MEDITECH Specification R1802
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MEDITECH 6.0 LAB SORR Medinet (Reference Lab Interface) Send Orders/Receive Results for LAB/MIC Version: 2.3 September 21, 2012 Reference number: R1802 Copyright © 2013 by Medical Information Technology, Inc. MEDITECH Circle, Westwood, Massachusetts 02090 (781) 821-3000 THIS INFORMATION IS PROPRIETARY AND SHOULD BE TREATED ACCORDINGLY.
Table of Contents
General Comments General Message Format and Functionality Message Structure Sample Messages Testing Notes Network Communications Protocol and Data Framing Asynchronous Communications Protocol and Data Framing Record Layouts MEDITECH Laboratory System to OV Laboratory System Record Layouts OV Laboratory System to MEDITECH Laboratory System Appendix
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General Comments This specification is concerned with defining an interface between the MEDITECH Laboratory application and another laboratory system for the purposes of sending laboratory and microbiology orders from the MEDITECH Laboratory application, and for receiving laboratory and microbiology results into the MEDITECH Laboratory application. The message formats in this document are HL7 version 2.3 compliant. In addition, this document covers the sequencing of records and the protocol that is to be used for communications between MEDITECH and the other vendor. A copy of this specification should be provided to the other vendor well in advance of MEDITECH software delivery so that any questions or concerns of the other vendor can be resolved as soon as possible. Proper cabling between the MEDITECH machine and the other vendor machine will need to be provided by the hospital. MEDITECH can assist in the specification of the correct cable configuration to be used for the inter-machine link. Separate links will be required for orders (which contain ADT data) transmitted to the other vendor laboratory system and for results to be transmitted from the other vendor laboratory system. It is possible that additional devices such as modems may need to be purchased by the hospital depending on the hardware platform of the other vendor system or on the proximity of the MEDITECH machine to the other vendor machine. MEDITECH may be of some assistance in determining specific needs in this area. If modems are to be employed for communications, two separate modems and two separate phone lines will be needed, one dedicated to sending orders and the other dedicated to receiving results. The machine to machine communications will need to be thoroughly tested by MEDITECH and the other vendor prior to any application level testing.
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General Message Format and Functionality GENERAL HL7 MESSAGE FORMAT Order and result data will be passed between the two systems in discrete MESSAGES. A single message may contain multiple variable length data transactions referred to as SEGMENTS. The number, type and content of segments in a given message will be determined based upon the type of message being sent. Each segment will begin with a 3 character code known as the Segment ID, followed by a number of fields which are delimited by the Field Separator character. Each segment will be terminated with a carriage return.
ORDER MESSAGES FROM MEDITECH: Messages will be passed from the MEDITECH Laboratory application to the other vendor laboratory system when: 1.
A laboratory specimen is placed in a shipping batch on the MEDITECH Laboratory application for the Lab Site associated with the MEDINET interface.
2.
A microbiology specimen is placed in a shipping batch on the MEDITECH Laboratory application for the Lab Site associated with the MEDINET interface.
For each specimen, an Order Message (ORM) will be transmitted. patient per Order Message will be sent.
Only one
An Order Message will consist of these message segments: MSH PID PV1 ORC NTE OBR OBX
Message Header Patient Identification Patient Visit Information Order Common Data Notes and Comments Observation Request Observation Result (Queries answered at order time)
MEDITECH will only message. MEDITECH Query messages, or laboratory system,
expect an Acknowledgement Message (ACK) in response to a ORM will not expect or accept any Order Response Message, any any Deferred Acknowledgement Messages from the other vendor as may be defined in the HL7 v2.3 specifications.
The other vendor is expected to extract out of the PID segment any needed data to file a patient onto their system. Direct ADT messages are not sent over the interface. Any observations that are required to perform a given Observation Request (OBR) will be contained in the Observation/Result (OBX) segment(s). These observations should not be returned when reporting results for the Observation Request. RESULT MESSAGES TO MEDITECH Messages will be passed from the other vendor laboratory system to the MEDITECH system when:
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1.
A result is entered and verified on the other vendor laboratory system for a procedure/test that was ordered by the MEDITECH system.
2.
A result is changed or deleted on the other vendor laboratory system for a result that had been previously transmitted to the MEDITECH system.
In each case, a Result Message (ORU) will be sent. Only one patient per Result Message will be accepted. An ORU message should contain only results for a single specimen. A Result Message will be composed of these segments: MSH PID ORC NTE OBR OBX NTE
Message Header Patient Identification Order Common Notes and Comments Observation Request Observation Result Notes and Comments
MEDITECH will not send an Order Response Message, an Order Query Message, or any Deferred Acknowledgement Messages to the other vendor laboratory system, as may be defined in the HL7 v2.3 specifications. An Acknowledgement Message (ACK) will be sent.
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Message Structure Orders will be sent from MEDITECH to the other vendor system using HL7 message type ORM (Observation Order). Results will be sent from the other vendor system and filed into the MEDITECH system using the HL7 message type ORU (Observation Result Unsolicited). Laboratory and microbiology results are sent using discrete values.
Observation Orders (ORM) message ORM MSH PID PV1 ORC [NTE] OBR [OBX]
Order Message Header Patient Identification Patient Visit Information Common Order Notes and Comments Observation Result ID Observation Result (Queries answered at order time)
Observation Results (ORU) message ORU MSH PID ORC [NTE] OBR OBX [NTE]
Observation Results Message Header Patient Identification Order Common Notes and comments - specimen/order comments Observation Result ID Observation/Result Notes and comments - result comments
PID
The Patient Identification segment will contain the patient identifiers as sent from MEDITECH.
PV1
The Patient Visit Information segment will contain additional patient data that the other vendor may need to complete the patient registration process.
ORC
The Order Common segment will contain the type of order message (new, cancel, change), ordering system order identifiers, and order placement date/time.
OBR
The Observation Request segment will repeat some of the same order identifiers contained in ORC, plus add collection/received date/time, ordering provider, and Microbiology specimen source.
NTE
Order specimen comments can be transmitted in NTE segments immediately following the ORC segment. Result comments are transmitted in NTE segments following OBX segments.
OBX
For results, all individual test and component results for a given order will be transmitted in OBX segments following that order's OBR segment. For orders, this segment will contain answers to queries captured at the time the order was placed.
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LABORATORY ORDERS A single message will contain all orders on a single MEDITECH specimen. Individual Order (OBR) segments are tied together using the PLACER GROUP NUMBER element in the ORC segment. The PLACER GROUP NUMBER will be the MEDITECH external specimen number. Each OBR segment will contain a unique PLACER ORDER NUMBER which must be returned with results. Order codes may be mapped by the MEDITECH Laboratory application.
LABORATORY RESULTS Results for only one MEDITECH specimen (PLACER GROUP NUMBER) may be reported per message. Results for a single specimen may be split between messages. Other vendor laboratory test codes may be mapped in the MEDITECH TEST Dictionary to the appropriate test. For specimens that originated on MEDITECH and were sent over the interface, the PLACER ORDER NUMBER in the OBR segment will be used to associate results back to the proper specimens and orders. If a specimen was not sent over the interface (e.g., downtime) the other vendor will not have a PLACER ORDER NUMBER for each order. The ORC segment can be used instead to link results. The PLACER GROUP NUMBER must, on the other vendor system, be manually set to be the MEDITECH specimen number. MEDITECH will then use the PLACER GROUP NUMBER to associate the OBR segment with correct specimen. This is a less reliable method of associating results than relying on the PLACER ORDER NUMBER, and therefore is only used for downtime situations.
MICROBIOLOGY ORDERS A single message will contain all orders on a single MEDITECH specimen. Individual Order (OBR) segments are tied together using the PLACER GROUP NUMBER element in the ORC segment. The PLACER GROUP NUMBER will be the MEDITECH external specimen number. Each OBR segment will contain a unique PLACER ORDER NUMBER which must be returned with results. Order codes may be mapped by the MEDITECH Laboratory application.
MICROBIOLOGY RESULTS The structure of microbiology results is more complex than for laboratory. One microbiology specimen as originated on MEDITECH (PLACER GROUP NUMBER) may be reported per ORU message. Results for multiple orders (OBR) segments may be split into individual messages. When a microbiology result is reported, multiple OBR segments will be transmitted for a single order, as follows: Each parent (i.e., PARENT RESULT field is not valued) OBR segment will contain a MEDITECH order identifier (PLACER ORDER NUMBER) as previously transmitted with the ORM Order Message. An ORC segment can be sent before a parent OBR to associate results with a specimen for specimens not sent over the interface (see LABORATORY RESULTS for more detail). A parent OBR segment will identify the ordered procedure (UNIVERSAL
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SERVICE IDENTIFIER) that results will reference. Any NTE segments following this OBR segment will contain order/specimen comments. Result comments for the procedure should be reported in OBX segments following this OBR segment. The OBR segment may be followed by any number of OBX segments which will contain text results for the resulted procedure(s), and will identify any organisms which have been isolated. Any organisms that are isolated should be assigned a numeric designation which is reported in the OBSERVATION SUB-ID field of the OBX segment. Note that OBX segments used to report isolated organisms should have CE (coded entry) in the VALUE TYPE field of the segment, as opposed to ST (string) for text results. Subsequent child (i.e., PARENT RESULT field is valued) OBR segments and OBX segments will be used to report any susceptibilities that have been run for the order. The OBR segment is used to identify the susceptibility procedure that was used and the organism for which it was run. The susceptibility procedure is identified in the UNIVERSAL SERVICE ID field. The Organism is identified in the PARENT RESULT field, using the number set up in the OBSERVATION SUB-ID field of an OBX segment of the parent result. OBX segments following child OBR segments will be used to report the individual antibiotics and the susceptibilities that were recorded for the antibiotic. MICROBIOLOGY RESULT TYPES In each OBX segment, the type of result being reported will be indicated in the OBSERVATION IDENTIFIER field. The particular instance of this type of result will be indicated in the OBSERVATION SUB-ID field. The actual result value will be contained in the OBSERVATION RESULT (ABNORMAL FLAGS for susceptibilities) field. Valid result types, with corresponding sub-identifiers and results, are as follows: OBS. ID VALUES
TYPE OF RESULT
OBS. SUB ID VALUES
OBSERVATION RESULT
CE
Organism Identification
1...N
Organism Name/ Mnemonic
ST
Procedure/Susceptibility Results
1...N
Results
SAMPLE MICROBIOLOGY RESULT GROUPING The following example microbiology result shows the relative grouping of message segments and pertinent field information. For exact field layout and definitions, refer to the Record Layout and Appendix sections of this specification. MSH PID
Message Header Patient Identifier
OBR NTE NTE OBX OBX OBX OBX
Order Identifier Order/Specimen Comment Line 1 Order/Specimen Comment Line 2 ST Line 1 Text of Line 1 ST Line 2 Text of Line 2 CE Organism 1 ECOLI (ORG 1) CE Organism 2 STREP SPECIES (ORG 2)
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OBR OBX NTE NTE OBX
Order Identifier Susceptibility Procedure 1 ST Antibiotic 1 Result Antibiotic Comment Line 1 Antibiotic Comment Line 2 ST Antibiotic 2 Result
ORG 1
OBR OBX OBX
Order Identifier Susceptibility Procedure 1 ST Antibiotic 1 Result ST Antibiotic 2 Result
ORG 2
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Sample Messages The following are some sample HL7 order and result messages. Sample Orders Multiple profiles/orderable tests may be sent in one message, linked by the PLACER GROUP NUMBER. A single message will contain only one PLACER GROUP NUMBER which will be a MEDITECH external specimen number. MSH|^~\&|LAB|MDH|||199903021705||ORM^O01|1.15|D|2.3| PID|1||M000340024||JOHNSON^MAX||19600903|M||C|5 MILK STREET^^BOSTON^MA^02215||| ||M||V000008867|012-34-5678| PV1||E|SE4^402^02^MDH|R|||LEC^LEVIN^CLAUDIA^M^^DR^|FRB^FRANKLIN^BEN^^^DR^|CON^C ONSULT^DOC^^^DR^|U||||A|||ADD^ADMIT^DOC^^^DR^|IN||SP||||||||||||||||H||||| ADM|||199704062330|199704081000| ORC|NW|6958^LAB||040701:C00004R||N|^^^^^R||199904071708| NTE|1||ORDERING COMENTS| OBR|1|6958^LAB||415263^17-HYDROXYPROGESTERONE^L|||199904071615|||||||1999040716 15||ABC^ABC^DEFG^^^^MD||||||||LAB|||^^^^^R| Sample Laboratory Result The OBR segment identifies the MEDITECH order for which results are being reported. Results associated with the given order are reported with OBX segments following the OBR segment. Multiple OBR segments may be contained in a single message. However, all OBR segments contained in a single message must be from the same PLACER GROUP NUMBER sent in the original ORC segment from MEDITECH. MSH|^~\&|LAB||||199903021900||ORU^R01|99783|P|2.3| PID|1||M000340024||JOHNSON^MAX||19600903|M||C|5 MILK STREET^^BOSTON^MA^02215||| ||M||V000008867|012-34-5678| ORC||6958^LAB||040701:C00004R|||||199704071116| OBR|1|6958^LAB|11687|415263^17-HYDROXYPROGESTERONE^L|||199704071200|||||||19970 4071230||ABC^ABC^DEFG^^^^MD||||||||LAB|F||^^^^^R| OBX|1|ST|12321^17-HYDROXYPROGESTERONE^L|1|132|MG/DL|120-140||||F|||199904071900 ||LABTECH1| Sample Microbiology Result In the example below, a CULT BACT/GS procedure composed of a gram stain and a culture, has been ordered. In the first OBR record, the CULT BACT/GS is identified as the ordered procedure. In the OBX segments that follow it, the results for the Gram Stain and the Culture are reported. In the last OBX segment for the Culture, an organism (Escherichia Coli) is identified and linked with the OBSERVATION SUB-ID 2.1 for identification purposes. The OBSERVATION SUB-ID is not strictly part of the result - it is used later in the message to identify which organism the susceptibilities are for. In the second OBR segment, the susceptibility procedure (NEG FLEX) is identified, and associated with the organism ESCHERICHIA COLI (OBSERVATION SUB-ID 2.1). Following this OBR segment are OBX segments with antibiotics and associated susceptibilities for this susceptibility procedure. MSH|^~\&|MIC||||199703101800||ORU^R01|934858|P|2.3| PID|1||M000340024||JOHNSON^MAX||19600903|M||C|5 MILK STREET^^BOSTON^MA^02215||| ||M||V000008867|012-34-5678|
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ORC||4301^MIC||031001:M0432|||||199703101116| OBR|1|4301^MIC|11688|GS^CULT BACT/GS^L|||199703101205|||||||199703101430|URC^^^ URINE, CATHETERIZED|ORD.DR^DOC^ORDERING||||||||MB|F||^^^^^R| OBX|1|ST|GS^GRAM STAIN^L|1|GRAM STAIN RESULTS:||||||F| OBX|2|ST|GS^GRAM STAIN^L|1|GRAM POSITIVE RODS||||||F| OBX|3|ST|CR1^CULT BACT UR VD^L|2|PRELIMINARY REPORT:||||||F| OBX|4|ST|CR1^CULT BACT UR VD^L|2|>100,000 ORG/ML OF:||||||F| OBX|5|ST|CR1^CULT BACT UR VD^L|2|GRAM POSITIVE RODS||||||F| OBX|6|ST|CR1^CULT BACT UR VD^L|2|IDENTIFICATION AND SUSCEPTIBILITY TO FOLLOW||| |||F| OBX|7|ST|CR1^CULT BACT UR VD^L|2|03/10/1997 0731||||||F OBX|8|ST|CR1^CULT BACT UR VD^L|2|***FINAL REPORT:***||||||F| OBX|9|ST|CR1^CULT BACT UR VD^L|2|>100,000 ORG/ML OF:||||||F| OBX|10|ST|CR1^CULT BACT UR VD^L|2| ESCHERICHIA COLI ||||||F| OBX|11|ST|CR1^CULT BACT UR VD^L|2|SUSCEPTIBILITY TO FOLLOW||||||F| OBX|12|ST|CR1^CULT BACT UR VD^L|2|03/05/97 1026||||||F| OBX|13|CE|CR1^CULT BACT UR VD^L|2.1|ECOLI^ESCHERICHIA COLI||||||F| OBR|2|4301^MIC|11688|NEG FLEX|||199703101205|||||||199703101430|URC^URINE, CATH ETERIZED|ORD.DR^DOC^ORDERING||||||||MB|F|CR1^2.1||4301^MIC| OBX|1|ST|AMP^AMPICILLIN||2|||S|||F| OBX|2|ST|U^AMP/SULBAC|| lower limit (if no upper limit, e.g., >10) c) < upper limit (if no lower limit, e.g.,
