Patient Administration (ADT, Admit Discharge Transfer) messages are used to

exchange the patient state within a healthcare facility. ADT messages keep patient demographic and visit information synchronized across healthcare systems. ADT is the most commonly used HL7 messaging type, with most clinical applications enabled to receive key ADT messages. ADT messages within the HL7 standard are typically initiated by the Hospital Information Systems (HIS), or a registration application, to inform ancillary systems that a patient has been admitted, discharged, transferred, merged, that other demographic data about the patient has changed (name, insurance, next of kin, etc.) or that some visit information has changed (patient location, attending doctor, etc.).

ADT-A01 patient admit ADT-A02 patient transfer ADT-A03 patient discharge ADT-A04 patient registration ADT-A05 patient pre-admission ADT-A08 patient information update ADT-A11 cancel patient admit ADT-A12 cancel patient transfer ADT-A13 cancel patient discharge

Order (ORM) is any request for materials (e.g., 500 ml of 2.5% saline) or services (e.g., a range of motion study, an EKG, a lipid panel, etc.). Orders are usually for a particular patient, but they can also be for a department (e.g., floor stock) or for a non-patient (e.g., an environment study where no specific patient is involved.) The transmission of clinical orders occurs between the application placing the order (the placer) and the clinical application filling the order (the filler). Typically, the caregiver (e.g., physician) is entering orders on the HIS application which acts as theplacer application in HL7 messaging parlance. The system to which the order is targeted (e.g., the lab in the case of a complete blood count order) is the filler of the order.

The HL7 ORM-O01 message functions as a general order message that is used to transmit information about an order. There is only one type of ORM message the ORM-O01 message. Trigger events for the ORM-O01 message involve changes to an order such as new orders, cancellations, information updates, discontinuation, etc. ORM messages are among the most widely used message types in the HL7 standard.

An order can be defined as a "request for service" that is sent between applications, or in some cases within a single application (an application can send orders to itself). An ORM message is composed of segments and groups of segments, each of which may be required, optional, repeatable, or a combination of these (see HL7 cardinality). The segments and groups of segments in the ORM-O01 message include the following:

SEGMENT/GROUP NAME MSH NTE Message header Notes and comments

OPTIONAL/REPEATABLE? Required Optional, Repeatable

PatientGroup Optional group (Required for new orders pertaining to a patient only) PID PID1 NTE-1 Patient identification Patient demographics Notes and comments Required Optional Optional, Repeatable

PatientVisitGroup Optional group, part of PatientGroup PV1 PV2 Patient visit Patient visit additional info Required Optional

InsuranceGroup Optional and repeatable group, part of PatientGroup IN1 IN2 IN3 Insurance Insurance additional info Insurance additional info certification Required Optional Optional

PatientGroup continued GT1 AL1 Guarantor Patient allergy information Optional Optional, Repeatable

OrderGroup Repeatable group ORC Common order Required

OrderDetailGroup Optional group, part of OrderGroup OBR NTE-2 DG1 Observation request Notes and comments Diagnosis Required Optional, Repeatable Optional, Repeatable

ObservationGroup Optional and Repeatable, part of OrderDetailGroup OBX NTE-3 Observation Notes and comments Required Optional, Repeatable

OrderGroup continued CTI BLG Clinical trial identification Billing Optional Optional

Like ADT messages, ORM messages contain a PID segment to provide patient identification information. However in the ORM message, this segment is only required in the case of new orders and only if the new order is related to a particular patient. Unless both of these conditions are met, the PID segment will not be included in the message. The OBX (Observation) segment also has a special function in the ORM message when compared to its use in other message types, such as the ORU (Observational Report - Unsolicited) message. In the ORM message, the OBX segment is part of an optional and repeatable group called the Observation group. When used, it carries clinical information that might be needed by the receiving system to interpret the observation that will be made, rather than information about observations and results (as in the ORU message). In HL7 pipe and hat format, an ORM message would look like this:

MSH|^~\&|HIS|MedCenter|LIS|MedCenter|20060307110114||ORM^O01|MSGID200603071101 14|P|2.3 PID|||12001||Jones^John^^^Mr.||19670824|M|||123 West St.^^Denver^CO^80020^USA||||||| PV1||O|OP^PAREG^||||2342^Jones^Bob|||OP|||||||||2|||||||||||||||||||||||||20060307110111| ORC|NW|20060307110114 OBR|1|20060307110114||003038^Urinalysis^L|||20060307110114

ORU-R01 message transmits observations and results from the producing system/filler i.e. LIS, EKG
system) to the ordering system/placer (i.e. HIS, physician office application). It may also be used to transmit result data from the producing system to a medical record archival system, or to another system not part of the original

order process. ORU messages are also sometimes used to register or link to clinical trials, or for medical reporting purposes for drugs and devices. Types of observations reported in the ORU-R01 message include:

Clinical lab results Imaging study reports EKG pulmonary function study results Patient condition or other data (i.e. vital signs, symptoms, allergies, notes, etc.)

The ORU message is a structured report where each observation is separated into an individual entity, and then separated into fields. ORU messages do not carry images; they use varying data types but most often use text, numbers and codes. In the ORU message, the OBR (Observation request) and OBX (Observation) segments are most significant due to their functions:

The OBR segment is used in all ORU messages as a report header, and contains important information about the order being fulfilled (i.e. order number, request date/time, observation date/time, ordering provider, etc.). This segment is part of a group that can be used more than once for each observation result that is reported in the message.

The OBX segment transmits the actual clinical observation results as a single observation or observationfragment. OBX segments can also be used more than once in the message, and may be followed by one or more NTE segments to provide additional notes and comments about the observation.

The segments and groups of segments in the ORU-R01 message include the following:

SEGMENT/GROUP NAME MSH Message header

OPTIONAL/REPEATABLE? Required

ResultsGroup Repeatable group, includes groups that follow (unless otherwise noted): PatientGroup Optional group PID PID1 NTE Patient identification Patient demographics Notes and comments Required Optional Optional, Repeatable

PatientVisitGroup Optional group, part of PatientGroup PV1 Patient visit Required

PV2

Patient visit additional info

Optional

OrderGroup Repeatable group ORC OBR NTE-1 Common order Observation request Notes and comments Optional Required Optional, Repeatable

ObservationGroup Repeatable group, part of OrderGroup OBX NTE-2 Observation Notes and comments Optional Optional, Repeatable

OrderGroup continued CTI Clinical trial identification Optional, Repeatable

Additional segment, not part of a group: DSC Continuation pointer segment Optional

In HL7 pipe and hat format, an ORU-R01 message would look like this (each OBR segment is shown in medical, each OBX segment is shown in red):

MSH|^~\&|LCS|LCA|LIS|TEST9999|199807311532||ORU^R01|3629|P|2.2 PID|2|2161348462|20809880170|1614614|20809880170^TESTPAT||19760924|M|||^^^^ 00000-0000|||||||86427531^^^03|SSN# HERE ORC|NW|8642753100012^LIS|20809880170^LCS||||||19980727000000|||HAVILAND OBR|1|8642753100012^LIS|20809880170^LCS|008342^UPPER RESPIRATORY CULTURE^L|||19980727175800||||||SS#634748641 CH14885 SRC:THROA SRC:PENI|19980727000000||||||20809880170||19980730041800||BN|F OBX|1|ST|008342^UPPER RESPIRATORY CULTURE^L||FINALREPORT|||||N|F||| 19980729160500|BN ORC|NW|8642753100012^LIS|20809880170^LCS||||||19980727000000|||HAVILAND OBR|2|8642753100012^LIS|20809880170^LCS|997602^.^L|||19980727175800||||G||| 19980727000000||||||20809880170||19980730041800|||F|997602|||008342 OBX|2|CE|997231^RESULT 1^L||M415|||||N|F|||19980729160500|BN NTE|1|L|MORAXELLA (BRANHAMELLA) CATARRHALIS NTE|2|L| HEAVY GROWTH NTE|3|L| BETA LACTAMASE POSITIVE

OBX|3|CE|997232^RESULT 2^L||MR105|||||N|F|||19980729160500|BN NTE|1|L|ROUTINE RESPIRATORY FLORA

HL7 DFT Detail Financial Transaction

The DFT message describes a financial transaction that is sent to a billing system and is used for patient accounting purposes. This message might include things like ancillary charges or patient deposits, and is sent between the DSS/Order Filler and the Charge Processor. The DSS/Order Filler would then verify that the procedure had been completed. Trigger events for the DFT-P03 message include:

Procedure ordered Procedure scheduled Procedure completed Future will define Report events for professional fees The segments and groups of segments in the DFT-P03 message include the following:

SEGMENT/ NAME GROUP MSH EVN PID PID1 PV1 PV2 DB1 OBX Message header Event type Patient identification Patient demographics Patient visit Patient visit additional info Disability segment Observation

OPTIONAL/REPEATABLE?

Required Required Required Optional Optional Optional Optional, Repeatable Optional, Repeatable

TransactionGroup Repeatable group

FT1

Financial transaction

Required

ProcedureGroup Optional and Repeatable group, part of TransactionGroup

PR1

Procedures

Required

ROL

Role

Optional, Repeatable

Additional segments, not part of a group

DG1 DRG GT1

Diagnosis Diagnosis Related Group Guarantor

Optional, Repeatable Optional Optional, Repeatable

InsuranceGroup Optional and Repeatable group

IN1 IN2 IN3

Insurance Insurance additional info Insurance additional info certification

Repeatable Optional Optional

Additional segments, not part of a group

ACC

Accident

Optional