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MEDITECH 6.0 LAB SORR Medinet (Reference Lab Interface)Send Orders/Receive Results for LAB/MIC

Version: 2.3

September 21, 2012

Reference number: R1802

Copyright © 2013 by Medical Information Technology, Inc.MEDITECH Circle, Westwood, Massachusetts 02090

(781) 821-3000

THIS INFORMATION IS PROPRIETARY AND SHOULD BE TREATED ACCORDINGLY.

Table of Contents

General Comments General Message Format and Functionality Message Structure Sample Messages Testing Notes Network Communications Protocol and Data Framing Asynchronous Communications Protocol and Data Framing Record Layouts MEDITECH Laboratory System to OV Laboratory System Record Layouts OV Laboratory System to MEDITECH Laboratory System Appendix

of 61MEDITECH Specification R1802

1/22/2014https://www.meditech.com/specifications/60/LAB_23_SPEC_HTM_Interface_Specificati...

General Comments

This specification is concerned with defining an interface between the MEDITECHLaboratory application and another laboratory system for the purposes ofsending laboratory and microbiology orders from the MEDITECH Laboratoryapplication, and for receiving laboratory and microbiology results into theMEDITECH Laboratory application.

The message formats in this document are HL7 version 2.3 compliant.

In addition, this document covers the sequencing of records and the protocolthat is to be used for communications between MEDITECH and the other vendor.

A copy of this specification should be provided to the other vendor well inadvance of MEDITECH software delivery so that any questions or concerns of theother vendor can be resolved as soon as possible.

Proper cabling between the MEDITECH machine and the other vendor machine willneed to be provided by the hospital. MEDITECH can assist in the specificationof the correct cable configuration to be used for the inter-machine link.

Separate links will be required for orders (which contain ADT data) transmittedto the other vendor laboratory system and for results to be transmitted fromthe other vendor laboratory system.

It is possible that additional devices such as modems may need to be purchasedby the hospital depending on the hardware platform of the other vendor systemor on the proximity of the MEDITECH machine to the other vendor machine.MEDITECH may be of some assistance in determining specific needs in this area.

If modems are to be employed for communications, two separate modems and twoseparate phone lines will be needed, one dedicated to sending orders and theother dedicated to receiving results.

The machine to machine communications will need to be thoroughly tested byMEDITECH and the other vendor prior to any application level testing.



General Message Format and Functionality

GENERAL HL7 MESSAGE FORMAT

Order and result data will be passed between the two systems in discreteMESSAGES. A single message may contain multiple variable length datatransactions referred to as SEGMENTS. The number, type and content of segmentsin a given message will be determined based upon the type of message beingsent. Each segment will begin with a 3 character code known as the Segment ID,followed by a number of fields which are delimited by the Field Separatorcharacter. Each segment will be terminated with a carriage return.

ORDER MESSAGES FROM MEDITECH:

Messages will be passed from the MEDITECH Laboratory application to the othervendor laboratory system when:

1. A laboratory specimen is placed in a shipping batch on the MEDITECHLaboratory application for the Lab Site associated with the MEDINETinterface.

2. A microbiology specimen is placed in a shipping batch on the MEDITECHLaboratory application for the Lab Site associated with the MEDINETinterface.

For each specimen, an Order Message (ORM) will be transmitted. Only onepatient per Order Message will be sent.

An Order Message will consist of these message segments:

MSH Message HeaderPID Patient IdentificationPV1 Patient Visit InformationORC Order Common DataNTE Notes and CommentsOBR Observation RequestOBX Observation Result (Queries answered at order time)

MEDITECH will only expect an Acknowledgement Message (ACK) in response to a ORMmessage. MEDITECH will not expect or accept any Order Response Message, anyQuery messages, or any Deferred Acknowledgement Messages from the other vendorlaboratory system, as may be defined in the HL7 v2.3 specifications.

The other vendor is expected to extract out of the PID segment any needed datato file a patient onto their system. Direct ADT messages are not sent over theinterface.

Any observations that are required to perform a given Observation Request (OBR)will be contained in the Observation/Result (OBX) segment(s). Theseobservations should not be returned when reporting results for the ObservationRequest.

RESULT MESSAGES TO MEDITECH

Messages will be passed from the other vendor laboratory system to the MEDITECHsystem when:



1. A result is entered and verified on the other vendor laboratory system fora procedure/test that was ordered by the MEDITECH system.

2. A result is changed or deleted on the other vendor laboratory system for aresult that had been previously transmitted to the MEDITECH system.

In each case, a Result Message (ORU) will be sent. Only one patient per ResultMessage will be accepted. An ORU message should contain only results for asingle specimen.

A Result Message will be composed of these segments:

MSH Message HeaderPID Patient IdentificationORC Order CommonNTE Notes and CommentsOBR Observation RequestOBX Observation ResultNTE Notes and Comments

MEDITECH will not send an Order Response Message, an Order Query Message, orany Deferred Acknowledgement Messages to the other vendor laboratory system, asmay be defined in the HL7 v2.3 specifications. An Acknowledgement Message(ACK) will be sent.



Message Structure

Orders will be sent from MEDITECH to the other vendor system using HL7 messagetype ORM (Observation Order).

Results will be sent from the other vendor system and filed into the MEDITECHsystem using the HL7 message type ORU (Observation Result Unsolicited).Laboratory and microbiology results are sent using discrete values.

Observation Orders (ORM) message

ORM OrderMSH Message HeaderPID Patient IdentificationPV1 Patient Visit InformationORC Common Order[NTE] Notes and CommentsOBR Observation Result ID[OBX] Observation Result (Queries answered at order time)

Observation Results (ORU) message

ORU Observation ResultsMSH Message HeaderPID Patient Identification

ORC Order Common[NTE] Notes and comments - specimen/order commentsOBR Observation Result ID

OBX Observation/Result[NTE] Notes and comments - result comments

PID The Patient Identification segment will contain the patient identifiers assent from MEDITECH.

PV1 The Patient Visit Information segment will contain additional patient datathat the other vendor may need to complete the patient registrationprocess.

ORC The Order Common segment will contain the type of order message (new,cancel, change), ordering system order identifiers, and order placementdate/time.

OBR The Observation Request segment will repeat some of the same orderidentifiers contained in ORC, plus add collection/received date/time,ordering provider, and Microbiology specimen source.

NTE Order specimen comments can be transmitted in NTE segments immediatelyfollowing the ORC segment. Result comments are transmitted in NTEsegments following OBX segments.

OBX For results, all individual test and component results for a given orderwill be transmitted in OBX segments following that order's OBR segment.For orders, this segment will contain answers to queries captured at thetime the order was placed.



LABORATORY ORDERS

A single message will contain all orders on a single MEDITECH specimen.Individual Order (OBR) segments are tied together using the PLACER GROUP NUMBERelement in the ORC segment. The PLACER GROUP NUMBER will be the MEDITECHexternal specimen number. Each OBR segment will contain a unique PLACER ORDERNUMBER which must be returned with results. Order codes may be mapped by theMEDITECH Laboratory application.

LABORATORY RESULTS

Results for only one MEDITECH specimen (PLACER GROUP NUMBER) may be reportedper message. Results for a single specimen may be split between messages.

Other vendor laboratory test codes may be mapped in the MEDITECH TESTDictionary to the appropriate test.

For specimens that originated on MEDITECH and were sent over the interface, thePLACER ORDER NUMBER in the OBR segment will be used to associate results backto the proper specimens and orders.

If a specimen was not sent over the interface (e.g., downtime) the other vendorwill not have a PLACER ORDER NUMBER for each order. The ORC segment can beused instead to link results. The PLACER GROUP NUMBER must, on the othervendor system, be manually set to be the MEDITECH specimen number. MEDITECHwill then use the PLACER GROUP NUMBER to associate the OBR segment with correctspecimen. This is a less reliable method of associating results than relyingon the PLACER ORDER NUMBER, and therefore is only used for downtime situations.

MICROBIOLOGY ORDERS

A single message will contain all orders on a single MEDITECH specimen.Individual Order (OBR) segments are tied together using the PLACER GROUP NUMBERelement in the ORC segment. The PLACER GROUP NUMBER will be the MEDITECHexternal specimen number. Each OBR segment will contain a unique PLACER ORDERNUMBER which must be returned with results. Order codes may be mapped by theMEDITECH Laboratory application.

MICROBIOLOGY RESULTS

The structure of microbiology results is more complex than for laboratory.

One microbiology specimen as originated on MEDITECH (PLACER GROUP NUMBER) maybe reported per ORU message. Results for multiple orders (OBR) segments may besplit into individual messages.

When a microbiology result is reported, multiple OBR segments will betransmitted for a single order, as follows:

Each parent (i.e., PARENT RESULT field is not valued) OBR segment willcontain a MEDITECH order identifier (PLACER ORDER NUMBER) as previouslytransmitted with the ORM Order Message. An ORC segment can be sent beforea parent OBR to associate results with a specimen for specimens not sentover the interface (see LABORATORY RESULTS for more detail).

A parent OBR segment will identify the ordered procedure (UNIVERSAL



SERVICE IDENTIFIER) that results will reference. Any NTE segmentsfollowing this OBR segment will contain order/specimen comments. Resultcomments for the procedure should be reported in OBX segments followingthis OBR segment. The OBR segment may be followed by any number of OBXsegments which will contain text results for the resulted procedure(s),and will identify any organisms which have been isolated. Any organismsthat are isolated should be assigned a numeric designation which isreported in the OBSERVATION SUB-ID field of the OBX segment. Note thatOBX segments used to report isolated organisms should have CE (codedentry) in the VALUE TYPE field of the segment, as opposed to ST (string)for text results.

Subsequent child (i.e., PARENT RESULT field is valued) OBR segments andOBX segments will be used to report any susceptibilities that have beenrun for the order. The OBR segment is used to identify the susceptibilityprocedure that was used and the organism for which it was run. Thesusceptibility procedure is identified in the UNIVERSAL SERVICE ID field.The Organism is identified in the PARENT RESULT field, using the numberset up in the OBSERVATION SUB-ID field of an OBX segment of the parentresult.

OBX segments following child OBR segments will be used to report theindividual antibiotics and the susceptibilities that were recorded for theantibiotic.

MICROBIOLOGY RESULT TYPES

In each OBX segment, the type of result being reported will be indicated in theOBSERVATION IDENTIFIER field. The particular instance of this type of resultwill be indicated in the OBSERVATION SUB-ID field. The actual result valuewill be contained in the OBSERVATION RESULT (ABNORMAL FLAGS forsusceptibilities) field. Valid result types, with correspondingsub-identifiers and results, are as follows:

OBS. ID OBS. SUB ID OBSERVATIONVALUES TYPE OF RESULT VALUES RESULT

CE Organism Identification 1...N Organism Name/Mnemonic

ST Procedure/Susceptibility 1...N ResultsResults

SAMPLE MICROBIOLOGY RESULT GROUPING

The following example microbiology result shows the relative grouping ofmessage segments and pertinent field information. For exact field layout anddefinitions, refer to the Record Layout and Appendix sections of thisspecification.

MSH Message HeaderPID Patient Identifier

OBR Order IdentifierNTE Order/Specimen Comment Line 1NTE Order/Specimen Comment Line 2OBX ST Line 1 Text of Line 1OBX ST Line 2 Text of Line 2OBX CE Organism 1 ECOLI (ORG 1)OBX CE Organism 2 STREP SPECIES (ORG 2)



OBR Order Identifier Susceptibility Procedure 1 ORG 1OBX ST Antibiotic 1 ResultNTE Antibiotic Comment Line 1NTE Antibiotic Comment Line 2OBX ST Antibiotic 2 Result

OBR Order Identifier Susceptibility Procedure 1 ORG 2OBX ST Antibiotic 1 ResultOBX ST Antibiotic 2 Result



Sample Messages

The following are some sample HL7 order and result messages.

Sample Orders

Multiple profiles/orderable tests may be sent in one message, linked by thePLACER GROUP NUMBER. A single message will contain only one PLACER GROUPNUMBER which will be a MEDITECH external specimen number.

MSH|^~\&|LAB|MDH|||199903021705||ORMÔ01|1.15|D|2.3|<CR>PID|1||M000340024||JOHNSON^MAX||19600903|M||C|5 MILK STREET^^BOSTON^MA^02215|||

||M||V000008867|012-34-5678|<CR>PV1||E|SE4^402^02^MDH|R|||LEC^LEVIN^CLAUDIA^M^^DR^|FRB^FRANKLIN^BEN^^^DR^|CON^C

ONSULT^DOC^^^DR^|U||||A|||ADDÂDMIT^DOC^^^DR^|IN||SP||||||||||||||||H|||||ADM|||199704062330|199704081000|<CR>

ORC|NW|6958^LAB||040701:C00004R||N|^^^^^R||199904071708|<CR>NTE|1||ORDERING COMENTS|<CR>OBR|1|6958^LAB||415263^17-HYDROXYPROGESTERONE^L|||199904071615|||||||1999040716

15||ABCÂBC^DEFG^^^^MD||||||||LAB|||^^^^^R|<CR>

Sample Laboratory Result

The OBR segment identifies the MEDITECH order for which results are beingreported. Results associated with the given order are reported with OBXsegments following the OBR segment. Multiple OBR segments may be contained ina single message. However, all OBR segments contained in a single message mustbe from the same PLACER GROUP NUMBER sent in the original ORC segment fromMEDITECH.

MSH|^~\&|LAB||||199903021900||ORU^R01|99783|P|2.3|<CR>PID|1||M000340024||JOHNSON^MAX||19600903|M||C|5 MILK STREET^^BOSTON^MA^02215|||

||M||V000008867|012-34-5678|<CR>ORC||6958^LAB||040701:C00004R|||||199704071116|<CR>OBR|1|6958^LAB|11687|415263^17-HYDROXYPROGESTERONE^L|||199704071200|||||||19970

4071230||ABCÂBC^DEFG^^^^MD||||||||LAB|F||^^^^^R|<CR>OBX|1|ST|12321^17-HYDROXYPROGESTERONE^L|1|132|MG/DL|120-140||||F|||199904071900

||LABTECH1|<CR>

Sample Microbiology Result

In the example below, a CULT BACT/GS procedure composed of a gram stain and aculture, has been ordered. In the first OBR record, the CULT BACT/GS isidentified as the ordered procedure. In the OBX segments that follow it, theresults for the Gram Stain and the Culture are reported. In the last OBXsegment for the Culture, an organism (Escherichia Coli) is identified andlinked with the OBSERVATION SUB-ID 2.1 for identification purposes. TheOBSERVATION SUB-ID is not strictly part of the result - it is used later in themessage to identify which organism the susceptibilities are for.

In the second OBR segment, the susceptibility procedure (NEG FLEX) isidentified, and associated with the organism ESCHERICHIA COLI (OBSERVATIONSUB-ID 2.1). Following this OBR segment are OBX segments with antibiotics andassociated susceptibilities for this susceptibility procedure.

MSH|^~\&|MIC||||199703101800||ORU^R01|934858|P|2.3|<CR>PID|1||M000340024||JOHNSON^MAX||19600903|M||C|5 MILK STREET^^BOSTON^MA^02215|||

||M||V000008867|012-34-5678|<CR>



ORC||4301^MIC||031001:M0432|||||199703101116|<CR>OBR|1|4301^MIC|11688|GS^CULT BACT/GS^L|||199703101205|||||||199703101430|URC^^^

URINE, CATHETERIZED|ORD.DR^DOCÔRDERING||||||||MB|F||^^^^^R|<CR>OBX|1|ST|GS^GRAM STAIN^L|1|GRAM STAIN RESULTS:||||||F|<CR>OBX|2|ST|GS^GRAM STAIN^L|1|GRAM POSITIVE RODS||||||F|<CR>OBX|3|ST|CR1^CULT BACT UR VD^L|2|PRELIMINARY REPORT:||||||F|<CR>OBX|4|ST|CR1^CULT BACT UR VD^L|2|>100,000 ORG/ML OF:||||||F|<CR>OBX|5|ST|CR1^CULT BACT UR VD^L|2|GRAM POSITIVE RODS||||||F|<CR>OBX|6|ST|CR1^CULT BACT UR VD^L|2|IDENTIFICATION AND SUSCEPTIBILITY TO FOLLOW|||

|||F|<CR>OBX|7|ST|CR1^CULT BACT UR VD^L|2|03/10/1997 0731||||||F<CR>OBX|8|ST|CR1^CULT BACT UR VD^L|2|***FINAL REPORT:***||||||F|<CR>OBX|9|ST|CR1^CULT BACT UR VD^L|2|>100,000 ORG/ML OF:||||||F|<CR>OBX|10|ST|CR1^CULT BACT UR VD^L|2| ESCHERICHIA COLI ||||||F|<CR>OBX|11|ST|CR1^CULT BACT UR VD^L|2|SUSCEPTIBILITY TO FOLLOW||||||F|<CR>OBX|12|ST|CR1^CULT BACT UR VD^L|2|03/05/97 1026||||||F|<CR>OBX|13|CE|CR1^CULT BACT UR VD^L|2.1|ECOLIÊSCHERICHIA COLI||||||F|<CR>OBR|2|4301^MIC|11688|NEG FLEX|||199703101205|||||||199703101430|URCÛRINE, CATH

ETERIZED|ORD.DR^DOCÔRDERING||||||||MB|F|CR1^2.1||4301^MIC|<CR>OBX|1|ST|AMPÂMPICILLIN||2|||S|||F|<CR>OBX|2|ST|UÂMP/SULBAC||<=4|||S|||F|<CR>OBX|3|ST|AZÂZTREONAM||<=8|||S|||F|<CR>OBX|4|ST|CEF^CEFAZOLIN||<=8|||S|||F|<CR>OBX|5|ST|CEFO^CEFOPERAZO||<=8|||S|||F|<CR>OBX|6|ST|TAX^CEFOTAXIME||<=4|||S|||F|<CR>OBX|7|ST|CAZ^CEFTAZIDIM||<=8|||S|||F|<CR>OBX|8|ST|ROXA^CEFUROX-AXETIL||<=4|||S|||F|<CR>OBX|9|ST|ROX^CEFUROX-SODIUM||<=4|||S|||F|<CR>OBX|10|ST|CF^CEPHALOTHI||<=2|||S|||F|<CR>OBX|11|ST|CIP^CIPROFLOXA||<=0.5|||S|||F|<CR>OBX|12|ST|GM^GENTAMICIN||<=0.5|||S|||F|<CR>OBX|13|ST|FM^NITROFURAN||<=32|||S|||F|<CR>OBX|14|ST|OFLÔFLOXACIN||<=1|||S|||F|<CR>OBX|15|ST|TIM^TICAR/CLAV||<=16|||S|||F|<CR>OBX|16|ST|NN^TOBRAMYCIN||<=0.5|||S|||F|<CR>OBX|17|ST|SXT^TMP/SXT||>=320|||R|||F|<CR>



Testing Notes

Each of the functions below should be initiated using multiple TEST patients inorder to generate all transaction types processed by the interface:

o Order a single LAB test and verify that it is sent to the other vendor andthey are able to file the order.

o Order a single MIC procedure and verify that it is sent to the other vendorand they are able to file the order.

o Order a LAB profile and verify that it is sent to the other vendor and theyare able to file the order.

o Order a LAB test and profile on the same specimen. Verify that the othervendor is able to file the order.

o Order LAB and MIC orders on the same requisition and verify that they aresent to the other vendor and filed.

o Enter comments on the LAB and MIC orders and verify that they can be seen bythe other vendor.

o Add a test onto a specimen already sent to the other vendor to verify thatthe order is sent. Do the same thing to an order which has not be sent.Perform this for both LAB and MIC specimens.

o Cancel part of a specimen and the entire specimen. Perform this functionbefore and after a batch has been created to send orders to the othervendor. Do this for both LAB and MIC specimens.

o Allow the other vendor to transmit results on the orders sent by MEDITECHand verify whether the results filed or rejected. If rejected, determinethe reason for the rejection and correct.

o Verify that result comments sent by the other vendor are displayed in LABfor both LAB and MIC specimens.

o For MIC, have the other vendor result organisms, sensitivities andantibiotics. Verify that this data files on the specimen in MEDITECH.

o If the units, reference ranges and panic flags are being taken from theother vendor instead of the MEDITECH LAB Test dictionary, verify that theproper values appear.

* Please note that if any Enter/Edit Result routine is invoked after theresults have filed over the interface from the other vendor, the units,reference ranges and panic flags will be updated with the MEDITECH Testdictionary values.



Network Communications Protocol and Data Framing

For network transfer of messages, MEDITECH supports TCP/IP socket connectionsover an Ethernet backbone.

MEDITECH supports the HL7 Minimal Lower Layer Protocol for framing HL7messages.

With MEDITECH as client: the MEDITECH system must be supplied with the IPaddress or network name of the remote system, along with a TCP port number onthe remote system to which the MEDITECH system can open a TCP/IP connection.It is assumed that the remote system will have a service listening at thedesignated port.

With MEDITECH as server: the MEDITECH system will establish a servicelistening at the port designated for the interface. The Other Vendor will beprovided with the IP address or network name of the MEDITECH background jobprocessor on which this service is running. MEDITECH will accept and processrequests for service at this address on this port.

Message transfer will be assumed to be initiated by the sender of messages,which will send an HL7 message and await to receive an HL7 Acknowledgement orQuery Response message.

HL7 MINIMAL PROTOCOL

The Minimal Lower Layer Protocol is described in section B.4 MINIMAL LOWERLAYER PROTOCOL of the Health Level Seven Version 2.1 specification.

With this protocol, an HL7 data message is framed with a single character tostart the data message and two characters to terminate the message. No othercharacters are added to the HL7 message.

The format of the transmission block is this:

<SB>ddddd<EB><CR>

Where:

<SB> is the Start Block character, ASCII <VT>, decimal <11>, hex <0B>.

ddd is the variable number of bytes representing the HL7 data message.

<EB> is the End Block character, ASCII <FS>, decimal <28>, hex <1C>.

<CR> is a Carriage Return Character, ASCII <CR>, decimal <13>, hex <0D>.

ACKNOWLEDGEMENT MESSAGES FOR NETWORK COMMUNICATIONS

With the HL7 Minimal Protocol, the sender of an HL7 message (such as an ADT,ORM, or ORU message) will send a message and expect to receive anacknowledgement message before sending another message.

If MEDITECH is the sender of messages, MEDITECH will expect an acknowledgementor query response message that contains the MESSAGE CONTROL ID of the message



originally sent by MEDITECH. MEDITECH will not process any application levelerror messages, nor will it process any delayed acknowledgement messages.

If MEDITECH is the receiver of messages, MEDITECH will send an ACK GeneralAcknowledgement message which contains the MESSAGE CONTROL ID of the messagereceived by MEDITECH. MEDITECH will not send any application level errormessages or any delayed acknowledgement messages. (ie, MEDITECH will treat allreceived messages as if the Accept Acknowledgement Type field contained 'AL'for always send accept acknowledgement, and the Application AcknowledgementType field contained 'NE', for never send application acknowledgement).



Asynchronous Communications Protocol and Data Framing

MEDITECH supports the HL7 recommended Hybrid Lower Layer Protocol for theframing and transmission of data messages over asynchronous RS-232 connections.

PHYSICAL LINE CHARACTERISTICS

For asynchronous serial data transfer, the RS232C specification will be usedfor cabling between machines. The following list outlines the physicalrequirements for this interface.

1. One dedicated RS232C communications line per connection between machines.

2. Asynchronous serial data transfer.

3. Physical Full Duplex - Logical Half Duplex (i.e. non-echo)

4. ASCII character code set.

5. Baud rates up to 9600.

6. Under normal circumstances, MEDITECH employs eight data bits, one stop bitand no parity (10 bit frame). Contact MEDITECH for the feasibility ofother data frame configurations.

ASYNCHRONOUS COMMUNICATIONS PROTOCOL

The following section describes the HL7 Hybrid Lower Layer Protocol (refer toAppendix B, section B.2 of the HEALTH INDUSTRY LEVEL 7 INTERFACE STANDARDS,Version 2.1).

HL7 HYBRID LOWER LAYER PROTOCOL TRANSMISSION BLOCKS

There are two types of blocks used for communication processing, DATA blocksand NAK blocks. A single HL7 message is transmitted in a single DATA block,while NAK blocks are used to signal transmission errors.

Both block types have the same format:

<SB>tvv<CR>ddddcccccxxx<EB><CR>

Where:

<SB> - Start Block character (1 byte). ASCII <VT>, decimal 11, hex <0B>.

t - Block Type (1 byte). 'D' = DATA block, 'N' = NAK block.

vv - Protocol ID (2 bytes). The HL7 specification version = '21'.

<CR> - Carriage Return (1 byte). ASCII <CR>, decimal 13, hex <0D>.

dddd - Data (variable number of bytes)In a data block, this is the data content of the block. The data cancontain any displayable ASCII characters and the carriage returncharacter, <CR>.



In a NAK block, this field contains a 1-byte reason code as follows:

'C' - character count wrong in previous data block received'X' - checksum wron in previous data block received'B' - data too long for input buffer in previous block received'G' - Error not covered elsewhere

ccccc - Block Size (5 bytes)Character count of all characters so far in the data block up to andincluding the last data character. For this version the protocol, thisis 5 + the size of the ddd field. Note that an encoded HL7 messageends with a <CR> character. This character is considered part of thedata.

xxx - Checksum (3 bytes)Exclusive-OR checksum of all characters in the block up to andincluding the last data character. The checksum is expressed as adecimal number in three ASCII digits.

<EB> - End Block character (1 byte). ASCII <FS>, decimal 28, hex 1C.

<CR> - Carriage Return (1 byte). ASCII <CR>, decimal 13, hex <0D>.

HL7 HYBRID LOWER LAYER PROTOCOL PROCESSING RULES

By definition, the Sending System sends the initiate message and theReceiving System sends back a response message. Each of these messages areformatted into a single LLP (Lower Level Protocol) data block. In the usualcase, where there are no errors, the Sending System will send a message andreceive the response. The Receiving System will receive the Sending System'smessage and send the response.

SENDING SYSTEM PROCESSING FOR HL7 LLP

Send the data block that contains the next HL7 encoded message.

Receive the response from the responding system. To receive the block thatcontains the response:

If a completely delimited block is not received before the receive timeout,resend the original block.

Ignore all incoming characters until a Start Block character is received. Anytime another Start Block character is received before the end of a block,ignore all previous characters. Receive characters until <EB> <CR> isrecognized. This is the end of the block.

If a block is received that does not have the proper:

1. Block Format2. Checksum (xxx),3. Block Size (ccccc) or4. has too many characters to be received in a single block

Resend the original block.

If the block is acceptable and the block type is 'N', it is a negativeacknowledgement. Resend the original block up to the maximum resend count then



return an indication of the error.

If the block is acceptable and has block type 'D' it is the response. Sendthe next message.

If the Sending System detects an error in the data block from the ReceivingSystem, resend the original block.

RECEIVING SYSTEM PROCESSING FOR HL7 LLP

Perform a listen function as required by the environment.

Receive the block that contains the initial message.

To receive a block:

Ignore all incoming characters until Start Block character is received. Anytimeanother Start Block Character is received before the end of a block, ignore allprevious characters. Receive characters until <EB> <CR> is recognized. Thisis the end of the block.

If a block is received that does not have the proper:

1) Block Format2) Checksum (xxx)3) Block Size (cccccc) or4) has too many characters to be received in a single block,

Construct and send a NAK block (type t='N') that includes the appropriatereason code in the data field.

If the receive block is valid, send the response message.

HL7 ACKNOWLEDGEMENT MESSAGES FOR ASYNCHRONOUS COMMUNICATIONS

MEDITECH will accept or send an ACK (General Acknowledgment) message if the HL7Sequence Number Protocol is employed. If the HL7 Sequence Number Protocol isnot employed, then MEDITECH will accept or send a Data Block as described abovewith no characters in the data part of the message. Such an empty Data Blockwill constitute a valid communications acknowledgement for the transmitted DataBlock.



Record Layouts MEDITECH Laboratory System to OV LaboratorySystem

Message ORM Segment MSH Message Header RecordMessage ORM Segment PID Patient IdentificationMessage ORM Segment PV1 Patient VisitMessage ORM Segment ORC Common OrderMessage ORM Segment OBR Observation Report IDMessage ORM Segment NTE Notes and CommentsMessage ORM Segment OBX ResultMessage ACK Segment MSH Message Header RecordMessage ACK Segment MSA Message Acknowledgement



Message ORM Segment MSH Message Header Record

Req - R = Required, C = Conditionally Required, O = Optional, NU = Not Supported

This segment defines the intent, source, destination, and some specifics of thesyntax in the Order (ORM) message.

ItemHL7

DescriptionReq Type Len

MEDITECHDescription

Req Type Len

MSH.1 Field Separator R ID 1 Field Separator R ID 1

MSH.2 Encoding Characters R N 4 Encoding Characters R N 4

MSH.3 Sending Application O AN 15 Sending Application O AN 15

MSH.4 Sending Facility O AN 10 Sending Facility O AN 10

MSH.7Message Date &Time

R N 12Message Date &Time

R N 12

MSH.9 Message Type R AN 26 Message Type R AN 26

MSH.10 Message Control ID R N 20 Message Control ID R N 20

MSH.11 Processing ID R N 1 Processing ID R N 1

MSH.15AcceptAcknowledgementType

O ID 2AcceptAcknowledgementType

O ID 2

MSH.16Application Ack.Type

O AN 2Application Ack.Type

O AN 2



Message ORM Segment PID Patient Identification


This segment will be the primary means of communicating patient identificationinformation. This segment also includes additional demographic informationabout the patient.

ItemHL7


MEDITECHDescription

Req Type Len

PID.1 Set ID R N 1 Set ID R N 1

PID.2 Patient Identifier O N 20External PatientIdentifier

O N 20

PID.3 Patient Identifier List R SID 25 Patient Identifier List R SID 25

PID.5 Patient Name R AN 250 Patient Name R AN 250

PID.7 Date of Birth O N 26 Date of Birth O N 26

PID.8 Administrative Sex O N 1 Administrative Sex O N 1

PID.10 Race O AN 250 Race O AN 250

PID.11 Patient Address O AN 250 Patient Address O AN 250

PID.16 Marital Status O ID 250 Marital Status O ID 250

PID.18Patient AccountNumber

R AN 250Patient AccountNumber

R AN 250

PID.19Social SecurityNumber (SSN)

O AN 15Social SecurityNumber (SSN)

O AN 15



Message ORM Segment PV1 Patient Visit


The PV1 segment contains information regarding the patient's visit along withadditional patient demographic information.

ItemHL7


MEDITECHDescription

Req Type Len

PV1.2 Patient Status O SN 1 Patient Status O SN 1

PV1.3Assigned PatientLocation

O AN 80Assigned PatientLocation

O AN 80

PV1.4 Admission Type O AN 2 Admission Type O AN 2

PV1.7 Attending Provider O AN 60 Attending Provider R AN 60

PV1.8 Referring Provider O AN 60 Referring Provider O AN 60

PV1.9 Consulting Provider O AN 60 Consulting Provider O AN 60

PV1.10 Hospital Service O AN 3 Hospital Service R AN 3

PV1.14 Admit Source O AN 6 Admit Source O AN 6

PV1.16 VIP Indicator O SN 2 VIP Indicator O SN 2

PV1.17 Admitting Provider O SN 60 Admitting Provider CR SN 60

PV1.18 Patient Type O AN 3 Patient Type R AN 3

PV1.20 Financial Class O AN 11 Financial Class CR AN 11

PV1.36DischargeDisposition

O AN 10DischargeDisposition

CR AN 10

PV1.39 Servicing Facility O AN 10 Servicing Facility R AN 10

PV1.41 Patient Status O AN 3 Patient Status R AN 3

PV1.44 Admit Date/Time O AN 19Admit/ServiceDate/Time

R AN 19

PV1.45DischargeDate/Time

O AN 19 Discharge Date/Time CR AN 19



Message ORM Segment ORC Common Order


The Common Order segment (ORC) is used to transmit fields that are common toall orders. Notably, this segment contains the PLACER GROUP NUMBER field.

ItemHL7


MEDITECHDescription

Req Type Len

ORC.1 Order Control R ID 2 Order Control R ID 2

ORC.2 Placer Order Number C EI 22 Placer Order Number C EI 22

ORC.4Placer GroupNumber

O EI 22Placer GroupNumber

O EI 22

ORC.6 Response Flag O ID 1 Response Flag O ID 1

ORC.7 Quantity/Timing O TQ 200 Quantity/Timing O TQ 200

ORC.9Date/Time ofTransaction

O TS 26Date/Time ofTransaction

O TS 26



Message ORM Segment OBR Observation Report ID


This segment will contain order specific information.

ItemHL7


MEDITECHDescription

Req Type Len

OBR.1 Set ID - OBR O SI 4 Set ID - OBR O SI 4

OBR.2Placer OrderNumber

R EI 22Placer OrderNumber

R EI 22

OBR.4 Universal Service ID R CE 250 Universal Service ID R CE 250

OBR.7ObservationDate/Time

C TS 26CollectionDate/Time

C TS 26

OBR.14Specimen ReceivedDate/Time

C TS 26Specimen ReceivedDate/Time

C TS 26

OBR.15 Specimen Source O CM 300 Specimen Source O CM 300

OBR.16 Ordering Provider O XCN 250 Ordering Provider O XCN 250

OBR.18 Placer Field 1 O ST 60MT LAB RequisitionNumber

O ST 60

OBR.24Diagnostic ServiceSect ID

O ID 10Diagnostic ServiceSect ID

O ID 10

OBR.25 Result Status C ID 1 Result Status C ID 1

OBR.27 Quantity/Timing O TQ 200 Quantity/Timing O TQ 200



Message ORM Segment NTE Notes and Comments


The NTE segment is defined as a common format for sending notes and comments.

ItemHL7


MEDITECHDescription

Req Type Len

NTE.1 Set ID - NTE O SI 4 Set ID - NTE O SI 4

NTE.3 Comment O FT 655 Comment O FT 655



Message ORM Segment OBX Result


This segment will contain observations required to perform the observationsassociated with the order in the OBR segment. These observations should not bereturned as part of the results of the ordered observation.

MEDITECH will use this segment to provide information about queries which wereanswered about the order at the time the order was placed.

ItemHL7


MEDITECHDescription

Req Type Len

OBX.1 Set ID - OBX O SI 4 Set ID - OBX R SI 4

OBX.2 Value Type C ID 2 Value Type O ID 2

OBX.3ObservationIdentifier

R CE 250ObservationIdentifier

R CE 250

OBX.5 Observation Value * AN 655 Observation Value O AN 655



Message ACK Segment MSH Message Header Record


This segment defines the intent, source, destination, and some specifics of thesyntax in the Acknowledgement (ACK) message. The Acknowledgement message willbe sent by the receiving system (MEDITECH) after receipt of a ORU message.

ItemHL7


MEDITECHDescription

Req Type Len

MSH.1 Field Separator R ST 1 Field Separator R AN 1

MSH.2 Encoding Characters R ST 4 Encoding Characters R AN 4

MSH.3 Sending Application O HD 180 Sending Application CR AN 180

MSH.4 Sending Facility O HD 180 Sending Facility O AN 180

MSH.5ReceivingApplication

O HD 180ReceivingApplication

CR AN 180

MSH.6 Receiving Facility O HD 180 Receiving Facility O AN 180

MSH.7Date/Time OfMessage

O TS 26Date/Time OfMessage

R AN 26

MSH.9 Message Type R CM 7 Message Type R AN 7

MSH.10 Message Control ID R ST 20 Message Control ID R AN 20

MSH.11 Processing ID R PT 3 Processing ID R AN 3

MSH.12 Version ID R ID 8 Version ID R AN 8



Message ACK Segment MSA Message Acknowledgement


The MSA segment will contain the MESSAGE CONTROL ID of the message that isbeing acknowledged.

ItemHL7


MEDITECHDescription

Req Type Len



Record Layouts OV Laboratory System to MEDITECH LaboratorySystem

Message ORU Segment MSH Message Header RecordMessage ORU Segment PID Patient IdentificationMessage ORU Segment ORC Common OrderMessage ORU Segment OBR Observation Report IDMessage ORU Segment NTE Notes and CommentsMessage ORU Segment OBX ResultMessage ORU Segment NTE Notes and CommentsMessage ACK Segment MSH Message Header RecordMessage ACK Segment MSA Message Acknowledgement



Message ORU Segment MSH Message Header Record


This segment defines the intent, source, destination, and some specifics of thesyntax in the Observation Results (ORU) message.

ItemHL7


MEDITECHDescription

Req Type Len

MSH.1 Field Separator R ID 1 Field Separator R ID 1

MSH.2 Encoding Characters R N 4 Encoding Characters R N 4

MSH.3 Sending Application O AN 15 Sending Application CR AN 15

MSH.4 Sending Facility O AN 10 Sending Facility O AN 10


O AN 15ReceivingApplication

CR AN 15

MSH.6 Receiving Facility O AN 15 Receiving Facility O AN 15

MSH.7Message Date &Time

R N 12Message Date &Time

R N 12

MSH.9 Message Type R AN 26 Message Type R AN 26

MSH.10 Message Control ID R N 20 Message Control ID R N 20

MSH.11 Processing ID R N 1 Processing ID R N 1

MSH.12 Version ID R AN 10 Version ID R AN 10



Message ORU Segment PID Patient Identification


This segment will be the primary means of communicating patient identificationinformation. This segment also includes additional demographic informationabout the patient.

ItemHL7


MEDITECHDescription

Req Type Len

PID.5 Patient Name R AN 250 Patient Name R AN 250

PID.7 Date of Birth O N 26 Date of Birth R N 26

PID.8 Administrative Sex O N 1 Administrative Sex R N 1

PID.18Patient AccountNumber

R AN 250Patient AccountNumber

R AN 250

PID.19Social SecurityNumber (SSN)

O AN 15Social SecurityNumber (SSN)

O AN 15



Message ORU Segment ORC Common Order


The Common Order segment is used to transmit fields that are common to allorders.

ItemHL7


MEDITECHDescription

Req Type Len

ORC.2 Placer Order Number C EI 22 Placer Order Number R EI 22

ORC.4Placer GroupNumber

O EI 22Placer GroupNumber

O EI 22

ORC.9Date/Time ofTransaction

O TS 26Date/Time ofTransaction

O TS 26



Message ORU Segment OBR Observation Report ID


This segment will contain order specific information in an Observation Result(ORU) Message. The default result date and time are contained in this segment.

ItemHL7


MEDITECHDescription

Req Type Len

OBR.1 Set ID - OBR O SI 4 Set ID - OBR R SI 4

OBR.2Placer OrderNumber

R EI 22Placer OrderNumber

R EI 22

OBR.4 Universal Service ID R CE 250 Universal Service ID R CE 250

OBR.7ObservationDate/Time

C TS 26CollectionDate/Time

R TS 26

OBR.14Specimen ReceivedDate/Time

C TS 26Specimen ReceivedDate/Time

R TS 26

OBR.15 Specimen Source O CM 300 Specimen Source CR CM 300

OBR.25 Result Status C ID 1 Result Status CR ID 1

OBR.26 Parent Result O CM 400 Parent Result CR CM 400

OBR.27 Quantity/Timing O TQ 200 Quantity/Timing O TQ 200

OBR.29 Parent O CM 200 Parent O CM 200



Message ORU Segment NTE Notes and Comments


The NTE segment is defined here for inclusion in messages defined in otherchapters. It is a common format for sending notes and comments.

At this level it is used to report specimen/order comments.

ItemHL7


MEDITECHDescription

Req Type Len

NTE.1 Set ID - NTE O SI 4 Set ID - NTE O AN 4

NTE.3 Comment O FT 64k Comment O AN 64k



Message ORU Segment OBX Result


This segment will contain results that are associated with a single PLACERORDER NUMBER.


The NTE segment is defined here for inclusion in messages defined in otherchapters. It is a common format for sending notes and comments.

At this level it is used to report result comments.

ItemHL7


MEDITECHDescription

Req Type Len

OBX.2 Value Type C ID 2 Value Type R ID 2

OBX.3ObservationIdentifier

R CE 250ObservationIdentifier

R CE 250

OBX.4 Observation Sub-ID C ST 20 Observation Sub-ID C ST 20

OBX.5 Observation Value * AN 655 Observation Value O AN 655

OBX.6 Units O CE 250 Units O CE 250

OBX.7 References Range ST 60 References Range O 60

OBX.8 Abnormal Flags O IS 5 Abnormal Flags O IS 5

OBX.11Observation ResultStatus

R ID 1Observation ResultStatus

R ID 1

OBX.14Date/Time ofObservation

O TS 26Date/Time ofObservation

O TS 26

OBX.15 Producer's ID O CE 250 Performing Site O CE 250

OBX.16ResponsibleObserver

O XCN 250ResponsibleObserver

O XCN 250

ItemHL7


MEDITECHDescription

Req Type Len

NTE.1 Set ID - NTE O SI 4 Set ID - NTE O AN 4

NTE.3 Comment O FT 64k Comment O AN 64k



Message ACK Segment MSH Message Header Record


This segment defines the intent, source, destination, and some specifics of thesyntax in the Acknowledgement (ACK) message. The Acknowledgement message willbe sent by the receiving system (other vendor) after receipt of a ORM message.

ItemHL7


MEDITECHDescription

Req Type Len

MSH.1 Field Separator R ST 1 Field Separator R AN 1

MSH.2 Encoding Characters R ST 4 Encoding Characters R AN 4

MSH.3 Sending Application O HD 180 Sending Application CR AN 180

MSH.4 Sending Facility O HD 180 Sending Facility O AN 180


O HD 180ReceivingApplication

CR AN 180

MSH.6 Receiving Facility O HD 180 Receiving Facility O AN 180

MSH.7Date/Time OfMessage

O TS 26Date/Time OfMessage

R AN 26

MSH.9 Message Type R CM 7 Message Type R AN 7

MSH.10 Message Control ID R ST 20 Message Control ID R AN 20

MSH.11 Processing ID R PT 3 Processing ID R AN 3

MSH.12 Version ID R ID 8 Version ID R AN 8



Message ACK Segment MSA Message Acknowledgement


The MSA segment will contain the MESSAGE CONTROL ID of the message that isbeing acknowledged.

ItemHL7


MEDITECHDescription

Req Type Len

MSA.1AcknowledgmentCode

R ID 2AcknowledgmentCode

R AN 2

MSA.2 Message Control ID R ST 20 Message Control ID R ST 20

MSA.3 Text Message O ST 80 Text Message O AN 80



Appendix

Field Definitions

NOTE HL7/MT DESCRIPTION LENGTH TYPE

MSA.1 HL7 Acknowledgment Code 2 IDMT Acknowledgment Code 2 AN

HL7 standard description

This field contains an acknowledgement code (see HL7 table 0008Acknowledgment code). MEDITECH will always send "AA" (for positiveacknowledgments).

Used in Message Segment: ACK MSA

MSA.2 HL7 Message Control ID 20 STMT Message Control ID 20 ST


This field contains the message control ID of the message sent by the sendingsystem. It allows the sending system to associate this response with themessage for which it is intended.


MSA.3 HL7 Text Message 80 STMT Text Message 80 AN


The field further describes an error condition.


MSH.1 HL7 Field Separator 1 STMT Field Separator 1 AN

Used in Message Segments: ACK MSH, ACK MSH

MSH.10 HL7 Message Control ID 20 STMT Message Control ID 20 AN




This field contains a number or other identifier that uniquely identifies themessage. The receiving system echoes this ID back to the sending system in theMessage Acknowledgment segment (MSA).


MSH.11 HL7 Processing ID 3 PTMT Processing ID 3 AN


This field is used to indicate whether the message was generated by aproduction/live system or a development/testing/training system.

MEDITECH value: P - production/liveD - development/testing/training


MSH.12 HL7 Version ID 8 IDMT Version ID 8 AN


The HL7 version being used. This specification is written to be complient withHL7 version 2.3, so this element will contain "2.3".


MSH.15 HL7 Accept Acknowledgement Type 2 IDMT Accept Acknowledgement Type 2 ID

MEDITECH description

Accept Acknowledgement Type: This value will always be populated with "AL".

Used in Message Segment: ORM MSH

MSH.16 HL7 Application Ack. Type 2 IDMT Application Ack. Type 2 AN


This field contains the conditions under which application acknowledgements arerequired to be returned in response to this message. Will always be populatedwith "NE".

Used in Message Segment: ORM MSH

MSH.2 HL7 Encoding Characters 4 ST



MT Encoding Characters 4 AN


This field contains the four encoding characters in the following order:component separator, repetition separator, escape character, and subcomponentseparator.


MSH.3 HL7 Sending Application 180 HDMT Sending Application 180 AN


This field uniquely identifies the sending application among all applicationswithin the network enterprise.

One of the two fields in the MSH segment--"Sending Application" and "ReceivingApplication"--will be used by MEDITECH to determine whether the incomingmessage targets the LAB (Laboratory) application or the MIC (Microbiology)application. If one is not valued, then the other must be. Valid values forthis field are as follows:

LAB for Laboratory ordersMIC for Microbiology orders


MSH.4 HL7 Sending Facility 180 HDMT Sending Facility 180 AN


This field uniquely identifies the sending application's facility.

MEDITECH value: MIS Facility Dictionary mnemonic associated with the patientfor whom the order is placed


MSH.5 HL7 Receiving Application 180 HDMT Receiving Application 180 AN


This field uniquely identifies the receiving application among all applicationswithin the network enterprise.

One of the two fields in the MSH segment--"Sending Application" and "ReceivingApplication"--will be used by MEDITECH to determine whether the incomingmessage targets the LAB (Laboratory) application or the MIC (Microbiology)application. If one is not valued, then the other must be. Valid values for



this field are as follows:

LAB for Laboratory ordersMIC for Microbiology orders


MSH.6 HL7 Receiving Facility 180 HDMT Receiving Facility 180 AN


This field uniquely identifies the receiving application's facility. MEDITECHdoes not by default require or send this field; but the element may beincorporated depending on the implementation used.


MSH.7 HL7 Date/Time Of Message 26 TSMT Date/Time Of Message 26 AN


This field contains the exact time of an event. The element will contain thetime in the format YYYYMMDDHHMM, where:

YYYY = 4 digit year (e.g., 1997)MM = 2 digit month (e.g., 04)DD = 2 digit day (e.g., 07)HH = 2 digit hour (e.g., 14)MM = 2 digit minute (e.g., 45)


MSH.9 HL7 Message Type 7 CMMT Message Type 7 AN


This field contains the message type and event trigger for the message. Thefirst component is the message type (see HL7 table 0076 - Message type); thesecond component is the event code (see HL7 table 0003 - Event type).

For acknowledgements to ORU messages the message type will be "ACK" and theevent code will be "R01".

For acknowledgements to ORM messages the message type will be "ACK" and theevent code will be "O01".


NTE.1 HL7 Set ID - NTE 4 SIMT Set ID - NTE 4 SI




SET ID.

Used in Message Segment: ORM NTE

NTE.3 HL7 Comment 655 FTMT Comment 655 FT


For ORM Messages from MEDITECH:

When the Order is being Cancelled (ORC 1 = "CA"), this field will be treated asa cancellation comment. Otherwise, it will contain a line of specimen comment.

For ORU Messages from the Other Vendor:

This field will be treated as a specimen comment, and be appended to the end ofany existing specimen comments

Used in Message Segment: ORM NTE

OBR.1 HL7 Set ID - OBR 4 SIMT Set ID - OBR 4 SI


Definition: For the first order transmitted, the sequence number shall be 1;for the second order, it shall be 2; and so on.

Used in Message Segments: ORM OBR, ORU OBR

OBR.14 HL7 Specimen Received Date/Time 26 TSMT Specimen Received Date/Time 26 TS


This field contains the date and time the specimen was received in the lab.The element will contain the date/time in the format YYYYMMDDHHMM, where:


MEDITECH element/value

For LAB Orders:LAB.L.SPEC.received.date & LAB.L.SPEC.received.time



For MIC Orders:LAB.M.SPEC.received.date & LAB.M.SPEC.received.time


OBR.15 HL7 Specimen Source 300 CMMT Specimen Source 300 CM


Source of specimen.

OBR|15.1.1 = SourceOBR|15.1.4 = Descripition


OBR|15.1.1 = LAB.M.SRC.lab.site.mnemonic or LAB.M.SPEC.sourceOBR|15.1.4 = LAB.M.SPDESC.lab.site.mnemonic or LAB.M.SPEC.spec.desc


OBR.16 HL7 Ordering Provider 250 XCNMT Ordering Provider 250 XCN


The identification of the provider who ordered the test, using the followingformat:

Mnemonic^Lastname^Firstname^Middlename^suffix^title^degree


For LAB Orders: LAB.L.SPEC.subm.doctorFor MIC Orders: LAB.M.SPEC.subm.doctor

Used in Message Segment: ORM OBR

OBR.18 HL7 Placer Field 1 60 STMT MT LAB Requisition Number 60 ST


MediTech LAB Requisition Number for the order.


LAB.C.REQ.number




OBR.2 HL7 Placer Order Number 22 EIMT Placer Order Number 22 EI


This field is a string of characters that designates an order uniquely. Thisfield will typically not exceed 25 characters in length.

This field will always be valued, as follows:

First component - MEDITECH internal specimen URN (unique record number)Second component - MEDITECH application associated with the specimen:

LAB - LaboratoryMIC - Microbiology


OBR.24 HL7 Diagnostic Service Sect ID 10 IDMT Diagnostic Service Sect ID 10 ID


Possible values are "LAB" for laboratory and "MB" for microbiology.


OBR.25 HL7 Result Status 1 IDMT Result Status 1 ID


This field is the status of results for this order. This field is required,only when sending Microbiology results. See HL7 table 0123 - Result statusfor more details. Possible values include:

F - Final resultsC - Final results (corrected result filed as final)D - Delete

The following possible values are for Microbiology results only:

CG - Global replace (completely replaces existing results with new)P - Preliminary results


OBR.26 HL7 Parent Result 400 CMMT Parent Result 400 CM




This field is used for microbiology results. This field will be used whenreporting susceptibility results for a previously identified organism. Thefield will contain two components: the OBSERVATION ID and the OBSERVATIONSUB-ID of the previously sent OBX segment which reported the organism.

Example: AFB CULT^2.1

The example links susceptibility result to the organism identified with theOBSERVATION SUB-ID "2.1" in an AFB Culture.

Used in Message Segment: ORU OBR

OBR.27 HL7 Quantity/Timing 200 TQMT Quantity/Timing 200 TQ


The order priority will be the sixth component of this field.


LAB Orders: LAB.L.SPEC.priorityMIC Orders: LAB.M.SPEC.priority


OBR.29 HL7 Parent 200 CMMT Parent 200 CM


This field is used when linking microbiology results. If this field has avalue, then treat OBR and OBX segments as sensitivities (OBR) and antibiotics(OBX).

Used in Message Segment: ORU OBR

OBR.4 HL7 Universal Service ID 250 CEMT Universal Service ID 250 CE


LAB:

OBR|4.1.1 = TEST MnemonicOBR|4.1.2 = TEST NameOBR|4.1.3 = Harcoded as "L" or "LN"

MIC:

OBR|4.1.1 = Procedure Mnemonic



OBR|4.1.2 = Procedure NameOBR|4.1.3 = Harcoded as "M" or "LN"


For LAB Orders:

OBR.4.1.1 - LAB.L.TEST.meth.loinc, LAB.L.TEST.dft.loinc,LAB.L.TEST.lab.site.val.ref.code, or LAB.L.TEST.mnemonic

OBR.4.1.2 - MIS.LOINC.name or LAB.L.TEST.nameOBR.4.1.3 - LN or L - Hardcoded

For MIC Orders:

OBR.4.1.1 - LAB.M.PROC.meth.loinc, LAB.M.PROC.dft.loinc,LAB.M.PROC.lab.site.val.ref.code or LAB.M.PROC.mnemonic

OBR.4.1.2 - MIS.LOINC.name or LAB.M.PROC.nameOBR.4.1.3 - LN or M - Hardcoded


OBR.7 HL7 Observation Date/Time 26 TSMT Collection Date/Time 26 TS


This field contains the collection date and time of the specimen. The elementwill contain the date/time in the format YYYYMMDDHHMM, where:



For LAB Orders:LAB.L.SPEC.collection.date & LAB.L.SPEC.collection.time

For MIC Orders:LAB.M.SPEC.collection.date & LAB.M.SPEC.collection.time


OBX.1 HL7 Set ID - OBX 4 SIMT Set ID - OBX 4 SI


This field contains a sequence number. For multiple data sets, the SET IDfield is used to identify repetitions. This will be a sequential integer formultiple OBX segments reported under a single OBR segment.



Used in Message Segment: ORM OBX

OBX.11 HL7 Observation Result Status 1 IDMT Observation Result Status 1 ID


This field indicates the result status (see HL7 table 0085 - Observationresult status codes interpretation). This element will always be one of thefollowing:

F - FinalP - PreliminaryC - CorrectionD - DeleteX - Results not obtained (not done)


LABF - FinalC - Edit (correction)D - DeleteX - Results not obtained (Not Done)

MICF - FinalP - PreliminaryD - DeleteX - Results not obtained (Not Done)

Used in Message Segment: ORU OBX

OBX.14 HL7 Date/Time of Observation 26 TSMT Date/Time of Observation 26 TS


This field contains the time of the observation. Whenever clinical results arereported, this field should be valued. Otherwise, the time when the resultsare received and filed over the interface will be defaulted in. The elementshould contain the time in the format YYYYMMDDHHMM, where:



OBX.15 HL7 Producer's ID 250 CEMT Performing Site 250 CE




Lab Site mnemonic for the results performing site. If it is an invalid mnemonicor blank it will default with the Filer MIS Toolbox Performing Site parameter.


OBX.16 HL7 Responsible Observer 250 XCNMT Responsible Observer 250 XCN


This field will contain the MEDITECH MIS User Dictionary mnemonic of the userwho entered/verified this particular result.


OBX.2 HL7 Value Type 2 IDMT Value Type 2 ID


For reporting the responses to ORM queries answered at the time an order isplaced, this field will contain "TX" for queries with a type of "Comment", or"CE" for group response type queries.

Used in Message Segments: ORM OBX, ORU OBX

OBX.3 HL7 Observation Identifier 250 CEMT Observation Identifier 250 CE


For outbound orders:

OBX|3.1.1 - Query MnemonicOBX|3.1.2 - Query Text

For inbound results:

OBX|3.1.1 -

This field contains a unique identifier for the observation.

Laboratory results:The first component is an identifying code which MEDITECH will map to atest/procedure. The second component is a free text name for theobservation and is optional. The third component should be "L", and isoptional.

Microbiology results:If the preceding OBR refers to an Ordered Microbiology Procedure, thenthis field should contain the Procedure Code associated with the Result



in OBX|5. If the Preceding OBR refers to a Sensitivity, then thisfield will contain an Antibiotic Code.

For OBX|3.4, we'll accept any value here. But what we look for is this:IF OBX|2 is "CE" we treat OBX|3.4 as an organism and go to the

process.organism macro.IF OBX|2 is anything else, we then check OBX|3.4 to see if it's "P:" or

"R:".


OBX|3.1.1 = LAB.C.REQ.order.queryOBX|3.1.2 = MIS.QUERY.text


OBX.4 HL7 Observation Sub-ID 20 STMT Observation Sub-ID 20 ST


Microbiology results:If the VALUE TYPE field in this segment is "CE", then this field willcontain x.y, where x is an integer which increments for each orderedprocedure, and y is an integer which increments for each organismassociated with the current ordered procedure. If VALUE TYPE is "ST" andthis field contains the x.y format, then it will be the same x.y as in aprior OBX with a "CE" (organism description) VALUE TYPE, and this segmentwill contain query (MIC prompt) and response data related to thatorganism. If VALUE TYPE is "ST" and this field contains an integer, itidentifies sequentially an ordered procedure.


Laboratory results:Generally 1; for tests with multiple results, the value should beincremented by 1 for each result.

Microbiology results:If the VALUE TYPE field in this segment is "CE", then this field willcontain x.y, where x is an integer which increments for each orderedprocedure, and y is an integer which increments for each organismassociated with the current ordered procedure. If VALUE TYPE is "ST" andthis field contains the x.y format, then it will be the same x.y as in aprior OBX with a "CE" (organism description) VALUE TYPE, and this segmentwill contain query (MIC prompt) and response data related to thatorganism. If VALUE TYPE is "ST" and this field contains an integer, itidentifies sequentially an ordered procedure.


OBX.5 HL7 Observation Value 655 ANMT Observation Value 655 AN




For outbound orders, OBX|5.1.1 will contain the Query Response.

For inbound results, OBX|5.1.1 will contain the result of the procedure.

If the length of the result is greater than 20, it is saved as a resultcomment, along with the abnormal flag, result range, and units.


OBX.6 HL7 Units 250 CEMT Units 250 CE


This field contains the units of the observation. (LAB)

The first component contains a identifier (mnemonic) for the units.


OBX.7 HL7 References Range See Record 60MT References Range See Record 60


Components: for numeric values in the format:

a) lower limit-upper limit (when both lower and upper limits are defined, e.g.,for potassium 3.5 - 4.5)

b) > lower limit (if no upper limit, e.g., >10)

c) < upper limit (if no lower limit, e.g., <15)

alphabetical values: the normal value may be reported in this location

When the observation quantifies the amount of a toxic substance, then the upperlimit of the range identifies the toxic limit. If the observation quantifies adrug, the lower limits identify the lower therapeutic bounds and the upperlimits represent the upper therapeutic bounds above which toxic side effectsare common.


OBX.8 HL7 Abnormal Flags 5 ISMT Abnormal Flags 5 IS


Laboratory results, numeric:L - low



H - highLL - critical lowHH - critical high

Laboratory results, non-numeric:A - abnormalN - normal

Microbiology susceptibilities are reported here and not in the OBSERVATIONVALUE (00573) field.

Microbiology results:For query (prompt) responses, this should be "A" or "N".For antibiotic OBX segments, reaction:

VS - very sensitiveMS - moderately sensitiveMR - moderately resistantVR - very resistantS - sensitiveI - intermediateR - resistant


ORC.1 HL7 Order Control 2 IDMT Order Control 2 ID


Order Messages (ORM) will use one of the following values in this field:

NW - new orderCA - cancel orderXO - change order

Used in Message Segment: ORM ORC

ORC.2 HL7 Placer Order Number 22 EIMT Placer Order Number 22 EI


Placer Order Number.


For LAB Orders: ORC|2.1 = LAB.L.SPEC.urnORC|2.2 = Harcoded as "LAB"

For MIC Orders: ORC|2.1 = LAB.M.SPEC.urnORC|2.2 = Harcoded as "MIC"

Used in Message Segments: ORM ORC, ORU ORC



ORC.4 HL7 Placer Group Number 22 EIMT Placer Group Number 22 EI


This field will contain the MEDITECH complete external specimen number.


LAB Orders: LAB.L.SPEC.number.completeMIC Orders: LAB.M.SPEC.number


ORC.6 HL7 Response Flag 1 IDMT Response Flag 1 ID


This field allows the placer application to determine the amount of informationto be returned from the filler. This field will always have a value of "N"(Only the MSA segment is returned).


ORC.7 HL7 Quantity/Timing 200 TQMT Quantity/Timing 200 TQ


Quantity/Timing. The order priority will be sent in the sixth component ofthis field.


MIS.XO.MSG.GEN.medi.infc.pri


ORC.9 HL7 Date/Time of Transaction 26 TSMT Date/Time of Transaction 26 TS


This field is the date and time the current transaction was entered by theordering application. For messages creating new orders, this is the date andtime the order was entered.




For LAB Orders:

LAB.L.SPEC.entered.date_LAB.L.SPEC.entered.time

For MIC Orders:

LAB.M.SPEC.entered.date_LAB.M.SPEC.entered.time


PID.1 HL7 Set ID 1 CXMT Set ID 1 N


There will only be one patient being sent at a time. Therefore, this willalways be set to the value of "1".

Used in Message Segment: ORM PID

PID.10 HL7 Race 250 CEMT Race 250 AN


Patients race mnemonic as defined within the MIS race dictionary. An exampleof this could be "CA" which is commonly defined for Caucasian.


@[email protected]


PID.11 HL7 Patient Address 250 ADMT Patient Address 250 AN


Patients mailing address. This field is comprised of the following components:

Component 1: StreetComponent 2: Street (Secondary, i.e. APT)Component 3: CityComponent 4: StateComponent 5: Zip Code


Component 1 - @pat.street, @MRI.DRC.pat.streetComponent 2 - @pat.street2, @MRI.DRC.pat.street2



Component 3 - @pat.city, @MRI.DRC.pat.cityComponent 4 - @pat.state, @MRI.DRC.pat.stateComponent 5 - @pat.zip, @MRI.DRC.pat.zip


PID.16 HL7 Marital Status 250 CEMT Marital Status 250 ID


Patients marital status as defined in the marital status dictionary in MIS.


@marital.status


PID.18 HL7 Patient Account Number 250 TXMT Patient Account Number 250 AN


This field contains the patient account number.

Optional 2nd Component: Patient Registration Category


DPM Information:

ADM.PAT.acct.num

Used in Message Segments: ORM PID, ORU PID

PID.19 HL7 Social Security Number (SSN) 15 STMT Social Security Number (SSN) 15 AN


US : Patient social security numberCAN: Patient Health Care Number


US : ADM.PAT.soc.sec.numberCAN: ADM.PAT.health.care.number




PID.2 HL7 Patient Identifier 20 CXMT External Patient Identifier 20 N


This field is populated with the patient identifier for the external system.


@MIS.HUB.mri.hub.id, [@mri.urn]@MIS.HUB.adm.hub.id [@urn]


PID.3 HL7 Patient Identifier List 250 CXMT Patient Identifier List 25 SID


This field contains multiple patient identifiers separated by a repetitioncharacter. A patients Medical Record Number, Social Security Number (ifavailable), HIM OID, and EMR Number are sent through this field. The followingformat of this field is as follows:

Anything between expressed with " " is a hardcoded value.

First Repetition:

Component 1: Medical Record NumberComponent 5: "MR"Component 6: Facility Mnemonic

Second Repetition:

Component 1: Social Security NumberComponent 5: "SS"Component 6: Facility Mnemonic

Third Repetition:(If Available)

Component 1: HIM OIDComponent 5: "PI"Component 6: Facility Mnemonic

Fourth Repetition:

Component 1: EMR IDComponent 5: "HUB"Component 6: Facility Mnemonic

Note: If there is no social security number entered on a patient, the fourthrepetition will assume the third repetition.

If HL7 version < 2.4 then only MRN repition will be available.




Medical Record Number: @unit.numberSocial Security Number: @soc.sec.numberHIM ID: @mri.urnEMR ID: @MRI.PAT.mri.hub.id


PID.5 HL7 Patient Name 250 PNMT Patient Name 250 AN


This field contains the name of the patient. This field is a 6 component fieldwhich is formatted as follows:

Component 1: Last NameComponent 2: First NameComponent 3: Middle InitialComponent 4: SuffixComponent 5: TitleComponent 6: Degree

If the HL7 Version is greater than 2.2 than PID.5.7 will populate with L andif there are multiple other names than PID.5.7 will be populated with an M.If the HL7 Versions is 2.2 or less than it won t populate PID.5.7.


@[email protected]@MRI.PAT.name


PID.7 HL7 Date of Birth 26 TSMT Date of Birth 26 N


This field contains the patients date of birth. This is formatted as follows:

YYYYMMDDHHMM


DPM Information:

ADM.PAT.pat.dob




PID.8 HL7 Administrative Sex 1 ISMT Administrative Sex 1 N


This field contains the sex of the patient. Possible values: M, F, and U.

M = MaleF = FemaleU = Unknown


DPM Information:

ADM.PAT.sex


PV1.10 HL7 Hospital Service 3 IDMT Hospital Service 3 AN


This field contains the treatment or type of surgery that the patient isscheduled to receive; defined as the Service in Admissions. It is a requiredfield with trigger events A01 (admit/visit notification), A02 (transfer apatient). The values that populate this field are built in the RegistrationService dictionary in MIS.


DPM Information:

ADM.PAT.service

Used in Message Segment: ORM PV1

PV1.14 HL7 Admit Source 6 ISMT Admit Source 6 AN


This field indicates where the patient was admitted. This is defined as theAdmit Source in Admissions. The values for this field are built in theAdmission Source dictionary in MIS.


DPM Information:



ADM.PAT.admit.source


PV1.16 HL7 VIP Indicator 2 IDMT VIP Indicator 2 SN


This is a Y/N flag that is defined as the VIP field in HIM - MPI desktop. Thisfield will be blank if no value is defined in HIM.


PV1.17 HL7 Admitting Provider 60 CNMT Admitting Provider 60 SN


"This field contains the admitting physician information as defined inAdmissions. The components of this field are populated by the MIS Persondictionary.

Component 1 - Provider Mnemonic


DPM Information:

ADM.PAT.admit.doctor


PV1.18 HL7 Patient Type 2 IDMT Patient Type 3 AN


This field contains the Patient's Account Type as defined in Admissions.Possible values are:

CLI - Clinical OutpatientER - Emergency Room PatientIN - InpatientINO - Observation PatientRCR - Recurring OutpatientREF - Referred OutpatientSDC - Surgical Day Care Patient




PV1.2 HL7 Patient Status 1 CXMT Patient Status 1 SN


PV1|2 can be populated with the following values:

"P", used for "PRE" patients"I", used for inpatients"E", used for ER patients"O", used for outpatients

The field can also be left blank, which appears to happen if the patient is an"SCH" patient.


PV1.20 HL7 Financial Class 11 IDMT Financial Class 11 AN


This is the Patient's Financial Class as defined as Fin Class in Admissions.The values for this field are defined in the Financial Class dictionary in MIS.


DPM Information:

ADM.PAT.financial.class


PV1.3 HL7 Assigned Patient Location 80 PLMT Assigned Patient Location 80 AN


This field contains the patient s assigned location as defined in Admissions.

Component 1 - LocationComponent 2 - RoomComponent 3 - Bed

Component 1 values are defined values in the Location dictionary in MIS. Theseare typically hospital wards or floors. Components 2 and 3 are defined in theRoom dictionary in MIS.


Component 1 - location - ADM.PAT.locationComponent 2 - room - ADM.PAT.roomComponent 3 - bed - ADM.PAT.bed




PV1.36 HL7 Discharge Disposition 2 IDMT Discharge Disposition 10 AN


This field contains the disposition of the patient at time of discharge (i.e.,discharged to home, expired, etc.). This is defined as the DischargeDisposition in Admissions. The values for this field are defined in theDischarge Disposition dictionary in MIS.


DPM Information:

ADM.PAT.discharge.disposition


PV1.39 HL7 Servicing Facility 2 IDMT Servicing Facility 10 AN


This field is used in a multiple facility environment to indicate thehealthcare facility with which this visit is associated. The Facility Mnemonicis defined within the ADM Toolbox parameters.


PV1.4 HL7 Admission Type 2 IDMT Admission Type 2 AN


This is a Patient's "Admit Priority" as defined in Admissions.


ADM.PAT.admit.priority


PV1.41 HL7 Patient Status 2 IDMT Patient Status 3 AN




This field contains the account status. Possible values are:

SCH - Scheduled PRE - PreadmittedADM - Admitted REG - RegisteredDIS - Discharged DEP - Departed"


PV1.44 HL7 Admit Date/Time 19 TSMT Admit/Service Date/Time 19 AN


This field contains the admit date/time. It is to be used if the eventdate/time is different than the admit date and time, i.e., a retroactiveupdate. This is defined as the Admit Date and Time in Admissions. Format isYYYYMMDDHHMM


DPM Information:

ADM.PAT.admit.dateADM.PAT.admit.time


PV1.45 HL7 Discharge Date/Time 19 TSMT Discharge Date/Time 19 AN


This field contains the discharge date/time. This is defined as the DischargeDate and Time in Admissions. Format is YYYYMMDDHHMM


DPM Information:

ADM.PAT.discharge.dateADM.PAT.discharge.time


PV1.7 HL7 Attending Provider 60 CNMT Attending Provider 60 AN


This field contains the attending physician information as defined inAdmissions. The components of this field are populated by the MIS Persondictionary.



Component 1 - Provider MnemonicComponent 2 - Last NameComponent 3 - First NameComponent 4 - Middle InitialComponent 5 - SuffixComponent 6 - TitleComponent 7 - Degree


ADM.PAT.attend.er.doctor


PV1.8 HL7 Referring Provider 60 CNMT Referring Provider 60 AN


This field contains the referring physician information as defined inAdmissions. The components of this field are populated by the MIS Persondictionary.

Component 1 - Provider MnemonicComponent 2 - Last NameComponent 3 - First NameComponent 4 - Middle InitialComponent 5 - SuffixComponent 6 - TitleComponent 7 - Degree


DPM Information:

ADM.PAT.refer.doctor


PV1.9 HL7 Consulting Provider 60 CNMT Consulting Provider 60 AN


This field contains the consulting physician information as defined inAdmissions. The components of this field are populated by the MIS Persondictionary.

Component 1 - Provider MnemonicComponent 2 - Last NameComponent 3 - First NameComponent 4 - Middle InitialComponent 5 - Suffix



Component 6 - TitleComponent 7 - Degree




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