HL7 Overview

HL7 Overview

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Learning Objectives

• Define “HL7”

• Understand the basic structure of HL7 messages

• Understand typical usage of HL7 messages

• Understand common message content and workflow

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Table of Contents

• Terminology

• Introduction

• Overview

• Summary

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Terminology

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Terminology

• Message Types are messages that reference a group of related actions (example: ADT)

• Trigger Events are specific actions that are associated with the generation of a message (example: ADT_A01)

• Segments are logical groups of data elements or “fields” (example: PID)

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Introduction

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Introduction

• Health care organizations often operate numerous information systems and integrate them via data transfer interfaces

• HL7 (Health Level 7) is the name of the organization and the predominant messaging standard for exchanging key sets of administrative and clinical data in the healthcare enterprise

• The cross-departmental usage of HL7 leads to the use of some generic labels

• Example: Diagnostic Service Section ID (~AE Title) and Universal Service ID (Procedure Code)

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Introduction

• Departmental system databases typically store a combination of redundant and unique data

• The most common redundant data are patient IDs and demographics

• Health care organizations usually assign primary responsibility for correctly identifying patients to a single department that manages the data in a single system

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Introduction

• The department(s) with primary responsibility for patient ID usually use(s) a system commonly referred to as a Healthcare Information System (HIS)

• Typical HIS functions are registration/admitting, and billing

• Order entry, claims, clinical viewing, decision support, and other functions may or may not be supported by the HIS

• The HIS is regarded as the master system

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Overview

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• What is HL7?– “Health Level Seven develops specifications, the most widely used being a

messaging standard that enables disparate healthcare applications to exchange keys sets of clinical and administrative data.”1

• What is a “Message?”– A message is a basic communication unit containing information that models

a real world event• How does one read a Message?

– A message is structured like an organizational chart

HL7 Overview

Message

Segment Segment Segment Segment

Fields Fields FieldsFields

Component Component

Common HL7 Message Types, Segments, and Fields based on HL7 Standards http://www.hl7.org

1 – About Health Level SevenSource: http://www.hl7.ie/about_us.asp

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HL7 Message Structure

Message

has

contains

comprised of

UserUser

SegmentsUser

UserFields

UserUser

Components

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Message Types

• ADT is an (A)dmit, (D)ischarge, and (T)ransfer message that is “triggered” by a patient admission, discharge, or transfer

• ORM is an (Or)der (M)essage which includes new orders, order status changes, and order cancels

• ORU is a Report/Result Message

• Example:<11>MSH|^~\&|IMAGING|PSJMC|TDSresults|PSJMC|20030926000401||

ORM^O01|783744|P|2.3<13>

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Message Segments<11>MSH|^~\&|IMAGING|PSJMD|TDS|PSJMD|

20030926133719||ORM^O01|785465|P|2.3<13>

PID||01000083270000160771229|555-55-555^^^PSJ||ESCARDA^NARVARO||19000606|M|||1234 SOMEWHERE AVE^^^CA^90001-0000||213-456-7890|312-987-6543||||60771229|55555555<13>

PV1||I|4S^S460|||||FEB^SINATRA^FRANK^E^^^MD^8888||||||||||IP||||||||||||||||||||||||||200102240414<13>

ORC|SN||100A-01011800||IP|N|1^^^200102241201^^S||200309261015|^INTERFACE^HIS||FEB^SINATRA^FRANK^E^^^MD^8888<13>

OBR|||100A-01011800|9025^CT PELVIS 72193^MWA||| 200102241201||||||--..|||FEB^SINATRA^FRANK^E^^^MD^8888||58944|||| 200102240414||CT|||1^^^200102240414^^S|ST1^TAPAIN^STEVEN^^^^MD^0275~SLP^POLISH^JOSEPH^L^^^MD^9828<13>

NTE|1||CT UROGRAM ,PT GOING TO OR 1230 TODAY<13>

<28><13>

• PID is a Patient Identifier Segment

• PV1 is a Patient Visit Segment

• ORC is the top level Order Information Segment

• OBR is the Order Detail Segment

• NTE is the Notes and Comments Segment

• OBX is the Report/Result Segment in an ORU Message

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Typical Message Content and Functions

• HL7 specifies requirements for SEQs/components but this does not confer an obligation to process this data

• Conversely, a target application may require data that is not HL7 required

• HL7 sometimes requires codified data

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Typical Message Work Flow

• ADT-establish patient, visit, update demographics, update visit

• Example: ADT_A04, A06, A08, A03

• ORM-order with account (PID-18) vs. visit (PV1-19), order response, result

• Example: ORM_O01, ORR_O02, ORU_R01

• ORU by definition is unsolicited-does not have to be in response to an order

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“Data Flow”

Process HL7 Message Type Exam Status

Patient admitted ADT01 N/A

Patient demographic change ADT08 N/A

Patient merge ADT18 or 34 N/A

Radiology procedure ordered/scheduled ORMNW S(cheduled)

Ordered procedure modified ORMXO S(cheduled)

Image acquisition at modality begins N/A I(n progress)

Procedure completed by technologist ORMSC C(omplete)

Report dictated by radiologist ORMSC D(ictated)

Preliminary report transcribed ORU P(reliminary)

Final report signed ORU F(inal)

Radiology procedure canceled ORMCA X(canceled)

*Table represents typical HL7 data flow – actual message types vary by organization

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HL7 Message Fields

Common Fields

• PID-02 MPI number• PID-03 MRN • PID-05 Patient name• PID-07 DOB• PID-08 Sex• PID-18 Patient Account No.• PID-19 SSN• PV1-07 Attending MD • PV1-17 Admitting MD

Order and Report Fields

• ORC-02 or OBR-02 Order Number

• ORC-03 or OBR-03 Accession No.

• ORC-12 Ordering MD• OBR-04 Exam Code and Exam

Description• OBR-07 Order Date and Time• OBR-24 Resource Name• OBR-25 Order/Exam Status• OBX-05 Result Text

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Summary

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Summary

• HL7 is a messaging protocol

• Message types, trigger events, and segments are identified with 3 character labels; fields are identified by position (SEQ) in segments.

• Data placement, basic structure, message types, and event definitions should be consistent in HL7 messaging

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Summary

• Due to variations in healthcare business requirements and supported functionality of different information systems there are many variations in HL7 conformance

• Variation in HL7 data content is present at the message, segment and field level

• Variation is also present in workflow

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