HL7 Overview

1. HL7 Overview

2. Learning Objectives • Define “HL7” • Understand the basic structure of HL7 messages • Understand typical usage of HL7 messages • Understand common message content and workflow

3. Table of Contents • Terminology • Introduction • Overview • Summary

4. Terminology

5. Terminology • Message Types are messages that reference a group of related actions (example: ADT) • Trigger Events are specific actions that are associated with the generation of a message (example: ADT_A01) • Segments are logical groups of data elements or “fields” (example: PID)

6. Introduction

7. Introduction • Health care organizations often operate numerous information systems and integrate them via data transfer interfaces • HL7 (Health Level 7) is the name of the organization and the predominant messaging standard for exchanging key sets of administrative and clinical data in the healthcare enterprise • The cross-departmental usage of HL7 leads to the use of some generic labels • Example: Diagnostic Service Section ID (~AE Title) and Universal Service ID (Procedure Code)

8. Introduction • Departmental system databases typically store a combination of redundant and unique data • The most common redundant data are patient IDs and demographics • Health care organizations usually assign primary responsibility for correctly identifying patients to a single department that manages the data in a single system

9. Introduction • The department(s) with primary responsibility for patient ID usually use(s) a system commonly referred to as a Healthcare Information System (HIS) • Typical HIS functions are registration/admitting, and billing • Order entry, claims, clinical viewing, decision support, and other functions may or may not be supported by the HIS • The HIS is regarded as the master system

10. Overview

11. Message Segment Segment Segment Segment Fields Fields Fields Fields Component Component HL7 Overview • What is HL7? • “Health Level Seven develops specifications, the most widely used being a messaging standard that enables disparate healthcare applications to exchange keys sets of clinical and administrative data.”1 • What is a “Message?” • A message is a basic communication unit containing information that models a real world event • How does one read a Message? • A message is structured like an organizational chart Common HL7 Message Types, Segments, and Fields based on HL7 Standardshttp://www.hl7.org 1 – About Health Level Seven Source: http://www.hl7.ie/about_us.asp

12. HL7 Message Structure Message has User User User User Segments Fields contains comprised of User User Components

13. Message Types • ADT is an (A)dmit, (D)ischarge, and (T)ransfer message that is “triggered” by a patient admission, discharge, or transfer • ORM is an (Or)der (M)essage which includes new orders, order status changes, and order cancels • ORU is a Report/Result Message • Example: <11>MSH|^~\&|IMAGING|PSJMC|TDSresults|PSJMC|20030926000401||ORM^O01|783744|P|2.3<13>

14. <11>MSH|^~\&|IMAGING|PSJMD|TDS|PSJMD|20030926133719||ORM^O01|785465|P|2.3<13><11>MSH|^~\&|IMAGING|PSJMD|TDS|PSJMD|20030926133719||ORM^O01|785465|P|2.3<13> PID||01000083270000160771229|555-55-555^^^PSJ||ESCARDA^NARVARO||19000606|M|||1234 SOMEWHERE AVE^^^CA^90001-0000||213-456-7890|312-987-6543||||60771229|55555555<13> PV1||I|4S^S460|||||FEB^SINATRA^FRANK^E^^^MD^8888||||||||||IP||||||||||||||||||||||||||200102240414<13> ORC|SN||100A-01011800||IP|N|1^^^200102241201^^S||200309261015|^INTERFACE^HIS||FEB^SINATRA^FRANK^E^^^MD^8888<13> OBR|||100A-01011800|9025^CT PELVIS 72193^MWA||| 200102241201||||||--..|||FEB^SINATRA^FRANK^E^^^MD^8888||58944|||| 200102240414||CT|||1^^^200102240414^^S|ST1^TAPAIN^STEVEN^^^^MD^0275~SLP^POLISH^JOSEPH^L^^^MD^9828<13> NTE|1||CT UROGRAM ,PT GOING TO OR 1230 TODAY<13> <28><13> PID is a Patient Identifier Segment PV1 is a Patient Visit Segment ORC is the top level Order Information Segment OBR is the Order Detail Segment NTE is the Notes and Comments Segment OBX is the Report/Result Segment in an ORU Message Message Segments

15. Typical Message Content and Functions • HL7 specifies requirements for SEQs/components but this does not confer an obligation to process this data • Conversely, a target application may require data that is not HL7 required • HL7 sometimes requires codified data

16. Typical Message Work Flow • ADT-establish patient, visit, update demographics, update visit • Example: ADT_A04, A06, A08, A03 • ORM-order with account (PID-18) vs. visit (PV1-19), order response, result • Example: ORM_O01, ORR_O02, ORU_R01 • ORU by definition is unsolicited-does not have to be in response to an order

17. “Data Flow” *Table represents typical HL7 data flow – actual message types vary by organization

18. Common Fields PID-02 MPI number PID-03 MRN PID-05 Patient name PID-07 DOB PID-08 Sex PID-18 Patient Account No. PID-19 SSN PV1-07 Attending MD PV1-17 Admitting MD Order and Report Fields ORC-02 or OBR-02 Order Number ORC-03 or OBR-03 Accession No. ORC-12 Ordering MD OBR-04 Exam Code and Exam Description OBR-07 Order Date and Time OBR-24 Resource Name OBR-25 Order/Exam Status OBX-05 Result Text HL7 Message Fields

19. Summary

20. Summary • HL7 is a messaging protocol • Message types, trigger events, and segments are identified with 3 character labels; fields are identified by position (SEQ) in segments. • Data placement, basic structure, message types, and event definitions should be consistent in HL7 messaging

21. Summary • Due to variations in healthcare business requirements and supported functionality of different information systems there are many variations in HL7 conformance • Variation in HL7 data content is present at the message, segment and field level • Variation is also present in workflow

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