Indiana state Department of health ISDH ELR HL7 Version 2.5.1 Message Structure Reference Guide 20170328 Valid through 2017 or until newer version released INDIANA STATE DEPARTMENT

ISDH ELR HL7 Version 2.5.1 Message Structure Reference Guide 20170328 Valid through 2017 or until newer version released

INDIANA STATE DEPARTMENT OF HEALTH ELR HL7 VERSION 2.5.1 IMPLEMENTATION GUIDE

INDIANA STATE DEPARTMENT OF HEALTH

Electronic Laboratory Reporting (ELR)

Indiana State Department of Health reserves the right to change requirements and/or update the contents of this implementation guide at any time.

HL7 version 2.5.1 Message Structure Reference Guide Version 1.0

i

ISDH ELR HL7 Version 2.5.1 Message Structure Reference Guide 20170328

INDIANA STATE DEPARTMENT OF HEALTH ELR HL7 VERSION 2.5.1 MESSAGE STRUCTURE REFERENCE GUIDE

Table of Contents PURPOSE ....................................................................................................................................................... 1

INTRODUCTION TO HL7 ................................................................................................................................ 1

THE CONDITIONS .......................................................................................................................................... 2

THE FILENAME .............................................................................................................................................. 2

THE MESSAGE ............................................................................................................................................... 3

THE DATA REQUIRED ................................................................................................................................ 3

THE MESSAGE SEGMENTS ........................................................................................................................ 4

Message Header: MSH ......................................................................................................................... 4

Patient Information: PID ...................................................................................................................... 5

Next of Kin: NK1 ................................................................................................................................... 7

Common Order: ORC ........................................................................................................................... 8

Observation Request: OBR ................................................................................................................. 10

Observation Result: OBX .................................................................................................................... 13

Specimen: SPM................................................................................................................................... 17

Notes and Comments: NTE ................................................................................................................ 19

Sample Messages ................................................................................................................................ 19

APPENDIX A ............................................................................................................................... Appendix A-1

REQUIREMENTS PER INDIANA ADMINISTRATIVE CODE TITLE 410 ....................................... Appendix A-1

COMMUNICABLE DISEASE ................................................................................................ Appendix A-1

BLOOD LEAD ...................................................................................................................... Appendix A-5

APPENDIX B: IAC 410 DATA ELEMENT LOCATION WITHIN HL7 MESSAGE ............................... Appendix B-1

APPENDIX C: HL7 MESSAGE DEFINITIONS ................................................................................ Appendix C-1

APPENDIX D: REPORTING OF CULTURES AND SUSCEPTIBILITIES .............................................. Appendix D-1

TEMPLATE FOR CULTURE RESULTS ....................................................................................... Appendix D-1

TEMPLATE FOR CULTURE AND SUSCEPTIBILITIES RESULTS .................................................. Appendix D-1

1 ISDH ELR HL7 Version 2.5.1 Message Structure Reference Guide 20170328 Valid through 2017 or until newer version released


PURPOSE This message structure reference guide is intended to supply guidance for creating the filename, message format, and message content which may help health care organizations develop complete and accurate electronic laboratory reports (ELR) for transmitting to the Indiana State Department of Health (ISDH). This guide should be used in addition to the following references:

The HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=98 ,

The Indiana Administrative Code, Title 410 Indiana State Department of Health http://www.in.gov/legislative/iac/iac_title?iact=410

o Article 1 for Communicable Disease Control (410 IAC 1)

o Article 29 for Reporting, Monitoring, and Preventive Procedures for Lead Poisoning (410 IAC 29)

National Institute of Standards and Technology (NIST) Electronic Lab Reporting Validation Suite website – Documentation and Sample Messages http://hl7v2-elr-testing.nist.gov/mu-elr/

If you will be attesting for Meaningful Use, you may find more information on the ISDH Meaningful Use website https://gateway.isdh.in.gov/MUSSE/Guidance.aspx?program=elr .

Other resources:

Logical Observation Identifiers Name and Codes (LOINC) - Database http://loinc.org/ ; Lookup http://loinc.org/relma

Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) – Database https://www.nlm.nih.gov/healthit/snomedct/international.html ; Lookup http://vtsl.vetmed.vt.edu/

Object Identifiers (OIDs) – Registry https://www.hl7.org/oid/

PHIN Vocabulary Access and Distribution Center (VADS) – Value Set Lookup https://phinvads.cdc.gov/vads/SearchVocab.action

INTRODUCTION TO HL7 HL7 is short for Health Level-7, which refers to a set of standards for creating a message to send health information from one health organization to another. In this particular guide, the ELR HL7 version 2.5.1 message is explained for transmitting laboratory report information from hospitals and laboratories to ISDH. The HL7 message is divided up into segments. The HL7 ELR segments that ISDH obtains information from are as follows:

http://www.hl7.org/implement/standards/product_brief.cfm?product_id=98

http://www.in.gov/legislative/iac/iac_title?iact=410

http://hl7v2-elr-testing.nist.gov/mu-elr/

https://gateway.isdh.in.gov/MUSSE/Guidance.aspx?program=elr

http://loinc.org/

http://loinc.org/relma

https://www.nlm.nih.gov/healthit/snomedct/international.html

http://vtsl.vetmed.vt.edu/

https://www.hl7.org/oid/

https://phinvads.cdc.gov/vads/SearchVocab.action

2



MSH – Message Header

PID – Patient Identification

NK1 – Next of Kin

ORC – Common Order

OBR – Observation Request

OBX – Observation Result

SPM – Specimen

NTE – Notes and Comments More information on HL7 terms, message segments, and data types may be found in Appendix C.

THE CONDITIONS ISDH requires reporting on communicable diseases and blood lead test results. The diseases and conditions can be found at http://www.in.gov/legislative/iac/T04100/A00010.PDF and summarized in Appendix A of this guide.

THE FILENAME The filename needs to adhere to a naming standard. The filename tells our application who is sending the file and whether it is a verified sender. Please use the following: TEST ENVIRONMENT

If you send data for only one facility (one CLIA) within the file: ELR + “_TEST_” + MSH 4.1 Value + “_” + CLIA NUMBER + “_” + control id + .hl7 Ex. ELR_TEST_ MY-LAB_ 15D0000000_20160928073317.hl7

If you send data for more than one facility within the file: ELR + “_TEST_” + MSH 4.1 Value + “_” + “combined” +“_” + control id + .hl7 Ex. ELR_TEST_ MY-LAB_ combined_20160928073317.hl7

PRODUCTION ENVIRONMENT

If you send data for only one facility (one CLIA) within the file: ELR + “_” + MSH 4.1 Value + “_” + CLIA NUMBER + “_” + control id + .hl7 Ex. ELR_ MY-LAB_ 15D0000000_20160928073317.hl7

If you send data for more than one facility within the file: ELR + “_” + MSH 4.1 Value + “_” + “combined” + “_” + control id + .hl7 Ex. ELR_ MY-LAB_ combined_20160928073317.hl7

MSH 4.1 is your facility identifier Control id may be a sequence number or date time stamp (your facility’s discretion)

http://www.in.gov/legislative/iac/T04100/A00010.PDF

3



THE MESSAGE

The HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1, http://www.hl7.org/implement/standards/product_brief.cfm?product_id=98, is the standard to follow for creating ELR messages for Meaningful Use. Per this standard, there are segments and fields that are required in order to be in compliance for Meaningful Use. Data types for those requirements will also be found in that guide.

ISDH also has information that is required by the State of Indiana in order to conduct proper investigations. Indiana Administrative Code, Title 410 Indiana State Department of Health, contains articles concerning laboratory requirements for communicable diseases and blood lead test results http://www.in.gov/legislative/iac/iac_title?iact=410:

Article 1 for Communicable Disease Control (http://www.in.gov/legislative/iac/T04100/A00010.PDF)

Article 29 for REPORTING, MONITORING, AND PREVENTIVE PROCEDURES FOR LEAD POISONING (http://www.in.gov/legislative/iac/T04100/A00290.PDF)

More information may be found on the following web pages

ISDH Communicable Disease information:

o http://www.in.gov/isdh/25362.htm Rules and Guidelines

o http://www.in.gov/isdh/25366.htm Communicable Disease Reporting

ISDH Blood Lead information:

o http://www.in.gov/isdh/24543.htm Blood Lead Sampling

THE DATA REQUIRED There are two types of data elements that ISDH requires for laboratory reporting:

Data required by the Indiana Administrative Code Title 410 Indiana State Department of Health

Data required for Meaningful Use per the HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1.

Appendices A and B contain IAC 410 rules for laboratory reporting, and data element mapping to the HL7 message segments.





http://www.in.gov/isdh/25362.htm



4



DATA USAGE PER HL7 2.5.1 STANDARD

THE MESSAGE SEGMENTS This section contains tables showing the message segment components of interest to ISDH, data elements, usage requirements, data type or format, and examples. Sample segments are shown at the end of each message segment, and full HL7 messages are shown at the end of this section. Please see Appendix A for IAC 410 rules, Appendix B for program area data mapping to message segments, and Appendix C for definitions and data type explanations. Required for communicable diseases and lead yellow Required for communicable diseases only orange Required for lead only pink R - Required RE - Required but may be empty CE - Conditionally required P - Preferred O - Optional x - Data element may repeat ~ - Repetition separator

Message Header: MSH The MSH segment contains information about how to parse and process the message.

MSH Sequence

Usage/ Repeat

Data Type

Description Will look similar to

1 R ST Field separator |

2 R ST Encoding Characters

^~\&

3 R HD Sending Application

MEDAPP^2.16.840.1.113883.3.1181.1.70ÎSO

4* R HD Sending Facility

4.1 R Sending Facility Name

LAB_NAME

4.2 R Sending Facility CLIA

15D0000000

4.3 R literal CLIA

5



MSH Sequence

Usage/ Repeat

Data Type


5 R HD Receiving Application

INELR^2.16.840.1.114222.4.3.3.10ÎSO

6 R HD Receiving Facility

ISDH^2.16.840.1.113883.3.300ÎSO or INDOH^2.16.840.1.113883.3.300ÎSO

7 R TS Date/Time of Message

20160818183002-0500

9 R literal ORU^R01ÔRU_R01

10* R ST Message Control ID

201608180001

11* R Processing ID T or P

12 R HL7 Version 2.5.1

17 R Country Code USA Value Set

21 R EI Message Profile Identifier

PHLabReport-NoAckÊLR_Receiver^2.16.840.1.113883.9.11ÎSO

* Notes pertaining to specific data elements: MSH-4: ISDH uses this field to identify the source of the data MSH-10: unique sequence number; may contain date/timestamp MSH-11: T for training/test, P for production NOTE: once a message is moved to Production, we do not want to receive Test labs MSH|^~\&|MEDAPP^2.16.840.1.113883.3.1181.1.70ÎSO|LAB_NAME^15D0000000^CLIA|INELR^2.16.840.1.114222.4.3.3.10ÎSO|ISDH^2.16.840.1.114222.4.1.3653ÎSO|20160915073202.000-0400||ORU^R01ÔRU_R01|2016091507320284|P|2.5.1|||NE|NE|||||PHLabReport-NoAck^^2.16.840.1.113883.9.11ÎSO

Patient Information: PID The PID segment is used to provide basic demographics regarding the subject of the testing.

PID Sequence

Usage/ Repeat

Data Type


1 R Literal 1

3* R x CX Patient Identifier

36363636^^^MPI&2.16.840.1.113883.19.3.2.1&ISO^MR or 4888844^^^^MR~CHRT101^^^^PI~999999999^^^^MA

3.1 R Identifier 36363636 or MR0011301

3.1 RE (lead only, if available)

Medicaid Number

999999999

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=1FD34BBC-617F-DD11-B38D-00188B398520

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PID Sequence

Usage/ Repeat

Data Type


3.4 R Assigning Authority

MPI&2.16.840.1.113883.19.3.2.1&ISO

3.5 R Identifier Type Code

MR or PI or MA, etc.

5* R x XPN Patient Name

5.1 R Family/Last Name

Smith

5.2 R Given/First Name

Jonathan

5.3 R MI A

5.7 R Name Type Code

L

7* R TS Date of Birth

20050602

8 R IS Sex F Value Set

10* R x CWE Race

10.1 R Race Code 2106-3 Value Set

10.2 RE Text White

10.3 R Name of Coding System

CDCREC

11 R x XAD Patient Address

11.1 R Street Address

2222 Home Street

11.3* R City Indianapolis

11.4 R USPS State Abbr

IN Value Set

11.5 R Zip Code 46207 or 46207-0001 Value Set

11.6 RE Country Code

USA

11.9 R County FIPS 6-4

18097 Value Set

13 R x XTN Patient Phone

13.6 RE Area Code 317

13.7 RE Local Phone

5551000

22* R CWE Ethnic Group

22.1 R Code N

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=74D34BBC-617F-DD11-B38D-00188B398520


https://www.hl7.org/fhir/valueset-usps-state.html

https://tools.usps.com/go/ZipLookupAction_input


7



PID Sequence

Usage/ Repeat

Data Type


22.2 RE Text Not Hispanic or Latino

22.3 R Value Set HL70189

*Notes pertaining to specific data elements: PID-3: Sending system’s patient identifier can have up to 4 identifiers from the list below (please do not send Social Security Numbers)

IDENTIFIER TYPE CODE DESCRIPTION

MR Medical record number Required

MA Medicaid number Required if available for blood lead

PI Patient internal identifier Optional

PT Patient external identifier Optional

WIC WIC identifier Optional

PID-5.7: name type code may be ‘L’ for legal name or ‘A’ for alias PID-7: if birthdate not available, provide age in OBX segment – see example under OBX PID-11.3: city name must be written out completely not abbreviated PID|1||36363636^^^MPI&2.16.840.1.113883.19.3.2.1&ISO^MRÂ&2.16.840.1.113883.19.3.2.1&ISO||EverymanÂdamÂ^^^^L^^^^^^^BS|Mum^Martha^M^^^^M|19800602|M||2106-3^White^CDCREC^^^^04/24/2007|2222 Home Street^Ânn Arbor^MI^99999ÛSA^H||^PRN^PH^^1^555^5552004|^WPN^PH^^1^955^5551009|engÊnglishÎSO6392^^^^3/29/2007|M^Married^HL70002^^^^2.5.1||||||N^Not Hispanic or Latino^HL70189^^^^2.5.1||||||||N|||200808151000-0700|Reliable^2.16.840.1.113883.19.3.1ÎSO PID|1||4888844^^^^MR~988776655^^^^MA ||Green^Susan^Q|Redfield|20040908|F||2106-3^White^HL70005|123 Main St.Âpt. 223^RushvilleÎN^46173ÛSA^P^^18139||^PRN^^^^512^7542270^^|||||||||H^Hispanic or Latino^HL70189||Y

Next of Kin: NK1 The NK1 segment is used to document information about a party associated with the patient. This is particularly important for lead testing of minors, since the NK1 is used to document information about the parent or guardian.

NK1 Sequence

Usage/ Repeat

Data Type


1 R SI Sequence 1

2 R x XPN Guardian Name

2.1 R Last Name Mum

2.2 R First Name Martha

2.3 O MI M

2.7 R Name Type Code L

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=2088950C-6EF8-E111-B875-001A4BE7FA90

8



NK1 Sequence

Usage/ Repeat

Data Type


3 R CWE Relationship

3.1 R Code GRD

3.2 R Description Guardian

3.3 R Value Set HL70063

3.7 RE Version 2.5.1

4 R x XAD Guardian Address

4.1 RE Street Address 2222 Home Street

4.3* RE City Indianapolis

4.4 RE USPS State Code IN Value Set

4.5 RE Zip Code 46207 or 46207-0001 Value Set

4.6 RE Country Code USA

4.9 RE County FIPS 6-4 18097 Value Set

5 R x XTN Guardian Phone

5.6 R Area Code 317

5.7 R Local Phone 5551000

*Notes pertaining to specific data elements: NK1-4.3: City name must be written out not abbreviated NK1|1|Mum^Martha^M^^^^L|MTH^Mother^HL70063^^^^2.5.1|444 Home StreetÂpt BÂnn Arbor^MI^99999ÛSA^H|^PRN^PH^^1^555^5552006

Common Order: ORC The ORC segment includes identifiers related to ordering the specimen (i.e., who placed the order, when it was placed, what action to take regarding the order, etc.).

ORC Sequence

Usage/ Repeat

Data Type


1 R Order Control RE

2 P EI Order Placer Order Number

1234ÊHR^2.16.840.1.113883.19.3.2.3ÎSO

3* R EI Order Filler Order Number

106929420161018^MediLabCo-Seattle^45D0470381^CLIA

3.1 R Entity Identifier 106929420161018

3.2 RE Name MediLabCo-Seattle

3.3 R Universal ID 45D0470381 or 2.16.840.1.113883.3.1181.1.136

3.4 R UID Type CLIA or ISO





9



ORC Sequence

Usage/ Repeat

Data Type


10 P XCN Order Entered By 0001^Smith^Suzi^^^^ or DBJ

12* R x XCN Ordering Provider/Physician

12.1 O ID Number 1011

12.2 R Last Name Jones

12.3 R First Name Alan

12.4 P MI A

12.5 P Suffix Jr

12.6 P Prefix Dr

13 O PL Enterer’s Location ^^^Good Health Hospital&2.16.840.1.113883.19.3.2.3&ISO^^^Building 1^4^Nursing unit 4 East^

14* R x XTN Ordering Provider/Physician Phone

14.6 R Area Code 317

14.7 R Local Phone Number 5551000

21 P x XON Ordering Facility Name Level Seven Healthcare, Inc.^L^^^^&2.16.840.1.113883.19.4.6ÎSO^XX^^^1234

22 R x XAD Ordering Facility Address 1005 Healthcare Drive^Ânn Arbor^MI^99999ÛSA^B

23 R x XTN Ordering Facility Phone ^WPN^PH^^^555^5553001

24* R x XAD Ordering Provider Address

24.1 R Street Address 444 Healthcare Drive

24.3* R City Indianapolis

24.4 R USPS State Code IN Value Set

24.5 R Zip Code 46207 or 46207-0001 Value Set

24.6 P Country Code USA

24.9 R County FIPS 6-4 18097 Value Set

* Notes pertaining to specific data elements:

ORC-3: used to trace observation back to source lab; same values in OBR-3 ORC-12, 14, 24: person who ordered the test ORC-24.3: City name must be written out not abbreviated ORC|RE||CHEM9700122^MediLabCo-Seattle^45D0470381^CLIA|||||||0001^Smith^Suzi^^^^||1234ÂdmitÂlanÂÎII^Dr^^^&2.16.84




10



0.1.113883.19.4.6ÎSO^L^^ÊI^&2.16.840.1.113883.19.4.6ÎSO^^^^^^^^MD||^WPN^PH^^1^555^5551005|||||||Level Seven Healthcare, Inc.^L^^^^&2.16.840.1.113883.19.4.6ÎSO^XX^^^1234|1005 Healthcare Drive^Ânn Arbor^MI^99999ÛSA^B|^WPN^PH^^1^555^5553001|4444 Healthcare Drive^Suite 123Ânn Arbor^MI^99999ÛSA^B ORC|RE|TEST000123A^NIST_Placer _App^2.16.840.1.113883.3.72.5.24ÎSO|system generated^NIST_Sending_App^2.16.840.1.113883.3.72.5.24ÎSO|system generated^NIST_Sending_App^2.16.840.1.113883.3.72.5.24ÎSO||||||DBJ||111111111^Bloodraw^Leonard^T^JR^DR^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^NPI_Facility&2.16.840.1.113883.3.72.5.26&ISO^^^^^^^MD||^WPN^PH^^1^555^7771234^11^Hospital Line~^WPN^PH^^1^555^2271234^4Ôffice Phone|||||||University Hospital^L^^^^NIST sending app&2.16.840.1.113883.3.72.5.21&ISO^XX^^^111|Firstcare Way^Building 1^Harrisburg^PA^17111ÛSA^L^^42043|^WPN^PH^^1^555^7771234^11^Call 9AM to 5PM|Firstcare Way^Building 1^Harrisburg^PA^17111ÛSA^B^^42043

Observation Request: OBR The OBR identifies the type of testing to be performed on the specimen and links that information to the testing order. Appendix D has more information on reporting cultures and susceptibilities.

OBR Sequence

Usage/ Repeat

Data Type


1 R SI ID (sequence #) 1

2* RE EI Placer Order Number 1234ÊHR^2.16.840.1.113883.19.3.2.3ÎSO


2.2 RE Name EHR



3* R EI Filler Order Number 106929420161018^CPSI Lab^2.16.840.1.113883.3.1181.1.136ÎSO


3.2 RE Name CPSI Lab



4* R CWE Test Requested

4.1 R Identifier 50545-3 LOINC Lookup

4.2 R Text Bacterial susceptibility panel:-:Pt:Isolate:OrdQn:MIC

4.3 R Coding System LN

4.7 P Coding System Version 2.40

7* R TS Observation Begin Date/Time

201508150930-0500

https://loinc.org/

11



OBR Sequence

Usage/ Repeat

Data Type


8* CE TS Observation End Date/Time

201508160945-0500

13 RE ST Relevant Clinical Info diarrhea

14* - - Specimen Received Date/Time

(Use SPM-18)

15* - - Specimen Source (Use SPM-4)

16* R x XCN Ordering Provider

16.1 O ID Number 1011

16.2 R Last Name Jones

16.3 R First Name Alan

16.4 P MI A

16.5 P Suffix Jr

16.6 P Prefix Dr

17* R XTN Call Back Phone Number

17.6 R Area Code 317

17.7 R Local Phone 5551000

22 R TS Results Date/Time 201508181030-0500

25* R Result Status F or P or C

26* CE (mic/susc)

PRL Parent Result

26.1 R CWE Parent Obs Id 26.1.1 R Identifier 625-4

LOINC Lookup 26.1.2 R Text Bacteria identified:Prid:Pt:Stool:Nom:Culture 26.1.3 R Coding System LN

26.2 R ST Parent Obs Sub-ID 1 26.3 R TX Parent Obs Value Desc Campylobacter jejuni

29* CE (mic/susc)

EIP Parent

29.1 R EI Placer-Assigned ID 23456&EHR&2.16.840.1.113883.19.3.2.3&ISO

29.2 R EI Filler-Assigned ID 9700122&Lab&2.16.840.1.113883.19.3.1.6&ISO

31 RE x CWE Reason for Study 787.91^DIARRHEAÎ9CDX^^^^07/09/2016

32* R (lead) Principal Result Interpreter (Pathology)

1235&Slide&Stan&S&&Dr&MD&&DOC&2.16.840.1.113883.19.4.6&ISO

32.1 R CNN Family Name, Given Name, Degree

&Stanley&Stan&&&&MD

* Notes pertaining to specific data elements: OBR-2: contains same values as in ORC-2 OBR-3: contains same values as in ORC-3 OBR-4: LOINC Strongly Suggested (ICD9, 10 not accepted) OBR-7: When specimen was collected (same value in SPM-17.1, and OBX-14) OBR-8: Same value in SPM-17.2 OBR-14: USE SPM-18 for HL7 2.5.1

https://loinc.org/

12



OBR-15: USE SPM-4 for HL7 2.5.1 OBR-16: same as ORC-12 OBR-17: same as ORC-14 OBR-25: P – Preliminary; F – Final; C – Corrected OBR-26: required for micro / susceptibility only (See Appendix D)

26.1 – composed of elements from OBX-3 of parent result (use & for separator) 26.2 – OBX-4 of parent result 26.3 – OBX-5.2 of parent result (optional)

OBR-29: for micro / susceptibility only (See Appendix D) 29.1 – composed of elements from OBR-2 of parent result (use & for separator) 29.2 – composed of elements from OBR-3 of parent result (use & for separator)

OBR-32: Name of person who examined the blood/interpreter – this may not be the physician

NOTE: Samples of OBR segments from The HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 and http://hl7v2-elr-testing.nist.gov/mu-elr/ : OBR|1|23456^©^2.16.840.1.113883.19.3.2.3ÎSO|9700123^Lab^2.16.840.1.113883.19.3.1.6ÎSO|625-4^Bacteria identified^LN^3456543^CULTURE, STOOL^99USI^2.26|||201608151030-0700||||||diarrhea|||1234ÂdmitÂlanÂÎII^Dr^^^&2.16.840.1.113883.19.4.6ÎSO^L|^WPN^PH^^1^555^5551005|||||2016081830-0500|||F||||||787.91^DIARRHEAÎ9CDX^^^^07/09/2016|1235&Slide&Stan&S&&Dr&MD&&DOC&2.16.840.1.113883.19.4.6&ISO

OBR|1|23456^©^2.16.840.1.113883.19.3.2.3ÎSO|9700123^Lab^2.16.840.1.113883.19.3.1.6ÎSO|50545-3^Bacterial susceptibility panel:-:Pt:Isolate:OrdQn:MIC^LN^^^^2.26|||201508151030-0700||||||anemia|||1234ÂdmitÂlanÂÎII^Dr^^^&2.16.840.1.113883.19.4.6ÎSO^L^^ÊI^&2.16.840.1.113883.19.4.6ÎSO^^^^^^^^MD|^WPN^PH^^1^555^5551005|||||2015081830-0500|||F|625-4&Bacteria identified:Prid:Pt:Stool:Nom:Culture&LN^1^Campylobacter jejuni|||23456&©&2.16.840.1.113883.19.3.2.3&ISO^9700122&Lab&2.16.840.1.113883.19.3.1.6&ISO||787.91^DIARRHEAÎ9CDX^^^^07/09/2015|1235&Slide&Stan&S&&Dr&MD&&DOC&2.16.840.1.113883.19.4.6&ISO OBR|1|OR980768901-1^^2.16.840.1.113883.3.72.5.30.2ÎSO|O2012987006172-1^DPHFL-Seminole^2.16.840.1.114222.4.1.908.283ÎSO|6812-2^Dengue virus IgM Ab [Titer] in Serum^LN^3752^Dengue Fever – IGM AB EIA^L^2.40^v1|||20120601095300|||||||||ÔNCALL^JOHN|^WPN^PH^^^407^2341212|||||20120602133506-0500|||F OBR|1|OR723222980^© System^2.16.840.1.113883.3.0.0.0.1ÎSO|SP531^LIS^2.16.840.1.113883.3.0.1.0.2ÎSO|51657-5^Hepatitis C Virus Ab[Presence] in Body Fluid^LN^137^HCV Profile^L^2.40|||201206010701|||||||||5608888^Terrell^Fred^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^^^^^^^^MD|^WPN^PH^^^812^4456256|||||20120603132900-0500|||F OBR|2||SP532^LIS^2.16.840.1.113883.3.0.1.0.2ÎSO|11011-4^Hepatitis C virus RNA [Units/volume] (viral load) in Serum or Plasma by Probe and target amplification method^LN^919A^Heptimax © HCV


13



RNA^L^2.40|||201206010701|||||||||5608888^Terrell^Fred^^^^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^^^^^^^^MD|^WPN^PH^^^812^4456256|||||20120603132900-0500|||F|48159-8&HCV Ab s/co SerPl EIA&LN&137C&Hepatitis C Antibody&L^^8.0|||^SP531&LIS&2.16.840.1.113883.3.0.1.0.2&ISO

Observation Result: OBX The OBX contains information regarding a single observation (result) related to a single test (OBR) or specimen (SPM) (including the specific type of observation, the result for the observation, when the observation was made, etc.).

OBX Sequence

Usage/ Repeat

Data Type


1 R SI Sequence 1 2* R ID Observation Value

Type CE or CWE or NM or SN ST or TX (for results that don’t qualify for above types ONLY)

3* R CWE Observation Identifier

3.1 R Identifier 625-4 LOINC Lookup

3.2 R Text Bacteria identified:Prid:Pt:Stool:Nom:Culture 3.3 R Coding System LN 3.4 O Alt/Local Code BAC 3.5 O Alt Text Bacteria Culture 3.6 O Alt/Local L

4* CE ST Observation Sub-ID 1

5*

R CWE Observation Value (CE / CWE type)

66543000^Campylobacter jejuni^SCT or 302620005^Salmonella group B phase 1 a-e^SCT^Sal^ Salmonella group B^99LabMicro^20080731

5.1 R Identifier 66543000 SNOMED CT Lookup

5.2 R Text Campylobacter jejuni 5.3 P Name of Coding

System SCT

5* R NM Observation Value (NM type)

123.4

5* R SN Observation Value (SN type)

^0^-^1 or 2^+ or =9.2 or 19.5

5.1 RE Comparator 5.2 RE Number 1 10000 5.3 RE Separator/Suffix -

https://loinc.org/

http://www.snomedbrowser.com/

14



OBX Sequence

Usage/ Repeat

Data Type


5.4 RE Number 2 90000 5* ST or

TX Observation Value (ST/TX type)

Only use these types when the above types are not applicable

6 CE (if OBX-2 is NM or SN)

CWE Units of Measure (UCUM)

6.1 R Identifier (units) 1 or μg/mL or ug/mL Value Set

6.3 RE Name of Coding System

UCUM Value Set

7 CE (if OBX-2 is SN)

ST Reference Range 0.0 – 5.0

8 CE x (if applicable to result)

CWE Abnormal Flags

8.1 R Flag Indicator H Value Set 8.2 P Text Above High Normal 8.3 O Value Set HL70078

11* R ID Observation Result Status

C or P or F

14* R

TS Date/Time of Observation (specimen collection time)

200906041458

17 RE x (if method missing in OBX-3)

CWE Observation Method 0086^Bacterial identificationÔBSMETHOD^^^^501-20080815

19 R TS Date/Time of Analysis (time testing performed)

200906051700

23* R XON Performing Organization Name (lab that produced test result)

GHH Lab^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^10D0290071

23.1 RE Name GHH Lab 23.10 RE CLIA 10D0290071

24 R XAD Performing Organization Address (lab that produced test result)

3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=872846DF-5F12-E211-8B0C-001A4BE7FA90

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=547FFCE9-6FF8-E111-B875-001A4BE7FA90

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=E2DB0027-57A7-DF11-9BDD-0015173D1785

15



OBX Sequence

Usage/ Repeat

Data Type


25 RE XCN Performing Organization Medical Director

9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI

25.2 P Family Name Slide

25.3 P Surname Stan

* Notes pertaining to specific data elements: OBX-2:

If the result in OBX-5 can be defined with a SNOMED code, CE or CWE is required here

If the result is a numeric value, use NM if single number result or use SN if interval, ratio, inequality, or categorical

Use ST or TX for string data only

See Appendix C for descriptions of data types OBX-3: Should be a LOINC code, LOINC description, and value ‘LN’ in 3.1-3.3 or 3.4-3.6 positions

Valid:

625-4^Bacteria identified:Prid:Pt:Stool:Nom:Culture^LN

625-4^Bacteria identified:Prid:Pt:Stool:Nom:Culture^LN^BAC^Bacteria Culture^99Lab^2.26^May 2006

If no equivalent LOINC exists, then a local code is sufficient for this field OBX-4:

Required if there is more than one OBX with the same OBX-3 value (LOINC), associated with the same OBR

The combination of OBX-3 and OBX-4 must be unique within a particular OBR OBX-5: Results should be returned as coded values (OBX-2=CE or CWE) where possible; SNOMED codes

are strongly recommended in OBX-5. SNOMED codes can be downloaded from the following website https://www.nlm.nih.gov/healthit/snomedct/international.html

OBX-11: C – correction; P – preliminary result; F – final result OBX-14: Same value in OBR-7 and SPM-17.1 OBX-23: Formerly in OBX-15 position

NOTE: If an observation does not have a SNOMED code associated with it (OBX-2 not CE or CWE), position OBX-3.1 or 3.4 must still be a LOINC, but OBX-2 may be NM, SN, ST, or TX, and OBX-5 must be formatted as shown in Appendix C.

https://www.nlm.nih.gov/healthit/snomedct/international.html

16



Samples of OBX segments from The HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 and http://hl7v2-elr-testing.nist.gov/mu-elr/: OBX|1|CWE|625-4^Bacteria identified:Prid:Pt:Stool:Nom:Culture^LN^^^^2.26|1|66543000^Campylobacter jejuni^SCT^^^^January 2007||||||P|||200906041458|||0086^Bacterial identificationÔBSMETHOD^^^^501-20080815||200906051700||||GHH Lab^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI OBX|1|CWE|11475-1^Microorganism identified in Unspecified specimen by Culture^LN^CXCSF^Cerebrospinal Fluid (CSF) Culture^L^2.40||17872004^Neisseria amsel ides^SCT^Neisseria meningitid^Neisseria amsel ides^L^07/31/2012^^Neisseria amsel ides||||||F|||201208081500-0800|||||201208101330-0800||||UCSD CLINICAL LABORATORIES – HILLCREST^^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^05D0643085|200 West Arbor Dr.^^San Diego^CA^92103ÛSA^L

OBX|2|NM|35659-2Âge at specimen collection^LN^^^^2.24|1|29|a^yearÛCUM^^^^1.6|||||F|||200808151030-0700|||||200808151030-0700||||GHH Lab^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI

OBX|3|SN|564-5^COLONY COUNT:NUM:PT:XXX:QN:VC^LN^^^^2.26|1|^10000^-^90000|1^ÛCUM^^^^1.6|||||P|||200808151030-0700|||||200808161030-0700||||Reliable Labs, Inc^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI OBX|1|SN|5671-3^Lead [Mass/volume] in Blood^LN^PB^lead blood^L^2.40^V1||=^9.2|ug/dL^microgram per deciliterÛCUMûg/dl^microgram per deciliter^L^1.1^V1|0.0 – 5.0|HÂbove High Normal^HL70078^H^High^L^2.7^V1|||F|||20120615|||0263Âtomic Absorption SpectrophotometryÔBSMETHODÊTAASÊlectrothermal Atomic Absorption Spectrophotometry^L^20090501^V1||20120617||||University Hospital Chem Lab^L^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^01D1111111|Firstcare Way^Building 2^Harrisburg^PA^17111ÛSA^L^^42043|1790019875^House^Gregory^FÎII^Dr^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^NPI_Facility&2.16.840.1.113883.3.72.5.26&ISO^^^^^^^MD OBX|1|SN|1742-6Âlanine aminotransferase [Enzymatic activity/Volume] in Serum or Plasma^LN^SALT^Serum ALT^L^2.40^V1||=^65|U/LênzymeunitperliterÛCUMÛ/LÛnits per liter^L^1.1^V1|7-56 units per liter of serum|HÂbove High Normal^HL70078^H^High^L^2.7^V1|||F|||20120806|||0262^SpectrophotometryÔBSMETHODÂLTMETHOD^Photometric rate, L-alanine with Pyridoxal -5- Phosphate^L^20090501^V1||20120806||||Sick Kids’ Hospital


17



Laboratory^L^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^01D2121212|Massachusetts Avenue^Building 2^Boston^MA^01236ÛSA^L^^25025|1790019875^House^Gregory^FÎII^Dr^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^NPI_Facility&2.16.840.1.113883.3.72.5.26&ISO^^^^^^^MD OBX|1|SN|11011-4^Hepatitis C virus RNA [Units/volume] (viral load) in Serum or Plasma by Probe and target amplification method^LN^HCVRNA^Hepatitis C RNA PCR^L||^7611200|[IU]/mLînternational unit per milliliterÛCUMÎU/ml^^L|<43 IU/mL|HÂbove high normal^HL70078|||F|||20120628070100|||||20120628092700||||Princeton Hospital laboratory^^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^34D4567890|123 High Street^^Princeton^NJ^08540ÛSAÔ^^34021|^Martin^Steven^M^^Dr.

Specimen: SPM The SPM segment carries information regarding the type of specimen, where and how it was collected, who collected it, and some basic characteristics of the specimen.

SPM Sequence

Usage/ Repeat

Data Type


1 R SI Sequence # 1

2 R EIP Specimen ID 23456&©&2.16.840.1.113883.19.3.2.3&ISO^9700122&Lab&2.16.840.1.113883.19.3.1.6&ISO

2.1 R EI Placer-Assigned ID 23456&©&2.16.840.1.113883.19.3.2.3&ISO

2.1.1 R Entity Identifier 23456

2.1.2 RE Name ©

2.1.3 R Universal ID 15D0000381 or 2.16.840.1.113883.19.3.2.3

2.1.4 R UID Type CLIA or ISO

2.2 R EI Filler-Assigned ID 9700122&Lab&2.16.840.1.113883.19.3.1.6&ISO

2.2.1 R Entity Identifier 9700122

2.2.2 RE Name Lab

2.2.3 R Universal ID 15D0000381 or 2.16.840.1.113883.19.3.2.3

2.2.4 R UID Type CLIA or ISO

4 R CWE Specimen Type (Source Material)

440500007^ Capillary blood specimen^SCT^^^^20080131

4.1 R Identifier/Code 440500007 or DCS

SNOMED CT Lookup

4.2 R Description Capillary blood specimen or Sputum Deep Cough

4.3 R Coding System SCT or HL70487

7 RE CWE Specimen Collection Method

7.1 R Results Code CAP Value Set

7.2 O Text Capillary specimen

8 RE CWE Specimen Source Site

8.1 R Results Code 181395001



18



SNOMED CT Lookup

8.2 O Text Venous structure of digit

17* R TS Specimen Collection Date/Time

201608151030-0500 or 20120615^20120618

18 R TS Specimen Received Date/Time

201607000000-0500

* Notes pertaining to specific data elements: SPM-17.1: Same value in OBR-7 and OBX-14 SPM-17.2: Same value in OBR-8 Samples of SPM segments from The HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 and http://hl7v2-elr-testing.nist.gov/mu-elr/: SPM|1|ÔRD723222-4&&2.16.840.1.113883.3.72.5.24&ISO||119339001^Stool specimen^SCT^Stl^Stool^L^07/31/2012|||||||||||||20110528123500-0500|20110529061500-0500 SPM|1|^FILL354795671&LIS&2.16.840.1.113883.3.0.1.0.2&ISO||119364003^Serum specimen (specimen)^SCT^S^Serum^L^07/31/2012|||||||||||||201206010701|201206010932 SPM|1|^SP004X10987&Filler_LIS&2.16.840.1.113883.3.72.5.21&ISO||440500007^Capillary Blood Specimen^SCT^CAPF^Capillary, filter paper card^L^07/31/2012^v1|73775008^Morning (qualifier value)^SCTÂMÂ.M. sample^L^07/31/2012^40939|NONE^none^HL70371^NA^No Additive^L^2.5.1^V1|1048003^Capillary Specimen Collection (procedure)^SCT^CAPF^Capillary, filter paper card^L^07/31/2012^V1|7569003^Finger structure (body structure)^SCT^FIL^Finger, Left^L^07/31/2012^V1|7771000^Left (qualifier value)^SCT^FIL^Finger, Left^L^07/31/2012^V1||P^Patient^HL70369^P^Patient^L^2.5.1^V1|1^{#}&Number&UCUM&unit&unit&L&1.1&V1|||||20120615^20120618|20120617100038

SPM|1|23456&©&2.16.840.1.113883.19.3.2.3&ISO^9700122&Lab&2.16.840.1.113883.19.3.1.6&ISO||WB^Whole Blood^HL70487^^^^^2.5.1||THYO^Thyoglycollate broth^HL70371^^^^2.5.1|BCAE^Blood Culture, Aerobic Bottle^HL70488^^^^2.5.1|49852007^Structure of median cubital vein (body structure)^SCT^^^^20080731|||P^Patient^HL60369^^^^2.5.1|2.0^mL&MilliLiter [SI Volume Units]&UCUM&&&&1.6|||||200808151030-0700|200808151100-0700



19



Notes and Comments: NTE The NTE is used to convey additional information regarding the associated segment. The NTE segment is not intended for automatic processing. It is primarily intended for human use and therefore should not be used to relay relevant clinical information.

NTE Sequence

Usage/ Repeat

Data Type


1 R SI Sequence # 1

2 R ID Source of Comment L

3 R x ST Comment This comment is intended to give supplemental information only. Not intended to contain clinical findings.

Notes are NOT to contain results – results must be in the OBX segment NTE|1|L|POSITIVE HBSAG VERIFIED BY ALGORITHM COUPLED WITH SCREENING INDEX NTE|1|L|see below~If recent~infection is suspected, repeat~testing in 4 to 6 weeks is~recommended. False negative~results may occur in severely~immunocompromised patients.~~The syphilis treponemal antibody~test is an immunoassay that measures~IgG antibody using three recombinant~treponemal protein antigens and is~the initial screening test for syphilis~in adults. All positive specimens are~then tested by the non-treponemal~rapid plasma amsel (RPR) test.~Discrepant results are resolved by the~Treponemal pallidum particle agglutination~assay (TP-PA).~~Ref: CDC MMWR Weekly, Feb 11, 2011~ 60(05);133-137.~http://www.cdc.gov/std/treatment/2010

Sample Messages A sample production message is shown below (parts taken from HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1): MSH|^~\&#|MEDSOFT^2.16.840.1.113883.19.3.2ÎSO|MERCY_HOSP_LAB^15D0000000^CLIA|SPH^2.16.840.1.113883.19.3.2ÎSO|20080818183002.1-0700||ORU^R01ÔRU_R01|1234567890|P|2.5.1|||NE|NE|USA||||USELR1.0^^2.16.840.1.114222.4.10.3ÎSO SFT|1|Level Seven Healthcare Software,Inc.^L^^^^&2.16.840.1.113883.19.4.6ÎSO^XX^^^1234|1.2|An Lab System|56734||20080817 PID|1||36363636^^^MPI&2.16.840.1.113883.19.3.2.1&ISO^MRÂ&2.16.840.1.113883.19.3.2.1&ISO~E95101100001^^^^PT||EverymanÂdamÂ^^^^L^^^^^^^BS|Mum^Martha^M^^^^M|19800602|M||2106-3^White^CDCREC^^^^04/24/2007|2222 Home Street^Ânn Arbor^MI^99999ÛSA^H||^PRN^PH^^1^555^5552004|^WPN^PH^^1^955^5551009|engÊnglishÎSO6392^^^^3/29/2007|M^Married^HL70002^^^^2.5.1||||||N^Not Hispanic or Latino^HL70189^^^^2.5.1||||||||N|||200808151000-0700|Reliable^2.16.840.1.113883.19.3.1ÎSO PV1|1|O|4E^234Â^Good Health Hospital&2.16.840.1.113883.19.3.2.3&ISO^N^N^Building 1^4^Nursing unit 4

20



East^1234&&2.16.840.1.113883.19.3.2.3&ISO^&2.16.840.1.113883.19.3.2.3&ISO|R||||||||||||||||||||||||||||||||||||||||200808151000-0700|200808151200-0700 PV2|||1^Sick^99AdmitReason|||||||||||||N||||||||Level Seven Healthcare, Inc.^L^^^^&2.16.840.1.113883.19.4.6ÎSO^XX^^^1234|||20010603|||19990603 ORC|RE|23456^©^2.16.840.1.113883.19.3.2.3ÎSO|9700123^Lab^2.16.840.1.113883.19.3.1.6ÎSO|||||||||1234ÂdmitÂlanÂÎII^Dr^^^&2.16.840.1.113883.19.4.6ÎSO^L||^WPN^PH^^1^555^5551005|||||||Level Seven Healthcare, Inc.^L^^^^&2.16.840.1.113883.19.4.6ÎSO^XX^^^1234|1005 Healthcare

Drive^Ânn Arbor^MI^99999ÛSA^B^^18097|^WPN^PH^^1^555^5553001|4444 Healthcare Drive^Suite 123Ânn Arbor^MI^99999ÛSA^B OBR|1|23456^©^2.16.840.1.113883.19.3.2.3ÎSO|9700123^Lab^2.16.840.1.113883.19.3.1.6ÎSO|625-4^Bacteria identified^LN^3456543^ CULTURE, STOOL^99USI^2.26|||200808151030-0700||||||diarrhea|||1234ÂdmitÂlanÂÎII^Dr^^^&2.16.840.1.113883.19.4.6ÎSO^L|^WPN^PH^^1^555^5551005|||||2008081830-0700|||F||||||787.91^DIARRHEAÎ9CDX^^^^07/09/2008|1235&Slide&Stan&S&&Dr&MD&&DOC&2.16.840.1.113883.19.4.6&ISO OBX|1|CWE|625-4^Bacteria identified:Prid:Pt:Stool:Nom:Culture^LN^^^^2.26|1|66543000^Campylobacter jejuni^SCT^^^^January 2007||||||P|||200906041458|||0086^Bacterial identificationÔBSMETHOD^^^^501-20080815||200906051700||||GHH Lab^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI SPM|1|23456&©&2.16.840.1.113883.19.3.2.3&ISO^9700122&Lab&2.16.840.1.113883.19.3.1.6&ISO||119339001^Stool specimen^SCT^^^^20080131|||||||P^Patient^HL60369^^^^2.5.1|10^g&gram&UCUM&&&&1.6|||||200808151030-0700|200808151100-0700 Sample lead test message from http://hl7v2-elr-testing.nist.gov/mu-elr/: MSH|^~\&|NIST^2.16.840.1.113883.3.72.5.20ÎSO|NIST^2.16.840.1.113883.3.72.5.21ÎSO|NIST^2.16.840.1.113883.3.72.5.22ÎSO|NIST^2.16.840.1.113883.3.72.5.23ÎSO|20120821140551-0500||ORU^R01ÔRU_R01|NIST-ELR-001.01|T|2.5.1|||NE|NE|||||PHLabReport-NoAck^HL7^2.16.840.1.113883.9.11ÎSO SFT|NIST Lab, Inc.^L^^^^NIST&2.16.840.1.113883.3.987.1&ISO^XX^^^123544|3.6.23|A-1 Lab System|6742873-12||20100617 PID|1||18547545^^^NIST MPI&2.16.840.1.113883.3.72.5.30.2&ISO^MRÛniversity H&2.16.840.1.113883.3.0&ISO~988776655^^^MA^MA||Lerr^Todd^G.^Jr^^^L~Gwinn^Theodore^F^Jr^^^B|Doolittle^Ramona^G.^Jr^Dr^^M^^^^^^^PhD|20090607|M||2106-3^White^CDCREC^W^White^L^1.1^4|123 North 102nd StreetÂpt 4D^Harrisburg^PA^17102ÛSA^H^^42043~111 SouthÂpt 14^Harrisburg^PA^17102ÛSA^C^^42043||^PRN^PH^^1^555^7259890^4^call before 8PM~^NETÎnternet^[email protected]^^^^^home|^WPN^PH^^1^555^7259890^4^call before 8PM||||||||N^Not Hispanic or Latino^HL70189^NH^Non amsel ̂ L^2.5.1^4||||||||N|||201206170000-0500|University H^2.16.840.1.113883.3.0ÎSO|337915000^Homo sapiens (organism)^SCT^human^human^L^07/31/2012^4 NTE|1|P|Patient is English speaker.|RE^Remark^HL70364^C^Comment^L^2.5.1^V1


21



NK1|1|Smith^Bea^G.^Jr^Dr^^L^^^^^^^PhD|GRD^Guardian^HL70063^LG^Legal Guardian^L^2.5.1^3|123 North 102nd StreetÂpt 4D^Harrisburg^PA^17102ÛSA^H^^42043|^PRN^PH^^1^555^7259890^4^call before 8PM~^NETÎnternet^[email protected]^^^^^home PV1|1|O||C||||||||||||||||||||||||||||||||||||||||20120615|20120615 ORC|RE|TEST000123A^NIST_Placer _App^2.16.840.1.113883.3.72.5.24ÎSO|system generated^NIST_Sending_App^2.16.840.1.113883.3.72.5.24ÎSO|system generated^NIST_Sending_App^2.16.840.1.113883.3.72.5.24ÎSO||||||||111111111^Bloodraw^Leonard^T^JR^DR^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^NPI_Facility&2.16.840.1.113883.3.72.5.26&ISO^^^^^^^MD||^WPN^PH^^1^555^7771234^11^Hospital Line~^WPN^PH^^1^555^2271234^4Ôffice Phone|||||||University Hospital^L^^^^NIST sending app&2.16.840.1.113883.3.72.5.21&ISO^XX^^^111|Firstcare Way^Building 1^Harrisburg^PA^17111ÛSA^L^^42043|^WPN^PH^^1^555^7771234^11^Call 9AM to 5PM|Firstcare Way^Building 1^Harrisburg^PA^17111ÛSA^B^^42043 OBR|1|TEST000123A^NIST_Placer _App^2.16.840.1.113883.3.72.5.24ÎSO|system generated^NIST_Sending_App^2.16.840.1.113883.3.72.5.24ÎSO|5671-3^Lead [Mass/volume] in Blood^LN^PB^lead blood^L^2.40^1.2|||20120615|20120615|||||Lead exposure|||111111111^Bloodraw^Leonard^T^JR^DR^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^NPI_Facility&2.16.840.1.113883.3.72.5.26&ISO^^^^^^^MD|^WPN^PH^^1^555^7771234^11^Hospital Line~^WPN^PH^^1^555^2271234^4Ôffice Phone|||||201206170000-0500|||F||||||V1586^HX-contact/exposure leadÎ9CDX^LEAD^Lead exposure^L^29^V1|111&Varma&Raja&Rami&JR&DR&PHD&&NIST_Sending_App&2.16.840.1.113883.3.72.5.21&ISO OBX|1|SN|5671-3^Lead [Mass/volume] in Blood^LN^PB^lead blood^L^2.40^V1||=^9.2|ug/dL^microgram per deciliterÛCUMûg/dl^microgram per deciliter^L^1.1^V1|0.0 – 5.0|HÂbove High Normal^HL70078^H^High^L^2.7^V1|||F|||20120615|||0263Âtomic Absorption SpectrophotometryÔBSMETHODÊTAASÊlectrothermal Atomic Absorption Spectrophotometry^L^20090501^V1||20120617||||University Hospital Chem Lab^L^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^01D1111111|Firstcare Way^Building 2^Harrisburg^PA^17111ÛSA^L^^42043|1790019875^House^Gregory^FÎII^Dr^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^NPI_Facility&2.16.840.1.113883.3.72.5.26&ISO^^^^^^^MD SPM|1|^SP004X10987&Filler_LIS&2.16.840.1.113883.3.72.5.21&ISO||440500007^Capillary Blood Specimen^SCT^CAPF^Capillary, filter paper card^L^07/31/2012^v1|73775008^Morning (qualifier value)^SCTÂMÂ.M. sample^L^07/31/2012^40939|NONE^none^HL70371^NA^No Additive^L^2.5.1^V1|1048003^Capillary Specimen Collection (procedure)^SCT^CAPF^Capillary, filter paper card^L^07/31/2012^V1|7569003^Finger structure (body structure)^SCT^FIL^Finger, Left^L^07/31/2012^V1|7771000^Left (qualifier value)^SCT^FIL^Finger, Left^L^07/31/2012^V1||P^Patient^HL70369^P^Patient^L^2.5.1^V1|1^{#}&Number&UCUM&unit&unit&L&1.1&V1|||||20120615^20120615|20120617100038 OBX|1|SN|35659-2Âge at Specimen Collection^LNÂGEÂGE^L^2.40^V1||=^3|a^YearÛCUM^Y^Years^L^1.1^V1|||||F|||20120615|||||20120617||||University Hospital Chem Lab^L^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^01D1111111|Firstcare Way^Building 2^Harrisburg^PA^17111ÛSA^L^^42043|1790019875^House^Gregory^FÎII^Dr^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^NPI_Facility&2.16.840.1.113883.3.72.5.26&ISO^^^^^^^MD Sample Hepatitis panel test message from http://hl7v2-elr-testing.nist.gov/mu-elr/ :


22



MSH|^~\&|NIST^2.16.840.1.113883.3.72.5.20ÎSO|NIST^2.16.840.1.113883.3.72.5.21ÎSO|NIST^2.16.840.1.113883.3.72.5.22ÎSO|NIST^2.16.840.1.113883.3.72.5.23ÎSO|20120821140551-0500||ORU^R01ÔRU_R01|NIST-ELR-005A.01|T|2.5.1|||NE|NE|||||PHLabReport-NoAck^HL7^2.16.840.1.113883.9.11ÎSO SFT|NIST Lab, Inc.^L^^^^NIST&2.16.840.1.113883.3.987.1&ISO^XX^^^123544|3.6.23|A-1 Lab System|6742873-12||20100617 PID|1||PATID1234^^^MPI&2.16.840.1.113883.3.0.0.0.3&ISO^MR^Princeton Hospital&2.16.840.1.113883.3.0&ISO||Smirnoff^Peggy^^^^^L||19750401|F||2106-3^White^CDCREC^wh^white^L|135 State StÂpt#5^Trenton^NJ^08625ÛSA^H^^34021||^PRN^CP^^1^609^1234567^^Patient has a home phone, but prefers this for contact~^NETÎnternet^[email protected]|||||||||N^Not Hispanic or Latino^HL70189^NH^^L ORC|RE|ORD723222^© System^2.16.840.1.113883.3.0.0.0.1ÎSO|R-511^LIS^2.16.840.1.113883.3.0.1.0.2ÎSO|||||||||1234567890^Fine^Larry^^^Dr.^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^Princeton Hospital&2.16.840.1.113883.3.0&ISO||^WPN^PH^^^609^9876543^1|||||||Princeton Hospital|123 High Street^^Princeton^NJ^08540|^WPN^PH^^^609^9876543^1|123 High Street^^Princeton^NJ^08540 OBR|1|ORD723222^© System^2.16.840.1.113883.3.0.0.0.1ÎSO|R-511^LIS^2.16.840.1.113883.3.0.1.0.2ÎSO|AHEPRÂcute Hepatititis Panel with Reflex^L|||20120628070100|||||||||1234567890^Fine^Larry^^^Dr.^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI^Princeton Hospital&2.16.840.1.113883.3.0&ISO|^WPN^PH^^^609^9876543^1|||||20120629132900-0500|||F OBX|1|CWE|22314-9^Hepatitis A virus IgM Ab [Presence] in Serum^LN^HAVM^Hepatitis A IgM antibodies (IgM anti-HAV)^L||260385009^Negative (qualifier value)^SCT^NEG^NEGATIVE^L||Negative||||F|||20120628070100|||||20120628080500||||Princeton Hospital laboratory^^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^34D4567890|123 High Street^^Princeton^NJ^08540ÛSAÔ^^34021|^Martin^Steven^M^^Dr. OBX|2|CWE|16933-4^Hepatitis B virus core Ab [Presence] in Serum^LN^HBVcAB^Hepatitis B core antibodies (anti-HBVc)^L||260385009^Negative (qualifier value)^SCT^NEG^NEGATIVE^L||Negative||||F|||20120628070100|||||20120628080500||||Princeton Hospital laboratory^^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^34D4567890|123 High Street^^Princeton^NJ^08540ÛSAÔ^^34021|^Martin^Steven^M^^Dr. OBX|3|CWE|5195-3^Hepatitis B virus surface Ag [Presence] in Serum^LN^HBVsAG^Hepatitis B surface antigen (HbsAg)^L||260385009^Negative (qualifier value)^SCT^NEG^NEGATIVE^L||Negative||||F|||20120628070100|||||20120628080500||||Princeton Hospital laboratory^^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^34D4567890|123 High Street^^Princeton^NJ^08540ÛSAÔ^^34021|^Martin^Steven^M^^Dr. OBX|4|CWE|13955-0^Hepatitis C virus Ab [Presence] in Serum by Immunoassay^LN^HCVAB^Hepatitis C antibody screen (anti-HCV)^L||10828004^Positive (qualifier value)^SCT^POS^POSITIVE^L||Negative|AÂbnormal^HL70078|||F|||20120628070100|||||20120628080500||||Princeton Hospital laboratory^^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^34D4567890|123 High Street^^Princeton^NJ^08540ÛSAÔ^^34021|^Martin^Steven^M^^Dr. OBX|5|SN|48159-8^Hepatitis C virus Ab Signal/Cutoff in Serum or Plasma by Immunoassay^LN^HCVSCO^Hepatitis C antibodies Signal to Cut-off Ratio^L||^10.8|{s_co_ratio}^Signal to cutoff ratioÛCUM^s/co^^L|0.0-0.9 s/co|HÂbove high

23



normal^HL70078|||F|||20120628070100|||||20120628080500||||Princeton Hospital laboratory^^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^34D4567890|123 High Street^^Princeton^NJ^08540ÛSAÔ^^34021|^Martin^Steven^M^^Dr. NTE|1||In order to reduce the incidence of a false positive result, the CDC recommends that all s/co ratios between 1.0 and 10.9 be confirmed with additional Hepatitis C quantitative PCR testing. Quantification range of the PCR assay is 43-69,000,000 IU/mL . OBX|6|SN|11011-4^Hepatitis C virus RNA [Units/volume] (viral load) in Serum or Plasma by Probe and target amplification method^LN^HCVRNA^Hepatitis C RNA PCR^L||^7611200|[IU]/mLînternational unit per milliliterÛCUMÎU/ml^^L|<43 IU/mL|HÂbove high normal^HL70078|||F|||20120628070100|||||20120628092700||||Princeton Hospital laboratory^^^^^CLIA&2.16.840.1.113883.4.7&ISO^XX^^^34D4567890|123 High Street^^Princeton^NJ^08540ÛSAÔ^^34021|^Martin^Steven^M^^Dr. SPM|1|^FILL35479&Princeton Hosp lab&2.16.840.1.113883.3.0&ISO||119364003^Serum specimen (specimen)^SCT^SER^Serum^L|||||||||||||20120628070100|20120628071500 Sample susceptibility panel test message from http://hl7v2-elr-testing.nist.gov/mu-elr/ (see Appendix D for template): MSH|^~\&|NIST^2.16.840.1.113883.3.72.5.20ÎSO|NIST^2.16.840.1.113883.3.72.5.21ÎSO|NIST^2.16.840.1.113883.3.72.5.22ÎSO|NIST^2.16.840.1.113883.3.72.5.23ÎSO|20120821140551-0500||ORU^R01ÔRU_R01|NIST-ELR-004.01|T|2.5.1|||NE|NE|||||PHLabReport-NoAck^HL7^2.16.840.1.113883.9.11ÎSO SFT|NIST Lab, Inc.^L^^^^NIST&2.16.840.1.113883.3.987.1&ISO^XX^^^123544|3.6.23|A-1 Lab System|6742873-12||20100617 PID|1||PATID1234^^^&2.16.840.1.113883.3.72.5.24&ISO^MR^Seminole Cnty Hlth C&2.16.840.1.113883.3.0&ISO||Jones^WilliamÂ^^^^L||19610615|M||2106-3^White^CDCREC|1955 Seminole Lane^Ôveido^FL^32765ÛSA^H^^12059||^PRN^PH^^1^407^2351234|||||||||N^Not Hispanic or Latino^HL70189^NL^not latino^L^2.5.1 ORC|RE|ORD723222-4^^2.16.840.1.113883.3.72.5.24ÎSO|R-783274-4^LIS^2.16.840.1.113883.3.72.5.25ÎSO|||||||||57422^RADON^NICHOLAS^^^Dr.^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI||^PRN^PH^^^407^2341212|||||||Seminole County Health Clinic|555 Orange Ave^Ôviedo^FL^32765^^B|^WPN^PH^^^813^8847284|555 Orange Ave^Ôviedo^FL^32765^^B OBR|1|ORD723222-4^^2.16.840.1.113883.3.72.5.24ÎSO|R-783274-4^LIS^2.16.840.1.113883.3.72.5.25ÎSO|625-4^Bacteria identified in Stool by Culture^LN^3456543^CULTURE STOOL^99USI^2.40|||20110528|||||||||57422^RADON^NICHOLAS^^^Dr.^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI|^PRN^PH^^^407^2341212|||||201106010900-0500|||F OBX|1|CWE|625-4^Bacteria identified in Stool by Culture^LN^Bacteria identified^Bacteria identified^99USI^2.40||85729005^Shigella flexneri^SCT^^^^^^Shigella flexneri||||||F|||20110528|||||20110531130655-0500||||Seminole County Health Department Laboratory^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|6756 Florida Avenue^Ôveido^FL^32765^^B|10092^Pafford^Hamlin^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^NPI SPM|1|ÔRD723222-4&&2.16.840.1.113883.3.72.5.24&ISO||119339001^Stool specimen^SCT^^^^07/31/2012|||||||||||||20110528|20110529 OBR|2||R-783274-5^LIS^2.16.840.1.113883.3.72.5.25ÎSO|50545-3^Bacterial susceptibility panel in Isolate by Minimum inhibitory concentration (MIC)^LN^Bact suscept^Bacteria


24



susceptibility^99USI^2.40|||20110528|||||||||57422^RADON^NICHOLAS^^^Dr.^^^NPI&2.16.840.1.113883.4.6&ISO^L^^^NPI|^PRN^PH^^^407^2341212|||||201106010900-0500|||F|625-4&Bacteria identified in Stool by Culture&LN&Bacteria identified&Bacteria identified&99USI^^Shigella flexneri|||^R-783274-4&LIS&2.16.840.1.113883.3.72.5.25&ISO OBX|1|SN|20-8Âmoxicillin+Clavulanate [Susceptibility] by Minimum inhibitory concentration (MIC)^LNÂmoxClavÂmoxicillin-clavulanic acid^99USI^2.40||=^16|ug/mL^microgram per milliliterÛCUM^^^^1.8.2||IÎntermediate^HL70078^^^^2.5.1|||F|||20110528|||||201106010900-0500||||Seminole County Health Department Laboratory^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|6756 Florida Avenue^Ôveido^FL^32765^^B|10092^Pafford^Hamlin^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^NPI OBX|2|SN|516-5^Trimethoprim+Sulfamethoxazole [Susceptibility] by Minimum inhibitory concentration (MIC)^LN^TMP-SMX^Trimethoprim-sulfamethoxazole^99USI^2.40||=^8^/^152|ug/mL^microgram per milliliterÛCUM^^^^1.8.2||R^Resistant^HL70078^^^^2.5.1|||F|||20110528|||||201106010900-0500||||Seminole County Health Department Laboratory^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|6756 Florida Avenue^Ôveido^FL^32765^^B|10092^Pafford^Hamlin^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^NPI OBX|3|SN|185-9^Ciprofloxacin [Susceptibility] by Minimum inhibitory concentration (MIC)^LN^CIPROFLOXACIN^CIPROFLOXACIN^99USI^2.40||<=^0.06|ug/mL^microgram per milliliterÛCUM^^^^1.8.2||S^Susceptible^HL70078^^^^2.5.1|||F|||20110528|||||201106010900-0500||||Seminole County Health Department Laboratory^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^XX^^^987|6756 Florida Avenue^Ôveido^FL^32765^^B|10092^Pafford^Hamlin^^^^^^&2.16.840.1.113883.3.72.5.30.1&ISO^L^^^NPI Sample culture result from HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 (focus on multiple OBX-3 with same value for same OBR – see Appendix D for template): MSH|^~\&|Lab1^1234^CLIA|Reliable^1234^CLIA|ELR^2.16.840.1.113883.19.3.2.3ÎSO|SPH^2.16.840.1.113883.19.3.2ÎSO|20070701132554-0400||ORU^R01ÔRU_R01|20070701132554000008|P^T|2.5.1|||NE|NE|USA||||USELR1.0^^2.16.840.1.113883.19.9.7ÎSO SFT|1|Level Seven Healthcare Software, Inc.^L^^^^&2.16.840.1.113883.19.4.6ÎSO^XX^^^1234|1.2|An Lab System|56734||20080817 PID|1||36363636^^^MPI&2.16.840.1.113883.19.3.2.1&ISO^MRÂ&2.16.840.1.113883.19.3.2.1&ISO~95101100001^^^^PI||EverymanÂdamÂ^^^^L^^^^^^^BS|Mum^Martha^M^^^^M|19750602|M||2106-3^White^CDCREC^^^^04/24/2007|2222 Home Street^Ânn Arbor^MI^99999ÛSA^H||^PRN^PH^^1^555^5552004|^WPN^PH^^1^955^5551009|engÊnglishÎSO6392^^^^3/29/2007|M^Married^HL70002^^^^2.5.1||||||N^Not Hispanic or Latino^HL70189^^^^2.5.1||||||||N|||200808151000-0700|Reliable^2.16.840.1.113883.19.3.1ÎSO ORC|RE|23456^©^2.16.840.1.113883.19.3.2.3ÎSO|9700123^Lab^2.16.840.1.113883.19.3.1.6ÎSO|||||||||1234ÂdmitÂlanÂÎII^Dr^^^&2.16.840.1.113883.19.4.6ÎSO^L^^ÊI^&2.16.840.1.113883.19.4.6ÎSO^^^^^^^^MD||^WPN^PH^^1^555^5551005|||||||Level Seven Healthcare, Inc.^L^^^^&2.16.840.1.113883.19.4.6ÎSO^XX^^^1234|1005 Healthcare Drive^Ânn

25



Arbor^MI^99999ÛSA^B|^WPN^PH^^1^555^5553001|4444 Healthcare Drive^Suite 123Ânn Arbor^MI^99999ÛSA^B OBR|1|23456^©^2.16.840.1.113883.19.3.2.3ÎSO|9700123^Lab^2.16.840.1.113883.19.3.1.6ÎSO|625-4^Bacteria identified^LN^3456543^ CULTURE, STOOL^99USI^2.26|||200808151030-0700||||||diarrhea|||1234ÂdmitÂlanÂÎII^Dr^^^&2.16.840.1.113883.19.4.6ÎSO^L^^ÊI^&2.16.840.1.113883.19.4.6ÎSO^^^^^^^^MD|^WPN^PH^^1^555^5551005|||||2008081830-0700|||P||||||787.91^DIARRHEAÎ9CDX^^^^07/09/2008|1235&Slide&Stan&S&&Dr&MD&&DOC&2.16.840.1.113883.19.4.6&ISO OBX|1|CWE|625-4^Bacteria identified:Prid:Pt:Stool:Nom:Culture^LN^^^^2.26|1|66543000^Campylobacter jejuni^SCT^^^^January 2007||||||P|||200808151030-0700|||0086^Bacterial identificationÔBSMETHOD^^^^501-20080815||200808161030-0700||||Reliable Labs, Inc^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI OBX|2|SN|564-5^COLONY COUNT:NUM:PT:XXX:QN:VC^LN^^^^2.26|1|^10000^-^90000|1^ÛCUM^^^^1.6|||||P|||200808151030-0700|||||200808161030-0700||||Reliable Labs, Inc^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI OBX|3|CWE|625-4^Bacteria identified:Prid:Pt:Stool:Nom:Culture^LN^^^^2.26|2|302620005^Salmonella group B phase 1 a-e^SCT^^^^January 2007||||||P|||200808151030-0700|||0086^Bacterial identificationÔBSMETHOD^^^^501-20080815||200808161030-0700||||Reliable Labs, Inc^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI OBX|4|SN|564-5^COLONY COUNT:NUM:PT:XXX:QN:VC^LN^^^^2.26|2|>^100000|1^ÛCUM^^^^1.6|||||P|||200808151030-0700|||||200808161030-0700||||Reliable Labs, Inc^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI OBX|5|CWE|625-4^Bacteria identified:Prid:Pt:Stool:Nom:Culture^LN^^^^2.26|3|77352002^Shigella^SCT^^^^January 2007||||||P|||200808151030-0700|||0086^Bacterial identificationÔBSMETHOD^^^^501- 20080815||200808161030-0700||||Reliable Labs, Inc^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI OBX|6|SN|564-5^COLONY COUNT:NUM:PT:XXX:QN:VC^LN^^^^2.26|3|<^1000|1^ÛCUM^^^^1.6|||||P|||200808151030-0700|||||200808161030-0700||||Reliable Labs, Inc^L^^^^CLIA&2.16.840.1.113883.19.4.6&ISO^XX^^^1236|3434 Industrial Loop^Ânn Arbor^MI^99999ÛSA^B|9876543^Slide^Stan^S^^^^^NPPES&2.16.840.1.113883.19.4.6&ISO^L^^^NPI SPM|1|23456&©&2.16.840.1.113883.19.3.2.3&ISO^9700122&Lab&2.16.840.1.113883.19.3.1.6&ISO||119339001^Stool specimen^SCT^^^^20080131|||||||P^Patient^HL60369^^^^2.5.1|10^g&gram&UCUM&&&&1.6|||||200808151030-0700|200808151100-0700

Appendix A-1



APPENDIX A

REQUIREMENTS PER INDIANA ADMINISTRATIVE CODE TITLE 410 The following is a consolidated summary of the laboratory reporting requirements in the IAC 410 for communicable diseases and lead poisoning, found at http://www.in.gov/legislative/iac/iac_title?iact=410 .

COMMUNICABLE DISEASE 410 IAC ARTICLE 1. COMMUNICABLE DISEASE CONTROL Rule 2.5. Disease Reporting and Control 410 IAC 1-2.5-76 Laboratories; reporting requirements Authority: IC 16-19-3-4; IC 16-41-2-1 Affected: IC 16-41-2-8 Sec. 76. (a) Each director, or the director’s representative, of a medical laboratory in which examination of any specimen derived from the human body yields:

(1) microscopic; (2) bacteriologic; (3) immunologic; (4) serologic; or (5) other;

evidence of infection by any of the organisms or agents listed in subsection (d) shall report the findings and any other epidemiologically necessary information to the department. HIV serologic results of tests performed anonymously in conjunction with the operation of a counseling and testing site registered with the department shall not be identified by the name of the patient, but by a numeric identifier code. For the appropriate method to report the results, see subsection (b). (b) The report required by subsection (a) shall, at a minimum, include the following:

(1) The name, date, and results of the test performed. (2) The laboratory’s normal limits for the test. (3) The laboratory’s interpretation of the test results. (4) The laboratory’s accession number or other numeric identifier, or both. (5) The name, address, and date of birth or age if date of birth is not available of the person from whom the specimen was obtained. (6) The anatomic source of the specimen. (7) The name, address, and telephone number of the:

(A) attending physician; (B) hospital; (C) clinic; or (D) other specimen submitter.

(8) The name, address, telephone number, and CLIA ID number of the laboratory performing the test.


Appendix A-2



(c) This subsection does not preclude laboratories from testing specimens, which, when submitted to the laboratory, are identified by a numeric identifier code and not by the name of the patient. If testing of such a specimen, identified by numeric code, produces results that are required to be reported under this rule, the laboratory shall submit a report that includes the following:

(1) The name, date, and results of tests performed. (2) The laboratory's normal limits for the tes’. (3) The laboratory's interpretation of the tes’ results. (4) The laboratory's accession number or other’numeric identifier, or both. (5) The numeric identifier code of the person from whom the specimen was obtained. (6) The anatomic source of the specimen. (7) The name and address of the:

(A) attending physician; (B) hospital; (C) clinic; or (D) other specimen submitter.

(8) The: (A) name; (B) address; (C) telephone number; and (D) CLIA ID number;

of the laboratory performing the test.

(d) Laboratory findings that demonstrate diseases that are to be reported immediately shall be reported by telephone or other instantaneous means of communication on first knowledge or suspicion of the result. Laboratory findings that demonstrate diseases that are to be reported within twenty-four (24) hours shall be reported to the department within twenty-four (24) hours. Laboratory findings that demonstrate diseases that are to be reported within seventy-two (72) hours shall be reported to the department within seventy-two (72) hours. Laboratory findings that demonstrate diseases that are to be reported within five (5) business days shall be reported to the department within five (5) business days. Laboratory findings demonstrating evidence of the following infections, diseases, or conditions shall be reported to the department:

(1) Anaplasma species. (2) Arboviruses, including, but not limited to, the following:

(A) St. Louis. (B) California group. (C) Eastern equine. (D) Western equine. (E) West Nile. (F) Japanese encephalitis. (G) Yellow fever. (H) Powassan. (I) Dengue and dengue hemorrhagic fever. (J) Chikungunya.

(3) Babesia species. (4) Bacillus anthracis. (5) Bordetella pertussis. (6) Borrelia burgdorferi. (7) Brucella species.

Appendix A-3



(8) Calymmatobacterium granulomatis. (9) Campylobacter species. (10) Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE). (11) Chlamydia psittaci. (12) Chlamydia trachomatis. (13) Clostridium botulinum. (14) Clostridium tetani. (15) Coccidioidomycosis. (16) Corynebacterium diphtheriae. (17) Coxiella b amsel id8) Cryptococcus neoformans. (19) Cryptosporidium species. (20) Cyclospora cayetanensis. (21) Dengue virus. (22) Eastern equine encephalitis virus. (23) Ehrlichia species. (24) Escherichia coli (E. coli) infection (Shiga toxin-producing (STEC)), including, but not limited to, E. coli 0157, E. coli 0157:H7, non-0157 E. coli, and Shiga toxin detected. (25) Francisella tularensis. (26) Giardia species. (27) Grimontia hollisae (Vibrio hollisae). (28) Haemophilus ducreyi. (29) Haemophilus influenzae, invasive disease amsel imicrobial susceptibility testing*. (30) Hantavirus. (31) The following hepatitis viruses:

(A) Anti-HAV IgM. (B) HBsAg, HBeAg, or IgM anti-HBc. (C) Genotype, RNA (PCR, NAT), or anti-HCV (e.g., EIA or any combination). (D) Delta. (E) Anti-HEV IgM and IgG.

(32) Histoplasma capsulatum. (33) HIV and related retroviruses. (34) Influenza. (35) Interferon gamma release assay (IGRA) for tuberculosis (positive results only). (36) Japanese encephalitis virus. (37) Kaposi's sarcoma (biopsies). (38) ’a Crosse (California serogroup) virus. (39) Legionella species. (40) Leptospira species. (41) Listeria monocytogenes, invasive disease. (42) Measles virus. (43) Mumps virus. (44) Mycobacterium leprae. (45) Mycobacterium tuberculosis. (46) Neisseria gonorrhoeae. (47) Neisseria meningitidis, invasive disea amsel idesmicrobial susceptibility testing*. (48) Novel influenza A. (49) Photobacterium damselae (Vibrio damsela).

Appendix A-4



(50) Plasmodium sp amsel(51) Powassan virus. (52) Pneumocystis carinii. (53) Poliomyelitis. (54) Rabies virus (animal or human). (55) Rickettsia (non-rickettsii species). (56) Rickettsia rickettsii. (57) Rubella vir amsel idalmonella species. (59) Salmonella serotype Paratyphi and antimicrobial susceptibility testing*. (60) Salmonella serotype Typhi (Typhoid fever) and antimicrobial susceptibility testing*. (61) Shigella species and antimicrobial susceptibility testing*. (62) Smallpox (variola) virus. (63) St. Louis encephalitis virus. (64) Staphylococcus aureus, vancomycin resistance equal to or greater than eight (8) μg/mL. (65) Streptococcus pneumoniae, invasive disease, and antimicrobial susceptibility testing*. (66) Streptococcus group A (Streptococcus pyogenes), invasive disease, and antimicrobial susceptibility testing*. (67) Streptococcus group B, invasive disease, and antimicrobial susceptibility testing*. (68) Taenia solium (and associated cysts). (69) Treponema pallidum. (70) Trichinella spiralis. (71) Varicella-zoster virus. (72) Vibrio species. (73) West Nile virus. (74) Western equine encephalitis virus. (75) Yellow fever virus. (76) Yersinia species, including the following:

(A) Pestis. (B) Enterocolitica. (C) Pseudotuberculosis.

*Reporting of disease is required to follow the "When to Report (from probab“e diagnosis)" time frame, and the antimi”robial susceptibility testing results are to be reported as soon as they become available.

(e) Laboratories may also report to the local health officer, but any such local report shall be in addition to reporting to the department. A laboratory may report by:

(1) electronic data transfer; (2) telephone; or (3) other confidential means of communication.

Instead of electronic data transfer or reporting by telephone, a laboratory may submit a legible copy of the laboratory report, provided that the information specified in subsection (b) or (c) appears thereon. Whenever a laboratory submits a specimen, portion of a specimen, or culture to the department laboratory resource center for confirmation, phage typing, or other service, this does not preclude a laboratory from reporting requirements as specified in this section. (f) Laboratories shall submit all isolates of the following organisms to the department's microbiology laboratory f’r further evaluation within three (3) business days of isolation:

(1) Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE). Isolates include organisms that are nonsusceptible to at least one (1) carbapenem antibiotic with MIC

Appendix A-5



>=2 μg/ml or zone diameter <=22 mm (<=21 mm for ertapenem), and meet one (1) of the following criteria:

(A) Positive for carbapenemase production by a phenotypic test (e.g., Modified Hodge or Carba NP). (B) Nonsusceptible to at least three (3) carbapenem antibiotics with MIC >=2 μg/ml or zone diameter <=22 mm (<=21 mm for ertapenem). (C) Positive for a carbapenemase gene marker.

Only one (1) isolate that meets these criteria should be submitted if the same organism is repeatedly recovered from the same patient. (2) Haemophilus influenzae, invasive disease amsel iseria meningitidis, invasive disea amsel ideserichia coli (E. coli) (Shiga toxin-producing (STEC)) isolates, if not available, submit a Shiga toxin detected enrichment broth from a clinical specimen. If detection of STEC from a stool specimen using a nonculture based method (isolate or broth if not available), submit stool specimen in Cary-Blair media. (5) Staphylococcus aureus, vancomycin resistance equal to or greater than eight (8) μg/mL. (6) Mycobacterium tuberculosis. (7) Streptococcus pneumoniae invasive disease isolates from persons less than five (5) years of age. (8) Listeria monocytogenes isolates from a normally sterile site. (9) Salmonella species isolates collected from a clinical specimen. If detection of Salmonella from a stool specimen using a nonculture based method, submit stool specimen in Cary-Blair medium. (10) Shigella species isolates collected from a clinical specimen. If detection of Shigella from a stool specimen using a nonculture based method, submit stool specimen in Cary-Blair medium. (11) Vibrio cholerae isolates collected amsel ol or vomitus. If detection of Vibrio cholerae from a stool specim amsel a nonculture based method, submit stool specimen in Cary-Blair medium. (12) Vibrio species (other than toxigenic Vibrio cholerae), Grimontia hollisa amsel o hollisae), and Photobacterium damselae (Vibrio damsela) isolates from a cli amselpecimen. If detection of Vibrio species, Grimontia hollisae (Vibrio hollisae), and Photobacterium damselae (Vibrio damsela) from a stool specimen using a nonculture based method, submit stool specimen in Cary-Blair medium.

(g) Laboratories shall submit all confirmed positive remnant HIV diagnostic specimens to a department designated laboratory for confirmation, testing, and further evaluation including, but not limited to, confirmed western blot positives. (h) Reporting by a laboratory, as required by this section, shall not:

(1) constitute a diagnosis or a case report; or (2) be considered to fulfill the obligation of the attending physician or hospital to report.

(i) Failure to report constitutes a Class A infraction as specified by IC 16-41-2-8.

BLOOD LEAD 410 IAC ARTICLE 29. REPORTING, MONITORING, AND PREVENTIVE PROCEDURES FOR LEAD POISONING Rule 3. Reporting 410 IAC 29-3-1 Reporting of blood lead test results

Appendix A-6



Authority: IC 16-41-39.4-1 Affected: IC 16-41-39.4-3 Sec. 1. (a) A person that examines the blood of an individual for the presence of lead must report to the department the results of the examination not later than one (1) week after completing the examination. The report must include at least the following:

(1) With respect to the individual whose blood is examined, the following: (A) Full name. (B) Date of birth. (C) Gender. (D) Full address, including street address, city, and zip code. (E) County of residence. (F) Race and ethnicity. (G) Parent's or guardian's name and ph’ne number, wh’re applicable. (H) Any other information that is required to be included to qualify to receive federal funding.

(2) With respect to the examination, the following: (A) The date. (B) The type of blood test performed. (C) The person's normal limits for the tes’. (D) The results of the test. (E) The person's interpretation of the res’lts of the test.

(3) The names, addresses, and telephone numbers of the following: (A) The person examining the blood. (B) The attending physician, hospital, clinic, or other specimen submitter.

(b) If a person required to report under subsection (a) has submitted more than fifty (50) results in the previous calendar year, the person must submit subsequent reports in an electronic format determined by the department. (c) Except as provided in subsection (d), if a person required to report under subsection (a) fails to provide complete information within ten (10) days after receiving written notification by the department, a civil penalty may be assessed in accordance with IC 16-41-39.4-3. (d) Subsection (c) does not apply to a person who acts in good faith to provide a complete report required under subsection (a), but who:

(1) after requesting information, is unable to collect all of the information required for a complete report; or (2) provides incorrect information on a completed report.

APPENDIX B-1



APPENDIX B: IAC 410 DATA ELEMENT LOCATION WITHIN HL7 MESSAGE

Category Data Element Notes Program Area Required Preferred Optional

Message Segment

Message Sender

Sending Facility Name Sending lab Included in filename

CD, Lead MSH-4.1

Sending Facility ID Sending lab CLIA CD, Lead MSH-4.2

Date/Time of Message CD, Lead MSH-7

Processing ID Test or Production CD, Lead MSH-11

HL7 Version CD, Lead MSH-12

Patient Patient ID Sending system ID (medical record #) No SSN

CD, Lead PID-3.1

Patient Medicaid Number

If applicable Lead PID-3.1

Patient Last Name CD, Lead PID-5.1

Patient First Name CD, Lead PID-5.2

Patient Middle Initial Lead CD PID-5.3

Patient DOB age if DOB not available

CD, Lead PID-7

Patient Gender Lead CD PID-8

Patient Race Lead CD PID-10

Patient Street Address CD, Lead PID-11.1

Patient City CD, Lead PID-11.3

Patient State 2-char USPS code CD, Lead PID-11.4

Patient Zip Code 5 or 10-digit zip code

CD, Lead PID-11.5

Patient Country CD, Lead PID-11.6

Patient County of Residence

FIPS 6-4 Lead CD PID-11.9

Patient Phone Area Code

CD, Lead PID-13.6

Patient Phone Local # CD, Lead PID-13.7

Patient Ethnicity Lead CD PID-22

Guardian Guardian Name If applicable Lead NK1-2, NK1-3

Guardian Address If applicable Lead NK1-4

Guardian Phone If applicable Lead NK1-5

Physician/ Provider

Ordering Provider Attending Physician Name

CD, Lead ORC-12, OBR-16

Ordering Provider Address

Attending Physician Address

CD, Lead ORC-24

APPENDIX B-2




Message Segment

Order Callback Phone Number

Attending Physician Phone


Ordering Facility Name CD, Lead ORC-21

Ordering Facility Address

CD, Lead ORC-22

Ordering Facility Phone CD, Lead ORC-23

Sending Laboratory

Placer Order Number CD, Lead ORC-2, OBR-2

Filler Order Number Used to trace observation back to source lab (Accession Number may be included)


Lab Test Test Name CD, Lead OBR-4

Result /Observation Identifier

LOINC CD, Lead OBX-3

Result /Observation sub-Identifier

Used if there is more than 1 OBX with same OBX-3 for same OBR

CD, Lead OBX-4

Result /Observation Value

CD, Lead OBX-5

Units if OBX-2 is NM or SN CD, Lead OBX-6

Reference Range if OBX-2 is SN (Interpretation of Result)

CD, Lead OBX-7

Abnormal Flag Normal Limits of Test

CD, Lead OBX-8

Observation Result Status

Preliminary or Final CD, Lead OBX-11

Date/Time of Analysis When test performed

CD, Lead OBX-19

Performing Organization Name

Reference Lab if applicable

CD, Lead OBX-15.2, OBX-23.1

Performing Organization Address

CD, Lead OBX-24

Performing Organization Medical Director

CD, Lead OBX-25

Specimen Specimen ID Accession Number CD, Lead SPM-2.2

Source of specimen CD, Lead SPM-4**

APPENDIX B-3




Message Segment

Date Specimen Taken Used to be known as date/time of observation

CD, Lead SPM-17, OBR-7, OBX-14

Person Interpreting Result

Result Interpreter Lead OBR-32

Person Completing Report Name

Entered By CD ORC-10

Person Completing Report Address

Enterer’s Location CD ORC-13

Table 1 Summary of Required Data Elements per IAC 410

CD – Communicable Disease ** - Specimen Source used to be located in OBR-15 but should be in SPM-4 for HL7 2.5.1

APPENDIX C -1 ISDH ELR HL7 Version 2.5.1 Message Structure Reference Guide 20170328


APPENDIX C: HL7 MESSAGE DEFINITIONS The tables below are only summaries of what can be found in the HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=98

BASIC HL7 MESSAGING TERMS

TERM DEFENITION

Message

A message is the entire unit of data transferred between systems in a single transmission. It is a series of segments in a defined sequence, with a message type and a trigger event.

Segment

A segment is a logical grouping of data fields. Segments within a defined message may be required or optional and may occur only once or may be allowed to repeat. Each segment is named and is identified by a segment ID, a unique three-character code.

Field

A field is a string of characters. Each field has an element name. The segment it is in and its sequence within the segment identify each field. Usage and cardinality requirements are defined in the Segment Definitions.

Component

A component is one of a logical grouping of items that comprise the contents of a coded or composite field. Within a field having several components, not all components are necessarily required to be populated.

Data type

A data type restricts the contents and format of the data field. Data types are given a two- or three-letter code. Some data types are coded or composite types with several components. The applicable HL7 data type is listed in each field definition.

Delimiters

The delimiter values are defined in MSH-1 and MSH-2 and are used throughout the message. The default delimiters are: | Field Separator ^ Component Separator & Sub-Component Separator ~ Repetition Separator \ Escape Character

SEGMENTS

SEGMENT NAME DESCRIPTION

MSH Message Header Information explaining how to parse and process the message Information includes identification of message delimiters, sender, receiver, message type, timestamp, etc.


APPENDIX C-2



SEGMENTS

SEGMENT NAME DESCRIPTION

PID Patient Identification Patient identifying and demographic information regarding the subject of testing.

NK1 Next of Kin Important for testing of minors; contains legal guardian information.

ORC Common Order Identifiers for the order for testing, who placed the order, when it was placed, and actions to take.

OBR Observation Request Information about a single test that is performed on a specimen and the type of test performed.

OBX Observation / Result Information regarding a single observation related to a single test or specimen.

SPM Specimen Information describing characteristics of a single specimen sample, including type, where or how collected, who collected it, and other basic characteristics of the sample.

NTE Notes and Comments Conveys additional information about specimen or circumstances around test. This information is not parsed by the receiver therefore, test results and specimen specifics must be placed in the OBX and SPM segments not the NTE segment. This information is for comments only.

DATA TYPES

TYPE NAME Structure Example

CQ Composite Quantity with Units

|QuantityÛnits (PHVS_UnitsOfMeasure_CDC)|

|150^m&meter&UCUM|

CE Coded Element |ID^Text^CodingSystemÂlternate IDÂlternate TextÂlternate Coding System| HL70396

|625-4^Bacteria identified:Prid:Pt:Stool: Nom:Culture^LN^BAC^Bacteria Culture ^99Lab^2.26^May 2006|

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=872846DF-5F12-E211-8B0C-001A4BE7FA90


APPENDIX C-3



DATA TYPES


CNN Composite ID Number and Name

ID&Family Name&Given Name&Second Given Name&Suffix&Prefix&Degree&&Local Code&OID&HL70301

111&Varma&Raja&Rami&JR&DR&PHD&&NIST_Sending_App&2.16.840.1.113883.3.72.5.21&ISO

CWE Coded with Exceptions

|ID^Text^ Coding SystemÂlternate IDÂlternate TextÂlternate Coding System^Coding System Version IDÂlternate Coding System Version IDÔriginal Text| HL70396

Except OBX-5: |625-4^Bacteria identified:Prid:Pt:Stool: Nom:Culture^LN^BAC^Bacteria Culture ^99Lab^2.26^May 2006| OBX-5 only: |302620005^Salmonella group B phase 1 a-e^SCT^Sal^ Salmonella group B^ 99LabMicro^20080731|

CX Extended Composite ID w/ Check Digit

|ID^^Âssigning AuthorityÎdentifier Type (HL70203)|

|36363636^^^MPI&2.16.840.1.113883.1 9.3.2.1&ISO^MR|

EI Entity Identifier |Entity ID^Namespace IDÔIDÎSO| |23456ÊHR^2.16.840.1.113883.19.3.2.3 ÎSO|

EIP Entity Identifier Pair |Placer ID^FillerID| |23456&EHR&2.16.840.1.113883.19.3.2. 3&ISO^9700122&Lab&2.16.840.1.11388 3.19.3.1.6&ISO|

FN Family Name

HD Hierarchic Designator

|Namespace IDÛniversal ID (OID or CLIA Number)Ûniversal ID Type (ISO or CLIA)|

|Lab^2.16.840.1.113883.19.3.1.1ÎSO| HD must contain an OID except MSH-4 where it must be a CLIA

IS Coded Value |Coded Value| |F|

NM Numeric |Numeric|

|123.4|

PL Person Location |Point of Care^Room^Bed^Facility^ Person Location Type^Building^Floor ^Location Description^Location Identifier^ Assigning Authority|

Note: While all components are optional, room number and facility are encouraged |^615^^ Hospital& 2.16.840.1.113883.19.3.2.3&ISO|

PRL Parent Result Link |Parent OBR ID^Parent OBR SubID^Parent OBR Value Descriptor|

|625-4^1^Campylobacter jejuni|

SI Sequence ID |Sequence Number| |1|

SN Structured Numeric |Comparator^Num1^Separator/Suffi x^Num2|

|^0^-^1| or |^1^/^2| or |^1^:^2| or |<^10| or |2^+|

ST String |String Data| |up to 254 characters of string text|

TS Time Stamp |YYYYMMDDHHMM.SSSS-ZZZZ| |201608021328.0000-0005|

TX Text Data |Text| |short String text|

XAD Extended Address |Street AddressÔther Designation^City^State^Zip^Country (PHVS_Country_ISO_3166-1)Âddress Type (HL70190)^^County (PHVS_County_FIPS_6-4)

|4444 Healthcare Drive^Suite 123ÎndianapolisÎN^46207ÛSA^B^^18097|


https://phinvads.cdc.gov/vads/ViewValueSet.action?id=8D279355-A4D8-E011-A639-0050568D00F8



https://phinvads.cdc.gov/vads/ViewValueSet.action?id=C6D34BBC-617F-DD11-B38D-00188B398520


APPENDIX C-4



DATA TYPES


XCN Extended Composite ID Number and Name

|ID Number^Family Name^Given Name^Middle Name^Suffix^Prefix ^^Âssigning Authority^Name Type (HL70200)^^ÎD Type (HL70203)^^^ ^^^^^ Professional Suffix (HL70360)|

|1234ÂdmitÂlanÂÎII^Dr^^^Lab&2.1 6.840.1.113883.19.4.6&ISO^L^^ÊI^^^^^ ^^^MD|

XPN Extended Person Name

|Family Name^Given Name^MI^ Suffix^Prefix^^Name Type (HL70200) ^^^^^^Professional Suffix (HL70360)|

|AdmitÂlanÂÎII^Dr^^L^^^^^^^MD|

XON Extended Composite Name and ID Number for Organizations

|Organization NameÔrganization Name Type (HL70204)^^^Âssigning AuthorityÎD Type (HL70203) ^^Ôrganization ID|

|Level Seven Healthcare, Inc.^L^^^^Lab&2.16.840.1.113883.19.4.6 &ISO^XX^^^1234|

XTN Extended Telecommunications Number

|^Telecommunication Use (HL70201)Êquipment Type (HL70202)Êmail Address^Country CodeÂrea Code^Local NumberÊxtensionÂny Text|

|^PRN^PH^^1^555^5552003|

https://phinvads.cdc.gov/vads/ViewValueSet.action?id=78A2EA5D-DDD3-E011-A127-0050568D00F8


https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.808


https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.808



APPENDIX D-1 ISDH ELR HL7 Version 2.5.1 Message Structure Reference Guide 20170328


APPENDIX D: REPORTING OF CULTURES AND SUSCEPTIBILITIES

TEMPLATE FOR CULTURE RESULTS MSH|…

PID|…

OBR|1| Placer number | Filler number | Identifier code for

the requested test or panel of tests(OBR-4) |…

OBX|1|CE| Specific organism identifier (OBX-3) | Sub-id for

the first organism (OBX-4) | Description of organism

(OBX-5) |…

OBX|2|SN| Other identifier (OBX-3) | Sub-id for the first

organism (OBX-4) | Observation on the organism (OBX-5) |…


the second organism (OBX-4) | Description of organism

(OBX-5) |…

OBX|4|SN| Other identifier (OBX-3) | Sub-id for the second

organism (OBX-4) | Observation on the Organism (OBX-5) |…


the third organism (OBX-4) | Description of organism

(OBX-5) |…

OBX|6|SN| Other identifier (OBX-3) | Sub-id for the third


SPM|1| Specimen identifier for the specimen being tested|…

TEMPLATE FOR CULTURE AND SUSCEPTIBILITIES RESULTS MSH|…

PID|…

Parent OBR Segment

OBR|1| Placer number (OBR-2) | Filler order number (OBR-3) |

Identifier code for the requested test or panel of tests

(OBR-4) |…

Parent OBX Segments for First Organism Identified


the first organism (OBX-4) | Description of organism

(OBX-5) |…

OBX|2|SN| Other identifier (OBX-3) | Sub-id for the first


APPENDIX D-2



Parent OBX Segments for Second Organism Identified


the second organism (OBX-4) | Description of organism(OBX-5) |…

OBX|4|SN| Other identifier (OBX-3) | Sub-id for the second

organism (OBX-4) | Observation on the Organism (OBX-5) |…

Parent OBX Segments for Third Organism Identified


the third organism (OBX-4) | Description of organism

(OBX-5) |…

OBX|6|SN| Other identifier (OBX-3) | Sub-id for the third


Child OBR for First Organism identified

OBR|2| Placer number (OBR-2)| Filler order number (OBR-3) |


(OBR-4) |||||||||||||||||||||| A pointer back to the parent

OBX segment that contained the identification of the first

organism, see below for description of "Pointers" (OBR-26)

||| Parent Filler order number (OBR-29) |…

Child OBX Segments for Susceptibilities of First Organism Identified

OBX|1|CE|Specific susceptibility identifier for first

antimicrobial (OBX-3) || Susceptibility finding (OBX-5)

||| Susceptibility interpretation (OBX-8) |…

OBX|2|CE|Specific susceptibility identifier for second



OBX|3|CE|Specific susceptibility identifier for third



Child OBR Segment for Susceptibilities of Second Organism Identified




OBX segment that contained the identification of the second



Child OBX Segments for Susceptibilities of Second Organism Identified


antimicrobial (OBX-3) || Susceptibility finding (OBX-5) |||

Susceptibility interpretation (OBX-8) |…





APPENDIX D-3





Child OBR Segment for Susceptibilities of Third Organism Identified




OBX segment that contained the identification of the third



Child OBX Segments for Susceptibilities of Third Organism Identified










SPM Segment

SPM|1| Specimen identifier for the specimen being tested|…

More detailed information and examples can be found in the HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1 http://www.hl7.org/implement/standards/product_brief.cfm?product_id=98


Indiana state Department of health ISDH ELR HL7 Version 2.5.1 Message Structure Reference Guide 20170328 Valid through 2017 or until newer version released INDIANA STATE DEPARTMENT

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