Hawaii Health Information Corporation
Enhancing Hawaii Hospital Information Content (eHHIC)
Deliverable 2:
Data Acquisition
Hawaii Health Information Corporation Logo, Hawaii's sources of healthcare data
TABLE OF CONTENTS
APPENDIX A: DATA SPECIFICATIONS FOR HL7
APPENDIX B: DATA SPECIFICATIONS FOR ASCII
APPENDIX D: HL7 INTERFACE ENGINE EVALUATION CRITERIA
APPENDIX E: HL7 INTEGRATION ENGINE EVALUATION
I. Objective
To receive lab data for 32 requested lab tests from 19 participating hospitals in the State of Hawaii from CY2008-CY2011 to enhance the clinical content of an all-payer, hospital-based, encounter-level database. This was achieved through:
II. Method
II. Conclusion
Providing detailed data specifications to guide the facilities minimized the effort required to create a successful extract. The data specifications provided the requirements to ensure that expectations were met.
Investing in current technology is critical to acquiring "big" data. This allowed us to be flexible in accommodating our providers as well as managing large sets of data (volume), combined from disparate sources (variety), supplied in a rapidly increasing flow of information (velocity).
III. Signatures
Prepared by:___________________________________________________
Position Title:_____________________________________________________
Date:_____________________________________________________
Approvals:
Project Manager:_________________________________________________________
Date:_____________________________________________________
Co-Principal Investigator:_________________________________________________________
Date:_____________________________________________________
Appendix A: Data Specifications for HL7
HHIC LABORATORY INFORMATION AHRQ PROJECT
INTRODUCTION
This document serves as a functional specification and technical requirements for integrating key lab results with Hawaii Health Information Corporation's (HHIC) inpatient database via Health Level 7 (HL7).We request a library of 32 laboratory tests and their respective LOINC codes be transmitted from each of our prospective ELR (Electronic Laboratory Reporting) providers.
HHIC uses these results of the key lab tests to enhance the content of their existing statewide, all-payer hospital discharge database by adding key hospitalization-related laboratory results. The enhanced data set will be used to improve the predicative methodology use to measure key patient outcomes, such as inpatient mortality.8
CONTENTS
HHIC Laboratory Information AHRQ Project
Table 1. Summary of Laboratory Tests and LOINC
Appendix A.1: The Health Level Seven (HL7) Standard
Appendix A.2: Message Segments: Field Specifications and Usage
Appendix A.6: Common Order (ORC) Segment
Appendix A.11: Selected HL7 Data types and Segment Sequencing
Appendix A.12: Optionality of Segments: Designation and Meaning
Appendix A.13: Sample ORU Messages
Appendix A.14: HHIC Use Only - Edits Applied After Receipt
GENERAL SPECIFICATIONS
The instructions and specification contained in the Implementation Guide- HL7 Specifications for Laboratory Observation Reporting (ORU Messages) are applicable to participating HHIC institutions submitting data to HHIC, effective with discharges of January, 2008.
Hospitalization-related (Inpatient) laboratory results should be obtained from laboratory hospital's clinical laboratory system/laboratory information system. Observed test results (e.g., finger stick) and other test results from glucometers, chemsticks, etc. should not be submitted. Submit test results specific to that laboratory test only. As an example, for the test of hemoglobin, do not submit a hemoglobin value that was reported as part of an arterial blood gas test result.
Units of Measure
Each laboratory test has a unique test code that represents both the laboratory test and the unit of measure. For example, the laboratory test lists Glucose with mg/dL as the unit of measurement. The laboratory test codes were designed to accept the submission of the units of measure used specified in the LOINC system. Please consult with the clinical laboratory system/laboratory information system personnel at your facility if you have questions regarding the laboratory units of measures outlined on page 10, Table 1.
Corrected Values
When two results are available for the same date and time the laboratory specimen was collected and one is labeled "corrected," submit the final corrected test result.
Data Submission Schedule
Lab will be submitted to HHIC as follows:
| Data Due at HHIC | File |
|---|---|
| July 1, 2011 | 50 test messages per hospital |
| September 1, 2011 | 1st Quarter 2008 |
| October — December, 2011 | 2nd, 3rd, 4th Quarter 2008 data (HHIC will provide a detailed schedule by October, 2011) |
| 2012 schedule | To be established by November, 2011 |
Data File Description
The file will be submitted in batch on a quarterly basis (at the beginning—and will move to a more frequent schedule as defined at a later time).
Each submission should include a summary document with the following information: hospital name/ID, time frame of messages submitted, number of messages sent in the batch.
Separate batch files should be submitted for each hospital.
Transmission Options
Data will be transmitted to HHIC in one of the following ways:
HHIC will collaborate with each provider to determine the best method.
LAB DATA SET
The lab data set includes the specified laboratory data of all inpatient admissions for the specified time period. Generally, data elements specified in the Implementation Manual follow HL7 standards.
The ORU message segments that HHIC requires follows: MSH, PID, PV1, OBR, OBX, NTE. The required message segments, associated fields, and key demographic data are listed on the following pages.
List of All Data Elements
The demographic fields to be sent in specific segments are listed in the table below. The specific ORU required segments (and fields) follow.
| NAME | Message location | HL7 DT | Length |
|---|---|---|---|
| *Account number | PID-18 | CX | 250 |
| *Admission Date | PV1-44 | TS | 26 |
| *Discharge Date | PV1-45 | TS | 26 |
| *Date of birth | PID-7 | TS | 26 |
| *Facility Name | MSH-4 | HD | 227 |
| Gender | PID-8 | IS | 1 |
| Hospital ID | TBD | HD | 6 |
| Hospital Test (order) | OBR-4 | CE | 250 |
| Hospital Test (result - LOINC) | OBR-3 | CE | 250 |
| Medical Record Number | PID-3 | CX | 250 |
| Ordering Physician (Last, First, MI) | OBR-16 | XCN | 250 |
| *Patient Name (Last, First, MI) | V | XCN | 250 |
| Physician NPI | OBR-16 | XCN | 250 |
| *Social Security Number | PID-19 | ST | 19 |
*for linking lab file to HHIC patient files
MSH Segment
| Seq | NAME | HHIC USE | Type | R/O | LEN |
|---|---|---|---|---|---|
| 1 | Field Separator | "|" | ST | R | 1 |
| 2 | Encoding characters | ^ ~ \ & | ST | R | 4 |
| 3 | Sending Application | LIS e.g. "SENDER_GenericLABSYSTEM-LIS" | HD | R | 227 |
| 4 | Sending Facility | The sender of the message information, hospital name. hospital name^ CLIA code^CLIA YourHospital-Honolulu^45D3456781^CLIA |
HD | R | 227 |
| 5 | Receiving Application | CLH, DLS or Hospital name | HD | R | 227 |
| 6 | Receiving Facility | The brief provider organization name assigned when the provider first registers with the lab | HD | R | 227 |
| 7 | Date/Time Of Message | 20110602161633 YYYYMMDDHHMM[SS] |
TS | R | 26 |
| 9 | Message Type | ORU^R01 | MSG | R | 7 |
| 10 | Message Control Id | The sending system must assign an identifier for the message that is unique within the namespace of the sending facility | ST | R | 50 |
| 11 | Processing ID | P | PT | R | 3 |
| 12 | Version ID | 2.3 | VID | R | 60 |
PID Segment
| Seq | NAME | HHIC USE | Type | R/O | LEN |
|---|---|---|---|---|---|
| 3 | Patient ID | Medical Record Number | ST | R | 250 |
| 5 | Patient Name | Last^First^Middle | XPN | R | 250 |
| 7 | Date/Time Of Birth | YYYYMMDD | TS | RE | 26 |
| 8 | Sex | F, M, or U | IS | R | 1 |
| 18 | Patient Account Number | Patient Account Number | ST | R | 250 |
| 19 | SSN - Patient | Sent if available | ST | RE | 16 |
PV1 Segment
| Seq | NAME | HHIC USE | Type | R/O | LEN |
|---|---|---|---|---|---|
| 2 | Patient Class | E (Emergency Department visits), I (Inpatient Admission), O (Outpatient) | IS | R | 1 |
| 44 | Admission Date/Time | Date and time of the patient presentation. | TS | RE | 26 |
| 45 | Discharge Date/Time | Date and time of the patient discharge. | TS | RE | 26 |
Common Order (ORC) Segment
Used to transmit fields that are common to all orders. The ORC is NOT a required segment for HHIC.
OBR Segment
| Seq | NAME | HHIC USE | Type | R/O | LEN |
|---|---|---|---|---|---|
| 3 | Filler Order Number | LIS order number = internal access number | EI | R | 50 |
| 4 | Universal Service Identifier | Ordered test code ^^^[lab order code]^[description] |
CE | R | 250 |
| 7 | Observation Date/Time | YYYYMMDDHHMMSS | TS | R | 26 |
| 16 | Ordering Provider | 1434567516^LASTNAME^PHYSICIANFIRST [PhysicianIDNPI]^[PhysicianLast]^[PhysicianFirst] |
XCN | R | 250 |
| 22 | Results Rpt/Status Chng - Date/Time | "activity end date/time" | TS | R | 26 |
| 25 | Result status | Only "F" | ID | R | 1 |
OBX Segment(See next page for "Summary of Required Lab Tests and LOINC")
| Seq | NAME | HHIC USE | Type | R/O | LEN |
|---|---|---|---|---|---|
| 3 | Observation Identifier | Local RESULT code^LOINC 4544-3^Hematocrit^LN^HCT^Hematocrit^LAB Result code^test description LOINC Code^LOINC description^LN^local code^local description^L |
CE | R | 250 |
| 4 | Observation sub-ID | 0 | ST | R | 20 |
| 5 | Observation value | Result Example 1 - Hepatitis A IgM test was positive OBX|1|CE|5182-1^Hepatitis A Virus IgM Serum Antibody EIA^LN||G-A200^Positive^SNM| Example 2 - antimicrobial susceptibility testing OBX|1|SN|7059-9^Vancomycin Susceptibility, Gradient Strip^LN||<^1 |
* | C | 9999 |
| 6 | Units | Unit of measure | CE | RE | 250 |
| 7 | Reference ranges | Upper and lower limit | ST | RE | 60 |
| 8 | Abnormal flags | Result value - S, I, or R, and should be provided in addition to the numeric value in OBX-5 When findings other than susceptibility results are sent, the abnormal flag should be valued (e.g., "H", "N", or "A") |
IS | RE | 5 |
| 11 | Observation Result Status | F = completed. Correct and final results | ID | R | 1 |
NTE Segment
| Seq | NAME | HHIC USE | Type | R/O | LEN |
|---|---|---|---|---|---|
| 1 | Set ID | NTE | SI | O | 4 |
| 2 | Source of Comment | Used when source of comment must be identified | ID | X | 8 |
| 3 | Comment | Comment | FT | RE | 65536 |
| 4 | Comment Type | CE | O | 250 |
Table1. Summary of REQUIRED Laboratory Tests and LOINC
| Lab Test | Lab Test Name | LOINC | Units | LOINC SHORTNAME | |
|---|---|---|---|---|---|
| Chemistry | Albumin | Albumin | 1751-7 | g/dL | Albumin SerPI-MCnc |
| Alkaline phosphatase | Alkaline phosphatase | 6768-6 | U/L;units/L | ALP SerPl-cCnc | |
| Blood urea nitrogen (BUN) | Urea nitrogen | 3094-0 | mg/dL | BUN SerPl-mCnc | |
| Bilirubin (total) | Bilirubin | 1975-2 | mg/dL | Bilirub SerPl-mCnc | |
| Calcium | Calcium | 17861-6 | mg/dL | Calcium SerPl-mCnc | |
| Chloride | Chloride | 2075-0 | mmol/L | Chloride SerPl-sCnc | |
| Creatine kinase-MB | Creatine kinase-MB | 13969-1 | ng/mL; ug/L | CK MB SerPl-mCnc | |
| Glucose | Glucose | 2345-7 | mg/dL | Glucose SerPl-mCnc | |
| Gamma glutamyl transferase | Gamma glutamyl transferase | 2324-2 | U/L;units/L | GGT SerPl-cCnc | |
| Potassium | Potassium | 2823-3 | mmol/L | Potassium SerPl-sCnc | |
| Phosphate | Phosphate | 2777-1 | mg/dL | Phosphate SerPl-mCnc | |
| BNP | Natriuretic peptide.B | 30934-4 | pg/mL | BNP SerPl-mCnc | |
| Sodium | Sodium | 2951-2 | mmol/L | Sodium SerPl-sCnc | |
| Troponin I | Troponin I.cardiac | 10839-9 | ug/L;ng/mL | Troponin I SerPl-mCnc | |
| SGOT | Aspartate aminotransferase | 1920-8 | U/L;units/L | AST SerPl-cCnc | |
| SGPT | Alanine aminotransferase | 1742-6 | U/L;units/L | ALT SerPl-cCnc | |
| Blood Gas | pO2 | Oxygen | 2703-7 | mm Hg | pO2 BldA |
| pCO2 | Carbon dioxide | 2019-8 | mm Hg | pCO2 BldA | |
| pH(arterial) | pH | 2744-1 | pH BldA | ||
| Base excess | Base excess | 1925-7 | mmol/L | Base excess BldA-sCnc | |
| Bicarbonate | Bicarbonate | 1960-4 | mmol/L | HCO3 BldA-sCnc | |
| Hematology | Hemoglobin | Hemoglobin | 718-7 | g/dL | Hgb Bld-mCnc |
| Hematocrit | Hematocrit | 4544-3 | L/L;% | Hct Fr Bld Auto | |
| Partial thromboplastin time (PTT) | Coagulation surface induced | 14979-9 | Sec | aPTT Time PPP | |
| Prothrombin time (PT) | Coagulation tissue factor induced | 5902-2 | Sec | PT Time PPP | |
| INR | Coagulation tissue factor induced.INR | 34714-6 | INR(POC) | INR PPP | |
| Platelet count | Platelets | 777-3 | 10^9/L | Platelet # Bld Auto | |
| White blood count (WBC) | Leukocytes | 6690-2 | 10*3/uL | WBC # Bld Auto | |
| Microbiology | Blood culture | 600-7 | |||
| Urine culture | Blood culture | 630-4 | |||
| Sputum culture | Blood culture | 6460-0 |
APPENDIX A.1: THE HEALTH LEVEL SEVEN (HL7) STANDARD
The ANSI HL7 standard is widely used for data exchange in the healthcare industry, and is quite lengthy, covering a variety of situations in patient care and healthcare finance. This document covers the subset of HL7 that will be used for LIS (laboratory information system) records received by HHIC from outside systems.
The basic unit transmitted in an HL7 implementation is the message. Messages are made up of several segments, each of which is one line of text, beginning with a three-letter code identifying the segment type. Segments are in turn made up of several fields separated by a delimiter character, "|". Below is an example LAB accession in HL7 2.3 format.
In this example, a message consisting of seven segments (MSH, PID, PV1, ORC, OBR, and OBX [0 thru 1]) is being sent to HHIC from a LAB database.
MSH|^~\&|YourHL7System|YourHIFACILITY |X| HHIC Database
|20110329082006||ORU^R01|201103290820062979|T|2.3
PID||55555^182P478_367903|15161516;1^^^1|55555^LAB^1|TEST^EMR^SAMPLE||1965101
5|F|||||||||IB873749|45879|123456789|H
PV1||O|XOP^^^LAB|||16626|16626^TEST^PHYSICIAN|||||||||||OP|182P478_367903560475_10
1_1|||||||||||||||||||||||||20110329000000
ORC|RE||E2908978T8191219L1143|||||||||16626^TEST^PHYSICIAN^LABT02|LAB
OBR|1|20110329082006|201103290820062979|ABC^Automated Bld
Cnt|||20110329045100|||||||20110329081100||16626^TEST^PHYSICIAN^LABT02||||T8191|2
19L1143^0|||H|F||^^^^^R
OBX|0|NM|6690-2^Leukocytes^LN^WBC^WBC^LAB|0|11.8|10(9)/L|3.8-
11.2|H|||F|||20110329081700|12D0664165^LAB-HMCW\91-2135 Fort Weaver Road, #
300\Ewa Beach\HI\96706-1929\Glen Doctor, MD
OBX|1|NM|^^LN^RBC^RBC^LAB|0|3.01|10(12)/L|3.9-
5.2|L|||F|||20110329081700|12D0664165^LAB-HMCW\91-2135 Fort Weaver Road, #
300\Ewa Beach\HI\96706-1929\Glen Doctor, MD
In the above example, the Message Header segment (MSH) carries the owner of the information being sent (YourHIFACILITY) and receiver (HHIC Database) and identifies the message as being of type ORU, Unsolicited Observation Result.
The Patient Identification segment (PID) carries the client's name (EMR TEST), birth date (19651015, in YYYYMMDD format), and other identifying fields.
PV1 carries the Patient Visit information,ORC carries Common Order information from the referring physician, OBR carries the observation request (e.g. perform biopsy), and several OBX segments carry the LAB laboratory observations, including clinical indications, gross description, and the diagnosis provided by the LAB physician or pathologist.
LAB/ will provide HL7 messages to communicate with HHIC. These files will be transmitted to the interface engine hosted at HHIC. Each HL7 file will contain one HL7 message that includes data for oneLAB accession.
HL7 does not require the use of a particular coding system to identify either the observation or the result. In the past, users tended to use their own unique code systems for identifying tests and other clinical observations because standard codes were not available. Such local code systems suffice for transmitting information within single institutions, but present high barriers to aggregating data from many sources for research or for public health record systems. Standard code systems such as LOINC® now exist for many of these purposes, and we strongly encourage their use in reporting. Standard codes (LOINC) can be sent as the only code in the OBX-3 field, or they can be sent along with the local code (your local lab code) as the second code system represented in that field (See OBX segment).
APPENDIX A.2: MESSAGE SEGMENTS: FIELD SPECIFICATIONS AND USAGE
HL7 Segment Structure
Each segment consists of several fields, separated by the field separator character, "|". The table below defines how each segment (described on pages 7-17) is structured.
| Field/Column | Description |
|---|---|
| SEQ | The ordinal position of the field in the segment. Since HHIC does not use all possible fields in the HL7 standard, these are not always consecutive. |
| NAME | HL7 element name for the field. |
| HHIC Use | Short explanation of the use of this field. |
| TYPE | HL7 data type of the field. See Appendix K for definition of HL7 data types. |
| R/0 | Refers to if a field is required or optional. R means required for HL7 message for LAB. RE means indicated, required, but message will not be rejected if not present. C means conditional (Conditional on the trigger event or on some other field(s)). (See Appendix L) |
| LEN | Maximum length of the field |
HL7 data types: Each field in the HL7 message has an HL7 data type. Appendix K of this document lists and defines the HL7 data types needed byHHIC. The elemental data types Numeric (NM) and String (ST) consist of one value, while some data types, such as Patient Name are composites.
Delimiter characters: Field values of composite data types consist of several components separated by the component separator, "^". When components are further divided into sub-components, these are separated by the sub-component separator, "&". Some fields are defined to permit repetitions separated by the repetition character, "~". When these special characters need to be included within text data, their special interpretations are prevented by preceding them with the escape character, "\".
APPENDIX A.3: MSH SEGMENT
The MSH segment defines the intent, source, destination, and some specifics of the syntax of a message.
| SEQ | NAME | HHIC Use | Type | T/O | LEN |
|---|---|---|---|---|---|
| 1 | Field Separator | "|" | ST | R | 1 |
| 2 | Encoding Characters | ^ ~ \ & | ST | R | 4 |
| 3 | Sending Application | LIS e.g. "SENDER_GenericLABSYSTEM-LIS" | HD | R | 227 |
| 4 | Sending Facility | The sender of the message information, hospital name.
hospital name^ CLIA code^CLIA YourHospital-Honolulu^45D3456781^CLIA |
HD | R | 227 |
| 5 | Receiving Application | CLH, DLS or Hospital name | HD | R | 227 |
| 6 | Receiving Facility | The brief provider organization name assigned when the provider first registers with the lab | HD | R | 227 |
| 7 | Date/Time Of Message | 20110602161633 YYYYMMDDHHMM[SS] |
TS | R | 26 |
| 9 | Message Type | ORU^R01 | MSG | R | 7 |
| 10 | Message Control Id | The sending system must assign an identifier for the message that is unique within the namespace of the sending facility | MSG | R | 50 |
| 11 | Processing ID | P | PT | R | 3 |
| 12 | Version ID | 2.3 | VID | R | 60 |
Notes:
MSH-1 Determines the field separator in effect for this message. Requires the HL7 recommended field separator of "|".
MSH-2 Determines the component separator, repetition separator, escape character, and sub-component separator in effect for the rest of this message. HHIC requires the HL7 recommended values of ^~\&.
Definition: Four characters in the following order:
Component separator '^' ASCII (94)
Repetition Separator '~' ASCII (126)
Escape character '\' ASCII (92)
Subcomponent separator '&smp;' ASCII (38)
MSH-3 Name of the sending application. When sending, LAB will use their LAB Information System identifier.
MSH-4 Identifies the sender (the owner of the message information). When sending, LAB will use "Hospital Name."
MSH-5 Name of the RECEIVING application. Regional or hospital lab that is processing the order.
MSH-6 Identifies the message receiver. This field identifies the organization responsible for the operations of the receiving application.
MSH-7 Date and time the message was created. This includes the time zone. See
the TS data type.YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]]]]][+/-ZZZZ] is the HL7 format for the Time Stamp. Z is the time zone offset. Send values only as far as needed. When a system has only a partial date, e.g., month and year, but not day, the missing values may be interpreted as zeros. The time zone is assumed to be that of the sender.
Example: 20110526132010-0800 - May 26th, 2011, 13:20:10, Pacific Time.
MSH-9 Two components give the HL7 message type/HL7 triggering event. For outbound results (to HHIC) this field should be âORU^R01â, where ORU is the message ID for Observation Result / Unsolicited and R01 is an Unsolicited Transmission.
MSH-10 The message control ID is a string (which may be a number) uniquely identifying the message among all those ever sent by the sending system. LAB will use "xxauniquevalue." CCYYMMDDnnnnnnn may be used, (or DDD - Julian date instead of MMDD) and nnnnnnn is the sequence number for that day. Calendar Date: CCYYMMDD with CC = century, YY = last 2 digits of year, and valid ranges of month = 01 through 12 and day = 01 through 31.
MSH-11 The processing ID to be used by LAB is P for production. T = Training / testing.
MSH-12 -- "2.3" to indicate HL7 Version 2.3.
NOTE: We have used 2.3 as the default version. 2.3 or higher may be sent, up to 2.5.1.
APPENDIX A.4: PID SEGMENT
The PID segment is used by all applications as the primary means of communicating patient identification information. This segment contains permanent patient identifying and demographic information that, for the most part, is not likely to change frequently.
| SEQ | NAME | HHIC Use | Type | R/O | LEN |
|---|---|---|---|---|---|
| 3 | Patient ID | Medical Record Number | CX | R | 250 |
| 5 | Patient Name | Last^First^Middle | XPN | R | 250 |
| 7 | Date/Time Of Birth | YYYYMMDD | TS | RE | 26 |
| 8 | Sex | F, M, or U | IS | R | 1 |
| 18 | Patient Account Number | Patient Account Number | CX | R | 250 |
| 19 | SSN - Patient | Sent if available | ST | RE | 16 |
Notes:
PID-3 The unique medical record number of the patient's chart within the system. Patient's unique identifier(s) from the facility.
PID-5 Example:
Doe^Mary^A [PatientLastName]^[PatientFirstName]
^[PatientMiddleName]. Last name and first name are required.
PID-7 Give the year, month, and day of birth (YYYYMMDD). LAB may ignore any time component in the birth date. Time stamp (TS) data type must be in the format: YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]]]]][ ]. The user values the field only as far as needed. When a system has only a partial date, e.g., month and year, but not day, the missing values may be interpreted as zeros. The time zone is assumed to be that of the sender.
PID-8 Use F, M, or U (F = Female, M = Male, U = Unknown)
PID-18 This field is required and must contain an account number. Definition: This field contains the patient account number assigned by accounting to which all charges, payments, etc., are recorded. The entire number including the check digit will be considered the patient account number.
PID-19 Sent only if stored in lab system.
APPENDIX A.5: PV1 SEGMENT
The PV1 (Patient Visit Segment Definition) segment is used by Registration/Patient Administration applications to communicate information on a visit-specific basis.
| SEQ | NAME | HHIC Use | Type | R/O | LEN |
|---|---|---|---|---|---|
| 2 | Patient Class | E (Emergency Department visits), I (Inpatient Admission), O (Outpatient) | IS | R | 1 |
| 44 | Admission Date/Time | Date and time of the patient presentation. | TS | RE | 26 |
| 45 | Discharge Date/Time | Date and time of the patient discharge. | TS | RE | 26 |
Notes:
PV1-2 Patient Class does not have a consistent industry-wide definition and is subject to site-specific variations. Patient Class = E (Emergency Department visits) or I (Inpatient Admission), or O (Outpatient). Literal values: "E", "I" or "O".
PV1-44 YYYYMMDDHHMM[SS[.S[S[S[S]]]]] [+/-ZZZZ]. Date and time patient arrived for services.
PV1-45 YYYYMMDDHHMM[SS[.S[S[S[S]]]]] [+/-ZZZZ] - Date and time patient was discharged from facility, as known/recorded/available.
APPENDIX A.6: COMMON ORDER (ORC) SEGMENT
Used to transmit fields that are common to all orders. The ORC is NOT a required segment by HHIC.
APPENDIX A.7: OBR SEGMENT
The Observation Request Segment carries general information about the sample, test, or result. For laboratory-based reporting, the OBR defines the attributes of the original request for laboratory testing. Essentially, the OBR describes a battery or panel of tests that is being requested or reported. The OBR is similar to a generic lab slip that is filled out when a physician requests a lab test. The individual test names and results for the panel of tests performed are reported in OBX segments, which are described below. As defined by the ORU syntax, there can be many OBXs per OBR, and there can be many OBRs per PID.
Example:
OBR|1|20110329082006|201103290820062979|ABC^Automated Bld Cnt|||20110329045100|||||||20110329081100||16626^TEST^PHYSICIAN^LABT02||||T8191|219L1143^0|||H|F||^^^^^R
| SEQ | NAME | HHIC Use | Type | R/O | LEN |
|---|---|---|---|---|---|
| 3 | Filler Order Number | LIS order number = internal access number | EI | R | 50 |
| 4 | Universal Service Identifier | Ordered test code ^^^[lab order code]^[description] |
CE | R | 250 |
| 7 | Observation Date/Time | YYYYMMDDHHMMSS | TS | R | 26 |
| 16 | Ordering Provider | 1434567516^LASTNAME^PHYSICIANFIRST [PhysicianID-NPI]^[PhysicianLastName]^[PhysicianFirstName] |
XCN | R | 250 |
| 22 | Results Rpt/Status Chng - Date/Time | "activity end date/time" | TS | R | 26 |
| 2 | Result status | Only "F" | ID | R | 1 |
Notes:
OBR-3 This is the LAB (LIS) internal order number.
Example: PL2010-123456 - [LABAccessionNumber].
Definition:
It is assigned by the order filler (receiving) application. This string must uniquely identifythe order (as specified in the order detail segment) from other orders in a particularfilling application (e.g., clinical laboratory). This uniqueness must persist over time.
OBR-4 This is an element containing the LAB case sample procedure type ID and
description.
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^<alternateidentifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
The LOINC is more desirable in the OBX segment, field 3. Panels will have one OBR followed by multiple OBX segments (one for each test in the panel).
OBR-7 This is the LAB collected date, including time and time zone. This field is the clinically relevant date/time of the observation. In the case of observations taken directly from a subject, it is the actual date and time the observation was obtained.
OBR-16 This is a complex element containing three components related to the ordering physician. When the provider is assigned a National Provider ID (NPI) the NPI is transmitted as the ID: 1) NPI or Hospital Physician ID (NPI strongly preferred), 2) last name of referring physician, and 3) first name of referring physician.
Example: 5551001234^Smith^Bob
OBR-22 This field is used to indicate the date and time that the results are composed into a report and released to the individual OBX), or that a status, is entered or changed.
OBR-25 This is the test status and will be "F" for finalized.
HL7 Table - Result status (For reference)
| Value | Description |
|---|---|
| O | Order received; specimen not yet received |
| I | No results available; specimen received, procedure incomplete |
| S | No results available; procedure scheduled, but not done |
| A | Some, but not all, results available |
| P | Preliminary: A verified early result is available, final results not yet obtained |
| C | Correction to results |
| R | Results stored; not yet verified |
| F | Final results; results stored and verified. Can only be changed with a corrected result. |
| X | No results available; Order canceled. |
| Y | No order on record for this test. (Used only on queries) |
| Z | No record of this patient. (Used only on queries) |
APPENDIX A.8: OBX SEGMENT
The Observation/Result segment is used to transmit the observations of the LAB. OBX segments have great flexibility to report information. When properly coded, OBX segments report a large amount of information in a small amount of space. OBX segments within the ORU message are widely used to report laboratory and other clinical information.
There can be many OBX segments identified like OBX|1|, OBX|2|, OBX|3|, OBX|4|, OBX|5|, and OBX|6|, etc.
Example:
OBX|0|NM|6690-2^Leukocytes^LN^WBC^WBC^LAB|0|11.8|10(9)/L|3.8-
11.2|H|||F|||20110329081700|12D0664165^LAB-HMCW\91-2135 Fort Weaver Road, # 300\Ewa
Beach\HI\96706-1929\Glen Doctor, MD
OBX|1|NM|^^LN^RBC^RBC^LAB|0|3.01|10(12)/L|3.9-5.2|L|||F|||20110329081700|12D0664165^LAB-
HMCW\91-2135 Fort Weaver Road, # 300\Ewa Beach\HI\96706-1929\Glen Doctor, MD
OBX|2|NM|718-7^Hemoglobin^LN^HGB^Hemoglobin^LAB|0|9.2|g/dL|11.6-
15.1|L|||F|||20110329081700|12D0664165^LAB-HMCW\91-2135 Fort Weaver Road, # 300\Ewa
Beach\HI\96706-1929\Glen Doctor, MD
OBX|3|NM|4544-3^Hematocrit^LN^HCT^Hematocrit^LAB|0|27.2|%|34.1-
44.2|L|||F|||20110329081700|12D0664165^LAB-HMCW\91-2135 Fort Weaver Road, # 300\Ewa
Beach\HI\96706-1929\Glen Doctor, MD
OBX|4|NM|^^LN^MCV^MCV^LAB|0|90.3|fL|80-100||||F|||20110329081700|12D0664165^LAB-
HMCW\91-2135 Fort Weaver Road, # 300\Ewa Beach\HI\96706-1929\Glen Doctor, MD
OBX|5|NM|^^LN^MCH^MCH^LAB|0|30.4|pg|27-33||||F|||20110329081700|12D0664165^LAB-
HMCW\91-2135 Fort Weaver Road, # 300\Ewa Beach\HI\96706-1929\Glen Doctor, MD
OBX|6|NM|^^LN^MCHC^MCHC^LAB|0|33.7|g/dL|32-36||||F|||20110329081700|12D0664165^LAB-
HMCW\91-2135 Fort Weaver Road, # 300\Ewa Beach\HI\96706-1929\Glen Doctor, MD
OBX|7|NM|^^LN^RDW^RDW^LAB|0|14.4|%|11-15||||F|||20110329081700|12D0664165^LAB-HMCW\91-
2135 Fort Weaver Road, # 300\Ewa Beach\HI\96706-1929\Glen Doctor, MD
OBX|8|NM|777-3^Platelets^LN^PLTC^Platelet Count^LAB|0|119|10(9)/L|150-
450|L|||F|||20110329081700|12D0664165^LAB-HMCW\91-2135 Fort Weaver Road, # 300\Ewa
Beach\HI\96706-1929\Glen Doctor, MD
| SEQ | NAME | OBX - HHIC Use | TYPE | R/O | LEN |
|---|---|---|---|---|---|
| 3 | Observation Identifier | Local RESULT code^LOINC 4544-3^Hematocrit^LNvHCT^Hematocrit^LAB Result code^test description LOINC Code^LOINC description^LN^local code^local description^L |
CE | R | 250 |
| 4 | Observation sub-ID | 0 | ST | R | 20 |
| 5 | Observation value | Result Example 1 - Hepatitis A IgM test was positive OBX|1|CE|5182-1^Hepatitis A Virus IgM Serum Antibody EIA^LN||G-A200^Positive^SNM| Example 2 - antimicrobial susceptibility testing OBX|1|SN|7059-9^Vancomycin Susceptibility, Gradient Strip^LN||<^1 |
* | C | 9999 |
| 6 | Units | Unit of measure | CE | RE | 250 |
| 7 | Reference ranges | Upper and lower limit | ST | RE | 60 |
| 8 | Abnormal flags | Result value - S, I, or R, and should be provided in addition to the numeric value in OBX-5 When findings other than susceptibility results are sent, the abnormal flag should be valued (e.g., "H", "N", or "A") |
IS | RE | 5 |
| 11 | Observation Result Status | F= completed. Correct and final results | ID | R | 1 |
Notes:
OBX-3 <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (IS)>
3.1 LOINC Code.
3.2 Text LOINCdescription
3.3 Name of Coding System 'LN'
3.4 Alternate Identifier Local code here
3.5 Text Local description here
3.6 Alternate Coding System "L"
It is strongly recommended that OBX-3 be populated with as specific a LOINC®code as possible to prevent any misinterpretation of reported results.
OBX-4 Used for processing but not mapped
OBX-5 Result value. Example for blood culture
For antimicrobial susceptibility testing, the OBX segment would appear as:
OBX|1|SN|7059-9^Vancomycin Susceptibility, Gradient Strip^LN||<^1|...
where OBX-3 uses a LOINC® code and OBX-5 has a numeric value. The value type listed inOBX-2 determines the structure of the reported result here (i.e., SN). The SN data type has the following structure:
<comparator> ^ <num1(NM)> ^ <separator or suffix> ^ <num2 (NM)>
Some examples of the SN representation are:
|>^100| Greater than 100
|^100^-^200| equal to range of 100 through 200
|^1^:^228| ratio of 1 to 128 (e.g., the results of a serological test)
|^2^+| categorical response (e.g., an interpretation of occult blood positivity)
For results of a culture that yielded Neisseria meningitides, OBX-2 would be listed as a coded element(CE) and OBX-5 would appear as:
L-22202^Neisseria meningitidis^SNM|
It is strongly recommended that the data types CE and SN be used whenever possible to minimizeambiguity in reporting. In those cases where laboratories have a local code which represents a cannedcomment, the local code can be Version 1.2 23 placed in OBX5 as a CE data type, and the canned comment can beplaced in an NTE directly following the OBX segment.
Example:
OBX|1|CE|600-7^Microorganism identified, Blood CulturevLN||^^^SALMPRES^^L|...
NTE|1|L|Numerous colonies of Salmonella were present on culture. A sub-
NTE|2|L|culture was inoculated and sent for further species identification.
OBX-6 Units, for example: |μg/mL^microgram/milliliter^ISO+|
OBX-7 Reference range. If numeric, the values of this field may report several values
in one of the following three formats:
OBX-8 Abnormal flags should be used for reporting microbiology sensitivity data. Abnormal flags for antimicrobial sensitivity reporting should conform to the recommendations of National Committee of Clinical Laboratory Standards (NCCLS, https://clsi.org/about/clsi-s-history/.
For most reported findings, the allowable values are S, I, or R, and should be provided in addition to the numeric value in OBX-5. For ELR, when findings other than susceptibility results are sent, the abnormal flag should be valued (e.g., "H", "N", or "A") to distinguish between tests that are interpreted as normal and those that are interpreted as abnormal.
OBX-11 Value Type refers to the content.
APPENDIX A.9: NTE Segment
The optional Notes and Comments (NTE) segment is allowed to repeat and may be inserted after any of the OBX segments. The note segment applies to the information in the segment that immediately precedes it, i.e., the observation reported in the preceding OBX segment. The NTE segment can carry any text relevant to the event or the observation and can give its source. The NTE segment is not further defined by HL7.
| SEQ | NAME | HHIC Use | TYPE | R/O | LEN |
|---|---|---|---|---|---|
| 1 | Set ID | NTE | SI | O | 4 |
| 2 | Source of Comment | Used when source of comment must be identified | ID | X | 8 |
| 3 | Comment | Used when source of comment must be identified | FT | RE | 65536 |
| 4 | Comment Type | CE | O | 250 |
Notes:
NTE-1 This field may be used where multiple NTE segments are included in a message. Their numbering must be described in the application message definition
NTE-2 Used when source of comment must be identified
NTE-3 Contains the comment contained in the segment
NTE-3 Contains a value to identify the type of comment text being sent in the specific comment record.
APPENDIX A.10: REFERENCES
See Version 2.3 of the Health Level 7 standard for a full description of all messages, segments, and fields. Information regarding HL7 is at www.hl7.org. See ELINCs standards at http://www.chcf.org/projects/2009/elincs.
IMPACT SIIS 2.0 - Implementation Guide for HL7 Messages & Segments https://www.ohiopublichealthreporting.info/Enrollment/FileSystem/hl7/4-HL7Guide-ImpactSIIS%20through%202.5%202011.pdf.
APPENDIX A.11:SELECTED HL7 Data Types and Segment Sequencing
| Data Type | Data Type Name | Data Type | Data Type Name |
|---|---|---|---|
| CE | Coded element | CQ | Composite Quantity with Units |
| CWE | Coded with Exceptions | CX | Extended Composite Id with Check digit |
| DT | Date | DTM | Date/Time |
| EI | Entity Identifier | ERL | Error Location |
| FC | Financial Class | FN | Family Name |
| HD | Hierarchic Designator | ID | Coded Values for HL7 Tables |
| IS | Coded value for User-Defined Tables | LA2 | Location with address variation 2 |
| MSG | Message Type | NM | Numeric |
| PT | Processing Type | SAD | Street Address |
| SI | Sequence ID | ST | String |
| SN | Structured Numeric | VID | Version Identifier |
| TS | Time Stamp | XCN | Extended Composite ID Number and Name for Persons |
| XAD | Extended Address | XTN | Extended telephone number |
| XPN | Extended Person Name |
Segment Sequence and Nesting
The sequence of segments in a message instance is indicated by the sequence of segments in the message-structure specification. Braces, { . . . } surrounding a group of segments indicate one or more repetitions of the enclosed group may occur. Brackets, [ . . . ] surrounding a group of segments indicates that the enclosed group is optional. If a group of segments is optional and may repeat it is enclosed in brackets and braces, [ { . . . } ].
MSH
PID
PV1
ORC
OBR
OBX
OBR
OBX
OBX
NTE
APPENDIX A.12: Optionality of Segments: Designation and Meaning
Usage refers to the optionality of individual segments and groups of segments. The following designations and their meanings are used in message structures:
| Value | Description | Comment |
|---|---|---|
| R | Required | A conforming sending application shall populate all "R" elements with a non-empty value. HHIC shall process (save / print / archive/etc.) or ignore the information conveyed by required elements. HHIC shall not raise an error due to the presence of a required element, but may raise an error due to the absence of a required element. |
| RE | Required but may be empty | The element may be missing from the message, but shall be sent by the sending application if there is relevant data to report. A conforming sending application shall be capable of providing all "RE" elements. If the conforming sending application knows the required values for the element, then it shall send that element. If the conforming sending application does not know the required values, then that element will be omitted. HHIC will be expected to process (save/print/archive/etc.) or ignore data contained in the element, but shall be able to successfully process the message if the element is omitted (no error message should be generated because the element is missing). |
| X | Not supported | For conformant sending applications, the element shall not be sent. HHIC shall ignore the element if it is sent. However, HHIC will not generate an application error if it receives the element. |
| C | Conditional - Specific to Message Profile | Used only in a shared message-structure specification, i.e., a specification that is shared by multiple Message Profiles. A shared message-structure is defined when the message structures of multiple message types are very similar. The specific usage of these segments is specified in each section where used. |
APPENDIX A.13: Sample ORU Messages
Example 1:
MSH|^~\&|LIS|M|||20090518161040||ORU^R01|91380000032|P|2.3|
PID|||15161516^^^^M||TEST^EMR SAMPLE^||19651015|M||||||||||46456|
PV1||O|XOP||||14516^TEST^PHYSICIAN||LAB||||||||^|||||||||||||||||||||||||||||
ORC|RE|||||||||||||||^|
OBR|||E2905964|^^^ADIF^CBC|||200905041213|||||||200905041223|^|14516^TEST^PHYSICIAN
||||M3
017||||H|F|CBC^ADIF|^^^^^R|^^~^^~^^||||^^|^^|^^||200905041213|
OBX|1|NM|WBC^WBC|1|10.7|10(9)/L|3.5-10.0|H|||C|||200905050732|C^LAB IT|
OBX|1|TX|WBC^WBC|2|*CORRECTED 05/05 AT 0732: ORIGINAL:
5.1||||||C|||200905050732|C^LAB
IT|
OBX|2|NM|RBC^RBC|1|2.96|10(12)/L|4.4-6.0|L|||F|||200905041231|C^LAB IT|
OBX|3|NM|HGB^Hemoglobin|1|10.3|g/dL|14-17|L|||F|||200905041231|C^LAB IT|
OBX|4|NM|HCT^Hematocrit|1|31.4|%|41-51|L|||F|||200905041231|C^LAB IT|
OBX|5|NM|MCV^MCV|1|106.0|fL|80-100|H|||F|||200905041231|C^LAB IT|
OBX|6|NM|MCH^MCH|1|34.8|pg|27-33|H|||F|||200905041231|C^LAB IT|
OBX|7|NM|MCHC^MCHC|1|32.9|g/dL|32-36||||F|||200905041231|C^LAB IT|
OBX|8|NM|RDW^RDW|1|20.4|%|11-15|H|||F|||200905041231|C^LAB IT|
OBX|9|NM|PLTC^Platelet Count|1|58|10(9)/L|150-450|L|||F|||200905041231|C^LAB IT|
OBX|10|NM|MPV^MPV|1|12.5|fL|6.9-10.9|H|||F|||200905041231|C^LAB IT|
OBX|11|TX|DFTYP^Diff Method|1|Auto||||||F|||200905041231|C^LAB IT|
OBX|12|NM|ANEUT^Neutrophils|1|69|%|40-70||||F|||200905041231|C^LAB IT|
OBX|13|NM|ALYM^Lymphs|1|17|%|20-45|L|||F|||200905041231|C^LAB IT|
OBX|14|NM|AMONO^Monocytes|1|11|%|4-10|H|||F|||200905041231|C^LAB IT|
OBX|15|NM|AEOS^Eosinophils|1|3|%|0-6||||F|||200905041231|C^LAB IT|
OBX|16|NM|ABASO^Basophils|1|0|%|0-2||||F|||200905041231|C^LAB IT|
OBX|17|NM|ANEUTA^Neutrophils, Absolute|1|3.52|10(9)/L|1.4-7.0||||F|||200905041231|C^LAB
IT|
OBX|18|NM|ALYMA^Lymphs, Absolute|1|0.86|10(9)/L|0.7-4.5||||F|||200905041231|C^LAB IT|
OBX|19|NM|AMONOA^Monocytes, Absolute|1|0.55|10(9)/L|0.1-1.0||||F|||200905041231|C^LAB IT|
OBX|20|NM|AEOSA^Eosinophils, Absolute|1|0.13|10(9)/L|0-0.6||||F|||200905041231|C^LAB IT|
OBX|21|NM|ABASOA^Basophils, Absolute|1|0.02|10(9)/L|0-0.2||||F|||200905041231|C^LAB IT|
Example 2:
MSH|^~\&|LIS|M|||20090518161040||ORU^R01|91380000033|P|2.3|
PID|||15161516^^^^M||TEST^EMR SAMPLE^||19651015|M||||||||||46456|
PV1||O|XOP||||14516^TEST^PHYSICIAN||LAB||||||||^|||||||||||||||||||||||||||||v ORC|RE|||||||||||||||^|
OBR|||E2905966|^^^HA1C^HemoglobinA1C|||200905041213|||||||200905041223|^|14516^TEST
^PHYSICIAN||||M3017||||RL|F|HA1C^HA1C|^^^^^R|^^~^^~^^||||^^|^^|^^||200905041213|
OBX|1|NM|HA1C^Hemoglobin A1C|1|2.8|%|4.0-6.0|L|||F|||200905041232|C^LAB IT|
OBX|1|TX|HA1C^Hemoglobin A1C|2|Note: Values <7% meet the treatment goal for patients with
diabetes|||||||||200905041232|C^LAB IT|
OBX|1|TX|HA1C^Hemoglobin A1C|3| mellitus.|||||||||200905041232|C^LAB IT|
MSH|^~\&|LIS|M|||20090518161041||ORU^R01|91380000034|P|2.3|
PID|||15161516^^^^M||TEST^EMR SAMPLE^||19651015|M||||||||||46456|
PV1||O|XOP||||14516^TEST^PHYSICIAN||LAB||||||||^|||||||||||||||||||||||||||||
ORC|RE|||||||||||||||^|
OBR|||E2905965|^^^UMIC^Urinalysis|||200905041213|||||||200905041223|^|14516^TEST^PHYSICIA N
||||M3017||||HU|F|UA^UMIC|^^^^^R|^^~^^~^^||||^^|^^|^^||200905041213| OBX|1|TX|UCOL^Color|1|Yellow||||||F|||200905041241|C^LAB IT|
OBX|2|TX|UAPP^Appearance|1|Clear||||||F|||200905041241|C^LAB IT|
OBX|3|NM|USGB^Specific Gravity|1|1.030||1.005-1.030||||C|||200905050733|C^LAB IT|v OBX|3|TX|USGB^Specific Gravity|2|*CORRECTED 05/05 AT 0733: ORIGINAL:v 1.015||||||C|||200905050733|C^LAB IT|
OBX|4|TX|UESTB^Leukocyte Esterase|1|Negative||NEG||||F|||200905041241|C^LAB IT|
OBX|5|TX|UNITB^Nitrite|1|Positive||NEG|A|||C|||200905050733|C^LAB IT|
OBX|5|TX|UNITB^Nitrite|2|*CORRECTED 05/05 AT 0733: ORIGINAL:
Negative||||||C|||200905050733|C^LAB IT|
OBX|6|NM|UPHB^PH|1|7.0||5.0-7.5||||F|||200905041241|C^LAB IT|
OBX|7|TX|UPRTB^Protein|1|Negative|mg/dL|NEG||||F|||200905041241|C^LAB IT|
OBX|8|TX|UGLB^Glucose|1|Negative|mg/dL|NEG||||F|||200905041241|C^LAB IT|
OBX|9|TX|UKETB^Ketones|1|Negative|mg/dL|NEG||||F|||200905041241|C^LAB IT|
OBX|10|NM|UROB^Urobilinogen|1|0.2|EU/dL|0.2-1.0||||F|||200905041241|C^LAB IT|
OBX|11|TX|UBILB^Bilirubin|1|Positive||NEG|A|||C|||200905050733|C^LAB IT|
OBX|11|TX|UBILB^Bilirubin|2|*CORRECTED 05/05 AT 0733: ORIGINAL:
Negative||||||C|||200905050733|C^LAB IT|
OBX|12|TX|UBLDB^Blood|1|Negative||NEG||||F|||200905041241|C^LAB IT|
OBX|13|TX|UWBC^WBC|1|0-1|/hpf|0-5||||F|||200905041241|C^LAB IT|
OBX|14|TX|URBC^RBC|1|0-2|/hpf|0-2||||F|||200905041241|C^LAB IT|
OBX|15|TX|UBAC^Bacteria|1|None|/hpf|NONE||||F|||200905041241|C^LAB IT|
OBX|16|TX|UMUC^Mucus|1|None|/lpf|||||F|||200905041241|C^LAB IT|
OBX|17|TX|USQEP^Squamous Ep|1|Occ|/lpf|||||F|||200905041241|C^LAB IT|
OBX|18|TX|UCOM^Comments|1|CLEAN CATCH||||||F|||200905041241|C^LAB IT|
Example 3:
MSH|^~\&|LIS|M|||20090518161041||ORU^R01|91380000035|P|2.3|
PID|||15161516^^^^M||TEST^EMR SAMPLE^||19651015|M||||||||||46456|
PV1||O|XOP||||14516^TEST^PHYSICIAN||LAB||||||||^|||||||||||||||||||||||||||||
ORC|RE|||||||||||||||^|
OBR|||E2905967|^^^ZZ01^Wound Cult,
Aero|||200905041213|||||||200905041223|^Leg|14516^TEST^PHYSICIAN||||M3018||||MC|F|WNDAE^Z
Z01|^^^^^R|^^~^^~^^||||^^|^^|^^||200905041213|
OBX|1|TX|SDES^Specimen Description|1|Leg||||||F|||200905041228|C^LAB IT|
OBX|2|TX|SREQ^Special Requests|1|None||||||F|||200905041228|C^LAB IT|
OBX|3|TX|CULT^Culture|1|Many (4+) Proteus mirabilis||||||F|||200905050758|C^LAB IT|
OBX|3|TX|CULT^Culture|2|Mod (3+) **Corrected Micro Report** Rhodotorula glutinis (
Previously|||||||||200905050758|C^LAB IT|
OBX|3|TX|CULT^Culture|3| reported as: Rhodotorula rubra|||||||||200905050758|C^LAB IT|
OBX|3|TX|CULT^Culture|4|Mod (3+) Pseudomonas aeruginosa|||||||||200905050758|C^LAB IT|
OBX|3|ST|CULT^Culture|5|. . . . . . . . . . . . COMMENT . . . . . . . . . .
.|||||||||200905050758|C^LAB IT|
OBX|3|ST|CULT^Culture|6|Called to: Dr office and XOP/Ruth @ 05/05/2009 07:58AM By:
SG2515|||||||||200905050758|C^LAB IT|
OBX|3|ST|CULT^Culture|7|Read back done and verified as correct.|||||||||200905050758|C^LAB IT|
OBX|4|TX|RPT^Report Status|1|Final 05/05/2009||||||F|||200905050758|C^LAB IT|
OBX|5|TX|ORG^Organism|1|Many (4+) Proteus mirabilis||||||F|||200905041245|C^LAB IT|
OBX|6|TX|MTYP^Method|1|Kirby Bauer||||||F|||200905041245|C^LAB IT|
OBX|7|TX|AUG^Amox/k Clav'ate|1|Susceptible|||SS^|||F|||200905041245|C^LAB IT|
OBX|8|TX|AMPI^Ampicillin|1|Susceptible|||SS^|||F|||200905041245|C^LAB IT|
OBX|9|TX|CFZ^Cefazolin|1|Susceptible|||SS^|||F|||200905041245|C^LAB IT|
OBX|10|TX|CTN^Cefotetan|1|Susceptible|||SS^|||F|||200905041245|C^LAB IT|
OBX|11|TX|CAX^Ceftriaxone|1|Susceptible|||SS^|||F|||200905041245|C^LAB IT|
OBX|12|TX|CIP^Ciprofloxacin|1|Susceptible|||SS^|||F|||200905041245|C^LAB IT|
OBX|13|TX|GM^Gentamicin|1|Intermediate|||I^|||F|||200905041245|C^LAB IT|
OBX|14|TX|TE^Tetracycline|1|Resistant|||R^|||F|||200905041245|C^LAB IT|
OBX|15|TX|TS^Trimeth/sulfa|1|Susceptible|||SS^|||F|||200905041245|C^LAB IT|
OBX|16|TX|ORG^Organism|1|Mod (3+) Pseudomonas aeruginosa||||||F|||200905050758|C^LAB IT|
OBX|17|TX|MTYP^Method|1|MIC (ug/mL)||||||F|||200905050758|C^LAB IT|
OBX|18|TX|AK^Amikacin|1|2 Susceptible|||SS^|||F|||200905050758|C^LAB IT|
OBX|19|TX|AZT^Aztreonam|1|14 Intermediate|||I^|||F|||200905050758|C^LAB IT|
OBX|20|TX|CAZ^Ceftazidime|1|1 Susceptible|||SS^|||F|||200905050758|C^LAB IT|
OBX|21|TX|CAX^Ceftriaxone|1|1 Susceptible|||SS^|||F|||200905050758|C^LAB IT|
OBX|22|TX|CIP^Ciprofloxacin|1|<1 Susceptible|||SS^|||F|||200905050758|C^LAB IT|
OBX|23|TX|GM^Gentamicin|1|10 Resistant|||R^|||F|||200905050758|C^LAB IT|
OBX|24|TX|IMP^Imipenem|1|2 Susceptible|||SS^|||F|||200905050758|C^LAB IT|
OBX|25|TX|TZP^Piperacillin/Tazo|1|1 Susceptible|||SS^|||F|||200905050758|C^LAB IT|
OBX|26|TX|TIM^Ticar/k Clav'ate|1|2 Susceptible|||SS^|||F|||200905050758|C^LAB IT|
OBX|27|TX|TO^Tobramycin|1|6 Intermediate|||I^|||F|||200905050758|C^LAB IT|
APPENDIX A.14: HHIC Use Only — Edits Applied After Receipt
Proposed Edits Applied During or After Receipt of the Data File
Duplicate Laboratory Record
Two or more laboratory records were submitted representing the same laboratory test collected at the same date and time.
Resolution: Remove duplicate laboratory records so only one valid laboratory record exists for a single laboratory test collected at a specified date and time.
Failure to Link Laboratory Record with Discharge Record
The laboratory record did not link to a unique inpatient discharge record. The fields used to perform this link are the Medical/Health Record Number, Admission Date, and Account Number.
Resolution: Verify and correct the Medical/Health Record Number, Admission Date, and Account Number.
Admission Lab Algorithm
For the purpose of improving the severity of illness model, the admission lab results will be incorporated into existing risk models, e.g. 3M's APR-DRGs or other appropriate models. While lab results throughout the inpatient stay may be found to have an important predictive component, the results of selected admission labs (the 32 identified for this study) are known to improve the predictive power of existing risk models such as 3M's APRDRGs. Thus, the admission lab results of the 32 lab tests identified for this study will be identified for this purpose. HHIC will use the following algorithm.9
The first lab value on the day of admission will be used as the "admission lab" because it is most likely to reflect the patient's status prior to any major interventions. If a value is not available, particularly if the patient was admitted late in the day (e.g., after 6 PM), then next day values will be used if no major procedure is documented on the day of admission. If no value is available using this algorithm, a value within seven days prior to admission that is closest to the day of admission can be used. Otherwise, the value will be considered missing.
Future Validations/Definitions/Edits
Further validations and edits will be applied over the course of working with data files. They will be published as they are incorporated.
Appendix B: Data Specifications for ASCII
Laboratory Observation Reporting Technical Specifications and Transmittal Instructions
Effective for Discharges on or after January 1, 2008
Table of Contents
TABLE 1. SUMMARY OF REQUIRED Laboratory Tests and LOINC
Ordering Physician Middle Name
Hospital or Lab Reporting Results
Hospital Test (result - LOINC)
Results Rpt/Status Chng Date/Time
Appendix A: HHIC Use Only - Edits Applied After Receipt
ASCII File Layout
Introduction
This document serves as a functional specification and technical requirements for integrating key lab results with Hawaii Health Information Corporation's (HHIC) inpatient database via an ASCII file layout. A library of 32 laboratory tests and the respective LOINC codes will be transmitted from each of our prospective Electronic Laboratory Reporting (ELR) providers.
HHIC uses the results of these lab tests to enhance the content of their existing statewide, all-payer hospital discharge database. The enhanced data set will be used to improve the predicative methodology to measure key patient outcomes, such as inpatient mortality.10
GENERAL SPECIFICATIONS
These instructions and specification are applicable to participating HHIC institutions submitting data to HHIC, effective with admissions of January, 2008.
Hospitalization—related (Acute Inpatient) laboratory results should be obtained from the hospital's clinical laboratory system/laboratory information system. Observed test results (e.g., finger stick) and other test results from glucometers, chemsticks, etc. should not be submitted. Submit test results specific to that laboratory test only. As an example, for the test of hemoglobin, do not submit a hemoglobin value that was reported as part of an arterial blood gas test result.
Units of Measure
Each laboratory test has a unique test code that represents both the laboratory test and the unit of measure. For example, the laboratory test lists Glucose with mg/dL as the unit of measurement. The laboratory test codes were designed to accept the submission of the units of measure used specified in the LOINC system. Please consult with the clinical laboratory system/laboratory information system personnel at your facility if you have questions regarding the laboratory units of measures outlined in Table 1.
Corrected Values
When two results are available for the same date and time the laboratory specimen was collected and one is labeled "corrected," submit the final corrected test result.
Data File Description
The file format will be a delimited text file where each column value is separated by a pipe (|) from the next column. Each line of the text file must contain a single record. An "end of file marker" must follow the line feed of the last record.
The file will be submitted in batch on a quarterly basis (at the beginningâand will move to a more frequent schedule as defined at a later time).
Each submission should include a summary document with the following information: hospital name/ID, time frame of messages submitted, number of messages sent in the batch.
Separate batch files should be submitted for each hospital.
Transmission Options
Data will be transmitted to HHIC in one of the following ways:
HHIC will collaborate with each provider to determine the best method.
TABLE1. SUMMARY OF REQUIRED Laboratory Tests and LOINC
| Lab Test | Lab Test Name | LOINC | Units | LOINC SHORTNAME | |
|---|---|---|---|---|---|
| Chemistry | Albumin | Albumin | 17517 | g/dL | Albumin SerPIMCnc |
| Alkaline phosphatase | Alkaline phosphatase | 67686 | U/L;units/L | ALP SerPlcCnc | |
| Blood urea nitrogen (BUN) | Urea nitrogen | 30940 | mg/dL | BUN SerPlmCnc | |
| Bilirubin (total) | Bilirubin | 19752 | mg/dL | Bilirub SerPlmCnc | |
| Calcium | Calcium | 178616 | mg/dL | Calcium SerPlmCnc | |
| Chloride | Chloride | 20750 | mmol/L | Chloride SerPlsCnc | |
| Creatine kinaseMB | Creatine kinaseMB | 139691 | ng/mL; ug/L | CK MB SerPlmCnc | |
| Creatinine | Creatinine | 21600 | mg/dL | Creat SerPlmCnc | |
| Glucose | Glucose | 2345-7 | mg/dL | Glucose SerPl-mCnc | |
| Gamma glutamyl transferase | Gamma glutamyl transferase | 2324-2 | U/L;units/L | GGT SerPl-cCnc | |
| Potassium | Potassium | 2823-3 | mmol/L | Potassium SerPl-sCnc | |
| Phosphate | Phosphate | 2777-1 | mg/dL | Phosphate SerPl-mCnc | |
| BNP | Natriuretic peptide.B | 30934-4 | pg/mL | BNP SerPl-mCnc | |
| Sodium | Sodium | 2951-2 | mmol/L | Sodium SerPl-sCnc | |
| Troponin I | Troponin I.cardiac | 10839-9 | ug/L;ng/mL | Troponin I SerPl-mCnc | |
| SGOT | Aspartate aminotransferase | 1920-8 | U/L;units/L | AST SerPl-cCnc | |
| SGPT | Alanine aminotransferase | 1742-6 | U/L;units/L | ALT SerPl-cCnc | |
| Blood Gas | pO2 | Oxygen | 2703-7 | mm Hg | pO2 BldA |
| pCO2 | Carbon dioxide | 2019-8 | mm Hg | pCO2 BldA | |
| pH(arterial) | pH | 2744-1 | pH BldA | ||
| Base excess | Base excess | 1925-7 | mmol/L | Base excess BldA-sCnc | |
| Bicarbonate | Bicarbonate | 1960-4 | mmol/L | HCO3 BldA-sCnc | |
| Hematology | Hemoglobin | Hemoglobin | 718-7 | g/dL | Hgb Bld-mCnc |
| Hematocrit | Hematocrit | 4544-3 | L/L;% | Hct Fr Bld Auto | |
| Partial thromboplastin time (PTT) | Coagulation surface induced | 14979-9 | Sec | aPTT Time PPP | |
| Prothrombin time (PT) | Coagulation tissue factor induced | 5902-2 | Sec | PT Time PPP | |
| INR | Coagulation tissue factor induced.INR | 34714-6 | INR(POC) | INR PPP | |
| Platelet count | Platelets | 777-3 | 10^9/L | Platelet # Bld Auto | |
| White blood count (WBC) | Leukocytes | 6690-2 | 10*3/uL | WBC # Bld Auto | |
| Microbiology | Blood culture | 600-7 | |||
| Urine culture | Blood culture | 630-4 | |||
| Sputum culture | Blood culture | 6460-0 |
Data Field Layout
| DATA ELEMENT | DATATYPE | HL7 Location (for reference) |
|---|---|---|
| *Sending Facility | A | MSH-4 |
| *Account Number | A | PID-18 |
| Medical Record Number | A | PID-3 |
| *Date of Birth | D | PID-7 |
| Gender | A | PID-8 |
| *Social Security Number | N | PID-19 |
| *Patient First Name | A | PID-5 |
| *Patient Last Name | A | PID-5 |
| *Patient Middle Initial | A | PID-5 |
| *Admission Date/Time | D | PV1-44 |
| *Discharge Date/Time | D | PV1-45 |
| Ordering Physician First Name | A | OBR-16 |
| Ordering Physician Last Name | A | OBR-16 |
| Ordering Physician Middle Initial | A | OBR-16 |
| Physician Identifier | N | OBR-16 |
| Receiving Application | A | MSH-5 |
| Create Date/Time | D | MSH-7 |
| Patient Class | A | PV1-2 |
| Hospital Test (order) | A | OBR-4 |
| Hospital Test (result — LOINC) | A | OBR-3 |
| Observation Date/Time | D | OBR-7 |
| Results Rpt/Status Chng-Date/Time | D | OBR-22 |
| Results Status | A | OBR-25 |
| Observation Value | A | OBX-5 |
| Units (of Measure) | A | OBX-6 |
| Reference Ranges | A | OBX-7 |
| Abnormal Flags | A | OBX-8 |
| Observation Results Status | A | OBX-11 |
| Comments | A | NTE-3 |
| *for linking lab file to HHIC patient files | ||
Sending Facility
Data Element: Sending Facility
HL7 Location: MSH-4
Data Type: Alpha
Definition: Identifies the sender (the owner of the message information). When sending, LAB will use "Hospital Name."
NOTE: For files submitted by Clinical Laboratory, this number will be their internally assigned number for the hospitals.
Account Number
Data Element: Account Number
HL7 Location: PID-18
Data Type: Alphanumeric
Definition: The number assigned to the patient's visit by the hospital. The account number is typically used for charge and/or billing purposes.
Instructions: Valid characters: A through Z, 0 through 9, . (period), and - (hyphen). Do not leave this field blank.
Medical Record Number
Data Element: Medical Record Number
HL7 Location: PID-3
Data Type: Alphanumeric
Definition: The number assigned to the patient's medical/health record by the hospital. The medical record number is typically used to do an audit of the history of treatment.
Date of Birth
Data Element: Date of Birth
HL7 Location: PID-7
Data Type: Date
Definition: Month, day, and year (including century) of birth of the patient.
Instructions: YYYYMMDD
If the month, day or year of birth is a single digit, use a preceding zero.
There should be no blanks in this field.
Do not leave this field blank.
Gender
Data Element: Gender
HL7 Location: PID-8
Data Type: Alpha
Definition: Sex of patient
M = Male
F = Female
U = Unknown
Social Security Number
Data Element: Social Security Number
HL7 Location: PID-19
Data Type: Numeric
Definition: The number assigned by the Social Security Administration.
Instructions: Valid characters: 0 through 9, no hyphens or spaces.
If SSN is unknown leave blank.
Patient First Name
Data Element: Patient First Name
HL7 Location: PID-5
Data Type: Alphanumeric
Definition: The patient's first name.
Instructions: Exclude middle names and middle initials
Uppercase only.
Patient Last Name
Data Element: Patient First Name
HL7 Location: PID-5
Data Type: Alphanumeric
Definition: The patient's last name.
Instructions: Uppercase Only.
Patient Middle Initial
Data Element: Patient Middle Initial
HL7 Location: PID-5
Data Type: Alphanumeric
Definition: The patient's middle initial.
Instructions: Include only the first middle initial.
Uppercase Only.
Admission Date/Time
Data Element: Patient Middle Initial
HL7 Location: PV1-44
Data Type: Date
Definition: Month, day, year and time of admission to the hospital as an acute care patient.
Instructions: YYYYMMDDHHMMSS
If the month, day or year of admission is a single digit, use a preceding zero. There should be no blanks in this field.
Do not leave this field blank.
Discharge Date/Time
Data Element: Discharge Date/Time
HL7 Location: PV1-45
Data Type: Date
Definition: Month, day, year and time of discharge from the hospital as an acute care patient.
Instructions: YYYYMMDDHHMMSS
If the month, day or year of discharge is a single digit, use a preceding zero. There should be no blanks in this field.
Do not leave this field blank.
Ordering Physician First Name
Data Element: Physician First Name
HL7 Location: OBR-16
Data Type: Alphanumeric
Definition: The physician's first name.
Instructions: Exclude middle names and middle initials
Uppercase only.
Ordering Physician Last Name
Data Element: Physician Last Name
HL7 Location: OBR-16
Data Type: Alphanumeric
Definition: The physician's last name.
Instructions: Uppercase only.
Ordering Physician Middle Initial
Data Element: Physician Middle Initial
HL7 Location: OBR-16
Data Type: Alphanumeric
Definition: The physician's middle initial.
Instructions: Include only the first middle initial.
Uppercase only.
Physician Identifier
Data Element: Physician Identifier
HL7 Location: OBR-16
Data Type: Numeric
Definition: Either the National Provider Identifier (NPI) that is issued to the individual physician by CMS or the identifier that is assigned to each physician by the hospital.
Instructions: Leave blank if unknown.
Hospital or Lab Reporting Results
Data Element: Hospital or Lab Reporting Results
HL7 Location: MSH-5
Data Type: Alpha
Definition: Name of the hospital or lab that is processing the order.
Create Date/Time
Data Element: Create Date/Time
HL7 Location: MSH-7
Data Type: Date
Definition: Date and time the message was created.
Instructions: YYYYMMDDHHMMSS
If the month, day or year of create date is a single digit, use a preceding zero. There should be no blanks in this field.
Do not leave this field blank.
Patient Class
Data Element: Patient Class
HL7 Location: PV1-2
Data Type: Alpha
Definition: Patient Class
E Emergency Department visits
I Inpatient Admission
O Outpatient
Hospital Test (Order)
Data Element: Hospital Test (Order)
HL7 Location: OBR-4
Data Type: Alpha
Definition: This is the local (ordered) test code.
Hospital Test (result - LOINC)
Data Element: Hospital Test (result - LOINC)
HL7 Location: OBR-3
Data Type: Alpha
Definition: LOINC Code
Instructions: It is strongly recommended that OBX-3 be populated with as specific a LOINC®code as defined in Table 1 to prevent any misinterpretation of reported results.
Observation Date/Time
Data Element: Observation Date/Time
HL7 Location: OBR-7
Data Type: Date
Definition: Month, day, year and time of lab test.
Instructions: YYYYMMDDHHMMSS
If the month, day or year of observation is a single digit, use a preceding zero. There should be no blanks in this field.
Do not leave this field blank.
Results Rpt/Status Chng Date/Time
Data Element: Results Rpt/Status Chng Date/Time
HL7 Location: OBR-22
Data Type: Date
Definition: Month, day, year and time of lab test.
Instructions: YYYYMMDDHHMMSS
If the month, day or year of results is a single digit, use a preceding zero. There should be no blanks in this field.
Do not leave this field blank.
Results Status
Data Element: Results Status
HL7 Location: OBR-25
Data Type: Alpha
Definition: The current status of the results of the lab test.
Instructions: Only test status of "F" for finalized should be included.
Observation Value
Data Element: Observation Value
HL7 Location: OBX-5
Data Type: Alpha
Definition: Result of lab test.
Units
Data Element: Units
HL7 Location: OBX-6
Data Type: Alpha
Definition: Units of measure.
Reference Ranges
Data Element: Reference Ranges
HL7 Location: OBX-7
Data Type: Alpha
Definition: Reference range. If numeric, the values of this field may report several values in one of the following three formats:
1. lower limit-upper limit when both lower and upper limits are defined, e.g., for potassium "3.5 - 4.5"
2. > lower limit if no upper limit, e.g., ">10"
3. < upper limit if no lower limit, e.g., "<15"
Abnormal Flags
Data Element: Abnormal Flags
HL7 Location: OBX-8
Data Type: Alpha
Definition: Abnormal flags should be used for reporting microbiology sensitivity data. Abnormal flags for antimicrobial sensitivity reporting should conform to the recommendations of National Committee of Clinical Laboratory Standards (NCCLS, https://clsi.org/about/clsis-history/). For most reported findings, the allowable values are S, I, or R, and should be provided in addition to the numeric value in OBX-5. When findings other than susceptibility results are sent, the abnormal flag should be valued (e.g., "H", "N", or "A") to distinguish between tests that are interpreted as normal and those that are interpreted as abnormal.
Observation Results Status
Data Element: Observation Results Status
HL7 Location: OBX-11
Data Type: Alpha
Definition: F = completed. Correct and final results
Comments
Data Element: Comments
HL7 Location: NTE-3
Data Type: Alpha
Definition: Contains the comment contained in the segment.
Appendix B.1: HHIC Use Only — Edits Applied After Receipt
Proposed Edits Applied During or After Receipt of the Data File
Duplicate Laboratory Record
Two or more laboratory records were submitted representing the same laboratory test collected at the same date and time.
Resolution: Remove duplicate laboratory records so only one valid laboratory record exists for a single laboratory test collected at a specified date and time.
Failure to Link Laboratory Record with Discharge Record
The laboratory record did not link to a unique inpatient discharge record. The fields used to perform this link are the Medical Record Number, Admission Date, and Account Number.
Resolution: Verify and correct the Medical Record Number, Admission Date, and Account Number.
Admission Lab Algorithm
For the purpose of improving the severity of illness model, the admission lab results will be incorporated into existing risk models, e.g. 3M's APR-DRGs or other appropriate models. While lab results throughout the inpatient stay may be found to have an important predictive component, the results of selected admission labs (the 32 identified for this study) are known to improve the predictive power of existing risk models such as 3M's APRDRGs. Thus, the admission lab results of the 32 lab tests identified for this study will be identified for this purpose. HHIC will use the following algorithm.11
The first lab value on the day of admission will be used as the âadmission labâ because it is most likely to reflect the patient's status prior to any major interventions. If a value is not available, particularly if the patient was admitted late in the day (e.g., after 6 PM), then next day values will be used if no major procedure is documented on the day of admission. If no value is available using this algorithm, a value within seven days prior to admission that is closest to the day of admission can be used. Otherwise, the value will be considered missing.
Future Validations/Definitions/Edits
Further validations and edits will be applied over the course of working with data files. These will be published as they are incorporated.
11 The proposed algorithm is subject to change following as we work with providers and work with data in more detail.
Appendix C: Data Elements
| DATA ELEMENT | Linking Variable |
|---|---|
| Sending Facility | Y |
| Account Number | Y |
| Medical Record Number | N |
| Date of Birth | Y |
| Gender | N |
| Social Security Number | Y |
| Patient First Name | Y |
| Patient Last Name | Y |
| Patient Middle Initial | Y |
| Admission Date/Time | Y |
| Admission Date/Time | Y |
| Discharge Date/Time | Y |
| Ordering Physician First Name | N |
| Ordering Physician Last Name | N |
| Ordering Physician Middle Initial | N |
| Physician Identifier | N |
| Receiving Application | N |
| Create Date/Time | N |
| Patient Class | N |
| Hospital Test (order) | N |
| Hospital Test (result — LOINC) | N |
| Observation Date/Time | N |
| Results Rpt/Status Chng-Date/Time | N |
| Results Status | N |
| Observation Value | N |
| Units (of Measure) | N |
| Reference Ranges | N |
| Abnormal Flags | N |
| Observation Results Status | N |
| Comments | N |
Appendix D: HL7 Interface Engine Evaluation Criteria
| Criteria | Definition |
|---|---|
| Scalability | The ability of the system, network, or process, to handle growing amounts of work/volume |
| Web Monitoring | Remote web server and website monitoring with alerts via SMS, e-mail, or phone |
| Filtering Ability | Connection can be implemented as a filter to modify a message received from an external system (such as code translation). |
| Product Support/Maintenance | Company is responsive and replies quickly. Configuration files can be backed up in less than 30 minutes and patches are timely and work accordingly. |
| Security/Transport | Virtual Private Networks(VPN), Secure File Transfer Protocol (SFTP) and Transmission Control Protocol/Internet Protocol (TCP/IP) are supported |
| Usability and Functionality | Crosswalks to cross reference data elements used by multiple applications; easy of setup and configuration |
| Capital Costs (3 years) | Initial price of software, hardware and maintenance fees |
| Resource Availability | Support and education available online; few outside resources needed |
| Technology Direction | Compatibility with other systems; version updates yearly |
| Outside Recommendations | Ease of Use/Customer Support/Product Functionality |
| Proof of Concept | HL7 Interface Demonstration |
Appendix E: HL7 Integration Engine Evaluation
Weighting
| Rankings (1-5 points) 5=Best | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Weighting | Rhapsody | Weighted Score | Corepoint | Weighted Score | Informatica* | Weighted Score | Iguane** | Weighted Score | |
| Scalability | |||||||||
| Ability to support 100% of transaction volumes | 2 | 3 | 6 | 3 | 6 | 2 | 4 | 2 | 4 |
| Infrastructure | 2 | 5 | 10 | 5 | 10 | 3 | 6 | 3 | 6 |
| Can handle future message types at no additional cost | 4 | 3 | 12 | 3 | 12 | 1 | 4 | 3 | 12 |
| TOTAL | 8 | TOTAL | 28 | TOTAL | 28 | TOTAL | 14 | TOTAL | 22 |
| Web Monitoring | |||||||||
| Remote access | 3 | 3 | 9 | 3 | 9 | 0 | 0 | 1 | 3 |
| Error handling | 4 | 3 | 12 | 3 | 12 | 0 | 0 | 1 | 4 |
| TOTAL | 7 | TOTAL | 21 | TOTAL | 21 | TOTAL | 0 | TOTAL | 7 |
| Filtering Ability | |||||||||
| Remotely | 2 | 3 | 6 | 3 | 6 | 0 | 0 | 0 | 0 |
| Locally | 4 | 4 | 16 | 4 | 16 | 0 | 0 | 3 | 12 |
| TOTAL | 6 | TOTAL | 22 | TOTAL | 22 | TOTAL | 0 | TOTAL | 12 |
| Support/Maintenance/Upgrades/Backup | |||||||||
| Customer Support | 4 | 2 | 8 | 4 | 16 | 2 | 8 | 2 | 8 |
| Backup | 3 | 3 | 9 | 3 | 9 | 0 | 0 | 3 | 9 |
| Ease of upgrading/timing of patches | 3 | 3 | 9 | 4 | 12 | 0 | 0 | 3 | 9 |
| TOTAL | 10 | TOTAL | 26 | TOTAL | 37 | TOTAL | 8 | TOTAL | 26 |
| Security/Transport | |||||||||
| VPN | 4 | 3 | 12 | 3 | 12 | 0 | 0 | 2 | 8 |
| TCP/IP | 3 | 3 | 9 | 3 | 9 | 0 | 0 | 2 | 6 |
| FTP | 3 | 3 | 9 | 3 | 9 | 0 | 0 | 2 | 6 |
| TOTAL | 10 | TOTAL | 30 | TOTAL | 30 | TOTAL | 0 | TOTAL | 20 |
| Useability and Functionality | |||||||||
| LOINC matching (mapping code sets) | 4 | 3 | 12 | 3 | 12 | 0 | 0 | 2 | 8 |
| Use of lookup tables | 4 | 3 | 12 | 3 | 12 | 0 | 0 | 2 | 8 |
| Translation across HL7 formats | 4 | 4 | 16 | 4 | 16 | 3 | 12 | 3 | 12 |
| TOTAL | 12 | TOTAL | 40 | TOTAL | 40 | TOTAL | 12 | TOTAL | 28 |
| Capital Costs (3 years) | |||||||||
| Initial price | 4 | 3 | 12 | 3 | 12 | 2 | 8 | 4 | 16 |
| Hardware | 3 | 3 | 9 | 3 | 9 | ||||
| Maintenance fee | 3 | 3 | 9 | 3 | 9 | 2 | 6 | 3 | 9 |
| TOTAL | 10 | TOTAL | 30 | TOTAL | 30 | TOTAL | 14 | TOTAL | 25 |
| Resource/Skill Set Availability/Manpower | |||||||||
| Few outside consultants needed | 4 | 2 | 8 | 3 | 12 | 0 | 1 | 2 | 8 |
| Little programming required | 4 | 3 | 12 | 3 | 12 | ||||
| In-house development benefits company | 4 | 4 | 16 | 4 | 16 | 4 | 16 | 2 | 8 |
| TOTAL | 12 | TOTAL | 36 | TOTAL | 40 | TOTAL | 17 | TOTAL | 16 |
| Technology Direction | |||||||||
1 See Deliverable 7 for details on linking
2 See Deliverable 3 for more detail regarding LOINC assignment
3 See Deliverable 3, Appendix B - "Data Transmission Format by Facility" for additional details.
4 KLAS' is a company whose mission is to improve healthcare technology delivery by measuring vendor performance and providing impartial ratings to help providers make informed decisions.
5 An HL7 interface was established in October 2011 at which time the transmission of 'live' laboratory data was implemented by facility.
6 Data from these two facilities were sent from one of the two centralized laboratories
7 Hospital approval for VPN transmission was not granted.
8 This effort is supported by CER funding received from The Agency for Healthcare Research and Quality (AHRQ). Todd Seto, MD, from The Queen's Medical Center is the Primary Investigator and will direct the comparative effectiveness research component of the research. Jill Miyamura, PhD, HHIC, is Co-Principal Investigator. HHIC's role is to demonstrate the feasibility of enhancing inpatient all-payer data with clinical (laboratory) data to support the purpose of comparative effectiveness research. More information on the grant, its aims and methodology can be found at http://www.hcup-us.ahrq.gov/datainnovations.jsp.
9 The proposed algorithm is subject to change following as we work with providers and work with data in more detail.
10 This effort is supported by CER funding received from The Agency for Healthcare Research and Quality (AHRQ). Todd Seto, MD, from The Queen's Medical Center is the Primary Investigator and will direct the comparative effectiveness research component of the research. Jill Miyamura, PhD, HHIC, is Co-Principal Investigator. HHIC's role is to demonstrate the feasibility of enhancing inpatient all-payer data with clinical (laboratory) data to support the purpose of comparative effectiveness research. More information on the grant, its aims and methodology can be found at http://www.hcup-us.ahrq.gov/datainnovations.jsp.
11 The proposed algorithm is subject to change following as we work with providers and work with data in more detail.
| Internet Citation: Enhancing Hawaii Hospital Information Content: Data Acquisition. Healthcare Cost and Utilization Project (HCUP). September 2014. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/datainnovations/clinicalcontentenhancementtoolkit/hi25.jsp. |
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