HL7 Conformance
HL7 Detailed Specification for Diagnostic Labs and Radiology Center Connectivity
Authored by Global Engineering Team, Health Gorilla
April 10, 2014
Table of Contents
About Health Gorilla’s Online Healthcare Marketplace.....................................................................................................................3 Overview.................................................................................................................................................................................................................... 4 HL7 Standard Formats for Data Interchange...........................................................................................................................................5 Facilitating Electronic Data Exchange....................................................................................................................................................5 Messages.................................................................................................................................................................................................................... 7 HL7 Attribute Table MSH – Message Header....................................................................................................................................8 HL7 Attribute Table – NTE – Notes and Comments.......................................................................................................................8 HL7 Attribute Table – PID– Patient Identification...........................................................................................................................9 HL7 Attribute Table – PV1– Patient Visit..........................................................................................................................................10 HL7 Attribute Table –ORC– Common Order..................................................................................................................................11 HL7 Attribute Table –OBR– Observation Request......................................................................................................................12 HL7 Attribute Table – OBX – Observation Result.........................................................................................................................13 HL7 Attribute Table – IN1– Insurance Segment............................................................................................................................14 HL7 Attribute Table – DG1 – Diagnosis Segment.........................................................................................................................15 HL7 Attribute Table – GT1 – Guarantor Segment........................................................................................................................15 Integration with Health Gorilla’s Online Healthcare Marketplace.............................................................................................16 Trademark Acknowledgements....................................................................................................................................................................17
HL7 Conformance
2 Confidential and Proprietary
About Health Gorilla’s Online Healthcare Marketplace
Health Gorilla™ is the first online healthcare marketplace to connect all doctors and clinicians with over 9,000+ diagnostic labs and 38,000+ radiology centers. Doctors and their teams can instantly place orders, get results, and completely eliminate paper faxes. Uniquely, our HIPAA compliant and ONC modular certified MU2 solution is available immediately at absolutely no charge for doctors and clinicians.
HL7 Conformance
3 Confidential and Proprietary
Overview
HL7 was first established as a standard in the late 1980’s as a collaborative effort between healthcare systems vendors and hospitals. The standard established a message format that different systems could use to exchange health data. The name HL7 was chosen because the original concept was to define message structures based upon the seventh level of the ideal network model. The Internet was not in widespread use at that time and most hospital networks varied considerably. For these reasons and more the HL7 standard was set up to define messages and not how those messages were actually sent. Version 2 was released and has been in use for over 20 years. Offering a lot of options and flexibility, the V2.x series of messages are widely used and very successful. Widespread adoption of HL7’s V2 is also due in part to its flexibility. It contains many optional data elements and data segments, making it easily adaptable to any use. The options also contributes the support of reliable conformance testing.
HL7 Conformance
4 Confidential and Proprietary
HL7 Standard Formats for Data Interchange
Health Gorilla uses the Health Level Seven (HL7) standard to enable Diagnostic Labs and Radiology Centers to exchange data with the Health Gorilla Online Healthcare Marketplace. This protocol allows us to support the transmission of data between Doctor’s offices, Diagnostic Facilities and the Health Gorilla Marketplace.
Facilitating Electronic Data Exchange Health Level Seven (HL7) is an application protocol for electronic data exchange in health care environments. The HL7 protocol is a collection of standard formats which specify the implementation of interfaces between computer applications from different vendors and HG. Flexibility is built into the protocol to allow compatibility for specialized data sets that have facility-specific needs. It can be described as a standard series of predefined logical formats for packaging healthcare data in the form of messages to be transmitted among computer systems. A message is a collection of data that sends information about an event which is typically a Diagnostic Lab order or result.
Introduction to HL7 Standards HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. These standards define how information is packaged and communicated from one party to another, setting the language, structure and data types required for seamless integration between systems. Instead of having to write specifications from scratch each time data needs to be sent between two systems, reference can be made between a uniform document whose definitions assist in providing a common understanding to both systems.
HL7 Benefits Healthcare Providers Hospitals, diagnostic labs, radiology centers and other healthcare provider organizations typically have many different computer systems used for everything from billing records to patient tracking. HL7 specifies a number of flexible standards, guidelines, and methodologies by which various healthcare systems can communicate with each other. Such guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards are meant to allow healthcare organizations to easily share clinical information.
Communication Protocol The HL7 Standard defines only the seventh level of the Open System Inter-connect (OSI) protocol. This is the application level. Levels 1-6 involve primarily communication protocols. The HL7 Standard provides some guidance in this area.
HL7 Conformance
5 Confidential and Proprietary
TCP/IP and HL7 Minimal Lower Level Protocol (MLLP) The interface between systems is established via a persistent or a transient (non-persistent) TCP/IP connection. Two TCP sockets provide bi-directional communications between each participating system. Within the context of the TCP socket, each participating system will connect as the client when it initiates a message. The other system will connect as the server to receive messages from the listen state. This interface uses the HL7 Minimal Lower Layer Protocol to format messages for data interchange, including acknowledgement messages. This protocol relies on the Message Header (MSH) Segment to define encoding, routing and acknowledgement rules governing the message.
Application Processing Rules The HL7 Standard describes the basic rules for application processing by the sending and receiving systems. Information contained in the Standard is not repeated here.
HL7 Conformance
6 Confidential and Proprietary
Messages
The following HL7 messages are used to support the exchange of Laboratory information. ACK
General Acknowledgement
ORU
Observational Results
ORM
Observational Orders
MSA
Message Acknowledgement
Segments Used In The Messages MSH
Message Header
NTE
Notes and Comments
OBR
Observation Request
OBX
Observation
ORC
Common Order
PID
Patient Identification
IN1
Insurance
DG1
Diagnosis
GT1
Guarantor
PV1
Patient Visit
HL7 Conformance
7 Confidential and Proprietary
HL7 Attribute Table MSH – Message Header Seq
Len
DT
OPT
1
1
ST
2
4
3 4
RP#
TBL#
ITEM#
ELEMENT NAME
R
00001
Field Separator
ST
R
00002
Encoding Characters
180
HD
O
0361
00003
Sending Application
180
HD
O
0362
00004
Sending Facility
5
180
HD
O
0361
00005
Receiving Application
6
180
HD
O
0362
00006
Receiving Facility
7
26
TS
R
00007
Date/Time of message
8
40
ST
O
00008
Security
9
13
CM
R
00009
Message Type
10
20
ST
R
00010
Message Control ID
11
3
PT
R
00011
Processing ID
12
60
VID
R
00012
Version ID
13
15
NM
O
00013
Sequence Number
14
180
ST
O
00014
Continuation Pointer
15
2
ID
O
0155
00015
Accept Acknowledgment Type
16
2
ID
O
0155
00016
Appilcation Acknowledgment Type
17
3
ID
O
0399
00017
Country Code
18
16
ID
O
0211
00692
Character set
19
250
CE
O
00693
Principal Language of Message
20
20
ID
O
01317
Alternate Character Set Handling Scheme
0076/003
0104
0356
HL7 Attribute Table – NTE – Notes and Comments Seq
Len
DT
OPT
1
4
SI
O
2
8
ID
O
3
65536
FT
O
4
250
CE
O
RP#
TBL# 01015
Y 0364
ITEM#
ELEMENT NAME
000096
Set ID – NTE
000097
Source of Comment
000098
Comment
01318
Comment Type
HL7 Conformance
8 Confidential and Proprietary
HL7 Attribute Table – PID– Patient Identification Seq
Len
DT
OPT
1
4
SI
2
20
3 4
RP#
TBL#
ITEM#
ELEMENT NAME
O
00104
Set ID – PID
CX
B
00105
Patient Id
250
CX
R
Y
00106
Patient Identifier List
20
CX
B
Y
00107
Alternate Patient Id
5
250
XPN
R
Y
00108
Patient Name
6
250
XPN
O
Y
00109
Mothers Maiden Name
7
26
TS
O
00110
Date and Time of Birth
8
1
IS
O
00111
Administrative sex
9
250
XPN
B
Y
00112
Patient Alias
10
250
CE
O
Y
00113
Race
11
250
XAD
O
Y
00114
Patient Address
12
4
IS
B
00115
Country Code
13
250
XTN
O
Y
00116
Phone Number – Home
14
250
XTN
O
Y
00117
Phone Number – Business
15
250
CE
O
0296
00118
Primary language
16
250
CE
O
0002
00119
Martial Status
17
250
CE
O
0006
00120
Religion
18
250
CX
O
00121
Patient Account Number
19
16
ST
B
00122
SSN Number
20
25
DLN
O
00123
Divers License Number
21
250
CX
O
Y
00124
Mothers Identifier
22
250
CE
O
Y
00125
Ethnic Group
23
250
ST
O
00126
Birth place
24
1
ID
O
00127
Multiple Birth Indicator
25
2
NM
O
26
250
CE
O
27
250
CE
28
250
29
0001 0005 0289
0189 0136
00128
Birth Order
0171
00129
Citizenship
O
0171
00130
Veterans Military Status
CE
B
0212
00739
Nationality
26
TS
O
00740
Patient Death Date and Time
30
1
ID
O
0136
00741
Patient Death Indicator
31
1
ID
O
Y
0136
01535
Identity Unknown Indicator
32
20
IS
O
Y
0445
01536
Identity Reliability Code
33
26
TS
O
01537
Last Update Date and Time
34
40
HD
O
01538
Last Update Facility
Y
HL7 Conformance
9 Confidential and Proprietary
HL7 Attribute Table – PV1– Patient Visit Seq
Len
DT
OPT
1
4
SI
O
2
1
IS
R
3
80
PL
O
4
2
IS
O
5
250
CX
6
80
7
RP#
TBL#
ITEM#
ELEMENT NAME
00131
Set Id- PV1
00132
Patient Class
00133
Assigned Patient Location
00134
Admission Type
O
00135
Pre-admit Number
PL
O
00136
Prior Patient Location
250
XCN
O
Y
0010
00137
Attending Doc
8
250
XCN
O
Y
0010
00138
Referring Doc
9
250
XCN
B
Y
0010
00139
Consulting Doc
10
3
IS
O
0069
00140
Hospital Service
11
80
PL
O
00141
Temporary Location
12
2
IS
O
0087
00142
Pre-admit Test Indicator
13
2
IS
O
0092
00143
Re-admission indicator
14
6
IS
O
0023
00144
Admit Source
15
2
IS
O
Y
0009
00145
Ambulatory Source
16
2
IS
O
Y
0099
00146
VIP Indicator
17
250
XCN
O
Y
0010
00147
Admitting Doc
18
2
IS
O
0018
00148
Patient Type
19
250
CX
O
20
50
FC
O
21
2
IS
22
2
IS
0004 0007
00149
Visit Number
0064
00150
Financial Class
O
0032
00151
Charge Price Indicator
O
0045
00152
Courtesy Code
Y
HL7 Conformance
10 Confidential and Proprietary
HL7 Attribute Table –ORC– Common Order Seq
Len
DT
OPT
RP#
TBL#
ITEM#
ELEMENT NAME
1
2
ID
R
N
00119
00215
Order Control
2
22
El
C
00216
Placer Order Number
3
22
El
C
00217
Filler Order Number
4
22
El
O
00218
Placer Group Number
5
2
ID
O
0038
00219
Order Status
6
1
ID
O
0121
00220
Response Flag
7
200
TQ
O
00221
Quantity / Timing
8
200
CM
O
00222
Parent
9
26
TS
O
00223
Date / time of transaction
10
250
XCN
O
Y
00224
Entered By
11
250
XCN
O
Y
00225
Verified By
12
250
XCN
O
Y
00226
Ordering Provider
13
80
PL
O
00227
Enter Location
14
250
XTN
O
00228
Call Back Phone Number
15
26
TS
O
00229
Order Effective Date / Time
16
250
CE
O
00230
Order Code control code reason
17
250
CE
O
00231
Entering Organization
18
250
CE
O
00232
Entering Organization
19
250
XCN
O
00233
Action By
20
250
CE
O
01310
Advanced Beneficiary Notice Code
21
250
XON
O
Y
01311
Ordering Facility Name
22
250
XAD
O
Y
01312
Ordering Facility Address
23
250
XTN
O
Y
01313
Ordering Facilitating Phone Number
24
250
XAD
O
Y
01314
Ordering Provider Address
25
250
CWE
O
N
01473
Order Status Modifier
N Y
Y/2
Y 0339
HL7 Conformance
11 Confidential and Proprietary
HL7 Attribute Table –OBR– Observation Request Seq
Len
DT
OPT
1
4
SI
2
22
3 4
RP#
TBL#
ITEM#
ELEMENT NAME
O
00237
Set ID- OBR
EI
C
00216
Placer Order Number
22
EI
C
00217
Filler Order Number
250
CE
R
00238
Universal Service Identifier
5
2
ID
B
00239
Priority- OBR
6
26
TS
B
00240
Requested Date / Time
7
26
TS
C
00241
Observation Date/ Time
8
26
TS
O
00242
Observation End Date/Time
9
20
CQ
O
00243
Collection Volume
10
250
XCN
O
00244
Collector Identifier
11
1
ID
O
00245
Specimen Action Code
12
250
CE
O
00246
Danger Code
13
300
ST
O
00247
Relevant Clinical Information
14
26
TS
C
00248
Specimen Received date/time
15
300
CM
O
0070/00163 00249
16
250
XCN
O
Y
00226
Ordering Provider
17
250
XTN
O
Y/2
00250
Order Call back Phone Number
18
60
ST
O
00251
Placer Field 1
19
60
ST
O
00252
Placer Field 2
20
60
ST
O
00253
Filler Field 1+
21
60
ST
O
00254
Filer Field 2 +
22
26
TS
C
00255
Results Report? Status Change – Date / Time
23
40
CM
O
00256
Charge To Practice
24
10
ID
O
0074
00257
Diagnostic Serv Sect ID
25
1
ID
C
0123
00258
Result Status
Y 0065
Specimen Source
HL7 Conformance
12 Confidential and Proprietary
HL7 Attribute Table – OBX – Observation Result Seq
Len
DT
OPT
1
4
SI
O
2
2
ID
C
3
250
CE
4
20
ST
5
655536
ITEM#
ELEMENT NAME
00569
Set ID- OBX
00570
Value Type (TX’ = the value in OBX.5 is block text ‘ED’ = the value in OBX.5 is base64 encoded data )
R
00571
Observation Identifier
C
00572
Observation Sub-ID
00573
Observation Type( Only used if OBX-2 is ‘ED’ Valid values: ‘PDF’, ‘GIF’, ‘JPG’, ‘BMP’, ‘HPDF’ )
6
250
CE
7
60
ST
O
00574
Units
O
00575
Reference Range
8
5
IS
O
00576
Abnormal Flag
9
5
NM
O
00577
Probability
10
2
ID
O
0080
00578
Nature of Abnormal test
11
1
ID
R
0085
00579
Observation Result Status
12
26
TS
13
20
ST
O
00580
Date last Observation Normal Value
O
00581
User Defined Access Checks
14
26
TS
O
00582
Date / Time of the Observation
15
250
CE
O
00583
Producers ID
16
250
XCN
O
Y
00584
Responsible Observer
17
250
CE
O
Y
00936
Observation Method
18
22
EI
O
Y
01479
Equipment Instance Identifier
19
26
TS
O
01480
Date / Time of the Analysis
C
RP#
TBL# 0125
Y
Y/5 Y
0078
HL7 Conformance
13 Confidential and Proprietary
HL7 Attribute Table – IN1– Insurance Segment Seq
Len
DT
OPT
1
4
SI
R
2
60
CE
R
3
59
CX
R
4
130
XON
O
5
106
XAD
6
48
7
RP#
TBL#
ITEM#
ELEMENT NAME
00426
Set ID - IN1
00368
Insurance Plan ID
Y
00428
Insurance Company ID
Y
00429
Insurance Company Name
O
Y
00430
Insurance Company Address
XPN
O
Y
00431
Insurance Co. Contact Person
40
XTN
O
Y
00432
Insurance Co Phone Number
8
12
ST
O
00433
Group Number
9
130
XON
O
Y
00434
Group Name
10
12
CX
O
Y
00435
Insured’s Group Employee ID
11
130
XON
O
Y
00436
Insured’s Group Employee Name
12
8
DT
O
00437
Plan Effective Date
13
8
DT
O
00438
Plan Expiration Date
14
55
CM
O
00439
Authorization Information
15
3
IS
O
00440
Plan Type
16
48
XPN
O
00441
Name Of Insured
17
2
IS
O
00442
Insured’s Relationship To Patient
18
26
TS
O
00443
Insured’s Date Of Birth
19
106
XAD
O
00444
Insured’s Address
0072
0086 Y 0063 Y
HL7 Conformance
14 Confidential and Proprietary
HL7 Attribute Table – DG1 – Diagnosis Segment Seq
Len
DT
OPT
RP#
TBL#
ITEM#
ELEMENT NAME
1
4
SI
R
2
2
ID
(B) R
0053
00375
Set ID - DG1
00376
Diagnosis Coding Method
3
60
CE
O
0051
00377
Diagnosis Code
4
40
ST
B
00378
Diagnosis Description
5
26
TS
O
00379
Diagnosis Date/Time
6 7
2
IS
R
0052
00380
Diagnosis Type
60
CE
B
0118
00381
Major Diagnostic Category
8
4
IS
B
0055
00382
Diagnostic Related Group
9
2
ID
B
0136
00383
DRG Approval Indicator
10
2
IS
B
0056
00384
DRG Grouper Review Code
11
60
CE
B
0083
00385
Outlier Type
12
3
NM
B
00386
Outlier Days
13
12
NM
B
00387
Outlier Cost
14
4
ST
B
00388
Grouper Version And Type
15
2
NM
B
00389
Diagnosis Priority
16
60
XCN
O
00390
Diagnosing Clinician
17
3
IS
O
0228
00766
Diagnosis Classification
18
1
ID
O
0136
00767
Confidential Indicator
19
26
TS
O
00768
Attestation Date/Time
Y
HL7 Attribute Table – GT1 – Guarantor Segment Seq
Len
DT
OPT
1
4
SI
R
2
59
CX
O
3
48
XPN
4
48
XPN
5
106
6
RP#
TBL#
ITEM#
ELEMENT NAME
00405
Set ID - GT1
Y
00406
Guarantor Number
R
Y
00407
Guarantor Name
O
Y
00408
Guarantor Spouse Name
XAD
O
Y
00409
Guarantor Address
40
XTN
O
Y
00410
Guarantor Ph Num-Home
7
40
XTN
O
Y
00411
Guarantor Ph Num-Business
8
26
TS
O
00412
Guarantor Date/Time Of Birth
9
1
IS
O
0001
00413
Guarantor Sex
10
2
IS
O
0068
00414
Guarantor Type
11
2
IS
O
0063
00415
Guarantor Relationship
12
11
ST
O
00416
Guarantor SSN
Data Types: Standard HL7 2.3 data types are used. Encapsulated PDFs in HL7 are attached in the OBX segment. When attached, the value of OBX.2 = ED OBX.5 = Embedded PDF
HL7 Conformance
15 Confidential and Proprietary
Integration with Health Gorilla’s Online Healthcare Marketplace
This specification is designed to provide information to diagnostic labs and radiology center partners sufficient to assist in the development of an interface between their lab information systems and Health Gorilla’s (HG) online healthcare marketplace. This document explains the technical details of our HL7 standard support. Interface development between HG and our vendors is approved by our business development team, then scheduled and managed by our engineering and development organization. We work in conjunction with our vendor partners to spend time analyzing and planning our interface to ensure that both parties are using the same optional features. Our interfaces support the transmission of HL7 data and HL7 encapsulated .PDF’s as well as DICOM IOD’s and DICOM encapsulated .PDF.
HL7 Conformance
16 Confidential and Proprietary
Trademark Acknowledgements
HL7® and Health Level Seven® are registered trademarks of Health Level Seven International. DICOM® is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communications of medical information. Health Gorilla™ is a trademark of Health Gorilla, Inc.
Copyright 2014 Health Gorilla.
Health Gorilla 256 Gibraltar Dr. #101 Sunnyvale, CA 94089 1.844.446.7455 (1.844.HGORILLA) www.HealthGorilla.com
HL7 Conformance
17 Confidential and Proprietary
www.HealthGorilla.com
Copyright © 2014 Health Gorilla, Inc. All rights reserved. Health Gorilla is a trademark of Health Gorilla, Inc.