17.09.1998ch4 modifications san diego 1 proposal for improving the consistency of chapter 4 (order...

17.09.1998 CH4 Modifications San Diego

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Proposal for Improving the Consistency of Chapter 4 (Order Entry)

Prof. Dr. Joachim Dudeck

Institut fuer Medizinische Informatik

Justus-Liebig-Universitaet Gießen

E-Mail: [email protected]


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Improving the Consistency of HL7Improving the Consistency of HL7

1. Problem - Missing Definitions

2. Proposals for Consistent Definitions

3. ORM / ORR - General Order Message

4. Specific Order Entry Messages

5. Diet Orders

6. Supply Orders

7. Pharmacy / Treatment Orders

8. Other Messages


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1. Problem - Missing Definitions1. Problem - Missing Definitions

A Communications Standard should be easy implementable

But in HL7 the most important message control parameters

Message Types Trigger Events

Action Control Codes

are not consistently used in different parts of the standard due to a lack of clear and

unequivocal definitions


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2. Proposals for Consistent Definitions2. Proposals for Consistent Definitions

Message Type

– The Message Type defines the structure of the message

– One Message Type should be allocated to one specific sequence of mandatory and / or optional segments.

– If the cardinality, the sequence or the optionality of segments is changed - a new message type had to be introduced


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Trigger Event

– defines the event, the change occurred in the environment which initiates the transmission of the message (i.e. admission or discharge of a patient, delivering of a new order)

– defines on a message level the action(s) to be carried out in the target system after having received the message


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Message Structure Identifier

– introduced in version 2.3.1 to identify unambiguously the message structure

– the inconsistencies in the message type definitions could be overcome without changing the standard to seriously


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2. Proposals for Consistent Definitions 2. Proposals for Consistent Definitions

Action Code / Message Control Code

– define the action to be carried out in the receiving system on a data / segment level

– have to be used if this action can not be defined on the message level, i.e. if a message consists of repeatable segments which can initiate different actions (add, update, delete)

– required in particular in repeatable segments


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3. ORM/ORR - General Order Message 3. ORM/ORR - General Order Message

ORM / ORR Messages

– Several Order Detail Segments can occur in these messages like OBR, RQD, RQ1, RXO, ODS and ODT

– Messages can also be transmitted without any Order Detail Segments

– The currently used Event Types O01 and O02 do not transmit any additional information

– The structure of a ORM /ORR message can therefore not be recognized neither from the message type nor from the event code


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3. ORM/ORR - General Order Message3. ORM/ORR - General Order Message

Proposal for restructuring ORM / ORR Messages

ORM / ORR messages should be used

– with the OBR segment only

– applying the following Trigger Events ONW New Order OMM Order Modification (including

cancel) OCM Order Control Message

– with the “Message Structure Identifier” ORM_O01 and ORR_O02


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ORM - general order message (events ONW, OMD, OCM)

The function of this message is to initiate the transmission of information about an order. Thisincludes placing new orders, cancellation of existing orders, discontinuation, holding, etc. ORMmessages can originate also with a placer, filler, or an interested third party.

The trigger event for this message is any change to an order. Such changes includesubmission of new orders, cancellations, updates, patient and nonpatient-specificorders, etc.

should be replaced by

The following trigger events are used within chapter 4

ONW - New Order(Order Control Codes NW, OK, UA)

OMM - Order Modification (including Cancel)Every other Control Code)

OCM - Order Control Message(Order Control Codes PA; CH; DE, RE, RR, SR, SS, SC, SN, NA)


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ORM General Order Message Chapter

{ ORC Common Order 4 [ OBR Order Detail Segment [{NTE}] Notes and Comments (for Detail) 2 [{DG1}] Diagnosis 6 [ { OBX Observation/Result 7 [{NTE}] Notes and Comments (for Results) 2 } ] ]


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ORM use notes

a) The abstract message syntax for some order segments vary slightly. Please refer to theappropriate sections for specific examples: for supply orders (RQ), see Section Fehler!Verweisquelle konnte nicht gefunden werden., “Fehler! Verweisquelle konnte nicht gefundenwerden.,” for pharmacy, see Section 4.8, “Fehler! Verweisquelle konnte nicht gefundenwerden.,” and for dietary orders, see Section Fehler! Verweisquelle konnte nicht gefundenwerden., “Fehler! Verweisquelle konnte nicht gefunden werden..”

b) The segment named “Order Detail Segment” represents whichever of these order detailsegment(s) is appropriate to the message, currently OBR, RQD, RQ1, RXO, ODS, ODT.

c) The NTE segment(s) can be included in the ORM message in four places; in each place the NTErefers to the segment which it follows. In particular, the NTEs following the MSH refer only tothe message header, the NTEs following the order detail segment apply to the service defined bythat ORC and order detail segment.


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4. Specific Order Entry Messages4. Specific Order Entry Messages

Further Order Entry Message Types

OMD/ORD Diet Order (Segments ODS / ODT)

OMS/ORS Supply Orders (Segment RQD)

OMN/ORN Nonstock Supply Orders (Segments RQD, RQ1)

RDO/RRO Pharmacy / Treatment Order Message(Segment RXO)

RDE/RRE already defined


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5. Diet Orders5. Diet Orders

OMD / ORD - DIET ORDERS A diet office needs to receive specific information, the most important being the diet orderitself. Diet restrictions (often called diet codes) are the basic building blocks of a diet order.

The following trigger events are used for diet orders 4

ONW - New Order(Order Control Codes NW, OK, UA)

OMM - Order Modification (including Cancel)Every other Control Code)

OCM - Order Control Message(Order Control Codes PA; CH; DE, RE, RR, SR, SS, SC, SN, NA)


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5. Diet Orders5. Diet OrdersOMD Dietary Order Chapter

MSH Message Header 2 [{NTE}] Notes and Comments (for Header) 2[ PID Patient Identification 3

[PD1] Additional Demographics 3 [{NTE}] Notes and Comments (for Patient ID) 2 [PV1 Patient Visit 3 [PV2]] Patient Visit - Additional Info 3 [{IN1 Insurance 6

[IN2] Insurance Additional Info 6 [IN3] Insurance Add’l Info - Cert. 6 }] [GT1] Guarantor 6 [{AL1}] Allergy Information 3]{ ORC Common Order Segment 4 [ {ODS} Dietary Orders, Suppl., Prefer. 4 [{NTE}] Notes and Comments (for ODS) 2 {OBX Results 7 [{NTE}]} Notes and Comments (for OBX) 2 ]}{ [ ORC Common Order Segment 4 {ODT} Diet Tray Instructions 4 [{NTE}] Notes and Comments (for ODT) 2 ]}


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5. Diet Orders5. Diet Orders

ORD Diet Order Acknowledgment Message Chapter

MSH Message Header 2MSA Message Acknowledgment 2[ERR] Error 2 [{NTE}] Notes and Comments (for MSA) 2[ [PID Patient Identification 3 [{NTE}] Notes and Comments (for Patient ID) 2 ] { ORC Common Order 4 [{ODS}] Dietary Orders, Supplements, and Preferences 4 [{NTE}] Notes and Comments (for ODS) 2 } [ { ORC Common Order 4 [{ODT}] Diet Tray Instructions 4 [{NTE}] Notes and Comments (for ODT) 2 } ]]


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RDE/RRE already correctly defined


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6. Supply Orders6. Supply Orders

4.7 OMS / ORS - SUPPLY ORDERS

Stock requisition orders use the OMS Message.

OMS Stock Requisition Order Message Chapter

ORS Stock Requiaition Order Acknowledgment Message Chapter

MSH Message Header 2MSA Message Acknowledgment 2[ERR] Error 2 [{NTE}] Notes and Comments (for Header) 2[ [PID Patient Identification 3 [{NTE}] Notes and Comments (for Patient ID) 2 ] { ORC Common Order 4 RQD Requisition Detail 4 [{NTE}] Notes and Comments (for RQD) 2 }]


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6. Supply Orders6. Supply OrdersNonstock requisitions use the OMN / ORN Messages.

OMN Nonstock Requisition Order Message Chapter

MSH Message Header 2 [{NTE}] Notes and Comments (for Header) 2[ PID Patient Identification 3 [PD1] Additional Demographics 3 [{NTE}] Notes and Comments (for Patient ID) 2 [PV1 Patient Visit 3 [PV2]] Patient Visit - Additional Info 3 [{IN1 Insurance 6

[IN2] Insurance Additional Info 6 [IN3] Insurance Add’l Info - Cert. 6 }] [GT1] Guarantor 6 [{AL1}] Allergy Information 3]{ ORC Common Order 4[ RQD Requisition Detail 4 [RQ1] Requisition Detail-1 4 [{NTE}] Notes and Comments (for RQD) 2 [ { OBX Observation/Result 7 [{NTE}] Notes and Comments (for OBX) 2 } ]] [BLG] Billing Segment 4}


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ORN Nonstock Requisition Order Acknowledgment Message Chapter

MSH Message Header 2MSA Message Acknowledgment 2[ERR] Error 2 [{NTE}] Notes and Comments (for Header) 2[ [PID Patient Identification 3 [{NTE}] Notes and Comments (for Patient ID) 2 ] { ORC Common Order 4 RQD Requisition Detail 4 [RQ1] Requisition Detail-1 4 [{NTE}] Notes and Comments (for RQD) 2 }]


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Supply Messages

– the “RQ1” Segment - “Nonstock requisition details”is an optional Segment

– It is therefore not necessary to distinguish between “stock” and “non-stock” supply messages

– One Supply Order Message would be sufficient (OMS / ORS)


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RDE/RRE already defined


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7. Pharmacy / Treatment Orders7. Pharmacy / Treatment Orders

4.8 PHARMACY/TREATMENT ORDERS

4.8.1 RDO / RRO - pharmacy/treatment order message

RDO Pharmacy/treatment Order Message Chapter

RRO Pharmacy/treatment Order Response Message Chapter

MSH Message Header 2MSA Message Acknowledgment 2[ERR] Error 2 [{NTE}] Notes and Comments (for Response Header) 2[ [PID Patient Identification 3 [{NTE}]] Notes and Comments (for Patient ID) 2 { ORC Common Order 4 [ RXO Pharmacy/Treatment Order 4 [{NTE}] Notes and Comments (for RXO) 2 {RXR} Pharmacy/Treatment Route 4 [{RXC}] Pharmacy/Treatment Component 4 [{NTE}] Notes and Comments (for RXC) 2 ] }]


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8. Other Messages8. Other Messages

Vaccine Administration Data

Message Types Trigger Events

VXQ Query Vacc.RecV01

VXX Response mult. V02

VXR Response single V03

VXU Unsolic. Update V04

Message Type and Trigger Event carry the same information


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8. Other Messages 8. Other Messages

Clinical Trials and Product Experiences

Message Type and Event Type definitions are already used according to the new definitions

17.09.1998ch4 modifications san diego 1 proposal for improving the consistency of chapter 4 (order...

Documents

supply order message

message level

message type definitions

defined slide

new message type

o02 slide

supply orders supply

unequivocal definitions