RIS-PACS Interface Specification HL7 Conformance Statement · The RIS is the system providing functions related to the management of orders; orders that it receives or it creates

RIS-PACS Interface Specification

HL7 Conformance Statement

Document version 1.0

Document status: Approved

HL7 Integration Statement

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The information in this documenti s property of EL.CO. and is confidential.

Use, Duplication, Distribution and Reproduction in whole or in part of this document without permission from EL.CO S.r.l.. is prohibited.

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Contents

1 Introduction ................................................................................................................................... 4

1.1 Purpose of this document ........................................................................................................ 4

1.2 Acronyms ................................................................................................................................ 4

1.3 Scenario .................................................................................................................................. 5

1.4 Related documents ................................................................................................................. 5

2 Implementation .............................................................................................................................. 6

2.1 Communication protocol ......................................................................................................... 6

2.2 Acknowledgment Mode .......................................................................................................... 6

Message Semantics ......................................................................................................................... 7

MSH Segment ................................................................................................................................. 7

MSA Segment ................................................................................................................................. 7

ERR Segment .................................................................................................................................. 7

3 HL7 Messages ................................................................................................................................. 8

3.1 Processing Roles ...................................................................................................................... 8

3.2 MSH – Message Header Segment ............................................................................................. 8

3.3 ADT Messages ....................................................................................................................... 10

3.3.1 ADTÂ08 - Update Patient Information........................................................................... 10

3.3.2 ADTÂ40 - Merge Patient - Patient Identifier List ............................................................ 13

3.4 ORM Messages ...................................................................................................................... 15

3.4.1 Procedure Scheduled ..................................................................................................... 15

3.4.2 Procedure Updated ........................................................................................................ 20


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1 Introduction

1.1 Purpose of this document

This document is an HL7 Conformance Statement for the PolaRis RIS interface.

We assume that the reader of this document is familiar with the terminology and concepts

that are used in HL7 standard and the IHE Technical Framework.

Here are described the messages managed by this interface that is between PolaRis and

an external PACS (Image Manager).

This document must be read in conjunction with the HL7 standard.

1.2 Acronyms

ACK General Acknowledgment

AL1 Patient Allergy Information Segment

ADT Admission, Discharge, and Transfer message

ERR Error Segment

EVN Event Type Segment

HL7 Health Level 7 Standard

IHE Integrating the Healthcare Enterprise

MRG Merge Patient Information Segment

MSA Message Acknowledgment Segment

MSH Message Header Segment

OBR Observation Request Segment

OBX Observation/Result Segment

ORC Common Order Segment

ORM General Order Message

ORR General Order Response Message

PID Patient Identification Segment

PV1 Patient Visit Segment

RIS Radiology Information System


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1.3 Scenario

In this document, we are going to focus on exchanged information between the RIS and a

PACS or Image Manager as well as the related messages used for this scope .

The RIS is the system providing functions related to the management of orders; orders

that it receives or it creates through the RIS’s user interface.

According to HL7 standard and IHE actors definition, a Radiology Information System is

referred to a Filler.

An Order Filler receives patient information from the ADT actor and orders from a Placer

(a system that generates orders for several departments); it can also generate itself some

new order.

PolaRis, a Department System Scheduler, has to schedule the orders and notify these

information to the PACS. The PACS receives information about the patient, procedure

timing and resources used to perform a procedure from the RIS.

In this document it’s described the communication specifications between Order Filler and

an external PACS.

1.4 Related documents

• HL7 Standard, on the web-site www.hl7.org

• IHE Radiology Technical Framework revision 8.0 – Final Text, on the web-site

www.ihe.net


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2 Implementation

PolaRis is a Radiology Information System, it permits to its users the management of the

orders it receives or orders it creates.

PolaRis acts as an Order Filler, in the IHE vocabulary, so it has to integrate itself with an

ADT system, with a Placer and, in particular, with one or more Image Manager and Report

Manager. These integrations follow the workflow described by the profiles Scheduled

Workflow and Patient Information Reconciliation defined by the IHE Radiology Technical

Framework (v 8.0).

2.1 Communication protocol

The protocol for the HL7 communication is the Minimal LLP (Minimal Lower Layer

Protocol).

Following this communication protocol, HL7 messages should conform to the MLLP block

format that is as follows:

• Each HL7 message should start with <0x0B>

• Each HL7 message should end with the two characters <0x1C><0x0D>

• Each HL7 segment should end with <0x0D>

2.2 Acknowledgment Mode

For each received message, an acknowledge message is sent to the sender.

This interface adopts the Original Acknowledgment mode. When the RIS interface

receives a message , it sends back an ACK message only after its own elaboration. In this

way, the result places in the ACK message is actually the result of the elaboration of the

message.

Adopted acknowledgment codes:

• AA – Message received and elaborated correctly.

• AE – Message received with an error during its elaboration

• AR – Message rejected: message non supported or not well formatted


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Message Semantics

ACK – Acknowledgment Message Chapter in

HL7 2.3.1

MSH Message Header 2

MSA Message Acknowledgment 2

[ERR] Error 2

MSH Segment

MSH shall be constructed as defined in next section 3.2 “MSH – Message Header

Segment”.

MSA Segment SEQ LEN DT OPT TBL# ITEM# ELEMENT NAME NOTE

1 2 ID R 0008 00018 Acknowledgment Code AA = result OK

AE = error during the

elaboration of the

message

AR = message not well

composed

2 20 ST R

00010 Message Control ID This field must be valued

with the value in MSH.10

of the message this ACK

is responding

3 80 ST O

00020 Text Message

4 15 NM O 00021 Expected Sequence

Number

5 1 ID O 0102 00022 Delayed

Acknowledgment Type

6 100 CE O

00023 Error Condition

ERR Segment SEQ LEN DT OPT TBL# ITEM# ELEMENT NAME NOTE

1 80 ID R 00024 Error Code and location


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3 HL7 Messages

Acting as an Order Filler and in its integration with a PACS, the PolaRis’s interface

supports the following transactions:

• Patient Update

• Procedure Scheduled

• Procedure Update

For each transaction every required message is supported, below are reported the HL7

detail for each message.

3.1 Processing Roles

When the RIS interface receives an HL7 message, before starting its elaboration, the

interface makes the following controls:

• MSH.3 and MSH.4 fields must be valued and the value should be supported

• MSH.5 and MSH.6 fields must be valued and the value should be the correct

• MSH.9 controls that is a supported message

The first control checks also for other fields that are required in other segments dependent

on the type of message and the triggering event.

3.2 MSH – Message Header Segment

The MSH segment describes the intent of the message, the sending and receiving

application and some specifics of the syntax of a message.

All HL7 messages should start with this segment. Here it is the description.


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SEQ LEN DT OPT TBL# ITEM# ELEMENT NAME

1 1 ST R

00001 Field Separator (used value | )

2 4 ST R

00002 Encoding Character (used values ^∼∼∼∼\& )

3 180 HD R

00003 Sending Application

4 180 HD R

00004 Sending Facility

5 180 HD R

00005 Receiving Application

6 180 HD R

00006 Receiving Facility

7 26 TS O

00007 Date/Time of Message

8 40 ST O

00008 Security

9 7 CM R

00009 Message Type

10 20 ST R

00010 Message Control ID

11 3 PT R

00011 Processing ID

12 60 VID R 0104 00012 Version ID

13 15 NM O

00013 Sequence Number

14 180 ST O

00014 Continuation Pointer

15 2 ID O 0155 00015 Accept Acknowledgment Type

16 2 ID O 0155 00016 Application Acknowledgment Type

17 2 ID O

00017 Country Code

18 6 ID C 0211 00018 Character Set – For ITALY the value should

be “8859/1”

19 60 CE O

00019 Principal Language Of Message – Not used

20 20 ID O 0356 00020 Alternate Character Set Handling Scheme –

Not used


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3.3 ADT Messages

In the healthcare workflow designed by the Technical Framework, PACS doesn’t receive

patient registration from ADT actors. It receives patient and visit information from the RIS.

The ADT messages the PACS receives are forwarded by the Filler.

Every integration between RIS and PACS manages ADTÂ08 and ADTÂ40. Below are

listed all ADT messages managed by this interface but, the forwarding operation by the

Filler to the Image Manager of messages is different from A08 to A40 and it’s configurable.

This means that if the PACS supports also messages like A02, A03 and others, the RIS’s

interface forwards also these ones, it sends just A08 and A40 about patient information.

Supported Event Type

Message

Type

ADT Trigger Event

ADTÂ02 Transfer a Patient

ADTÂ03 Discharge/End Visit

ADTÂ06 Change an Outpatient to an Inpatient

ADTÂ07 Change an Inpatient to an Outpatient

ADTÂ08 Update Patient Information

ADTÂ11 Cancel Admit / Visit Notification

ADTÂ12 Cancel Transfer

ADTÂ13 Cancel Discharge / End Visit

ADTÂ40 Merge Patient - Patient Identifier List

3.3.1 ADTÂ08 - Update Patient Information

This trigger event is used when any patient demographic information has changed. This

change is notified to Image Manager if there is a scheduled procedure.

The Patient ID cannot be updated with this message. An A40 message shall be used for

this purpose.


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3.3.1.1 Message Semantics

ADTÂ08 Chapter in

HL7 2.3.1


EVN Event Segment 3

PID Patient Information 3

PV1 Patient Visit 3

[{OBX}] Observation / Result 7

[{AL1}] Allergy Information 3

3.3.1.2 MSH Segment

MSH shall be constructed as defined in section 3.2 “MSH – Message Header Segment”.

3.3.1.3 EVN Segment

SEQ LEN DT OPT TBL# ITEM# ELEMENT NAME NOTE

1 3 ID O 0003 00099 Event Type Code If present its value shall

be equal to the second

component of the field

MSH.9

2 26 TS R

00100 Recorder Date/Time

3 26 TS O

00101 Date/Time Planned

Event

4 3 IS O 0062 00102 Event Reason Code

5 60 XCN O 0188 00103 Operator ID

6 26 TS R2

01278 Event Occurred

3.3.1.4 PID Segment


3 20 CX R

00106 Patient Identifier List CX.1=ID

CX.4^1=Assigning

Authority.

5 48 XPN R

00108 Patient Name XPN.1= Family Name

XPN.2 = Given Name

18 20 CX C(1)

00121 Patient Account

Number

CODICE_FISCALE

( IHE National Extension for

Italy )


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Here are reported only the required fields of the PID segment. All the other fields are to be

considered conditional and they shall be present if the value of the field has been changed

by the ADT.

3.3.1.5 PV1 Segment


2 1 IS R 0004 00132 Patient Class See the table defined in

section 3.3.2.5 for the

supported values

19 20 CX C

00149 Visit Number

51 1 IS C 0326 01226 Visit Indicator Shall be valued with

value ‘V’ if PV1.19 is

present

At least one of the fields PID.18 or PV1.19 shall be valued.

3.3.1.6 OBX Segment

The OBX segment is used to communicate patient’s height and weight.

SEQ LEN DT OPT TBL# ITEM# ELEMENT

NAME

NOTE

1 4 SI O

00569 Set ID – OBX

2 3 ID C 0125 00570 Value Type ‘ST’

3 80 CE R

00571 Observation

Identifier

4 20 ST C

00572 Observation

Sub-ID

5 65536 * C

00573 Observation

Value

6 60 CE O 00574 Units Weight Units: KG

Height Units: CM or M

11 1 ID R 0085 00579 Observation

Result Status

OBX employment example:

OBX|1|ST|^BODY WEIGHT||70|kg|||||F

OBX|2|ST|^BODY HEIGHT||170|cm|||||F


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3.3.1.7 AL1 Segment

The AL1 segment contains patient allergy information.


1 4 SI R

00203 Set ID–AL1

2 2 IS O 0127 00204 Allergy Type

3 60 CE R

00205 Allergy

Code/Mnemonic/Description This field contains ID of the

allergy and its description

4 2 IS O 0128 00206 Allergy Severity

5 15 ST O

00207 Allergy Reaction

6 8 DT O

00208 Identification Date

3.3.2 ADTÂ40 - Merge Patient - Patient Identifier List

This message is used to notify a merge between two patients.


ADTÂ40 Chapter in

HL7 2.3.1


EVN Event Segment 3


MRG Merge Information 3

[PV1] Patient Visit 3

3.3.2.2 MSH Segment


3.3.2.3 EVN Segment

EVN segment shall be constructed as defined in section 3.3.1.3.


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3.3.2.4 PID Segment


3 20 CX R


CX.4^1=Assigning

Authority.

5 48 XPN R


XPN.2 = Given Name

3.3.2.5 PV1 Segment


2 1 IS R 0004 00132 Patient Class See the table defined in

section 3.3.2.5 for the

supported values

11 80 PL O

00141 Temporary Location

3.3.2.6 MRG Segment


1 20 CX R 00211 Prior Patient Identifier

List CX.1 = ID

CX.2 = Assigning

Authority

2 20 CX O 00212 Prior Alternate Patient

ID Not used

3 20 CX O

00213 Prior Patient Account

Number

4 20 CX R2 00214 Prior Patient ID

5 20 CX O

01279 Prior Visit Number

6 20 CX O 01280 Prior Alternate Visit ID

7 48 XPN R2

01281 Prior Patient Name

For a major detail of segments and for a detailed semantics and compilation of messages

(different from A08 and A40) listed above, we refer to the document “PolaRis-ADTOP-HL7

Conformance Statement.pdf”.


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3.4 ORM Messages

The Order Messages (ORM) are those kind of messages used in IHE transactions

“Procedure Scheduled” and “Procedure Updated”.

These transactions manage the workflow of an order from the Filler to Image Manager.

Below It’s described detailed messages with the required fields of each segment. For a

detailed management of all the fields, required and not, for PID and PV1 segments the

reference are respectively sections 3.3.1.4 and 3.3.1.5 of the document “PolaRis-ADTOP-

HL7 Conformance Statement.pdf”.

3.4.1 Procedure Scheduled

This event is used by the RIS to inform the PACS that a procedure has been scheduled.

Using this transaction PolaRis informs Image Manager about procedure timing, resources

used to perform a procedure, patient and visit information.


ORMÔ01 Chapter in

HL7 2.3.1



PV1 Patient Visit 3

{ ORC Common Order 4

OBR } Order Detail 4

[ZDS] Additional Identification Information

3.4.1.2 MSH Segment



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3.4.1.3 PID Segment


3 20 CX R


CX.4^1=Assigning

Authority.

5 48 XPN R


XPN.2 = Given Name

7 26 TS R2

00110 Date / Time of Birth

8 1 IS R 0001 00111 Sex

10 80 CE R2 0005 00113 Race

11 106 XAD R2

00114 Patient Address XAD.1^1 = Street

Address

XAD.1^3 = Dwelling

number

XAD.3 = City

(description)

XAD.4 = Province

XAD.5 = CAP (IHE Italy)

XAD.7 = Address Type

supported:

H (home), L (legal

Address), BDL (Birth

Location)

XAD.9 = City ID (in Italy

the used ID is the ISTAT

code)

18 20 CX C

00121 Patient Account Number CODICE_FISCALE

( IHE National Extension

for Italy )

19 16 ST O

00122 SSN Number – Patient TESSERA SANITARIA

( IHE National Extension

for Italy )

26 80 CE O 0171 00129 Citizenship

3.4.1.4 PV1 Segment


2 1 IS R 0004 00132 Patient Class See the table below for

the supported values

3 80 PL C

00133 Assigned Patient

Location PL.1 = point of care

PL.2 = room

PL.3 = bed

PL.4 = facility

This field shall be valued

if the procedure is

scheduled for an in-

patient


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7 60 XCN C 0010 00137 Attending Doctor XCN.1 = ID

XCN.2 = Family Name

XCN.3 = Given Name

XCN.6 = Prefix


if the procedure is


patient

8 60 XCN C 0010 00138 Referring Doctor XCN.1 = ID

XCN.2 = Family Name

XCN.3 = Given Name

XCN.6 = Prefix


if the procedure is

scheduled for an

outpatient

9 60 XCN R2 0010 00139 Consulting Doctor XCN.1 = ID

XCN.2 = Family Name

XCN.3 = Given Name

XCN.6 = Prefix

10 3 IS C 0069 00140 Hospital Service This field shall be valued

if the procedure is


patient

15 2 IS C 0009 00145 Ambulatory Status

17 60 XCN C 0010 00147 Admitting Doctor XCN.1 = ID

XCN.2 = Family Name

XCN.3 = Given Name

XCN.6 = Prefix


if the procedure is


patient

19 20 CX C

00149 Visit Number

51 1 IS C 0326 01226 Visit Indicator Shall be valued with

value ‘V’ if PV1.19 is

present


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3.4.1.5 ORC Segment


1 2 ID R 0119 00215 Order Control NW 2 22 EI R2

00216 Placer Order Number

3 22 EI R

00217 Filler Order Number

5 2 ID R 0038 00219 Order Status SC

6 1 ID O 0121 00220 Response Flag Not used when the

order is placed by the

Filler 7 200 TQ R

00221 Quantity/Timing TQ.1 = quantity

TQ.4 = Date and time of

the scheduled

procedure 10 120 XCN R2

00224 Entered By XCN.1 = ID operator

XCN.2 = Family Name

XCN.3 = Given Name

XCN.6 = Prefix

12 120 XCN R2

00226 Ordering Provider XCN.1 = ID

XCN.2 = Family Name

XCN.3 = Given Name

XCN.6 = Prefix 13 80 PL R2

00227 Enterer’s Location

14 40 XTN R2

00228 Call Back Phone

Number

17 60 CE R2

00231 Entering Organization

3.4.1.6 OBR Segment


1 4 SI O

00237 Set ID - OBR

2 75 EI R2

00216 Placer Order Number

3 75 EI R

00217 Filler Order Number

4 200 CE R

00238 Universal Service ID CE.1 = ID

CE.2 = Description

5 2 ID R2

00239 Priority TQ.6 = Priority Code

12 60 CE R2

00246 Danger Code

13 300 ST R2

00247 Relevant Clinical Info.

15 300 CM C 0070 00249 Specimen Source


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16 80 XCN R2

00226 Ordering Provider XCN.1 = ID

XCN.2 = Family Name

XCN.3 = Given Name

XCN.6 = Prefix

17 40 XTN R2

00250 Order Callback Phone

Number

18 60 ST R

00251 Placer field 1 Accession Number

19 60 ST R

00252 Placer field 2 Requested Procedure ID

20 60 ST R

00253 Filler Field 1 Scheduled Procedure ID

24 10 ID R 0074 00257 Diagnostic Serv Sect ID

27 200 TQ R

00221 Quantity/Timing

TQ.1 = quantity (if not present

default is 1)

TQ.4 = Date and time of the

scheduled procedure

TQ.6 = Priority Code

30 20 ID R2 0124 00262 Transportation Mode

31 300 CE R2

00263 Reason for Study

44 80 CE O 0088 00393 Procedure Code

3.4.1.7 ZDS Segment

ZDS is a custom segment, not defined in HL7 standard and it’s used to notify to the PACS

the information generated by the RIS.

If the PACS supports this segment, then it can be used for this purpose and inserted in the

ORM message of Procedure Scheduled.


1 200 RP R

Z0001 Study Instance UID See below for this field

composition

The element Study Instance UID is composed as indicated below.

Component Number Component Name Shall Contain

1 Reference Pointer DICOM compliant Study Instance UID value

2 Application ID “PolaRis”

3 Type of data “Application”


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4 Subtype “DICOM”

3.4.2 Procedure Updated

This transaction is used to notify changes to procedure information from the RIS to the

PACS.

This event is triggered when the RIS cancels, re-schedules or modify characteristics of a

procedure previously scheduled.


ORMÔ01 Chapter in

HL7 2.3.1



PV1 Patient Visit 3

{ ORC Common Order 4

OBR } Order Detail 4

[ZDS] Additional Identification Information

3.4.2.2 MSH Segment


3.4.2.3 PID Segment

PID shall be constructed as defined in section 3.4.1.3.

3.4.2.4 PV1 Segment

PV1 shall be constructed as defined in section 3.4.1.4.

軐


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3.4.2.5 ORC Segment

ORC shall be constructed as defined in section 3.4.1.5.

The only difference is the value of the fields ORC.1 and ORC.5 that follows the rules listed

below.

ORC.1 Value ORC.1 Description Originator ORC.5 Value

CA Cancel Order Request RIS CA

DC Discontinue Order request RIS CA

XO Change order request,

order is still scheduled or in

Progress

RIS SC

XO Change order request,

order has been completed

RIS CM

3.4.2.6 OBR Segment

OBR shall be constructed as defined in section 3.4.1.6.

3.4.2.7 ZDS Segment

ZDS shall be constructed as defined in section 3.4.1.7.

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RIS-PACS Interface Specification HL7 Conformance Statement · The RIS is the system providing functions related to the management of orders; orders that it receives or it creates

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