HL7 Exam 3

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Terms in this set (...)

HL7
Health Level 7
Goal of HL7
Main goal of HL7 is to have patient information transferred throughout the network in accordance with patient events.
HL7 Standard
Standard that governs text based systems within healthcare, communication b/w network components is possible
RIS: What kind of system is this?
The text based system: RIS (Radiology Information System).
HIS: What kind of system is this?
The text based data system: HIS (Hospital Information System).
What is an ADT Message?
Patient administration messages: ADT messages: admit, discharge and transfer.
How do you break down and HL7 message?
A message is a set of elements.
The highest structure level is the segment.

A segment is a collection of data relating to one particular aspect of the message.

Each segment or line contains one or more fields of defined data types.

Fields can contain components and subcomponents.

Each segment of a message is identified by its ID segment. The segment ID is the 1st 3 characters of the segment.
Segment: What is this and where is it found in a message?
A segment is a collection of data relating to one particular aspect of the message
Each segment of a message is identified by its ID segment. The segment ID is the 1st 3 characters of the segment
Element: What is this and where is it found in a message?
HL7 V2 message is read by breaking it into its elements and then interpreting those elements according to the version of HL7 for which the message was written.

As far as an element, yes it's basically the same thing as a segment. It's going to be found at the first part of an HL7 message.
Field Separator: What is this and where is it found in a message?
The field separator is the first field in the MSH segment. It is always the 4th character in the segment. In the example, the field separator is the vertical bar (|).
Repetition Separator: What is this and where is it found in a message?
The repetition separator is the 2nd character of the encoding characters. It is used to separate occurrences within a field that repeat. In the example it is the tilde (~). This is the HL7 default. A repetition means the same things as an occurrence. Every occurrence is considered to be a repetition, including the 1st.
What is an ID segment?
Each segment of a message is identified by its ID segment. The segment ID is the 1st 3 characters of the segment.
Abstract Message Syntax: What is this?
The abstract message syntax is the definition table in the HL7 standard that details the specifics for all segments that appear in the message. For example, the ADT^A01 message has certain segments that are required and certain that are required and certain segments that are optional.

Brackets [] are used to indicate a segment that is optional. Those that appear w/o brackets are required.

Braces {} indicate that a segment may repeat. Segments must appear in the order specified.
Message Header: What is this? How is it represented in a HL7 message?
Every MSH message begins with a header segment (MSH). This segment contains information about the origin, destination, version and expected response.
Event Segment: What is this? How is it represented in a HL7 message?
The event segment is used to capture detailed time and person information about the specific event that triggered the generation of the message.

EVN is the 2nd segment in messages generated in patient administration, financial management and document management.
Patient Identification: What is this? How is it represented in a HL7 message?
Administrative and clinical areas use the PID segment to transmit identifying and demographic patient information. It allows for unambiguous identification as well as data such as name, address, sex and account # to be transferred.
Patient Visit: What is this? How is it represented in a HL7 message?
Messages in administrative and clinical areas use the PV1 segment to transmit visit information for the patient. PV1 contains location, practitioner and accounting information for a patient visit. There may also be a PV2 segment that contains supplemental visit information.
Observation: What is this? How is it represented in a HL7 message?
The OBX segment is used to transmit information about a single observation. OBX segments may be used for a variety of purposes such as communicating a vital sign or reporting a result. There may be more than one OBX segment per message.
Patient Allergy: What is this? How is it represented in a HL7 message?
The AL1 segment is used to transmit information about a single patient allergy. There may be more than one AL1 segment.
The first field gives the order of this segment in the collection of AL1 segments sent in this group. In our example the value is 1 indicating that this is the first AL segment in the message. In our case it is also the only segment...circled in orange.
part of a two way dialogue
Know that the General Acknowledgement Message,
Original Mode Acknowledgement
In original mode acknowledgment, 2 messages are exchanged. The first is from the sending system and the second is from the receiving system, stating whether it was able to process the request
Enhanced Mode Acknowledgement
In enhanced mode acknowledgment, 3 messages are exchanged. The first is again from the sending system. The second is from the receiving system and is a commit acknowledgment or what is known as a ACK message. This states whether the receiving system was able to take custody of the message. The third message is again from the receiving system and is an application acknowledgment. This states whether the receiving system was able to process the information inside the message. The advantage of the enhanced mode is that the sending system can proceed to the next message in the queue without waiting for the message to be processed.
ACK Message
acknowledgment which at least tells whether the receiving system was able to accept the message.
Values
The values for sending application and facility in the ADT message are the same, as the values for receiving application and facility in the ACK message
AA: Application Acknowledgement
When the message is received and processed without a problem, a code of AA (application acknowledgment) is sent
AE: Application Error
AE (application error) is sent if there is a processing problem with the receiving system that is related to the message or its structure. The problem should be diagnosed and corrected by the sending system before reattempting to send the message.
AR: Application Reject
A code of AR (application reject) is sent for one of two reasons. There may be a problem with a value in one of the MSH.

There may have been a problem with the receiving system that had nothing to do with the message or its structure. In this case, the sending system may try sending the message again later.
ERR Segment:
The ERR segment contains information about one or more errors detected in the message.
General Order Message: ORM
The general order message (ORM) includes messages specific to circumstances in which orders can be placed and reported on.
Order Common Information: ORC
The ORC segment contains order common information. This is data about the order message itself rather than about the service, so it contains information such as the order date & time and the ordering physician.
Observation Request: OBR
The OBR request segment contains observation request information about the service being ordered, rather than information about the order message itself. It is the order detail segment that is used in areas such as radiology and lab.
Order Response Message: ORR
The order response message (ORR) is sent as acknowledgment of the ORM message, the general order message.
General Results Message
The results message is the second dialogue in the ordering and results process. The first dialogue is the ORM-ACK or the ORM-ORR message and response. The second dialogue begins with an ORU (order results unsolicited) message from the filler and is acknowledged by a general ACK acknowledgment from the order placer
CDA: clinical document architecture, and it is a document markup standard that specifies the structure and semantics of a clinical document such as a discharge summary or progress note for the purpose of exchange.

A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content. It can be transferred within a message and can exist independently, outside the transferring message.
CDA definition and what it does.
CCOW definition and what it does.
CCOW: clinical context object working group.

CCOW is a vendor independent standard developed by the HL7 organization to allow clinical applications to share information at the point of care.
The IHE provides profiles, which are based on existing standards for certain clinical use situations.

It facilitates a testing scenario and then demonstration of how the standards, such as the DICOM and HL7 standards are used with PACS. This is used in order to provide a working and integrated environment.
IHE and PACS: How do they work together?
IHE Actors: What are some examples?
IHE Actors are responsible for producing, managing and/or acting on information in the context of an IHE Profile.

Acquisition Modality generates data such as images and measurements based on sensor readings.

Department System Scheduler/Order Filler manages orders performed by a department.

Evidence Creator creates additional evidence objects based on processing other data. E.g. a processing workstation

Image Archive provides long term storage of imaging-related data.

Order Placer generates and distributes orders.
What is the IHE Integration Profile?
IHE Integration Profiles organize and leverage the integration capabilities that can be achieved by coordinated implementation of communication standards.
Scheduled Workflow
Scheduled Workflow=ensure data availability/consistency.
Patient Information Reconciliation
Patient Information Reconciliation coordinates reconciliation of the patient record when images are acquired for unidentified or misidentified patients.
Consistent Presentation of Images
Consistent Presentation of Images maintains the consistency of presentation for grayscale images and their presentation state information.
Presentation of Grouped Procedures
Presentation of Grouped Procedures facilitates viewing and reporting on images for individual requested procedures (e.g. chest, abdomen, pelvis) that an operator has grouped into a single scan
Access to Radiology Information
Access to Radiology Information shares images, diagnostic reports, and related information inside a single network.
Simple Image and Numeric Report
Simple Image and Numeric Report specifies how Diagnostic Radiology Reports are created, exchanged, and used.
Key Image Note Integration Profile
The Key Image Note Integration Profile enables a user to flag as significant one or more images in a study by referencing them in a note linked with the study
Basic Security (HIPAA and patient privacy)
Basic Security is for HIPPA regulations.
Charge Posting
Charge Posting collects and posts timely billable claims, including both radiology and other departments.
Post-Processing Workflow
Post-Processing Workflow provides worklists, status and result tracking for post-acquisition tasks, such as Computer-Aided Detection or Image Processing.
Reporting Workflow
Reporting Workflow provides worklists, status and result tracking for reporting tasks, such as dictation, transcription and verification.
Evidence Documents
Evidence Documents specifies how data objects such as digital measurements are created, exchanged, and used.
What is the IHE IT Infrastructure and what does it entail?
the IHE helped by creating the IHE IT Infrastructure, that can help with supporting the information exchange.

Retrieve Information for Display Profile

Enterprise User Authentication

Patient Identifier Cross Referencing

Consistent Time Integration