Utah Statewide Immunization Information System (USIIS) Implementation Guide for HL Immunization Messaging. Version 1.

Transcription

1 Utah Statewide Immunization Information System () Implementation Guide for HL Immunization Messaging Version 1.2 September 2016

2 Table of Contents TABLE OF CONTENTS INTRODUCTION... 3 Intended Audience... 4 Scope MESSAGES SUPPORTED BY HL7 MESSAGING STRUCTURE HL7 DATA TYPES SEGMENTS AND MESSAGE DETAILS... 7 BHS Batch Header Segment BHS Field Definitions BTS Batch Trailer Segment ERR Error Segment ERR field definitions: FHS File Header Segment FHS Field Definitions FTS File Trailer Segment MSA Message Acknowledgement Segment MSA Field Definitions MSH Message Header Segment MSH Field Definitions NK1 Next of Kin Segment NK1 Field Definitions NTE Note Segment NTE Field Definitions OBX Observation Result Segment OBX Field Definitions ORC Order Request Segment ORC Field Definitions PD1 Patient Demographic Segment PD1 Field Definitions PID Patient Identifier Segment PID Field Definitions QAK Query Acknowledgement Segment QAK Field Definitions QPD Query Parameter Definition Segment QPD Field Definitions RCP Response Control Parameter Segment RCP Field Definitions RXA-- Pharmacy/Treatment Administration Segment RXA Field Definitions RXR-- Pharmacy/Treatment Route Segment RXR Field Definitions MESSAGES FOR TRANSMITTING IMMUNIZATION INFORMATION TO Send Immunization Information to VXU Business Rules VXU Segment... 63

3 Immunization Information Message Acknowledgment ACK Query and Response for an Immunization History QPB and RSP CHANGE HISTORY APPENDIX A: CODE TABLES APPENDIX B: GUIDANCE ON USAGE AND EXAMPLE MESSAGES... 67

4 1. Introduction In order for different health information systems to exchange data, the structure and content of the data to be exchanged must be standardized. Three controlling documents define the standards applies to implementing HL7 data exchange. They are arranged in a hierarchy of documents, each refining and constraining the HL7 Standard. Figure 1: HL7 Guideline Document Hierarchy The first document is the HL standard developed by Health Level Seven, a not for profit ANSI accredited standards developing organization. This standard defines the structure and content of immunization messages, but leaves many specific implementation details undecided. Information on HL7 and a copy of the HL7 message standard can be obtained from the Health Level Seven website at The second document is the s Implementation Guide for Immunization Transactions using Version of the Health Level Seven (HL7) Standard Protocol, version 1.4, 11/9/2012. This guide gives specific instructions regarding how to report to immunization information systems. It leaves some implementation decisions to each state immunization information system. This guide and other technical information can be obtained from the IIS website at guidance/hl7.html The third document is this document. It describes State of Utah implementation decisions and defines what will and will not accept. It is written in accordance with the standards set in the first two documents. This Utah state implementation guide points out differences from the Implementation Guide. In cases where this guide differs from the Implementation Guide, this guide will provide both the and Utah usage specification. Page 3 of 71 Updated: 30 Sep 2013

5 Intended Audience This Utah Implementation Guide is intended for use by technical and implementation teams from Electronic Health Record (EHR) system vendors and other state IIS to implement an HL immunization interface with. The reader of this guide should have a HL7 foundation and be familiar with the contents of the Implementation Guide. Scope This Utah Implementation Guide is intended to guide the implementation of an HL immunization interface between external Health Systems and. This includes: Sending immunization information for individuals to, to include demographic and immunization information Requesting immunization histories for individuals from responses to requests for immunization histories for individuals acknowledgments of receipt of immunization information error responses Note: does not yet support sending immunization forecasts. Organization and Flow This guide is designed to be consistent with the organization and flow of the Implementation Guide. This chapter defines high level use cases supported by. Subsequent chapters define how implements those use cases. Finally, this guide has an appendix example messages. This guide is intended to be used in conjunction with the Implementation Guide. 2. Messages Supported by This section describes the messages supported by in terms of use cases. Use Case Send Immunization Information to Message VXU Purpose For an external system to send immunization information to. Information may be a new record or an update to an existing record. It includes patient demographic information. In addition to EHR systems and other state IIS, external systems such as vital records could use this message to send immunization information to. will receive this information. Page 4 of 71 Updated: 30 Sep 2013

6 Request an Immunization History from Returns Immunization History Returns Acknowledgment of Receipt of a Message QBP RSP ACK QCK For an external system to request an immunization history from. returns one of five outcomes: 1. No match found 2. One match found, and immunization history is returned. 3. More than one match found, and the number is less than or equal to the maximum number allowed; immunization history is not returned. 4. More than one match found, but the number is more than the maximum number allowed; immunization history is not returned 5. Error Message is not well formed and has fatal errors. For to acknowledge receipt of a message from an external system. This can be to acknowledge receipt of immunization information or a request for an immunization history. The acknowledgement may indicate an accurate receipt or an error. 3. HL7 Messaging Structure Chapter 3 of the Implementation Guide contains basic descriptions of terms and definitions that are common to both the and Utah guides. The majority of the terms and definitions will not be redefined in this guide. A key attribute of HL7 fields, components, and sub components is the Code. The table below includes the acceptable Codes used in this implementation guide. Code Description Information R Required The sending application SHALL populate R elements with a non empty value. The receiving application shall process or ignore the information conveyed by required elements. The receiving application may raise an error due to the absence of a required element. RE Required but may be empty The sending application shall populate RE elements with a non empty value if there is relevant data. Page 5 of 71 Updated: 30 Sep 2013

7 Code Description Information C Conditional This usage has an associated condition (predicate). If the condition is satisfied (predicate true): The sending application shall follow the usage for the element, which shall be R, RE, O or X. If the condition is not satisfied (predicate false): The sending application shall follow the usage for the element, which shall be R, RE, O or X. O Optional These elements are entirely optional to provide by the sending system and also optional to consume by the IIS. X Not Supported The element is not supported by. The sending application shall not populate X elements unless the guide indicates that the information may be sent and is ignored by. 4. HL7 s The Implementation Guide contains clearly defined HL7 data types that are the building blocks of an HL7 message. Similar to the terms and definitions found in the HL7 Messaging Infrastructure section above, this guide will define unclear sections or further define Utah constraints. adheres to the HL7 data types described in Chapter 4 of the Implementation Guide. Page 6 of 71 Updated: 30 Sep 2013

8 5. Segments and Message Details This chapter contains tables for each segment supported by. usage that differs from usage is described, to include further constraints on fields to accommodate business rules. Additional clarifications are provided as well. Chapter 6 will address how these segments are assembled into specific messages that meet the use cases listed in Chapter 2. Table 5 1 Message Segments Segment (Name) BHS BTS ERR Definition The Batch Header Segment. The BHS segment wraps a group of 1 or more messages. These may be a mixture of acceptable message types. This segment is not required for real time messaging e.g., a stream of messages. Batch Trailer Segment. The BTS segment defines the end of a batch. It is required if the message has a matching BHS. Error Segment. The ERR segment reports information about errors in processing the message. The segment may repeat. Each error will have its own ERR segment. Message Note Any Optional C Required at the beginning of any batch of messages. Not required for a real time messaging. Any ACK, RSP Required if message starts with BHS. Ability to create and process is required. Required if message starts with BHS. Ability for sending system to process is required. Used to mark the end of any batch of messages. If the batch of messages starts with a BHS, then this segment is required. Page 7 of 71 Updated: September 2016

9 Segment (Name) FHS FTS IN1, IN2, IN3 MSA MSH Definition File Header Segment. The FHS segment may be used to group one or more batches of messages. This is an optional segment, even if batches are sent. Its use is not anticipated for use in real time transactions. File Trailer Segment. The FTS segment defines the end of a file of batches. It is only used when the FHS segment is used. Insurance Segments. The IN1 IN3 segments contain insurance policy coverage information necessary to produce properly pro rated and patient and insurance bills. Message Acknowledgment Segment. The MSA segment is included in the RSP and ACK messages. It contains information used to identify the receiver s acknowledgement response to an identified prior message. Message Segment Header. The MSH segment defines the intent, source, destination, and some specifics of the syntax of a message. Message Note Any Optional Optional Used to mark the beginning of a file of batches. Not accepted for a real time messaging. Any Required to Required to Used to mark the end terminate a file terminate a file of a file of batches. of batches. of batches. Required if FHS is (Matches FHS) used. VXU RSP, ACK All Optional. These segments are not anticipated for use in immunization messages, but may be specified for local use. Ability to create and process is required for conformant systems. Ability to create and process is required for conformant systems. Optional Ability for sending system to process is required. Ability for sending system to create is required. does not support these segments and will not process the information. Required for all messages. Page 8 of 71 Updated: September 2016

10 Segment (Name) NK1 NTE OBX ORC PD1 Definition Next of Kin Segment. The NK1 segment contains information about the patient s next of kin or other related parties. Note Segment. The NTE segment is used for sending notes and comments. It is used in relation to OBX in the VXU and RSP. Observation Result Segment. The OBX segment has several uses. It carries observations about the object of its parent segment. In the VXU/RSP it is associated with the RXA or immunization record. The basic format is a question and an answer. Order Request Segment. The ORC segment is used to transmit fields that are common to all orders (all types of services that are requested). While not all immunizations recorded in an immunization message are able to be associated with an order, each RXA must be associated with one ORC, based on HL standard. Patient Demographic Segment. The PD1 segment contains additional demographic information that is likely to change about Message VXU, RSP VXU, RSP VXU, RSP VXU, RSP VXU, RSP Note Ability to create and process is required for conformant systems. Ability to create and process is required for conformant systems. Ability to create and process is required for conformant systems. Ability to create and process is required for conformant systems. Ability to create and process is required for Ability for sending system to create is required. Ability for sending system to create is optional. Ability for the sending application to create is required. Ability for the sending application to create is required. Ability for sending application to Used to carry a note related to the parent OBX segment. Used to give important information related to an immunization (RXA). Used to give information about a group of one or more RXA. Page 9 of 71 Updated: September 2016

11 Segment (Name) PID PV1 QAK Definition the patient. In immunization messages, this is information about the need to protect the client s information and how they should be part of reminder efforts and their current status in the IIS. Patient Identifier Segment. The PID segment contains patient identifying and demographic information that, for the most part, is not likely to change. Used by all applications as the primary means of communicating patient identification information frequently. Patient Visit Segment. The PV1 segment contains information related to a specific visit. Query Acknowledgement Segment. The QAK segment contains information sent with responses to a query. Message VXU, RSP Note conformant systems. Ability to create and process is required for conformant systems. create is required. Ability for sending application to create is required. VXU, RSP Optional Optional. will not process this information. RSP Ability to create and process is required for conformant systems. QPD Query Parameter Definition Segment. QBP, RSP Ability to create and process is required for Ability for sending application to process is required for a bi directional interface. Ability for sending application to Previously used to carry funding program eligibility status. HL requires using OBX for this purpose. Page 10 of 71 Updated: September 2016

12 Segment (Name) Definition Message Note conformant systems. RCP Response Control Parameter Segment QBP Ability to create and process is required for conformant systems. RXA Pharmacy/Treatment Administration Segment VXU, RSP Ability to create and process is required for conformant systems. RXR Pharmacy/Treatment Route Segment VXU, RSP Ability to create and process is required for conformant systems. create is required for a bi directional interface. Ability for sending application to process is required for a bi directional interface. Ability for sending application to create is required. Ability for sending application to create is required. Page 11 of 71 Updated: September 2016

13 BHS Batch Header Segment Table 5 2 Batch Header Segment (BHS) SEQ IG 1 Batch Field Separator ST [1..1] [1..1] R R The BHS.1 field shall be 2 Batch Encoding Characters ST [1..1] [1..1] R R The BHS.2 field shall be ^~\& 3 Batch Sending Application HD [0..1] [0..1] O X does not support; if sent it will be 4 Batch Sending Facility HD [0..1] [0..1] O X does not support; if sent it will be 5 Batch Receiving Application HD [0..1] [0..1] O X does not support; if sent it will be 6 Batch Receiving Facility HD [0..1] [0..1] O X does not support; if sent it will be 7 Batch Creation Date/Time TS [0..1] [0..1] O X does not support; if sent it will be 8 Batch Security ST [0..1] [0..1] O X does not support; if sent it will be 9 Batch Name/ID/ ST [0..1] [0..1] O X does not support; if sent it will be 10 Batch Comment ST [0..1] [0..1] O X does not support; if sent it will be 11 Batch Control ID ST [0..1] [0..1] O X does not support; if sent it will be 12 Reference Batch Control ID ST [0..1] [0..1] O X does not support; if sent it will be Page 12 of 71 Updated: September 2016

14 BHS Field Definitions BHS 1 Batch Field Separator (ST) Definition: This field contains the separator between the segment ID and the first real field, BHS 2 batch encoding characters. The required value is,(ascii 124). Note that this field is different from other fields and immediately follows the Segment name code. BHS 2 Batch Encoding Characters (ST) Definition: This field contains the four characters in the following order: the component separator, repetition separator, escape characters, and subcomponent separator. The required values are ^~\& (ASCII 94, 126, 92, and 38, respectively). BTS Batch Trailer Segment Table 5 3 Batch Trailer Segment (BTS) SEQ IG 1 Batch Message Count ST [0..1] [0..1] O R Required to indicate the count of individual messages contained in the batch. 2 Batch Comment ST [0..1] [0..1] O X does not support; if sent it will be 3 Batch Totals NM [0..1] [0..1] O X does not support; if sent it will be Page 13 of 71 Updated: September 2016

15 ERR Error Segment Table 5 4 Error Segment (ERR) SEQ IG 1 Error Code and Location ELD [0..0] [0..0] X X ERR 1 is not supported for use in messages starting with HL7 version Error Location ERL [0..1] [0..1] RE RE 3 HL7 Error Code CWE 0357 [1..1] [1..1] R R 4 Severity ID 0516 [1..1] [1..1] R R 5 Application Error Code CWE [0..1] [0..1] O X 6 Application Error Parameter ST [0..1] [0..1] O X 7 Diagnostic Information TX [0..1] [0..1] O X 8 User Message TX [0..1] [0..1] O X 9 Inform Person Indicator IS [0..1] [0..1] O X 10 Override CWE [0..1] [0..1] O X 11 Override Reason Code CWE [0..1] [0..1] O X 12 Help Desk Contact Point XTN [0..1] [0..1] O X ERR field definitions: will include one or more ERR segments in an ACK message with an acknowledgement code of AE (message was processed and errors are being reported). This indicates that had an fatal internal error and will process the message when resolved. No action is required from the sending application and the message should not be resent. Page 14 of 71 Updated: September 2016

16 will include ERR segments in an ACK message with an acknowledgement code of AR (message was rejected). This indicates a violation error with the message content or format. The sending application should not resend the message unless the error is fixed. may include ERR segments in an ACK message with an acknowledgement code of AA (message was accepted without error). This indicates a warning regarding data quality. No action is required from the sending application and the message should not be resent. ERR 2 Error Location (ERL) Definition: Identifies the location in a message related to the identified error, warning or message. Each error will have an ERR, so no repeats are allowed on this field. ERR 3 HL7 Error Code (CWE) Definition: Identifies the HL7 error code. Refer to HL7 Table 0357 Message Error Condition Codes for valid values. ERR 4 Severity (ID) Definition: Identifies the severity of an application error. Refer to HL7 Table 0516 Error severity for valid values. If ERR 3 has a value of "0", ERR 4 will have a value of "I". FHS File Header Segment Table 5 5 File Header Segment (FHS) SEQ IG 1 File Field Separator ST [1..1] [1..1] R R The FHS.1 field shall be 2 File Encoding Characters ST [1..1] [1..1] R R The FHS.2 field shall be ^~\& Page 15 of 71 Updated: September 2016

17 SEQ IG 3 File Sending Application HD [0..1] [0..1] O X does not support; if sent it will be 4 File Sending Facility HD [0..1] [0..1] O X does not support; if sent it will be 5 File Receiving Application HD [0..1] [0..1] O X does not support; if sent it will be 6 File Receiving Facility HD [0..1] [0..1] O X does not support; if sent it will be 7 File Creation Date/Time TS [0..1] [0..1] O X does not support; if sent it will be 8 File Security ST [0..1] [0..1] O X does not support; if sent it will be 9 File Name/ID ST [0..1] [0..1] O X does not support; if sent it will be 10 File Header Comment ST [0..1] [0..1] O X does not support; if sent it will be 11 File Control ID ST [0..1] [0..1] O X does not support; if sent it will be 12 Reference File Control ID ST [0..1] [0..1] O X does not support; if sent it will be FHS Field Definitions FHS 1 File Field Separator (ST) Definition: This field has the same definition as the corresponding field in the MSH segment. The value shall be. FHS 2 File Encoding Characters (ST) Page 16 of 71 Updated: September 2016

18 Definition: This field has the same definition as the corresponding field in the MSH segment. The value shall be ^~\& FTS File Trailer Segment Table 5 6 File Trailer Segment (FTS) SEQ IG 1 File Batch Count NM [0..1] [0..1] O O Required to indicate the number of batches contained in the file if FHS is used. 2 File Trailer Comment ST [0..1] [0..1] O X does not support; if sent it will be MSA Message Acknowledgement Segment Table 5 7 Message Acknowledgement Segment (MSA) SEQ IG 1 Acknowledgment Code ID 0008 [1..1] [1..1] R R will value this field with AA indicating that the message was received. Note: AA does not indicate that the message was successfully processed into. 2 Message Control ID ST [1..1] [1..1] R R 3 Text Message ST [0..0] [0..0] X X does not support; if sent it will be Page 17 of 71 Updated: September 2016

19 SEQ 4 Expected Sequence Number 5 Delayed Acknowledgment IG NM [0..1] [0..1] O X does not support; if sent it will be [0..1] [0..1] O X does not support; if sent it will be 6 Error Condition CE [0..0] [0..0] X X does not support; if sent it will be MSA Field Definitions MSA 1 Acknowledgment Code (ID) Definition: This field contains an acknowledgment code. See message processing rules. Refer to HL7 Table 0008 Acknowledgment code for valid values. will value this field with AA indicating that the message was received. Note: AA does not indicate that the message was successfully processed into. MSA 2 Message Control ID (ST) Definition: This field contains the Message Control ID (MSH 10) of the message sent by the sending system. It allows the sending system to associate this response with the message for which it is intended. This field echoes the message control id sent in MSH 10 by the initiating system. MSH Message Header Segment Table 5 8 Message Header Segment (MSH) SEQ IG 1 Field Separator ST [1..1] [1..1] R R This field shall be Page 18 of 71 Updated: September 2016

20 SEQ IG 2 Encoding Characters ST [1..1] [1..1] R R This field shall be ^~\& 3 Sending Application HD 0361 [0..1] [0..1] RE R The sending application shall value this element with a assigned code (that identifies the EHR system). In a QBP response, shall value this element with. 4 Sending Facility HD 0362 [0..1] [0..1] RE R The sending application shall value this element with the assigned code of the Provider Location code. In a QBP response, shall value this element with UT Receiving Application HD 0361 [0..1] [0..1] RE R The sending application shall value this element with a assigned code (that is an interface identifier). Page 19 of 71 Updated: September 2016

21 SEQ IG 6 Receiving Facility HD 0362 [0..1] [0..1] RE R The sending application shall value this element with UT0000. In a QBP response, shall value this element with the value that was provided in the MSH 4.1 of the corresponding VXU or QBP messages. 7 Date/Time Of Message TS [1..1] [1..1] R R The sending application shall value this element with the date/time the message was created. This will be used for logging. 8 Security ST [0..1] [0..1] O X does not support; if sent it will be 9 Message MSG 0076 [1..1] [1..1] R R Page 20 of 71 Updated: September 2016

22 SEQ IG 10 Message Control ID ST [1..1] [1..1] R R The sending application shall value this element with a unique message identifier. See below for recommended format. In a QBP response, shall value this element with the MSH 10 provided in the corresponding VXU or QPB messages. 11 Processing ID PT 0103 [1..1] [1..1] R R When in Production, the sending application shall value this element with P. 12 Version ID VID [1..1] [1..1] R R The sending application shall send in this element. 13 Sequence Number NM [0..1] [0..1] O X does not support; if sent it will be 14 Continuation Pointer ST [0..1] [0..1] O X does not support; if sent it will be 15 Accept Acknowledgment 16 Application Acknowledgment ID 0155 [0..1] [0..1] RE RE ID 0155 [0..1] [0..1] RE RE 17 Country Code ID 0399 [0..1] [0..1] O O Page 21 of 71 Updated: September 2016

23 SEQ IG 18 Character Set ID [0..1] [0..1] O O expects ASCII printable values. 19 Principal Language Of Message 20 Alternate Character Set Handling Scheme CE [0..1] [0..1] O X does not support; if sent it will be ID [0..1] [0..1] O X does not support; if sent it will be 21 Message Profile Identifier EI [0..*] [0..*] C C MSH Field Definitions MSH 1 Field Separator (ST) Definition: This field contains the separator between the segment ID and the first real field, MSH 2 encoding characters. Required value is, (ASCII 124). MSH 2 Encoding Characters (ST) Definition: This field contains the four characters in the following order: the component separator, repetition separator, escape character, and subcomponent separator. Required values are ^~\& (ASCII 94, 126, 92, and 38, respectively). MSH 3 Sending Application (HD) Definition: This field contains the assigned code that represents the EHR system. In a QBP response, shall value this element with. MSH 4 Sending Facility (HD) Definition: This field contains the assigned code of the Provider Location code. This field represents the submitter of the data contained in the message. Note: should be contacted to obtain this value for each Provider. In a QBP response, shall value this element with UT0000. Page 22 of 71 Updated: September 2016

24 MSH 5 Receiving Application (HD) Definition: This field contains the assigned code that represents an interface identifier. MSH 6 Receiving Facility (HD) Definition: This field contains UT0000. shall value this element with the value that was provided in the MSH 4.1 of the corresponding VXU or QBP messages. MSH 7 Date/Time of Message (TS) Definition: This field contains the date/time that the sending system created the message. The degree of precision should be at least to the minute. MSH 9 Message (MSG) Definition: This field contains the message type, trigger event, and the message structure ID for the message. Message structure component is required. MSH 10 Message Control ID (ST) Definition: This field contains an identifier assigned by the sending application that uniquely identifies a unique message instance. This identifier is unique within the scope of the sending facility (MSH 4), sending application (MSH 3), and the YYYYMMDD portion of message date (MSH 7). recommends the following format: YYYYMMDDTEXT9999, where TEXT relates to the application and 9999 is a sequentially generated number that is unique for the date. shall echo this ID back to the sending system in the Message acknowledgment segment (MSA). MSH 11 Processing ID (PT) Definition: This field is used to decide whether to process the message as defined in HL7 Application (level 7) Processing rules. Reference Table HL The choices are Production, Debugging and Training. In most cases, P or Production should be used. MSH 12 Version ID (VID) Page 23 of 71 Updated: September 2016

25 Definition: This field contains the identifier of the version of the HL7 messaging standard used in constructing, interpreting, and validating the message. Only the first component need be populated. MSH 15 Accept Acknowledgment (ID) Definition: Refer to HL7 Table 0155 Accept/application acknowledgment conditions for valid values. expects NE and will ignore other values. MSH 16 Application Acknowledgment (ID) Definition: expects AL and will ignore other values. MSH 17 Country Code (ID) Definition: This field contains the country of origin for the message. If this field is not valued, assumes the code is USA. Refer to HL7 Table 0399 Country code. MSH 18 Character Set (ID) Definition: expects ASCII printable and will ignore other values. NK1 Next of Kin Segment The NK1 segment contains information about the patient s next of kin. Utilizing NK1 1 set ID, multiple NK1 segments can be sent, each subsequent NK1 increments the previous set ID by 1. Therefore, if three NK1 were sent in one message, the first would have a set id of 1, the second would have 2 and the third would have 3. Table 5 9 Next of Kin Segment (NK1) SEQ IG 1 Set ID NK1 SI [1..1] [1..1] R R Sequence number. 1 for 1 st occurrence, 2 for the 2 nd occurrence, etc. supports one occurrence; Page 24 of 71 Updated: September 2016

26 SEQ IG additional occurrences will be 2 Name XPN [1..*] [1..1] R R Maximum lengths: Last name = 40 characters First name = 20 characters Middle name = 20 characters supports one occurrence of NK1 and will ignore multiple occurrences, if provided. considers the first name occurrence to be the legal name and ignores the Name code component NK Relationship CE 0063 [1..1] [1..1] R R supports three relationship codes: MTH, FTH, GRD; other types will be 4 Address XAD [0..*] [0..*] RE RE Maximum street length = 60 characters. Maximum city length = 28 characters. 5 Phone Number XTN [0..*] [0..*] RE RE 6 Business Phone Number XTN [0..*] [0..*] O X does not support; if sent it will be 7 Contact Role CE [0..1] [0..1] O X does not support; if sent it will be Page 25 of 71 Updated: September 2016

27 SEQ IG 8 Start Date DT [0..1] [0..1] O X does not support; if sent it will be 9 End Date DT [0..1] [0..1] O X does not support; if sent it will be 10 Next of Kin / Associated Parties Job Title 11 Next of Kin / Associated Parties Job Code/Class 12 Next of Kin / Associated Parties Employee Number ST [0..1] [0..1] O X does not support; if sent it will be JCC [0..1] [0..1] O X does not support; if sent it will be CX [0..1] [0..1] O X does not support; if sent it will be 13 Organization Name NK1 XON [0..1] [0..1] O X does not support; if sent it will be 14 Marital Status CE [0..1] [0..1] O X does not support; if sent it will be 15 Administrative Sex IS [0..1] [0..1] O X does not support; if sent it will be 16 Date/Time of Birth TS [0..1] [0..1] O X does not support; if sent it will be 17 Living Dependency IS [0..1] [0..1] O X does not support; if sent it will be 18 Ambulatory Status IS [0..1] [0..1] O X does not support; if sent it will be 19 Citizenship CE [0..1] [0..1] O X does not support; if sent it will be 20 Primary Language CE [0..1] [0..1] O X does not support; if sent it will be Page 26 of 71 Updated: September 2016

28 SEQ IG 21 Living Arrangement IS [0..1] [0..1] O X does not support; if sent it will be 22 Publicity Code CE [0..1] [0..1] O X does not support; if sent it will be 23 Protection Indicator ID [0..1] [0..1] O X does not support; if sent it will be 24 Student Indicator IS [0..1] [0..1] O X does not support; if sent it will be 25 Religion CE [0..1] [0..1] O X does not support; if sent it will be 26 Mother s Maiden Name XPN [0..1] [0..1] O X does not support; if sent it will be 27 Nationality CE [0..1] [0..1] O X does not support; if sent it will be 28 Ethnic Group CE 0189 [0..1] [0..1] O 0 29 Contact Reason CE [0..1] [0..1] O X does not support; if sent it will be 30 Contact Person s Name XPN [0..1] [0..1] O X does not support; if sent it will be 31 Contact Person s Telephone Number XTN [0..1] [0..1] O X does not support; if sent it will be 32 Contact Person s Address XAD [0..1] [0..1] O X does not support; if sent it will be 33 Next of Kin/Associated Party s Identifiers CX [0..1] [0..1] O X does not support; if sent it will be 34 Job Status IS [0..1] [0..1] O X does not support; if sent it Page 27 of 71 Updated: September 2016

29 SEQ IG 35 Race CE [0..1] [0..1] O X will be 36 Handicap IS [0..1] [0..1] O X does not support; if sent it will be 37 Contact Person Social Security Number ST [0..1] [0..1] O X 38 Next of Kin Birth Place ST [0..1] [0..1] O X does not support; if sent it will be 39 VIP Indicator IS [0..1] [0..1] O X does not support; if sent it will be NK1 Field Definitions NK1 1 Set ID NK1 (SI) Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment, the sequence number shall be 1 (one), for the second occurrence, the sequence number shall be 2 (two), etc. Note: supports one occurrence of the segment; additional occurrences will be NK1 2 Name (XPN) Definition: This field contains the name of the next of kin. The legal name must be sent in the first sequence. Note: does not support repetition of this field. Position Field Name Constraint 1 Family name Required. Maximum length: 40 characters. 2 Given name Optional. Maximum length: 20 characters. 3 Middle initial or name Optional. Maximum length: 20 characters. 4 Suffix Optional. Page 28 of 71 Updated: September 2016

30 5 Prefix does not support this 6 Degree does not support this 7 Name type code does not support this 8 Name representation code does not support this NK1 3 Relationship (CE) Definition: This field contains the personal relationship that the next of kin has to the patient. Refer to User defined Table 0063 Relationship for valid values. Position Field Name Constraint 1 Identifier Required. accepts the following values: MTH, FTH or GRD. Other types and the associated names, will be 2 Test does not support this 3 Name of coding system does not support this 4 Alternate identifier does not support this 5 Alternate text does not support this 6 Name of alternate coding system does not support this NK1 4 Address (XAD) Definition: Maximum street length = 60 characters. Maximum city length = 28 characters. NK1 5 Phone Number (XTN) Definition: The primary telephone number must be sent in the first sequence. NK1 28 Ethnic Group (CE) accepts the following valid values from Table H N Value Hispanic or Latino Description Not Hispanic or Latino Page 29 of 71 Updated: September 2016

31 U Unknown NK1 35 Race (CE) accepts the following values for Race Codes. Value Description American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander Black or African American White Other Race (empty field) NTE Note Segment Unknown/undetermined The NTE segment is used for sending notes and comments. It is used in relation to OBX in the VXU and RSP. Table 5 10 Note Segment (NTE) SEQ IG 1 Set ID NTE SI [0..1] [0..1] O X does not support this 2 Source of Comment ID [0..1] [0..1] O X does not support this 3 Comment FT [1..1] [1..1] R R Maximum 500 characters. 4 Comment CE [0..1] [0..1] O X does not support this Page 30 of 71 Updated: September 2016

32 NTE Field Definitions NTE 3 Comment (FT) Definition: This field contains the comment contained in the segment. Maximum length is 500 characters. OBX Observation Result Segment The observation result segment has several uses. It carries observations about the object of its parent segment. In the VXU/RSP it is associated with the RXA or immunization segment. The basic format is a question (OBX 3) and an answer (OBX 5). Table 5 11 Observation Segment (OBX) SEQ IG 1 Set ID OBX SI [1..1] [1..1] R R OBX sequence number. 1 for the 1 st occurrence, 2 for the 2 nd occurrence, etc. 2 Value ID [1..1] [1..1] R R supports CE and DT. 3 Observation Identifier CE NIP003 [1..1] [1..1] R R This value indicates the type of observation included in OBX 5. It poses the question that is answered by OBX 5. Refer to the Master Observation Table Observation Identifiers and Values below. 4 Observation Sub ID ST [1..1] [1..1] R R 5 Observation Value varies [1..1] [1..1] R R This value indicates the observation. It is the answer to the question that is posed by OBX 3. Refer to Master Observation Page 31 of 71 Updated: September 2016

33 SEQ IG Table Observation Identifiers and Values below. 6 Units CE [0..1] [0..1] C(R / X does not support this RE) 7 References Range ST [0..1] [0..1] O X does not support this 8 Abnormal Flags IS [0..1] [0..1] O X does not support this 9 Probability NM [0..1] [0..1] O X does not support this 10 Nature of Abnormal Test ID [0..1] [0..1] O X does not support this 11 Observation Result Status ID 0085 [1..1] [1..1] R X does not support this 12 Effective Date of Reference Range Values 13 User Defined Access Checks TS [0..1] [0..1] O X does not support this ST [0..1] [0..1] O X does not support this 14 Date/Time of the Observation TS [0..1] [0..1] RE RE If OBX 2 is valued DT. 15 Producer's Reference CE [0..1] [0..1] O X does not support this 16 Responsible Observer XCN [0..1] [0..1] O X does not support this 17 Observation Method CE [0..1] [0..1] C(RE/ O) X does not support this Page 32 of 71 Updated: September 2016

34 SEQ IG 18 Equipment Instance EI [0..1] [0..1] O X does not support this Identifier 19 Date/Time of the Analysis TS [0..1] [0..1] O X does not support this 20 Reserved for harmonization with V Reserved for harmonization with V Reserved for harmonization with V Performing Organization Name 24 Performing Organization Address 25 Performing Organization Medical Director [0..1] [0..1] O X does not support this [0..1] [0..1] O X does not support this [0..1] [0..1] O X does not support this XON [0..1] [0..1] O X does not support this XAD [0..1] [0..1] O X does not support this XCN [0..1] [0..1] O X does not support this OBX Field Definitions OBX 1 Set ID OBX (SI) Definition: This field contains the sequence number. The first instance shall be set to 1 and each subsequent instance shall be the next number in sequence. OBX 2 Value (ID) Definition: This field contains the format of the observation value in OBX. If the value is CE then the result must be a coded entry. Page 33 of 71 Updated: September 2016

35 Note: supports CE and DT, reflecting the uses for OBX. OBX 3 Observation Identifier (CE) Definition: This field contains a unique identifier for the observation being sent in the OBX segment. Consider that OBX 3 poses the question and OBX 5 answers it. For example, OBX 3 may indicate VIS Statement Published Date and the value in OBX 5 is the answer, the date. accepts and returns OBX for the following immunization specific information: Vaccination Contraindication Vaccination Contraindication Effective Date Vaccination Reaction Immunity Vaccine Information Statement Published Date Vaccine Information Statement Presented Date Patient Eligibility for Vaccine Funding Vaccine See the Master Observation Table below for valid values. will not process data sent for other uses. Note: The Implementation Guide used suffixes (e.g., LN to indicate linked) on the first sequence in OBX 3 to group related observations such as VIS dates for component vaccine. This is no longer acceptable. Grouping of related observations will be accomplished using Observation sub id (OBX 4). OBX 4 Observation Sub ID (ST) Definition: This field is used to relate more than one observation to the same immunization by setting the value to the same number. This field may also be used to link related components of an observation. Each component of the observation would share an Observation sub id. For example, recording VIS Published Date and VIS Presented Date for a combination vaccination requires six (6) OBX segments. One OBX would indicate the vaccine group. It would have a pair of OBX indicating the VIS publication date and the VIS receipt date. These would have the same OBX 4 value to allow them to be linked. The second set of three would have another OBX 4 value common to each of them. Page 34 of 71 Updated: September 2016

36 OBX 5 Observation Value (varies) Definition: This is the answer to the question posed in OBX 3. OBX 2 value type specifies the data type for this field. accepts and returns OBX for: Immunization Contraindications, Immunization Reactions, Vaccine Information Published Date, Vaccine Information Statement Presented Date and Immunization Funding Source. See the following Master Observation Table for valid values. Master Observation Table Observation Identifiers and Values supports the following OBX uses. If data are sent for other uses, will not process. Observation Identifier Observation Value OBX 3 Question Description OBX 3.1 OBX 5 Answer OBX 5.1 Vaccine Funding Program Vaccine Funding Program Eligibility Category (CE) HL7 codes, table 0064 VIS published date Vaccine Information Statement published date (DT) date VIS presented date Vaccine Information Statement presented date (DT) date Contraindication Vaccination Contraindication (CE) PHNVS_VaccinationContraindication_IIS Contraindication effective date (DT) date Reaction Vaccination Reaction (CE) PHVS_VaccinationReaction_IIS Immunity Disease with presumed immunity (CE) PHVS_EvidenceOfImmunity_IIS Vaccine Contraindications accepts the following values. For combination vaccines, the vaccine type the statement(s) provide information about. In the case when there are multiple vaccines that could be used, the correct choice is the "unspecified" formulation (CE) CVX Code Description HL7 Table Page 35 of 71 Updated: September 2016

37 VXC30 Allergy (anaphylactic) to proteins of rodent or neural origin PHINVS VXC17 Allergy (anaphylactic) to 2 phenoxyethanol PHINVS VXC18 Allergy to baker s yeast (anaphylactic) PHINVS Allergy to eggs (anaphylactic) SCT Gelatin allergy (disorder) SCT Neomycin allergy (disorder) SCT VXC19 Allergy to thimerosal (anaphylactic) PHINVS VXC20 Allergy to previous dose of this vaccine or to any of its unlisted components (anaphylactic) PHINVS Allergy to aluminum (disorder) SCT Latex allergy (disorder) SCT Polymyxin B allergy (disorder) SCT VXC21 Previous history of intussusception PHINVS VXC22 Encephalopathy within 7 days or previous dose of DTP or DTaP PHINVS VXC23 Current fever with moderate to severe illness PHINVS VXC24 Current acute illness, moderate to severe (with or without fever)(e.g., diarrhea, otits media, PHINVS vomiting) Chronic disease (disorder) SCT VXC25 History of Arthus hypersensitivity reaction to a tetanus containing vaccine administered < 10 years PHINVS previously VXC26 Underlying unstable, evolving neurologic disorders, (including seizure PHINVS disorders, cerebral palsy, and developmental delay) VXC27 immunodeficiency due to any cause, including HIV (hematologic and solid PHINVS tumors, congenital immunodeficiency, long term immunosuppressive therapy, including steroids) Patient currently pregnant (finding) SCT Thrombocytopenic disorder SCT History of purpura (situation) SCT Streptomycin allergy (disorder) Vaccination Reaction Page 36 of 71 Updated: September 2016

38 accepts the following values. Value Description HL7 Table Anaphylasis SCT VXC10 Collapse or shock like state within 48 hours of dose PHINVS VXC11 Convulsions (fits, seizures) within 72 hours of dose PHINVS Encephalopathy SCT VXC12 Fever of >40.5 C (105 F) within 48 hours of dose PHINVS VXC13 Guillain Barre syndrome (GBS) within 6 weeks of dose PHINVS VXC15 Intussusception within 30 days of dose PHINVS VXC9 Persistent, inconsolable crying lasting > 3 hours within 48 hours of dose PHINVS VXC14 Rash within 14 days of dose PHINVS Table 0064, Financial Class / Vaccine Funding Program accepts the following values. Code Financial Class VFC Qualified V02 VFC Medicaid Y V03 VFC Uninsured Y V04 VFC American Indian/Alaskan Native Y V05 VFC Under insured at a FQHC Y V01 Not VFC eligible N V07 VFC Local specific eligibility CHIP Y Maintained for backward compatibility with HL H01 Self Pay N H02 Medicaid N H03 Insured N V06 CHIP Y Page 37 of 71 Updated: September 2016

39 UT01 Primary Care Network (PCN) N UT04 Special Projects N OBX 14 Date/Time of the Observation (DT) Definition: Records the date of the observation. Time component is optional. ORC Order Request Segment The Common Order segment (ORC) is used to transmit fields that are common to a group of immunizations. While not all immunizations recorded in an immunization message are able to be associated with an order, each RXA must be associated with one ORC, based on HL standard. Table 5 12 Common Order Segment (ORC) SEQ IG 1 Order Control ID 0119 [1..1] [1..1] R R The value for VXU and RSP shall be RE. 2 Placer Order Number EI [0..1] [0..1] RE X does not support this 3 Filler Order Number EI [1..1] [1..1] R R Unique identifier 4 Placer Group Number EI [0..1] [0..1] O X does not support this 5 Order Status ID [0..1] [0..1] O X does not support this 6 Response Flag ID [0..1] [0..1] O X does not support this 7 Quantity/Timing TQ [0..0] [0..0] X X does not support this 8 Parent EIP [0..1] [0..1] O X does not support this Page 38 of 71 Updated: September 2016

40 SEQ IG 9 Date/Time of Transaction TS [0..1] O X does not support this 10 Entered By XCN [0..1] RE RE Name of person who entered or recorded the immunization. Maximum lengths (character) Last name = 40 First name = 20 Middle name = Verified By XCN [0..1] O X does not support this 12 Ordering Provider XCN [0..1] C(RE/ X does not support this O) 13 Enterer's Location PL [0..1] O X does not support this 14 Call Back Phone Number XTN [0..1] O X does not support this 15 Order Effective Date/Time TS [0..1] O X does not support this 16 Order Control Code Reason CE [0..1] O X does not support this 17 Entering Organization CE [0..1] O X does not support this 18 Entering Device CE [0..1] O X does not support this 19 Action By XCN [0..1] O X does not support this Page 39 of 71 Updated: September 2016

41 SEQ IG 20 Advanced Beneficiary CE [0..1] O X does not support this Notice Code 21 Ordering Facility Name XON [0..1] O X does not support this 22 Ordering Facility Address XAD [0..1] O X does not support this 23 Ordering Facility Phone XTN [0..1] O X does not support this Number 24 Ordering Provider Address XAD [0..1] O X does not support this 25 Order Status Modifier CWE [0..1] O X does not support this 26 Advanced Beneficiary Notice Override Reason CWE [0..1] O X does not support this 27 Filler's Expected Availability TS [0..1] O X does not support this Date/Time 28 Confidentiality Code CWE [0..1] O X does not support this 29 Order CWE [0..1] O X does not support this 30 Enterer Authorization Mode CNE [0..1] O X does not support this 31 Parent Universal Service Identifier CWE [0..1] O X does not support this Page 40 of 71 Updated: September 2016

42 ORC Field Definitions ORC 1 Order Control (ID) Definition: Determines the function of the order segment. The value for VXU and RSP shall be RE. ORC 3 Filler Order Number (EI) Definition: The filler order number is used to identify uniquely the order among all orders sent by a provider organization that filled the order. In the case where a historic immunization is being recorded (i.e. from an immunization card), the sending system shall assign an identifier as if it were an immunization administered by the sending provider. In the case where an RXA is conveying information about an immunization that was not given (e.g. refused) the filler order number shall be ORC 10 Entered By (XCN) Definition: This identifies the individual that entered the immunization information. PD1 Patient Demographic Segment The Patient Demographic Segment contains patient demographic information. Three primary uses for this information include: 1) indicating whether the person wants his/her data protected; and 2) whether the person wants to receive recall/reminder notices; and 3) the person s current status in the registry. Table 5 13 Patient Demographic Segment (PD1) SEQ IG 1 Living Dependency IS [0..1] O X does not support this 2 Living Arrangement IS [0..1] O X does not support this Page 41 of 71 Updated: September 2016

43 SEQ IG 3 Patient Primary Facility XON [0..1] O X does not support this 4 Patient Primary Care Provider Name & ID No. XCN [0..1] O X does not support this 5 Student Indicator IS [0..1] O X does not support this 6 Handicap IS [0..1] O X does not support this 7 Living Will Code IS [0..1] O X does not support this 8 Organ Donor Code IS [0..1] O X does not support this 9 Separate Bill ID [0..1] O X does not support this 10 Duplicate Patient CX [0..1] O X does not support this 11 Publicity Code CE 0215 [0..1] RE RE supports 01 or Protection Indicator ID 0136 [0..1] RE RE supports Y or N. 13 Protection Indicator Effective Date DT [0..1] C(RE/ X) X does not support this Page 42 of 71 Updated: September 2016

44 SEQ IG 14 Place of Worship XON [0..1] O X does not support this 15 Advance Directive Code CE [0..1] O X does not support this 16 Immunization Registry Status 17 Immunization Registry Status Effective Date 18 Publicity Code Effective Date IS 0441 [0..1] RE RE DT [0..1] C(RE/ X) DT [0..1] C(RE/ X) X X does not support this does not support this 19 Military Branch IS [0..1] O X does not support this 20 Military Rank/Grade IS [0..1] O X does not support this 21 Military Status IS [0..1] O X does not support this PD1 Field Definitions PD1 11 Publicity Code (CE) Page 43 of 71 Updated: September 2016

45 Definition: This field contains a code indicating the level of publicity allowed for the patient (e.g., No Publicity, Family Only). This refers to how a person wishes to be contacted for reminder or recall. Refer to User defined Table 0215 Publicity Code for suggested values. HL7 Table 0215, Publicity code accepts the following values. Value Description 01 No reminder/recall 02 Reminder/recall any method 03 Reminder/recall no calls 04 Reminder only any method 05 Reminder only no calls 06 Recall only any method 07 Recall only no calls 08 Reminder/recall to provider 09 Reminder to provider 10 Only reminder to provider, no recall 11 Recall to provider 12 Only recall to provider, no reminder PD1 12 Protection Indicator (ID) Definition: This field identifies whether a person s information may be shared with other providers. If protection indicator is not actively determined by the clinician, it shall be empty. Protection State Yes, protect the data. Client (or guardian) has indicated that the information shall be protected. No, it is not necessary to protect data from other clinicians. Code Y N Page 44 of 71 Updated: September 2016