 5 160 FT R N This is field is limited to 165 characters.

EXAMPLE: (this example is for a patient whose primary language is Spanish.)

NTE|11|300551A|ENG|11N|Avoid prolonged or excessive exposure to direct and/or artificial sunlight while taking this medication.

NTE|11|300551A|ENG|13N|It is very important that you take or use this exactly as directed. Do not skip doses or discontinue unless directed by your doctor.

NTE|11|300551A|ENG|7|It may be advisable to drink a full glass of orange juice or eat a banana daily while on this medication NTE|11|300551A|ENG|9N|Some non-prescription drugs may aggravate your condition. Read all labels carefully. If a warning appears, check with your doctor.

NTE|11|300551A|ENG|94N|Herbal/dietary supplement products may interact with this medication. Discuss any such product with your doctor or pharmacist before taking.

NTE|11|300551A|SPA|11N|Evite exponerse excesivamente o por per¡odos prolongados a los rayos solares directos y/o artificiales mientras tome este medicamento.

NTE|11|300551A|SPA|13N|Es muy importante que lo tome o lo use exactamente seg£n las indicaciones. No omita ninguna dosis ni lo deje de usar a menos que lo mande el mdico.

NTE|11|300551A|SPA|9N|Algunos medicamentos sin receta mdica pueden agravar su afecci¢n. Lea todas las etiquetas con cuidado. Consulte a su mdico si se incluye alguna advertencia.

NTE|11|300551A|SPA|94N|Los productos o suplementos herbarios/dietticos pueden interaccionar con este medicamento. Antes de tomar tales productos, cons£ltelo a su mdico o farmacutico.

Continuation segment (NTE|11A) – Optional segment.

This segment is required if the warning label length exceeds 220 characters. This new segment is used to transmit the additional text to complete the warning label. If this segment is needed, it will follow the NTE|11 segment used to transmit the first 220 characters of the warning text.

Set ID = 11A 1 4 ST R N

Rx Index 2 20 FT R N This is the RX Index. This number must. Match the data in the NTE|11 segment, sequence number 2 Field.

Language Flag 3 2 ST R N This field indicates the language for printing the warnings ISO Table 639 is used for the language codes. (Appendix C)

Record Number 4 10 ST R N This is the record number from the tables. When using First Data Bank, this number is the record number for the warning in their tables.

Patient Medication Warning Instructions (con’t)

5 220 FT R N This is field is limited to 220 characters.

When the continuation segment is needed it will follow the NTE|11 segment with the first part of the warning label.

BTS – Batch Trailer Segment – Required segment

Field Name Seq# Len D T R/O Rep Qty Tbl Desc

Batch Message Count 1 10 ST R N This is the number of patient order messages in the batch.

Batch Comment 2 80 ST O N This field is not used now.

Batch Totals 3 20 ST R N This field will contain the number of Rx’s in the batch.

EXAMPLE:

BTS|50||77

FTS – File Trailer Segment – Required segment Field Name Seq# Len DT R/O Rep Qty Tbl Desc

File Batch Count 1 10 NM R N This is the number of batches in the file. A file can contain from one to many batches.

File Trailer Comments 2 80 ST O N

This field will contain the free text reason the file was rejected by the receiving station. The sending station will not use this field.

FTS|1

Batch Transmission Acknowledgement/Non-Acknowledgement (.TAC)

MSH

MSA

MSH – Message Header Segment – Required segment Field Name Seq# Len DT R/O Rep Qty Tbl Desc

Field Separator 1 1 ST R N HL7 recommended field separator.

Encoding Characters 2 4 ST R N HL7 recommended encoding characters.

Sending Application 3 15 ST R N

The name of the application creating the batch.

Within the VA this will always be VistA. Outside Agencies will use the medical center name of origin.

Receiving Application 5 30 ST R N This is the application receiving the data.

Message Creation Date/Time 7 26 TS R N Date and time the message was created on the sending station’s system.

Message Type 9 7 C R N 0076 The type of message being sent. This will always be ORR^O02.

Message Control ID 10 20 ST R N

This is a number that uniquely identifies this message from all other messages. The format of the message number is station number-transmission date/time.

Same value as [BHS-11].

Processing ID 11 1 ID R N 0103 This will always be P.

Version ID 12 8 ID R N 0104 This will be 2.3.1 Accept Ack Type 15 2 ID R N 0155 This will always be NE for this MSH segment.

Application Ack Type 16 2 ID R N 0155 This will always be NE for this MSH segment.

MSH|^~\&|VistA||CHCS||20010925202704||ORR^O02|573-013240530|P|2.3.1|||NE|NE

MSA – Message Acknowledgement Segment – Required segment

Field Name Seq# Len DT R/O Qty Tbl Item# Desc Acknowledgement Code 1 2 ID R 0008 00018 Acknowledgement Code

Message Control ID 2 20 ST R This is the Station Number and transmission date/time.

Text Message 3 80 ST O

This field will contain the reject reason code, the order sequence number, and Rx sequence number for any errors detected. Format will be Reason Code~Order Sequence Number~Rx Sequence Number. Field may repeat.

Batch Reject Reason Code Table

REASON CODE REASON TEXT SEGMENT-SEQUENCE

1 File Field Separator FHS-1 2 File Encoding Characters FHS-2 3 File Sending Application FHS-3 4 File Sending Facility FHS-4 5 File Receiving Facility FHS-6 6 File Creation Date/Time FHS-7 7 File Control ID FHS-11 8 Batch Field Separator BHS-1 9 Batch Encoding Characters BHS-2

10 Batch Sending Application BHS-3 11 Batch Receiving Application BHS-5 12 Batch Creation Date/Time BHS-7 13 Batch Name/ID/Type BHS-9 14 Batch Control ID BHS-11 15 Order Control ORC-2 16 Order Facility Name ORC-21 17 Ordering Facility Address ORC-22 18 Ordering Facility Phone Number ORC-23

19 REFILL INSTRUCTIONS NTE|2

20 NON REFILL INSTRUCTIONS NTE|3

21 COPAY INSTRUCTIONS NTE|4

22 Message Control ID MSH for each order MSH-10 23 Patient ID PID-3 24 Patient Name PID-5 25 Patient Address PID-11 26 Patient Phone Number PID-13 27 Order Control ORC-1 28 Placer Order Number ORC-2 29 Placer Group Number ORC-4 30 Quantity Timing ORC-7 31 Entered By ORC-10 32 Ordering Provider ORC-12 33 Order Effective Date ORC-15 34 Quantity/Timing RXE-1

Batch Reject Reason Code Table

REASON CODE REASON TEXT SEGMENT-SEQUENCE

35 Give Code RXE-2 36 Give Amount – Minimum RXE-3 37 Give Units RXE-5 38 Provider’s Administration Instructions RXE-7 39 Number of Refills RXE-12 40 Pharmacist Verifier ID RXE-14 41 Prescription Number RXE-15 42 Number of Refills Remaining RXE-16 43 D/T of Most Recent Refill RXE-18 44 Rx Number ZR1-1 45 Rx Patient Status ZR1-2 46 Renewable ZR1-3 47 Copayment ZR1-4 48 Safety Cap ZR1-5 49 Refill Text ZR1-6 50 Clinic ZR1-7 51 Days Supply ZR1-8 52 Rx Barcode Value ZR1-9 53 Drug Warning ZR1-10 54 Mail Flag ZR1-11 55 Rx Expiration Date ZR1-12 56 Batch Message Count BTS-1 57 Batch Comment BTS-2 58 Batch Totals BTS-3 59 File Batch Count FTS-1 60 File Trailer Comments FTS-2 61 Control Substance Flag ZR1-21

EXAMPLES:

Transmission Acceptance:

MSA|CA|573-013240530

Transmission Reject:

MSA|CR|573-013240530|51~1~3^54~3~1

CMOP Production Transmission Acknowledgment/Non Acknowledgement (.TAC)

MSH

MSA

After the Central Database system receives the TAC file from the local production systems, the Central Database will be update according to the status in the TAC file and will send a second acknowledgment/ non-acknowledgment sequence to the VA VistA system.

9.8.1 MSH – Message Header Segment – Required segment

Field Separator 1 1 ST R N HL7 recommended field separator.

Encoding Characters 2 4 ST R N HL7 recommended encoding characters.

Sending Application 3 15 ST R N The name of the application creating the batch. Within the VA this will always be VistA. Outside Agencies will use the medical center name of origin.

Receiving Application 5 30 ST R N This is the application receiving the data.

Message Creation Date/Time 7 26 TS R N Date and time the message was created on the sending station’s system.

Message Type 9 7 C R N 0076 The type of message being sent. This will always be

ORR^O01.

Message Control ID 10 20 ST R N

This is a number that uniquely identifies this message from all other messages. The format of the message number is station number-transmission date/time.

Same value as [BHS-11].

Processing ID 11 1 ID R N 0103 This will always be P.

Version ID 12 8 ID R N 0104 This will be 2.3.1 Accept Ack Type 15 2 ID R N 0155 This will always be NE for this MSH segment.

Application Ack Type 16 2 ID R N 0155 This will always be NE for this MSH segment.

MSH|^~\&|VistA||CHCS||20010925202704||ORR^O02|573-013240530|P|2.3.1|||NE|NE

MSA – Message Acknowledgement Segment – Required segment

Field Name Seq# Len DT R/O Qty Tbl Item# Desc Acknowledgement Code 1 2 ID R 0008 00018 Acknowledgement Code

Message Control ID 2 20 ST R This is the Station Number and transmission date/time.

Text Message 3 80 ST O

This field will contain the reject reason code, the order sequence number, and Rx sequence number for any errors detected.

Format will be Reason Code~Order Sequence Number~Rx Sequence Number.

Field may repeat. (see Batch Reject Reason Code Table in section 9.7)

EXAMPLES:

Transmission Acceptance:

MSA|CA|573-013240530

Transmission Reject:

MSA|CR|573-013240530|51~1~3^54~3~1

MID-SOUTH CMOP File Types

The MID-SOUTH CMOP uses various file types with the contractor in accomplishing the transfer of data to provide the services necessary for Manifesting and printing Document Sets for parcels.

MID-SOUTH CMOP’s will transmit the following file types: MMR, MRF, and MMC:

In order to print the Document Set, and/or Medication Guides, MID-SOUTH CMOP will transmit to the contractor a file in HL7 format listed in the CMOP Outsource Interface EDI Document (see Attachment) at various intervals.

This format may have more than one extension, however currently the extensions are “.TRN” or “.PMI” The contractor will use this file to pull the necessary information to extract data from the National Data Bank database stored on the vendors system to print refill documents and other patient information needed in the Document Set.

The contractor will also extract the product code from this file in order to print the required Medication Guides if needed with the Document Set.

At periodic intervals, the MID-SOUTH CMOP will transmit an Order File with a MMR extension. This file contains the elements listed below and may be modified to meet the Contractor and/or MID-SOUTH CMOP’s data needs, if agreed upon by both parties. This file contains information about each parcel sent to the contractor. MID- SOUTH CMOP will also transmit this same type of file for controlled parcels delivered to the contractor in a lock BMC. The Control file will have a “c” at the beginning of the file name. Both control and non-control files will then have a datetime stamp as the file name with a MMR extension. (ie. C20080930233000.MMR or 20080930233000.MMR ).