HL7 Conformance. HL7 Detailed Specification for Diagnostic Labs and Radiology Center Connectivity

HL7 Conformance HL7 Detailed Specification for Diagnostic Labs and Radiology Center Connectivity Authored by Global Engineering Team, Health Gorilla...
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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

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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.

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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.

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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.

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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www.HealthGorilla.com

Copyright © 2014 Health Gorilla, Inc. All rights reserved. Health Gorilla is a trademark of Health Gorilla, Inc.

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