Guidance for use of the HL7 Automated Dispensing System Interface for Automated Dispensing in the Long Term and Post-Acute Care Settings VERSION 1.Ø This paper offers guidance to the pharmacy industry for consistent use of the HL7 ADS Interface for automated dispensing in the Long Term and Post-Acute Care settings.

       

November 2Ø12 National Council for Prescription Drug Programs 924Ø East Raintree Drive Scottsdale, AZ 8526Ø Phone: Fax: E-mail: http:

(48Ø) 477-1ØØØ (48Ø) 767-1Ø42 [email protected] www.ncpdp.org

Guidance for the use of the HL7 ADS Interface for Automated Dispensing in the Long Term and Post-Acute Care Settings Version 1.Ø

NCPDP recognizes the confidentiality of certain information exchanged electronically through the use of its standards. Users should be familiar with the federal, state, and local laws, regulations and codes requiring confidentiality of this information and should utilize the standards accordingly. NOTICE: In addition, this NCPDP Standard contains certain data fields and elements that may be completed by users with the proprietary information of third parties. The use and distribution of third parties' proprietary information without such third parties' consent, or the execution of a license or other agreement with such third party, could subject the user to numerous legal claims. All users are encouraged to contact such third parties to determine whether such information is proprietary and if necessary, to consult with legal counsel to make arrangements for the use and distribution of such proprietary information.

Published by: National Council for Prescription Drug Programs

Publication History: Version 1.Ø January 2Ø13

HL7 ® Material included in the NCPDP document is copyrighted by Health Level Seven® International. All Rights Reserved. Use of HL7 copyrighted materials is limited to HL7 Members and is governed by HL7 International’s Intellectual Property Policy. HL7 and Health Level Seven are registered trademarks of Health Level Seven International Reg. U.S. Pat & TM Off.

All rights reserved. Permission is hereby granted to any organization to copy and distribute this material as long as the copies are not sold. National Council for Prescription Drug Programs 924Ø E. Raintree Drive Scottsdale, AZ 8526Ø (48Ø) 477-1ØØØ [email protected]

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TABLE OF CONTENTS 1.  SCOPE...................................................................................................................................... 6  1.1  1.2  1.3 

PURPOSE .........................................................................................................................................6  GOALS..............................................................................................................................................6  RECOMMENDATION ..........................................................................................................................6 

2.  SYSTEM TOPOLOGY .............................................................................................................. 7  2.1  2.2 

INTERNAL PHARMACY SYSTEMS .....................................................................................................7  EXTERNAL PHARMACY SYSTEMS ....................................................................................................7 

3.  COMMUNICATION RULES ..................................................................................................... 9  3.1  3.2  3.3  3.4 

ENCODING CHARACTERS ................................................................................................................9  DELIMITERS .....................................................................................................................................9  ACKNOWLEDGEMENTS ....................................................................................................................9  MESSAGE SEGMENTS .....................................................................................................................9 

4.  MESSAGES ............................................................................................................................ 10  4.1  PATIENT ADMINISTRATION.............................................................................................................10  4.1.1  ADT ^AØ1^ADT_AØ1- Admit/Visit Notification ..............................................................10  4.1.1.1  4.1.1.2  4.1.1.3 

4.1.2 

ADT ^AØ1^ADT_AØ1 Sequence .................................................................................................10  Message ADT ^AØ1^ADT_AØ1 Structure .................................................................................11  ADT ^AØ1^ACK Structure ............................................................................................................11 

ADT ^AØ2^ADT_AØ2 - Transfer a patient ......................................................................12 

4.1.2.1  4.1.2.2  4.1.2.3 

ADT ^AØ2^ADT_AØ2 Sequence .................................................................................................12  Message ADT ^AØ2^ADT_AØ2 Structure .................................................................................12  ADT ^AØ2^ACK Structure ............................................................................................................12 

ADT ^AØ3^ADT_AØ3- Discharge/End Visit ...................................................................................13  4.1.2.4  4.1.2.5  4.1.2.6 

4.1.3 

ADT ^AØ3^ADT_AØ3 Sequence .................................................................................................13  Message ADT ^AØ3^ADT_AØ3 Structure .................................................................................13  ADT ^AØ3^ACK Structure ............................................................................................................13 

ADT ^AØ8^ADT_AØ1 - Update patient Information ......................................................14 

4.1.3.1  4.1.3.2  4.1.3.3 

ADT ^AØ8^ADT_AØ1 Sequence .................................................................................................14  Message ADT ^AØ8^ADT_AØ1 Structure .................................................................................14  ADT ^AØ8^ACK Structure ............................................................................................................14 

4.2  ORDERS .........................................................................................................................................15  4.2.1  RDE^O11^RDE_O11 - Pharmacy Encoded Order Message .......................................15  4.2.1.1  4.2.1.2  4.2.1.3 

4.2.2 

RDE^O11^RDE_O11 Sequence ..................................................................................................15  Message RDE^O11^RDE_O11 Structure...................................................................................15  RDE^O11^ACK Structure..............................................................................................................15 

RDS^O13^RDS_O13 - Pharmacy Dispense Message .................................................16 

4.2.2.1  4.2.2.2  4.2.2.3 

RDS^O13^RDS_O13 Sequence ..................................................................................................16  Message RDS^O13^RDS_O13 Structure...................................................................................16  RDS^O13^ACK Structure..............................................................................................................16 

5.  SEGMENTS ............................................................................................................................ 18  5.1  ERR - ERROR SEGMENT ..............................................................................................................19  5.2  EVN - EVENT TYPE SEGMENT ......................................................................................................19  5.3  MSA - MESSAGE ACKNOWLEDGE SEGMENT ...............................................................................19  5.4  MSH - MESSAGE HEADER SEGMENT ...........................................................................................19  5.5  ORC – COMMON ORDER SEGMENT .............................................................................................20  5.5.1  SEQ 1: Order Control .........................................................................................................21  5.5.2  SEQ 2: Placer Order Number ..........................................................................................21  5.5.3  SEQ 3: Filler Order Number .............................................................................................21  5.5.4  SEQ 9: Time of Transaction ..............................................................................................21  5.5.5  SEQ 1Ø: Entered By...........................................................................................................21  Version 1.Ø

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings SEQ 11: Verified By ............................................................................................................22  5.5.6  5.5.7  SEQ 12: Ordering Provider ................................................................................................22  5.6  PID - PATIENT IDENTIFICATION SEGMENT ....................................................................................23  5.6.1  SEQ 3: Patient Identifier List .............................................................................................23  5.6.2  SEQ 4: Alternate Patient ID ..............................................................................................23  5.6.3  SEQ 5: Patient Name .........................................................................................................24  5.7  PV1 - PATIENT VISIT SEGMENT ....................................................................................................24  5.7.1  SEQ 3: Assigned Patient Location ...................................................................................25  5.8  RXD – PHARMACY DISPENSE SEGMENT......................................................................................25  5.9  RXR – ROUTE SEGMENT ..............................................................................................................26  5.1Ø  RXE – PHARMACY ENCODED ORDER SEGMENT .........................................................................26  5.11  TQ1 – TIMING & QUANTITY SEGMENT..........................................................................................28  5.11.1  SEQ 3 Repeat Pattern ........................................................................................................28  6.  FREQUENTLY ASKED QUESTIONS.................................................................................... 30  7.  REFERENCE INFORMATION ............................................................................................... 31  8.  APPENDIX A. HISTORY OF CHANGES ............................................................................... 32 

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Disclaimer This document is Copyright © 2Ø12 by the National Council for Prescription Drug Programs (NCPDP). It may be freely redistributed in its entirety provided that this copyright notice is not removed. It may not be sold for profit or used in commercial documents without the written permission of the copyright holders. This document is provided “as is” without any express or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. If you require legal advice, you should consult with an attorney. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by NCPDP. The listing of an organization does not imply any sort of endorsement and the NCPDP takes no responsibility for the products or tools. The existence of a link or organizational reference in any of the following materials should not be assumed as an endorsement by the NCPDP. The writers of this paper will review and possibly update their recommendations should any significant changes occur. This document is for Education and Awareness Use Only.

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1. SCOPE The guidance put forth in this document are based on the use of the Automated Dispensing System (ADS) Interface used for automated dispensing in the Long Term and Post-Acute Care (LTPAC) settings. The interface is based on the Health Level Seven (HL7) messaging currently in use in LTPAC today.

1.1 PURPOSE Work Group 14 (WG14) Long Term and Post-Acute Care (LTPAC) formed the Long-Term Post-Acute Care (LTPAC) Automated Dispensing System (ADS) Interface Task Group in August 2Ø1Ø to perform a gap analysis of current and proposed technology standards, including NCPDP, HL7, and proprietary implementations, in order to prepare recommendations for dispensing automation interface standards in the LTPAC setting. The task group focused on automation used in the LTPAC setting for packaging, labeling, and distributing medications, including internal pharmacy and remote dispensing technologies. The task group did not address any upstream and/or downstream technologies, such as ePrescribing and Document Management.

1.2 GOALS When the task group was formed, the following goals were defined: • Identify types of automated dispensing used in LTPAC • Identify current and proposed technology standards and other proprietary implementations • Perform a gap analysis of existing standards/implementations for each type dispensing • Provide a recommendation to use an existing standard, such as HL7, modify an existing NCPDP standard, or create an entirely new NCPDP standard.

 

1.3 RECOMMENDATION WG14 recommends the usage of the HL7 messages, segments, and fields as outlined in this document. HL7 is the most commonly used interface standard for automated dispensing in the LTPAC setting. However, the work group identified significant variations of the standard across different systems and implementations. As a result, most – if not all – systems will require modification in order to adhere to the recommendations outlined in this document. Despite that challenge, the work group recommends that adoption of a standard interface will lower implementation and support costs in the long-term, ultimately benefiting the entire industry.

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2. SYSTEM TOPOLOGY To establish the boundaries and provide an understanding of the systems involved in automated dispensing in the LTPAC setting, a system topology has been created. The two categories of automated dispensing, as described below, are Internal Pharmacy Systems and External Pharmacy System (i.e. Remote Dispensing).

2.1 INTERNAL PHARMACY SYSTEMS Traditional pharmacy operations manage the fulfillment of prescriptions (orders) within the four walls of the pharmacy. The following diagram describes the local interface requirements for automated fulfillment, verification, and packing.

Figure 2.1: Pharmacy Internal Systems

All pharmacies have some type of Pharmacy Information System (PhIS) while the other items noted in figure 2.1 may be contained within the application space of the PhIS or supplied by different vendors. Since PV2 (second level pharmacist verification) and Packing/Shipping solutions are generally contained within the application space of the PhIS, and third party Document Management solutions are connected through proprietary interfaces, this guide focuses on the interface between PhIS and the internal fulfillment system (i.e. automated dispensing system). The use of the this guide is recommended only in situations in which the PhIS and the internal fulfillment system are supplied by different vendors. In situations in which PhIS and the internal fulfillment system are closed loop, this guide is not applicable.

2.2 EXTERNAL PHARMACY SYSTEMS With the advancement in technology systems that allow for patient-specific dispensing at the long-term care facility, this guide also addresses the connectivity between the PhIS and remote dispensing systems in order to prevent the propagation of proprietary interfaces. In this case, multiple systems are distributed across multiple facilities outside of the pharmacy. As such, this guide assumes the remote dispensing systems are managed by a “controller” that routes the orders to the correct system. Therefore, in this scenario, the PhIS is not expected to be responsible for the proper routing to each system.

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Figure 2.2: Pharmacy External Systems with Controller

The additions of a Wide Area Network (WAN) adds a few considerations when establishing a communication security methodology; however the same message sets will be used in either internal fulfillment or external dispensing of patient specific orders. Furthermore, it is the remote dispensing systems responsibility to establish and maintain the WAN connections, thus under the message security section Figure 2.2 will be addressed as the ADS messages leave the local networks protection.

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3. COMMUNICATION RULES This section describes the general and minimum communication standards. Communication rules will follow the HL7 messaging standards to include the message structures and message transmission protocols.

3.1 ENCODING CHARACTERS The intent of this guide is for use in the United States of America and systems that recognize the US exchanges. The only printable character set is the ASCII set. Valid characters are ASCII hexadecimal characters 2Ø to 7E inclusive.

 

3.2 DELIMITERS It is recommended that the standard HL7 delimiters be used for messages unless changes are agreed upon by the trading partners. Message Delimiters Segment Terminator Field Separator Component Separator Subcomponent Separator Repetition Separator Escape Character

| ^ & ~ /

No substitution MSH-1 MSH-2 position 1 MSH-2 position 2 MSH-2 position 3 MSH-2 position 4

3.3 ACKNOWLEDGEMENTS The ADS Interface will use a logical level acknowledgement. These acknowledgement values will described for each message in the sequence portion of the message. In general it is the responsibility of sending application to ensure the transmission and receipt of the message. It is the responsibility of receiving application to acknowledge the logical acceptance or rejection of the message. It is not responsibility of the receiving application to ensure the receipt of the message.

be the the the

 

3.4 MESSAGE SEGMENTS With the diversity of the HL7 protocol and the multi-use of many messages, this guide describes each of the messages supported as well as the standard and minimum data elements required in the message. If a receiving application receives additional segments and/or fields the receiving application should not reject the message if the primary data set is complete and logically acceptable.

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4. MESSAGES This section outlines the events that drive certain message transmissions as well as the expected/acceptable return messages. The segment usage will be summarized, and the segment definitions will be described in the following section.

4.1 PATIENT ADMINISTRATION To support proper order grouping, package labeling and general ADS management, the following Patient Administration messages are needed: LTPAC ADS Patient Administration Messages ADT^AØ1^ADT_AØ1 ADT^AØ2^ADT_AØ2 ADT^AØ3^ADT_AØ3 ADT^AØ8^ADT_AØ1 ADT^A22^ADT_A21

Admit/Visit Notification Transfer a Patient Discharged/End Visit Update patient Information Delete a Patient Record

4.1.1 ADT ^AØ1^ADT_AØ1- ADMIT/VISIT NOTIFICATION Message Considerations HL7 - Message NCPDP Name Usage

ADT ^AØ1^ADT_AØ1 Patient Admit Optional - ADS can alternatively obtain patient information sent in the New Order message. Additional info such as Diagnosis and Allergies are included in this message, but are optional.

Trigger

Patient Admitted to LTPAC Facility

4.1.1.1 ADT ^AØ1^ADT_AØ1 SEQUENCE

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4.1.1.2 MESSAGE ADT ^AØ1^ADT_AØ1 STRUCTURE Segment

Name

MSH EVN PID [PD1] PV1

Message Header Event Type Patient Identification Additional Demographics Patient Visit

Usage

Cardinality

R R R R R

[1..1] [1..1] [1..1] [1..1] [1..1]

Usage

Cardinality

R R

[1..1] [1..1]

O

[Ø..1]

Comment

4.1.1.3 ADT ^AØ1^ACK STRUCTURE Segment

Name

MSH MSA

Message Header Message Acknowledgment Error

[{ERR}]

Comment

 

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4.1.2 ADT ^AØ2^ADT_AØ2 - TRANSFER A PATIENT Message Considerations HL7 - Message NCPDP Name Usage

ADT ^AØ2^ADT_AØ2 Patient Transfer This is Optional unless the ADS defines this field as Required. A Patient Transfer will only be processed via an ADT^AØ2 and not an ADT^AØ8 It is also the responsibility of the ADS to update the active orders with the new patient location.

Trigger

Patient Transferred within a LTPAC Facility

4.1.2.1 ADT ^AØ2^ADT_AØ2 SEQUENCE

 

4.1.2.2 MESSAGE ADT ^AØ2^ADT_AØ2 STRUCTURE Segment

Name

MSH EVN PID [PD1] PV1

Message Header Event Type Patient Identification Additional Demographics Patient Visit

Usage R R R R R

Cardinality

Comment

[1..1] [1..1] [1..1] [1..1] [1..1]

4.1.2.3 ADT ^AØ2^ACK STRUCTURE Segment

Name

Usage

MSH MSA [{ERR}]

Message Header Message Acknowledgment Error

R R O

Cardinality

Comment

[1..1] [1..1] [Ø..1]

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ADT ^AØ3^ADT_AØ3- DISCHARGE/END VISIT Message Considerations HL7 - Message NCPDP Name Usage

Trigger

ADT ^AØ3^ADT_AØ3 Patient Discharge This is Optional unless the ADS defines this field as Required. ADS should discontinue all orders when a Discharge message is received (dispensing system would decide if discontinued order message is required). Follows same guidelines as transfer AØ3 followed by AØ8. Patient Discharged from LTPAC Facility

4.1.2.4 ADT ^AØ3^ADT_AØ3 SEQUENCE  

 

4.1.2.5 MESSAGE ADT ^AØ3^ADT_AØ3 STRUCTURE Segment

Name

Usage

MSH EVN PID [PD1] PV1

Message Header Event Type Patient Identification Additional Demographics Patient Visit

Cardinality

R R R R R

[1..1] [1..1] [1..1] [1..1] [1..1]

Usage

Cardinality

Comment

4.1.2.6 ADT ^AØ3^ACK STRUCTURE Segment

Name

MSH MSA [{ERR}]

Message Header Message Acknowledgment Error

R R O

Comment

[1..1] [1..1] [Ø..1]

 

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4.1.3 ADT ^AØ8^ADT_AØ1 - UPDATE PATIENT INFORMATION Message Considerations HL7 - Message NCPDP Name Usage

ADT ^AØ8^ADT_AØ1 Patient Update This is Optional unless the ADS defines this field as Required Should not be used for transfer and discharge, but can follow a transfer or discharge record.

Trigger

Patient Data changed for given LTPAC Facility. Note if transfer use Patient Transfer "ADT^AØ2"

4.1.3.1 ADT ^AØ8^ADT_AØ1 SEQUENCE  

 

 

4.1.3.2 MESSAGE ADT ^AØ8^ADT_AØ1 STRUCTURE Segment MSH EVN PID [PD1] PV1

Name Message Header Event Type Patient Identification Additional Demographics Patient Visit

Usage R R R R R

Cardinality [1..1] [1..1] [1..1] [1..1] [1..1]

Comment

4.1.3.3 ADT ^AØ8^ACK STRUCTURE Segment MSH MSA [{ERR}]

Name Message Header Message Acknowledgment Error

Usage R R O

Cardinality [1..1] [1..1] [1..1]

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4.2 ORDERS In order to support patient and time-specific dispensing, as well as accurate billing of medications dispensed via an automated system, the following Order messages are needed: LTPAC ADS Order Messages RDE^O11^RDE_O11 RDS^O13^RDS_O13

Pharmacy Encoded Order Message Pharmacy Dispense Message

4.2.1 RDE^O11^RDE_O11 - PHARMACY ENCODED ORDER MESSAGE Message Considerations HL7 - Message NCPDP Name Usage Trigger

RDE^O11^RDE_O11 Pharmacy Encoded Order Message Required Order is created, changed, or discontinued in pharmacy system

4.2.1.1 RDE^O11^RDE_O11 SEQUENCE

4.2.1.2 MESSAGE RDE^O11^RDE_O11 STRUCTURE Segment

Name

Usage

MSH PID PD1 PV1 ORC TQ1 RXR RXE

Message Header Patient Identification Additional Demographics Patient Visit Common Order Timing/Quantity Treatment Route Treatment Encoded Order

R R R R R R R R

Cardinality

Comment

[1..1] [1..1] [1..1] [1..1] [1..1] [1..1] [1..1] [1..1]

4.2.1.3 RDE^O11^ACK STRUCTURE Version 1.Ø

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings Segment

Name

Usage

MSH MSA [{ERR}]

Message Header Message Acknowledgment Error

Cardinality

R R O

Comment

[1..1] [1..1] [1..1]

4.2.2 RDS^O13^RDS_O13 - PHARMACY DISPENSE MESSAGE Message Considerations HL7 - Message NCPDP Name Usage

RDS^O13^RDS_O13 Pharmacy Dispense Message This is Optional unless the ADS defines this field as Required. Information sent to pharmacy system about what doses were dispensed from the system. Can be a partial dispense of the order (i.e. order was for 3Ø days but dispense log is what was dispensed that day on a dose by dose basis.)

Trigger

ADS packages one or more doses for the order

4.2.2.1 RDS^O13^RDS_O13 SEQUENCE



4.2.2.2 MESSAGE RDS^O13^RDS_O13 STRUCTURE Segment

Name

Usage

MSH PID PD1 PV1 ORC RDE

Message Header Patient Identification Additional Demographics Patient Visit Common Order Treatment Dispense

Cardinality

R R R R R R

Comment

[1..1] [1..1] [1..1] [1..1] [1..1] [1..1]

4.2.2.3 RDS^O13^ACK STRUCTURE Segment

Name

Usage

MSH

Message Header

R

Cardinality

Comment

[1..1]

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings Segment

Name

Usage

MSA [{ERR}]

Message Acknowledgment Error

R O

Cardinality

Comment

[1..1] [1..1]

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5. SEGMENTS HL7 Optionality and Conformance Usage HL7 Optionality

Allowed Conformance Usage

R - Required O - Optional

R R, RE, O, C, CE, X

C - Conditional X – Not Supported B – Backward Compatibility

C, CE, R X R, RE, O, C, CE, X

W - Withdrawn

R, RE, O, C, CE, X

Comment O is only permitted for constrainable profiles

O is only permitted for constrainable definitions

Usage Value R

RE

Description Required

Required but may be empty

O

Optional

C

Conditional

Comment A conforming sending application shall populate all “R” elements with a non-empty value. 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. Any element designated as required in a standard HL7 message definition shall also be required in all HL7 message profiles of that standard message. 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 capable 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). This code indicates that the Usage for this element has not yet been defined. A usage of ‘Optional’ may not be used in ‘implementation’ profiles (no-optionality profiles). Conformance may not be tested on an Optional field. Narrower profiles may be defined based on this profile, and may assign any usage code to the element This usage has an associated condition predicate (See section Error! Reference source not found., "Error! Reference source not found."). If 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. If 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 and the element is not present, though it may raise an error if the element IS present.

CE

Conditional but it may be empty

This usage has an associated condition predicate (See section Error!

Reference source not found., "Error! Reference source not found.").

If 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 capable 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 not raise an error due to the presence or absence of the element. If the predicate is not satisfied: The conformant sending application shall not populate the element. The conformant receiving application may raise an application error if the element is present. Version 1.Ø

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings Value X

Description Not supported

Comment For conformant sending applications, the element will not be sent. Conformant receiving applications may ignore the element if it is sent, or may raise an application error.

5.1 ERR - ERROR SEGMENT SEQ 1 2 3 4 5 6 7 8 9 1Ø 11 12

LEN 493 18 7Ø5 2 7Ø5 8Ø 2Ø48 25Ø 2Ø 7Ø5 7Ø5 652

DT

NAME

USAGE

ELD ERL CWE ID CWE ST TX TX IS CWE CWE XTN

Error Code and Location Error Location HL7 Error Code Severity Application Error Code Application Error Parameter Diagnostic Information User Message Inform Person Indicator Override Type Override Reason Code Help Desk Contact Point

B O R R O O O O O O O O

COMMENTS USE ERR 2 & 3 leave blank

5.2 EVN - EVENT TYPE SEGMENT SEQ 1 2 3 4 5 6 7

LEN 3 26 26 3 25Ø 26 241

DT

NAME

USAGE

ID TS TS IS XCN TS HD

Event Type Code Recorded Date/Time Date/Time Planned Event Event Reason Operator ID Event Occurred Event Facility

B R O O O O O

COMMENTS USE MSH-9 leave blank

5.3 MSA - MESSAGE ACKNOWLEDGE SEGMENT SEQ 1 2 4

LEN

DT

NAME

2 2Ø 15

ID ST NM

Acknowledge Code Message Control ID Expected Sequence Number

USAGE

COMMENTS

R R O

Note MSA-3, 5, 6 have been deprecated

5.4 MSH - MESSAGE HEADER SEGMENT SEQ 1 2 3 4 5

LEN 1 4 227 227 227

DT

NAME

ST ST HD HD HD

Field Separator Encoding Characters Sending Application Sending Facility Receiving Application

USAGE R R R R R

COMMENTS "|" ACSII 124 "^~\&" ASCII 94,126,92,38 PhIS or ADS Pharmacy or Location of ADS PhIS or ADS

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings SEQ

LEN

DT

NAME

USAGE

HD TS ST MSG ST PT VID NM ST ID

Receiving Facility Date/Time of Message Security Message Type Message Control ID Processing ID Version ID Sequence Number Continuation Pointer Accept Acknowledgement Type

R R O R R R R O O O

6 7 8 9 1Ø 11 12 13 14 15

227 26 4Ø 15 2Ø 3 6Ø 15 18Ø 2

16

2

ID

Application Acknowledgement Type

O

17 18 19

3 16 25Ø

ID ID CE

Country Code Character Set Principal language of Message

O O O

2Ø

2Ø

ID

Alternative Character Set Handling Scheme

O

21

427

EI

Message Profile Identifier

O

COMMENTS Pharmacy or Location of ADS

5.5 ORC – COMMON ORDER SEGMENT SEQ

LEN

DT

NAME

USAGE

1 2 3 4 5 6 7 8 9 1Ø 11 12 13 14 15 16 17 18 19 2Ø 21 22 23 24 25

2 22 22 22 2 1 2ØØ 2ØØ 26 25Ø 25Ø 25Ø 8Ø 25Ø 26 25Ø 25Ø 25Ø 25Ø 25Ø 25Ø 25Ø 25Ø 25Ø 25Ø

ID EI EI EI ID ID TQ EIP TS XCN XCN XCN PL XTN TS CE CE CE XCN CE XON XAD XTN XAD CWE

Order Control Placer Order Number Filler Order Number Placer Group Number Order Status Response Flag Quantity/Timing Parent Time of Transaction Entered By Verified By Ordering Provider Enterers Location Call Back Phone Number Order Effective Date/Time Order Control Code Reason Entering Org. Entering Device Action By Advanced Beneficiary Notice Ordering Facility Name Ordering Facility Address Ordering Facility Phone Ordering Provider Address Order Status Modifier

R C R O O O B O R R R R O O O O O O O O O O O O O

COMMENTS CPOE Tracking Number Prescription Number

Use TQ1 Segment

Pharmacy Tech Pharmacist Doctor/Prescriber

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings SEQ

LEN

DT

NAME

26 27 28 29 3Ø 31

USAGE

6Ø

CWE

Advanced Beneficiary Notice Override Reason

C

26 25Ø 25Ø 25Ø 25Ø

TS CWE CWE CWE CWE

Sellers Expected Availability DT Confidentiality Code Order Type Enterer Authorization Mode Parent Universal Service ID

O O O O O

COMMENTS

5.5.1 SEQ 1: ORDER CONTROL NW - New Order DC- Discontinue RF - Refill XO - Update Order CA - Cancel Order RE - Observation to Follow Example: |NW|

5.5.2 SEQ 2: PLACER ORDER NUMBER CPOE Tracking Number

5.5.3 SEQ 3: FILLER ORDER NUMBER Prescription Number

5.5.4 SEQ 9: TIME OF TRANSACTION Date time stamp of the transaction must use second as the precision domain and it is the option of the sending application to use fractional seconds if needed. Format: 1) YYYYMMDDMMSS.SS^S 2) YYYYMMDDMMSS^S

5.5.5 SEQ 1Ø: ENTERED BY Entered By will use the first 7 SEQ of the XCN data type. SEQ 1 2 3 4 5 6 7

LEN 15 194 3Ø 3Ø 2Ø 2Ø 5

NAME

Example

ID Number Family Name Give Name Initials Suffix Prefix Degree

123456789 Doe John JED JR DR RPH TECH

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings Example: |123456789^DOE^JOHN^JED^^TECH|

5.5.6 SEQ 11: VERIFIED BY Verified By will use the first 7 SEQ of the XCN data type. SEQ

LEN 1 2 3 4 5 6 7

15 194 3Ø 3Ø 2Ø 2Ø 5

NAME

Example

ID Number Family Name Give Name Initials Suffix Prefix Degree

123456789 Doe John JED JR DR RPH

Example: |123456789^DOE^JOHN^JED^^RPH|

5.5.7 SEQ 12: ORDERING PROVIDER Ordering Provider will use the first 7 SEQ of the XCN data type. SEQ

LEN

1 2 3 4 5 6 7

15 194 3Ø 3Ø 2Ø 2Ø 5

NAME

Example

ID Number Family Name Give Name Initials Suffix Prefix Degree

123456789 Doe John JED JR DR MD

Example: |123456789^DOE^JOHN^JED^^MD|

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings

5.6 PID - PATIENT IDENTIFICATION SEGMENT SEQ

LEN

DT

1 2 3 4 5 6 7 8 9 1Ø 11 12 13 14 15 16 17 18 19 2Ø 21 22 23 24 25 26 27 28 29

4 2Ø 25Ø 2Ø 25Ø 25Ø 26 1 25Ø 25Ø 25Ø 4 25Ø 25Ø 25Ø 25Ø 25Ø 25Ø 16 25 25Ø 25Ø 25Ø 1 2 25Ø 25Ø 25Ø 26

SI CX CX CX XPN XPN TS IS XPN CE XAD IS XTN XTN CE CE CE CX ST DLN CX CE ST ID NM CE CE CE TS

3Ø 31 32 33 34 35 36 37 38 39

1 1 2Ø 26 241 25Ø 25Ø 8Ø 25Ø 25Ø

ID ID IS TS HD CE CE ST CE CWE

NAME

USAGE

Set ID-PID Patient ID Patient Identifier List Alternate Patient ID Patient Name Mother’s Maiden Name Date/Time of Birth Administrative Sex Patient Alias Race Patient Address Country Code Phone Number - Home Phone Number - Business Primary language Marital Status Religion Patient Account Number SSN Number Driver License Number Mother's Identification Ethnic Group Birth Place Multiple Birth Indicator Birth Order Citizenship Veterans Military Status Nationality Patient Death Date and Time Patient Death Indicator Identity Unknown Indicator Identity Reliability Code Last Update Date/Time Last Update Facility Species Code Breed Code Strain Production Class Code Tribal Citizenship

O B R O R O C O O O O B O O O O O O B B O O O O O O O B O

COMMENTS Use PID-3 PhIS Patient ID ADS Patient ID

O O O O O C C O O O

5.6.1 SEQ 3: PATIENT IDENTIFIER LIST Patient ID in the PhIS

5.6.2 SEQ 4: ALTERNATE PATIENT ID Version 1.Ø

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings Patient ID in the ADS system or secondary Patient ID in dual systems

5.6.3 SEQ 5: PATIENT NAME SEQ 1 2 3 4

LEN 194 3Ø 3Ø 2Ø

NAME Family Name Give Name Middle Name Suffix

Example Doe John James JR

Example: |DOE^JOHN^JAMES^JR|

5.7 PV1 - PATIENT VISIT SEGMENT SEQ

LEN

DT

NAME

USAGE

1 2 3 4 5 6 7 8 9 1Ø 11 12 13 14 15 16 17 18 19 2Ø 21 22 23 24 25 26 27 28 29 3Ø 31 32 33

4 1 8Ø 2 25Ø 8Ø 25Ø 25Ø 25Ø 3 8Ø 2 2 6 2 2 25Ø 2 25Ø 5Ø 2 2 2 2 8 12 3 2 4 8 1Ø 12 12

SI IS CX IS CX PL XCN XCN XCN IS PL IS IS IS IS IS XCN IS CX FC IS IS IS IS DT NM NM IS IS DT IS NM NM

34

1

IS

Set ID-PID Patient Class Assigned Patient Location Admission Type Preadmit Number Prior Patient Location Attending Doctor Referring Doctor Consulting Doctor Hospital Service Temporary Location Preadmit 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

O R R O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O

COMMENTS

Default to “I” for Inpatient

O

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings SEQ

LEN

DT

NAME

USAGE

35 36 37 38 39 4Ø 41 42 43 44 45 46 47 48 49 5Ø 51 52

8 3 47 25Ø 2 1 2 8Ø 8Ø 26 26 12 12 12 12 25Ø 1 25Ø

DT IS DLD CE IS IS IS PL PL TS TS NM NM NM NM CX IS XCN

Delete Account Date Discharge Disposition Discharged to Location Diet Type Servicing Facility Bed Status Account Status Pending Location Prior Temporary Location Admit Date/Time Discharge Date/Time Current Patient Balance Total Charges Total Adjustments Total Payments Alternate Visit ID Visit Indicator Other Healthcare Provider

COMMENTS

O O O O O B O O O O O O O O O O O O

5.7.1 SEQ 3: ASSIGNED PATIENT LOCATION SEQ 1 2 3 4 5 6

LEN 2Ø 2Ø 2Ø 2Ø 2Ø 2Ø

NAME

Example

Nursing Unit Room Bed Facility ID Floor Number Facility

West Wing W1Ø1 1 1234567 1 LTC HOME

Example: |West Wing^W1Ø1^1^1234567^1^LTC HOME|

5.8 RXD – PHARMACY DISPENSE SEGMENT SEQ

LEN

DT

NAME

USAGE

1 2 3 4 5 6 7 8

4 25Ø 26 2Ø 25Ø 25Ø 2Ø 2Ø

NM CE TS NM CE CE ST NM

Dispense Sub-ID Counter Dispense/Give Code Date/Time for Dispense Actual Dispense Amounts Actual Dispense Units Actual Dosage Form Prescription Number Number of Refills Remaining

R R R R C O R

9

2ØØ

ST

Dispense Notes

O

1Ø 11

2ØØ 1

XCN ID

Dispensing Provider Substitution Status

O O

COMMENTS

NDC of actual drug dispensed

Use for dose disposition (Dispensed, Destroyed, Re-Dispensed) and disposition reason code

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings SEQ

LEN

DT

12 13 14 15

1Ø 2ØØ 1 25Ø

CQ LA2 ID CE

16 17 18 19 2Ø

2Ø 25Ø 2Ø 26 25Ø

NM CE ST TS CE

21 22 23

25Ø 2Ø 25Ø

24 25 26 27

NAME

USAGE O C O O

CE NM CE

Total Daily Dose Dispense-to Location Needs Human Review Pharmacy/Treatment Supplier Special Dispensing Instructions Actual Strength Actual Strength Unit Substance Lot Number Substance Expiration Date Substance Manufacturer Name Indication Dispense Package Size Dispense Package Size Unit

2 25Ø 25Ø 25Ø

IC CE CE CE

Dispense Package Method Supplementary Code Initiating Location Packaging/Assembly Location

O O O O

28

5

NM

Actual Drug Strength Volume

O

29

25Ø

CWE

Actual Drug Strength Volume Units

O

3Ø 31

18Ø 1Ø6

CWE XAD

Dispense to Pharmacy Dispense to Pharmacy Address

O O

32 33

1 25Ø

ID CWE

Pharmacy Order Type Dispense Type

O O

COMMENTS

O O O O O O O O

5.9 RXR – ROUTE SEGMENT SEQ 1 2 3 4 5 6

LEN 25Ø 25Ø 25Ø 25Ø 25Ø 25Ø

DT

NAME

USAGE

CE CWE CE CWE CE CWE

Route Administration Site Administration Device Administration Method Routing Instruction Administration Site Modifier

COMMENTS

R O O O O O

5.10 RXE – PHARMACY ENCODED ORDER SEGMENT SEQ 1 2 3 4

LEN 2ØØ 25Ø 2Ø 2Ø

DT TQ CE NM NM

NAME

USAGE

Quantity/Timing Give Code Give Amount - Minimum Give Amount - Maximum

B R R O

COMMENTS Use TQ1 Segment NDC | Drug Name | Drug ID

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings SEQ

LEN

DT

NAME

USAGE

5 6 7

25Ø 25Ø 25Ø

CE CE CE

Give Units Give Dosage Form Provider's Administration Instructions

8 9 1Ø 11 12 13

2ØØ 1 2Ø 25Ø 3 25Ø

LA1 ID NM CE NM XCN

Deliver-to Location Substitution Status Dispense Amount Dispense Units Number of Refills Ordering Provider's DEA Number

O O O O O O

14

25Ø

XCN

Pharmacist/Treatment Supplier's Verifier ID

O

15 16

2Ø 2Ø

ST NM

Prescription Number Number of Refills Remaining

O O

17

2Ø

NM

Number of Refills/Doses Dispensed

O

18

26

TS

D/T of Most Recent Refill or Dose Dispensed

O

19 2Ø 21

1Ø 1 25Ø

CQ ID CE

Total Daily Dose Needs Human Review Pharmacy/Treatment Supplier's Special Dispensing Instructions

O O O

22 23 24 25 26 27 28 29

2Ø 6 25Ø 2Ø 25Ø 25Ø 2Ø 25Ø

ST ST CE NM CE CE NM CE

Give Per (Time Unit) Give Rate Amount Give Rate Units Give Strength Give Strength Units Give Indication Dispense Package Size Dispense Package Size Unit

O O O O O O O O

3Ø 31 32 33 34

2 25Ø 26 5 25Ø

ID CE TS NM CWE

Dispense Package Method Supplementary Code Original Order Date/Time Give Drug Strength Volume Give Drug Strength Volume Units

O O O O O

35

6Ø

CWE

Controlled Substance Schedule

O

36 37

1 6Ø

ID CWE

Formulary Status Pharmaceutical Substance Alternative

O O

38

25Ø

CWE

Pharmacy of Most Recent Fill

O

39 4Ø

25Ø 25Ø

NM CWE

Initial Dispense Amount Dispensing Pharmacy

O O

COMMENTS

R O

e.g. Take with Food

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings SEQ

LEN

DT

NAME

USAGE

41

25Ø

XAD

Dispensing Pharmacy Address

O

42 43 44

8Ø 25Ø 1

PL XAD ID

Deliver-to Patient Location Deliver-to Address Pharmacy Order Type

O O O

COMMENTS

5.11 TQ1 – TIMING & QUANTITY SEGMENT SEQ 1 2 3 4 5 6 7 8 9 1Ø 11 12 13 14

LEN 4 2Ø 54Ø 2Ø 2Ø 2Ø 26 26 25Ø 25Ø 25Ø 1Ø 2Ø 1Ø

DT

NAME

SI CQ RPT TM CQ CQ TS TS CWE TX TX ID CQ NM

ID Quantity Repeat Pattern Explicit Time Relative Time and Units Service Duration Start Date Time End Date Time Priority Condition Text Text Instructions Conjunction Current Duration Total Occurrences

USAGE R R R R O O R R O O R O O O

COMMENTS Counter starting at 1 and going up

Comma separated HOA times

Text SIG Not needed for ADS

5.11.1 SEQ 3 REPEAT PATTERN •

Use Hour of Administration (HOA) code if it is a daily med. Examples: 4 times daily = QID 3 times daily = TID If it is a skip day order, use HOA~QxD. A skip of 1 becomes Q2D QOD~Q2D QJ repeats on a particular day of the week. If is missing, the repeat rate is assumed to be 1. Day numbers are counted from 1=Monday to 7=Sunday. So Q2J2 means every second Tuesday; Q1J6 means every Saturday. If it is a day of the week order, use QxJØØØØØØØ. MWF becomes Q1J135

•

D (Daily) QJ# Only included when all of the days are not selected 1 = Mon, 2 = Tue, 3 = Wed, 4 = Thu, 5 = Fri, 6 = Sat, 7 = Sun Example: QJ135 = MWF

•

E (Every x Days) Q#D

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings Example: Q2D = every 2nd days Example: Q3D = every 3rd day •

•

M (Monthly) QL#,# Each # represents a day of the month. Only those days selected are included in the list. Example: QL3 = 3rd Example: QL1,15 = 1st and 15th\

Examples: 1. 1 tab bid at 8am and 8pm |TQ1|1|1^TAB|BID|Ø8ØØ, 2ØØØ|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH TWICE DAILY|| 2. 1 tab in the morning and 2 tabs at bedtime |TQ1|1|1^TAB|QD|Ø8ØØ|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH ONCE DAILY|A| |TQ1|2|2^TAB|HS|2ØØØ|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH AT BEDTIME|| 3. 1 cap 9am every other day |TQ1|1|1^CAP|QOD~QOD|Ø9ØØ|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH EVERY OTHER DAY|| 4. 1 tab qid x 3, tid x 3, bid x 3, qd x 3 |TQ1|1|1^TAB|QID|Ø8ØØ||3^D| 2Ø1ØØ5Ø5161Ø|2Ø1ØØ5Ø816Ø9|||TAKE 1 TABLET BY MOUTH 4 TIMES A DAY FOR 3 DAYS|S| |TQ1|2|1^TAB|TID|Ø8ØØ||3^D| 2Ø1ØØ5Ø8161Ø|2Ø1ØØ51116Ø9|||TAKE 1 TABLET BY MOUTH 3 TIMES A DAY FOR 3 DAYS|S| |TQ1|3|1^TAB|BID|Ø8ØØ||3^D| 2Ø1ØØ511161Ø|2Ø1ØØ51416Ø9|||TAKE 1 TABLET BY MOUTH 2 TIMES A DAY FOR 3 DAYS|S| |TQ1|4|1^TAB|QD|Ø8ØØ||3^D| 2Ø1ØØ514161Ø|2Ø1ØØ51716Ø9|||TAKE 1 TABLET BY MOUTH 1 TIME DAILY FOR 3 DAYS|| 5. 1 tab daily at 9am on M W F |TQ1|1|1^TAB|MWF~Q1JØ1Ø1Ø1Ø|Ø9ØØ|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH ONCE DAILY ON MONDAY, WEDNESDAY, AND FRIDAY|| 6. 1 tab PRN |TQ1|1|1^TAB|PRN|PRN|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH AS NEEDED|| 7. 1 tab Q 4 H prn Pain |TQ1|1|1^TAB|Q4HP|PRN|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH EVERY FOUR HOURS AS NEEDED|| 8. 2 tabs to start, then 1 tab daily x 4 days |TQ1|1|2^TAB|STAT|Ø8ØØ||1|2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 2 TABLETS BY MOUTH TO START|| |TQ1|1|1^TAB|QD|Ø8ØØ||4|2Ø1ØØ513162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH DAILY ||

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings

6. FREQUENTLY ASKED QUESTIONS

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings

7. REFERENCE INFORMATION HL7: www.hl7.org

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Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and PostAcute Care Settings

8. APPENDIX A. HISTORY OF CHANGES

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