MADSEN OTObase HL7 Integration Reference Guide V1.0 Jan 2013

Reference Guide

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OTObase HL7 Integration Reference Guide 28-Jan-2013 V1.0

Decos Software development, December 2009

Document History Doc. version 1.0

Last updated 28-01-2013

Who Ramashankar

Sections updated ALL

Remarks -

Contents 1.

HL7 General Overview ... 4

OTObase EMR Connector for HL7 Interface ... 4

Supported HL7 Messages Types ... 5

3.1

ORM (Observation/Order Request Order Message) ... 5

3.1.1

Placing new Order request ... 5

3.1.1.1

Message Header (MSH) Segment ... 5

3.1.1.2

Patient Identification (PID) Segment... 6

3.1.1.3

Common Order (ORC) Segment ... 7

3.1.1.4

Observation Request (OBR) Segment ... 8

3.1.1.5

Example of ORM Message for new Order request ... 9

3.1.2

Opening Existing Order ... 9

3.1.2.1

Example of ORM Message for opening existing Order ... 9

3.2

ACK (Acknowledgements) message for ORM ... 10

3.2.1

Message Header (MSH) Segment ... 10

3.2.2

Message Acknowledgement (MSA) Segment ... 10

3.2.3

Example of ACK Message for Success ... 11

3.2.4

Example of ACK Message for Failure ... 11

3.3

QRY_A19 (Patient Query Request Message) ... 11

3.3.1

Message Header (MSH) Segment ... 11

3.3.2

Query Definition (QRD) Segment ... 12

3.3.3

Example of QRY_A19 Message ... 12

3.4

ADR_A19 (Patient Query Response Message)... 12

3.4.1

Message Header (MSH) Segment ... 13

3.4.2

Message Acknowledgement (MSA) Segment ... 13

3.4.3

Query Definition (QRD) Segment ... 14

3.4.4

Patient Identification (PID) Segment ... 14

3.4.5

Patient Visit (PV1) Segment ... 15

3.4.6

Example of ADR_A19 Message when Patient found ... 17

3.4.7

3.5

ORU (Observation Result Unsolicited) Message... 17

3.5.1

Message Header (MSH) Segment ... 17

3.5.2

Common Order (ORC) Segment ... 18

3.5.3

Observation Request (OBR) Segment ... 19

3.5.4

Observation Result (OBX) Segment ... 20

3.5.5

Example of ORU Message ... 21

3.6

ACK (Acknowledgements) message for ORU ... 21

3.6.1

Message Header (MSH) Segment ... 21

3.6.2

Message Acknowledgement (MSA) Segment ... 22

3.6.3

Example of ACK Message for success ... 22

3.6.4

Example of ACK Message for failure... 22

Communication Protocol ... 23

1. HL7 General Overview The HL7 (Health Level Seven) standard was developed by a community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. The HL7 refers to the highest level of the international Standards Organization’s (ISO) communication model for Open System Interconnection (OSI). The application level addresses the data definition to be exchanged, the interchange timing, and the communication of certain error to the application. The seventh level supports such functions as security checks, participant identification, availability checks, exchange mechanism negotiations and most importantly support standard for exchange of data among healthcare applications.

2. OTObase EMR Connector for HL7 Interface The OTObase EMR connector for HL7 Interface provides standard messaging format for transferring information from system to system. OTObase EMR Connector provides a workflow to interchange the electronic data of patient such as demographic data and audiology measurement report. The following response paradigms relate to the communication between EMR System and the OTObase HL7 interface.

•

ORM (Observation/Order Request Message) messages are sent by the EMR system to OTObase while ORU (Observation Result Message) messages containing the finished transcriptions are sent back to the EMR system by OTObase. OTObase will send the QRY (Patient Query Message) messages to the EMR System and EMR System will send ADR (Patient Query Response Message) message to the OTObase. OTObase will send the ACK (Acknowledgment Message) to the EMR System as a reply of ORM message. EMR message should send the ACK message to the OTObase as a © 2013 Otometrics

reply of ORU message. Patient Query message send by OTObase should be replied by EMR System via ADR message only.

3. Supported HL7 Messages Types The below tables defines the color codes for HL7 message field’s usage i.e. Required, Optional or Unused: Sr. 1 2 3

Use Identifier O R U

Description Optional Required Unused

The Following are the HL7 messages types supported by OTObase EMR Connector for HL7 Interface: 3.1

ORM (Observation/Order Request Order Message) The function of this message is to initiate the transmission of information about an order/observation. This includes placing new observation request and opening existing order details. 3.1.1 Placing new Order request The HL7 Order message (ORM) should contain the following information in order to place new observation/order request in OTObase. 3.1.1.1 Pos 1 2

3 4 5 6 7 8 9

Message Header (MSH) Segment Element Field Separator Encoding Characters 1. Component 2. Repeat 3. Escape 4. Subcomponent Sending Application Name Sending Facility Name Receiving Application Receiving Facility Date and Time of Message Security Message Type 1. Message Type 2. Trigger Event Message Control Identifier

Use R R

R R R R R U R

Example Pipe symbol - | ^~& ^ ~

Processing ID

12 13

HL7 Version Sequence Number

R U

Continuation Pointer

Accept Acknowledgement Type

Application Acknowledgement Type

Country Code

Character Set

Principle Language of Message

3.1.1.2 Pos 1 2 3 4 5

6 7

Patient Identification (PID) Segment Element Set ID Patient ID – External ID Patient ID – Internal ID Alternate Patient ID Patient Name 1. Last Name 2. First Name 3. Middle Initial 4. Suffix 5. Prefix Mother’s Maiden Name Date and Time of Birth

Use U O R U R

P = Production T = Training D= Debugging 2.4,2.5,2.6,2.7. A non-null value in this field implies that The sequence number protocol is in use. This numeric field is incremented by one For each subsequent value. This field is used to define continuations in application-specific ways. AL = Always NE = Never ER = Erroneous conditions SU = Successfully completion AL = Always NE = Never ER = Erroneous conditions SU = Successfully completion ISO 3166 provides a list of country codes Alternate character sets not used. ISO 639 provides a list of codes

Example

00004

Fischer Martin

Mr. U R

8 9

10 11

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 3.1.1.3 Pos 1 2 3 4 5 6 7 8

Sex Patient Alias 1. Last Name 2. First Name 3. Middle Initial 4. Suffix 5. Prefix Race Patient Address 1. Street Or Mailing Address 2. Other destination 3. City 4. State 5. Postal Code 6. Country County Code Phone Number – Home Phone Number – Business Primary Language Marital Status Religion Patient Account Number Social Security Number Driver’s License Number Mother’s Identifier Ethnic Group Birth Place Multiple Birth Indicator Birth Order Citizenship Veteran’s Military Status Nationality Patient Death and Time Patient Death Indicator Common Order (ORC) Segment Element Order Control Placer Order Number Filler Order Number Placer Group Number Order Status Response Flag Quantity/Timing Parent

R U

U R 123 West St. Denver CO 80020 USA U R R O O O O O U U U U U U U U U U U

Use O O U U U U U U

01-22010-4520 01-22011-4520

Example NW 3071014

9 10 11 12 13 14 15 16 17 18 19 3.1.1.4 Pos 1 2 3

4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Date and Time of Transaction Entered By Verified By Ordering Provider Enterer’s Location Callback Phone Number Order Effective Date and Time Order Control Code Reason Entering Organization Entering Device Action By

U U U U U U U U U U U

Observation Request (OBR) Segment Element Set ID Placer Order Number Filler Order Number

Use O R R

Universal Service Identifier Priority Requested Date and Time Observation Date and Time Observation End Date and Time Collection Volume Collector Identifier Specimen Action Code Danger Code Relevant Clinical Information Specimen Received Date and Time Specimen Source Ordering Provider Order Callback Phone Number Placer Field 1 Placer Field 2 Filler Field 1 Filler Field 2 Results Report/Status Change Date and Time Charge to Practice Diagnostic Service Section ID

Example 1 20060307110 0109 Note: value of this filed will be used in case of request is being sent to open exiting order/observation details.

25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43

Result Status Parent Result Quantity / Timing Result Copies to Parent Transportation Mode Reason for Study Principal Result Interpreter Assistant Result Interpreter Technician Transcriptionist Scheduled Date and Time Number of Sample Containers Transport Logistics of Collected Samples Collector’s Comment Transport Arrangement Responsibility Transport Arranged Escort Required Planned Patient Transport Comment

U U U U U U U U U U U U U U U U U U U

3.1.1.5 Example of ORM Message for new Order request The following is an example ORM message MSH|^~&|EMR|EMR|OTObase| OTObase |20060307110114| |ORM^O01| ORM20130125110113 |P|2.7 PID|||00004||Fischer^Martin^^^Mr.||19670824|M|||123 West St. ^^Denver ^CO ^80020 ^USA||||||| PV1||O|OP^PAREG^||||2342^Jones^Bob|||OP|||||||||2|||||||||||||||||||||||||20060307110111| ORC|NW|20060307110114 OBR|1|20060307110114||003038^Urinalysis^L|||20060307110114

3.1.2 Opening Existing Order The HL7 Order message (ORM) should contain the all information same as Placing new Order request (see section 3.1.1 Placing new Order request) along with the Filler Id in the OBR segment (see section 3.1.1.4 Observation Request Segment position 3). 3.1.2.1 Example of ORM Message for opening existing Order The following is an example ORM message MSH|^~&|EMR|EMR|OTObase| OTObase |20060307110114||ORM^O01| ORM20130125110114 |P|2.7 PID|||00004||Fischer^Martin^^^Mr.||19670824|M|||123 West St. ^^Denver ^CO ^80020 ^USA||||||| PV1||O|OP^PAREG^||||2342^Jones^Bob|||OP|||||||||2|||||||||||||||||||||||||20060307110111| ORC|NW|20060307110114 OBR|1|20060307110114|1009|003038^Urinalysis^L|||20060307110114 © 2013 Otometrics

3.2 ACK (Acknowledgements) message for ORM OTObase sends acknowledgement (ACK) messages to all ORM messages. The structure of the ACK is as follows: 3.2.1 Message Header (MSH) Segment Pos Element 1 Field Separator 2 Encoding Characters 1. Component 2. Repeat 3. Escape 4. Subcomponent 3 Sending Application Name

Use R R

Sending Facility Name

Receiving Application

Receiving Facility

Date and Time of Message

8 9 10 11

Security Message Type Message Control Identifier Processing ID

U R R O

12 13 14 15 16

HL7 Version Sequence Number Continuation Pointer Accept Acknowledgement Type Application Acknowledgement Type Country Code Character Set Principle Language of Message

R U U U U

17 18 19

Message Control ID Text Message

configuration) OTObase (User defined during configuration) EMR System (User defined during configuration) EMR System (User defined during configuration)

YYYYMMDDhhmmss 20130125052045 ACK ORM20130125052045 P = Production T = Training D= Debugging 2.4,2.5,2.6,2.7.

U U U

3.2.2 Message Acknowledgement (MSA) Segment Pos Element Use 1 Acknowledgement Code R

2 3

Example Pipe symbol - | ^~& ^ ~

& OTObase (User defined during

R O

4 5 6

Expected Sequence Number Delayed Acknowledgement Type Error Condition

U U O

3.2.3 Example of ACK Message for Success The following is an example of success ACK message. MSH|^~&|OTObase | OTObase| EMR | EMR | 20130128012045||ACK| ORM20130125110114 |P|2.7 MSA|AA| ORM20130125110114|Success||||

3.2.4 Example of ACK Message for Failure The following is an example of failure ACK message. MSH|^~&|OTObase | OTObase| EMR | EMR | 20130128012045||ACK| ORM20130125110114 |P|2.7 MSA|AE| ORM20130125110114|Failure||||

3.3

QRY_A19 (Patient Query Request Message) The function of this message is to send patient information query to the EMR system. This message will contain the patient number for unique identification filter.

3.3.1 Message Header (MSH) Segment Pos Element 1 Field Separator 2 Encoding Characters 1. Component 2. Repeat 3. Escape 4. Subcomponent 3 Sending Application Name

Use R R

Sending Facility Name

Receiving Application

Receiving Facility

Date and Time of Message

8 9

Security Message Type 1. Message Type 2. Trigger Event

U R

Message Control Identifier

Example Pipe symbol - | ^~& ^ ~

& OTObase (User defined during configuration) OTObase (User defined during configuration) EMR System (User defined during configuration) EMR System (User defined during configuration)

Processing ID

12 13 14 15 16

HL7 Version Sequence Number Continuation Pointer Accept Acknowledgement Type Application Acknowledgement Type Country Code Character Set Principle Language of Message

R U U U U

17 18 19

3.3.2 Query Definition (QRD) Segment Pos Element 1 Query Date Time

U U U

Use R

Query Format Code

3 4 5 6 7 8

Query Priority Query ID Deferred Response Type Deferred Response Date Time Quantity Who Subject Filter 1. Patient ID Number 2. Family Name 3.Given Name What Subject Filter What Department Data Code What Data Code Value Query Result Level

R U U U U R

9 10 11 12

P = Production T = Training D= Debugging 2.4,2.5,2.6,2.7.

Example YYYYMMDDhhmmss 201301251911 R (record oriented response) I (Immediate)

10204

U U U U

3.3.3 Example of QRY_A19 Message The following is an example of patient query request message (for Patient Number: 10204). MSH|^~&|OTObase|OTObase|EMR|EMR|20130125191110||QRY^A19|QRY20130125191110|P|2.7 QRD|201301251911|R|I|||||10204||||

This message queries for the demographics information for a patient based upon the patient id/number (medical record number). The Patient ID Number is specified in QRD-8- who subject field. 3.4

ADR_A19 (Patient Query Response Message) This message should be send by the EMR system in response to the Patient Query Request (QRY_A19) message sent by OTObase. This message should contain the patient © 2013 Otometrics

demographic information for particular patient based upon the patient ID Number (medical record number). 3.4.1 Message Header (MSH) Segment Pos Element 1 Field Separator 2 Encoding Characters 1. Component 2. Repeat 3. Escape 4. Subcomponent 3 Sending Application Name

Use R R

Sending Facility Name

Receiving Application

Receiving Facility

Date and Time of Message

8 9

Security Message Type 1. Message Type 2. Trigger Event

U R

10 11

Message Control Identifier Processing ID

R O

12 13 14 15 16

HL7 Version Sequence Number Continuation Pointer Accept Acknowledgement Type Application Acknowledgement Type Country Code Character Set Principle Language of Message

R U U U U

17 18 19

Example Pipe symbol - | ^~& ^ ~

& EMR System (User defined during configuration) EMR System (User defined during configuration) OTObase (User defined during configuration) OTObase (User defined during configuration)

YYYYMMDDhhmmss 20130125052045 ADR^A19 ADR A19 QRY20130128145136 P = Production T = Training D= Debugging 2.4,2.5,2.6,2.7.

U U U

3.4.2 Message Acknowledgement (MSA) Segment Pos Element Use 1 Acknowledgement Code R

2 3 4 5 6

Message Control ID Text Message Expected Sequence Number Delayed Acknowledgement Type Error Condition

3.4.3 Query Definition (QRD) Segment Pos Element 1 Query Date Time

R O U U O

Use R

Query Format Code

3 4 5 6 7 8

R U U U U R

9 10 11 12

3.4.4 Patient Identification (PID) Segment Pos Element 1 Set ID 2 Patient ID – External ID 3 Patient ID – Internal ID (Patient Identifier ListID Number) 4 Alternate Patient ID 5 Patient Name 1. Last Name 2. First Name 3. Middle Initial 4. Suffix 5. Prefix 6 Mother’s Maiden Name 7 Date and Time of Birth 8 9

Sex Patient Alias

QRY20130128145136 Success, Or Failure

Example YYYYMMDDhhmmss 201301251911 R (record oriented response) I (Immediate)

10204

U U U U

Use U O R

Example

9068

U R Fischer Martin

Mr. U R R U

10 11

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

1. Last Name 2. First Name 3. Middle Initial 4. Suffix 5. Prefix Race Patient Address 1. Street Or Mailing Address 2. Other destination 3. City 4. State 5. Postal Code 6. Country County Code Phone Number – Home Phone Number – Business Primary Language Marital Status Religion Patient Account Number Social Security Number Driver’s License Number Mother’s Identifier Ethnic Group Birth Place Multiple Birth Indicator Birth Order Citizenship Veteran’s Military Status Nationality Patient Death and Time Patient Death Indicator

U R 123 West St. Denver CO 80020 USA U R R O O O O O U U U U U U U U U U U

01-22010-4520 01-22011-4520

S102T44503

3.4.5 Patient Visit (PV1) Segment Information present in Patient Visit segment is not used in current version of OTObase. Pos 1 2 3 4 5 6 7

Element Set ID Patient Class Assigned Patient Location Admission Type Pre admit Number Prior Patient Location Attending Doctor 1. Last Name

Use U U U U U U U

Example

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44

2. First Name 3. Middle Initial Referring Doctor 1. Last Name 2. First Name 3. Middle Initial Consulting Doctor 1. Last Name 2. First Name 3. Middle Initial Hospital Service Temporary Location Pre-admit Test Indicator Re-admission Indicator Admit Source Ambulatory Status VIP Indicator Admitting Doctor Patient Type Visit Number Financial Class Charge Price Indicator Courtesy Code Credit Rating Contract Code Contract Effective Date Contract Amount Contract Period Interest Code Transfer to Bad Debt Code Transfer to Bad Debt Date Bad Debt Agency Code Bad Debt Transfer Amount Bad Debt Recovery Amount Delete Account Indicator Delete Account Date Discharge Disposition Discharged to Location Diet Type Servicing Facility Bed Status Account Status Pending Location Prior Temporary Location Admit Date and Time

45 46 47 48 49 50 51 52

Discharge Date and Time Current Patient Balance Total Charges Total Adjustments Total Payments Alternative Visit ID Visit Indicator Other Healthcare Provider

U U U U U U U U

3.4.6 Example of ADR_A19 Message when Patient found The following is an example of patient query response message (for Patient Number: 10204). MSH|^~&|AWS1|ZISSERVER|OTObase|OTObase|20130128145137||ADR^A19|QRY201301281451 36|P|2.7|| MSA|AA|QRY20130128145136 QRD|201301281451|R|I|||||10204 PID|||00004||Fischer^Martin^^^Mr.||19670824|M|||123 West St. ^^Denver ^CO ^80020 ^USA||||||| PV1||I|A5TA^5014^||||0019^Jonge^^MWC^^de^Jhr. Dr.|||||||||||O|0000519145|||||||||||||||||||||||||200405201030|

Above message contains patient demographic & visit information. 3.4.7 Example of ADR_A19 Message when Patient not found The following is an example of patient query response message (for Patient Number: 10204) if patient information not found. MSH|^~&|AWS1|ZISSERVER|OTObase|OTObase|20130128145137||ADR^A19|QRY201301281451 36|P|2.7|| MSA|AE| QRY20130128145136|Patient Not found.

3.5

ORU (Observation Result Unsolicited) Message OTObase returns finished transcriptions (PDF report containing latest Tone, Speech & Impedance measurement for both ears) to the EMR system using Observation Result Unsolicited (ORU) messages that are triggered by the OTObase when patient is Signed Off (manually/automatically). The HL7 message will contain the following information.

3.5.1 Message Header (MSH) Segment Pos Element 1 Field Separator 2 Encoding Characters 1. Component 2. Repeat 3. Escape 4. Subcomponent 3 Sending Application Name

Use R R

Example Pipe symbol - | ^~& ^ ~

Sending Facility Name

OTObase (User defined during configuration)

Receiving Application

EMR System (User defined during configuration) EMR System (User defined during configuration)

Receiving Facility

Date and Time of Message

8 9

Security Message Type 1. Message Type 2. Trigger Event

U R

10 11

Message Control Identifier Processing ID

R O

12 13 14 15 16

HL7 Version Sequence Number Continuation Pointer Accept Acknowledgement Type Application Acknowledgement Type Country Code Character Set Principle Language of Message

R U U U U

17 18 19

3.5.2 Common Order (ORC) Segment Pos Element 1 Order Control 2 Placer Order Number 3 Filler Order Number 4 Placer Group Number 5 Order Status 6 Response Flag 7 Quantity/Timing 8 Parent 9 Date and Time of Transaction 10 Entered By 11 Verified By 12 Ordering Provider 13 Enterer’s Location 14 Callback Phone Number 15 Order Effective Date and Time 16 Order Control Code Reason

YYYYMMDDhhmmss 20130125052045 ORU^R01 ORU R01 ORU20130128145120 P = Production T = Training D= Debugging 2.4,2.5,2.6,2.7.

U U U

Use O O O U U U U U U U U U U U U U

Example NW 3071014 105400

17 18 19

Entering Organization Entering Device Action By

3.5.3 Observation Request (OBR) Segment Pos Element 1 Set ID 2 Placer Order Number 3 Filler Order Number 4 Universal Service Identifier 5 Priority 6 Requested Date and Time 7 Observation Date and Time 8 Observation End Date and Time 9 Collection Volume 10 Collector Identifier 11 Specimen Action Code 12 Danger Code 13 Relevant Clinical Information 14 Specimen Received Date and Time 15 Specimen Source 16 Ordering Provider 17 Order Callback Phone Number 18 Placer Field 1 19 Placer Field 2 20 Filler Field 1 21 Filler Field 2 22 Results Report/Status Change Date and Time 23 Charge to Practice 24 Diagnostic Service Section ID 25 Result Status 26 Parent Result 27 Quantity / Timing 28 Result Copies to 29 Parent 30 Transportation Mode 31 Reason for Study 32 Principal Result Interpreter 33 Assistant Result Interpreter 34 Technician 35 Transcriptionist 36 Scheduled Date and Time

U U U

Use O R R U U O U U

Example 1 3071014 105400

37 38 39 40 41 42 43

Number of Sample Containers Transport Logistics of Collected Samples Collector’s Comment Transport Arrangement Responsibility Transport Arranged Escort Required Planned Patient Transport Comment

3.5.4 Observation Result (OBX) Segment Pos Element 1 Set ID 2 Value Type

3 4 5

Observation Identifier Observation Sub-ID Observation Value

6 7 8 9 10 11 12

Units References Range Abnormal Flags Probability Nature of Abnormal Test Observation Result Status Date of Last Observation Normal Values User-Defined Access Checks Date and Time of the Observation Producer’s ID Responsible Observer Observation Method

13 14 15 16 17

U U U U U U U

Use R R

O R

Example AD = Address DT Date ED Encapsulated Data FT Formatted Text (Display) ST String Data. TM Time TN Telephone Number TS Time Stamp (Date & Time) TX Text Data (Display) 102012 PDF Report Raw data (eg. Acrobat^text^pdf^Base64^JV BE Ri0xLjQK Jcfsj6IKNSAwIG9 iago8PC9MZ W5ndGggNiAwIFIvRmlsdG)

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MADSEN OTObase HL7 Integration Reference Guide V1.0 Jan 2013