HL7 Web User Interface User s Guide

Transcription

1 HL7 Web User Interface User s Guide

2 COPYRIGHT NOTICE All rights, domestic and international, are reserved by Computrition, Inc. Requests for permission to reproduce or distribute this manual should be addressed to the address below. Computrition, Inc. Product Advancement Division 8521 Fallbrook Avenue, Suite 100 West Hills, CA (800) All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior written permission of Computrition, Inc. No patent is assumed with respect to the use of the information contained herein. While every precaution has been taken in the preparation of this manual, Computrition assumes no responsibility or liability for damages resulting from the use (or misuse) of the information contained herein. Computrition is a registered trademark of Computrition, Inc.

3 Contents Product Installation... 1 System Requirements... 1 Installation... 1 Browser Compatibility... 1 Getting Started... 2 Sign In... 2 Sign Out... 3 Getting Help... 3 Status Page... 3 The Menu... 5 User Preferences... 5 Change Password... 6 Pause Streams... 7 View User Activity... 7 Manage Installations... 9 Manage Users Restart / Shut Down Installations Appendix A: HL7 Patient Information ADT Introduction Procedure Communications Sequence Numbers Site Preparation / Setup Other Considerations Data Specifications Transaction Type: ADT Segment Ordering Section A Section B Section C Appendix B: HL7 Dietary Orders Introduction Prerequisites Procedure Communications Data Specifications Field Descriptions Components:<HL7 timestamp> Sample Message Cancel Messages i

4 Product Installation System Requirements The following VMWare virtualization options are suitable for running the HL7WebUI service on the same server as the HL7 Interface service: Red Hat Enterprise Linux (RHEL) 7 or CentOS 7 Minimal install with Security Tools Security Profile: DISA STIG for CentOS7 V1R1. One administrative user. Two (2) CPUs. 40 GB Disk space 6 GB RAM SELinux running in enforced, targeted mode. Installation Please refer to the HL7WebUI-Deployment document provided separately. Browser Compatibility The HL7 Web User Interface is compatible with the latest versions of the browsers below: Chrome Safari Firefox Internet Explorer/Edge 1

5 Getting Started Sign In Navigate to the URL provided by the IT department or your Computrition Technical Support Team member. You should be presented with the following page: Select Sign In to navigate to the sign in page. An initial administrative username and password are generated during the installation process. Your IT department or your Computrition Technical Support Team member will provide you with these credentials to sign in for the first time. For users other than the initial administrative user, your username and password will be assigned by the HL7 Interface administrator. 2

6 Sign Out From any page in the HL7 Interface Web UI, use the drop-down menu in the top-right corner of the page to find the Sign Out link. Select this link to sign out of your session. Getting Help Documentation can be accessed from the bottom of any screen by clicking on the User Documentation link. You can also quickly navigate to the Computrition website by selecting the Computrition Home Page link at the bottom-right of any screen. Once there, you can navigate to our support site if you need to submit a ticket. Status Page The status page of the HL7 Web UI shows all interfaces that have been installed along with the input and output stream for each. Information is displayed in the following format by default: Configuration Status Stream Data In Stream Data Out All - Link to main page Time of last message # Received messages # Dequeued messages Installation Name Date of last message # Good messages # Sent messages Interface Status of interface # Bad messages # Warnings Streams Input or Output # Errors 3

7 The last column contains drop-down menus where you can access additional functions for each interface and/or stream. Input streams have only one option View Input Log. The input log lists all the activity of the input thread Output streams have the following options: View Output Log Lists all the activity of the output thread. Printed Error Logs Select a date, and it will take you to all the HL7 errors that were generated for that date. Error logs also contain PHI and viewing should only be visible to those with a need to know. Lookup MRN Enter a medical record number (MRN) and get a list of all HL7 messages for that MRN. Pause Stream - Allows you to pause the stream, so changes can be made to the database for the HL7 interface. Once a stream has been paused, a new option appears in the drop-down, Resume Stream o Resume Stream Select to restart the stream. Selecting the Hospitality Suite HL7 Interface banner at the top of the screen will always take you back to the main page. 4

8 The Menu The management menu for the HL7 Web UI can be accessed by selecting the down arrow at the topright corner of the screen next to your user name. Use the links in this menu to access the various HL7 management tasks. Options available in the menu depend on the level of access that has been granted to you by your administrator, so some options may not appear for all users. User Preferences All users have the option to change their own HL7 Web UI preferences. Show Stream Data - Individual users can select to show or not show the stream data. Unchecking the box will hide the Stream Data column. 5

9 Time Zone to Use - If the HL7 interface server is in a different time zone than the web server, the time display defaults to the interface server s time zone. The status display in the HL7 Web UI can display the local time zone instead. If you have your preferences set to display the local time zone, it will be displayed next to the time in the Stream Data on the Status Page. The stream, printed errors log, and MRN lookup results are always based on the interface server s time zone. Change Password Users can change their own passwords. Password must contain at least 8 characters, have at least one digit, have at least one special character (! # $ % ( ) * +, -. / [ \ ] ^ _ ` { } ~) and have at least one uppercase character. The username cannot be in the password. 6

10 Pause Streams Allows you to pause all streams at once to make larger scale maintenance. Once the changes you need to make are complete, be sure to resume all streams. View User Activity View User Activity provides visibility to all activity through the HL7 Web UI. Information shown is the Date/Time the activity occurred, the user id, the module and what activity was performed. Recent Activity shows a list of all actions taken within the HL7 Web UI for the last 30 days as in the screenshot below: 7

11 MRN Lookups shows each medical record lookup for the number of days defined by the HL7 interface configuration (contact Customer Support if you wish to change this setting). Records contain PHI viewing these should only be available to those with a need to know. The default value is 15 days: User Management shows all user management activities for the past 30 days: Recent User Sessions shows all users who have logged in and/or out for the past 30 days: Export Activity allows you to download a copy of all activity that has occurred for the past 180 days in CSV format. The Back button at the top of the page can be used at any time to return to the Select an Activity Report menu. There is also a shortcut to return to the top of the page. 8

12 Manage Installations Interface installations can be managed within the HL7 Web UI. Only administrative users should have the option to manage installations. Update Installation Allows you to update existing settings Delete Installation Allows you to delete an existing installation. Define Installation Allows you to create and define the settings for a new installation. Installations can be made inactive by unchecking the Is active checkbox. An installation is the same as one running instance of the HL7 Interface service. Interfaces are defined within the installation s configuration file. The Computrition Technical Support team will help with the initial setup of Installations and Interfaces. The port tells the Web UI how to communicate with its underlying HL7 interface. The port is often set to 8080 but does not have to be. Coordinate this setting with Computrition s Customer Support. 9

13 Each installation has two timeout settings (defined in seconds): Connection Timeout Default is 2 seconds. Log & MRN lookup timeout Default 30 seconds. These timeouts define how long the HL7 Web UI waits for a response from the backend HL7 interface. Response times that exceed the defined timeout thresholds will result in a connection timeout to the backend HL7 interface. Setting a longer timeout (up to 60 seconds) for the MRN timeout gives the backend HL7Interface time to scan through the logs to find the messages associated with the specific MRN. Manage Users User accounts can be managed using Manage Users. Managing users should only be done by HL7 Interface administrators. Choose the user ID from the drop-down list to make changes. The administrator can change any user s password using Change Password. Update User Allows the administrator to update the permissions granted to a user. Delete User Allows the administrator to delete any user account. 10

14 Define New User Allows the administrator to create a new User ID and assign permissions. User options and permissions for the new user are displayed below: Name Enter a user name for the new user. Password Enter the user s initial password, then re-enter it to confirm. The user may change it to their own after signing in to HL7 Web UI for the first time. Is Active Use the checkbox to set a user account as active or inactive. Useful when you want to disable a user s account temporarily, but not delete it completely. Check the box to mark the user as active; uncheck it to mark them as inactive. Manage Users Check the box to allow the user to manage other users using Manage users. Note: You are not able to change permissions for your own login ID. Manage Installations Check the box to grant the user access to Manage installations. View Stream Logs Check the box to grant the user access to View Input Log and View Output Log in the dropdown next to each installation. View Printed Error Logs Check the box to grant the user access to Printed Error Logs from drop-down next to OUTPUT stream only. Printed Error logs contain error information that would have printed. Error logs contain PHI and viewing should be allowed only for those with a need to know. Lookup by MRN Check the box to grant the new user access to view all transaction information for a specific MRN. Opens a new webpage where you can enter the MRN, view transaction in date/time order below. Number of days displayed is defined by the HL7 interface configuration (contact Customer Support if you wish to change that setting, the default value is 15 days. Records contain PHI and viewing should be allowed only for those with a need to know. View Activity Check the box to grant the new user access to view user activity logs. Pause & Resume Streams Check the box to grant the new user the ability to pause a stream or multiple streams and/or resume a single stream or multiple streams. Restart Installations Check the box to allow the user to restart single installations. This option appears in the main drop-down list if an installation has been selected. Shutdown Installations Check the box to grant the new user the ability to shut down all installations. Note: Installations would need to be shut down if the entire system needs to be shut down; such as during an upgrade or new EHR interface installation. Once an installation is shut down, it can only be restarted from a command line on the HL7 interface server. Once the Shutdown Installations button is selected, the Web User Interface is not accessible until the interface is restarted from the HL7 interface server. 11

15 Restart / Shut Down Installations Selecting an individual installation from the Status Page presents two new options from the menu dropdown by the username Restart (Installation Name) and Shutdown (Installation Name). Restart Installation Allows you to bounce the interface after changes have been made, or if there is a problem. The process takes approximately 10 seconds to fully resume normal operation. Shutdown Installation Completely shuts down all messages. If the installation is shut down from the Web UI, it must be restarted from the interface server. 12

16 Appendix A: HL7 Patient Information ADT Specifications Introduction This appendix describes the Computrition Hospitality Suite HL7 ADT Interface, which has been developed to assist hospital Information Systems in providing the dietary departments with up-to-date patient information. This appendix provides specifications for admits, transfers, discharges, etc., as well as optional allergy information. It has been adapted from the HL7 Patient Information ADT Interface Standard Specifications document. This appendix is not a complete definition of the HL7 standard. It describes the Computrition implementation and is intended to be used as a supplement to the HL7 2.1 standard document. References herein have been made to the Health Level Seven Version 2.1 specifications, copyrighted in 1991 by Health Level Seven, Inc Procedure 1. The HIS department extracts the data from the central hospital's information system and formats it per the HL7 message formats included in this document and in the HL7 2.1 standard document. 2. The Hospitality Suite Interface receives the formatted HL7 messages, acknowledges their receipt to the HIS sender, stores them in local safe storage for subsequent update to the Hospitality Suite Database. HIS Responsibilities It is the responsibility of the Hospital to provide any additional hardware and/or software required to enable TCP/IP communications between the hospital s interface engine and the Computrition interface. The hospital is completely responsible for the transfer of data in the specified format. Data formats must match EXACTLY as specified. Computrition Responsibilities Computrition will provide a computer system pre-configured for your hospital network, on which the Hospitality Suite HL7 interface will have been pre-loaded. In the normal course of operation, the interface will receive HL7 messages from HIS and update the patient database accordingly. Communications All data communication is via TCP/IP utilizing the Berkeley sockets mechanism. The TCP/IP connection is initiated by the HIS system (the client), with the Hospitality Suite HL7 interface monitoring the line for incoming data (the server). The purchase price of the interface does not reflect the purchase or related expenses incurred by the hospital due to the acquisition of any additional hardware and/or software required to achieve the communications goals stated in this document. This includes the installation of data communications lines, as well as the testing of their functionality, all of which is the responsibility of the hospital. The Computrition Hospitality Suite HL7 ADT interface operates as a server, listening on a pre-defined TCP/IP port for connection attempts from a remote program. Once such a connection is established, the 13

17 Hospitality Suite HL7 ADT Interface expects all HL7-encoded messages to be encapsulated within start-stop delimiters as outlined in Section C.4 of the Minimal Lower Layer Protocol as specified in the Health Level Seven Implementation Support Guide. All messages originating from the Computrition HL7 interface (Acknowledgement messages) will be encapsulated in the same way. The start of a message is delimited by a StartBlock character, 0x0B. The end of a message is delimited by an EndBlock character, 0x1C, followed by an ASCII carriage return, 0x0D. Example: <StartBlock> data--all segments comprising the message being sent <EndBlock> <Carriage Return> Note that the HL7 encoding rules require a <cr> (0x0D) character following each message segment. Sequence Numbers The Hospitality Suite HL7 ADT Interface supports a subset of the Optional Sequence Number protocol discussed in the HL7 standard. The Sequence Number protocol may be enabled on a site-specific basis, depending on customer requirements. Site Preparation / Setup It is important that each site, when planning an interface, be in contact with its Interface Coordinator at Computrition to ensure that each HL7 message type, segment, and data field usage is fully understood, that any interface options that may be required are enabled, and any customizations that may be needed for the specific customer have been clearly specified and agreed to by both parties prior to implementation. Note: The Interface Coordinator is one of a select set of developers or experienced technical support persons, all of whom are experienced in implementing the HL7 interface at customer sites. Your Interface Coordinator will be your primary contact for technical interface-related questions during the planning, installation, and testing phases, and will also be available for interface support issues, should the need arise, after implementation is completed. The Hospitality Suite HL7 interface normally attempts to process all messages it receives. If at your site you will be sending messages for patients or for events that should not result in a database update on the Hospitality Suite system, it is imperative that you work with your Interface Coordinator to ensure that you both have a clear understanding of the ramifications and any methodologies required to ensure that the Hospitality Suite Patient database does not become cluttered with unwanted data. Other Considerations The sections below briefly outline the HL7 events for which the Hospitality Suite HL7 ADT Interface will accept messages, and the segments and data fields required/expected in those messages. 14

18 Data Specifications The Hospitality Suite HL7 ADT interface is a single-direction interface. All data transfer is from the HIS to Computrition. The only messages originated by Computrition are Acknowledgement messages, confirming receipt of messages from HIS. Computrition's HL7 implementation is a subset of the HL7 standard, version 2.1, with extensions. Transaction Type: ADT The following message types will be accepted by the Hospitality Suite HL7 ADT interface: Descriptions: Type A01 A02 A03 A04 A06 A07 A08 A11 A12 A13 A17 A18 A21 A22 A31 A52 A53 A60 Description Inpatient Admission Transfer Discharge Register a Patient Transfer Outpatient to Inpatient Transfer Inpatient to Outpatient Update Patient Information Cancel Admit Cancel Transfer Cancel Discharge Patient Bed Swap Merge Patient Information Patient goes on leave Patient returns from leave Update Person Information Cancel A21 Cancel A22 Patient Allergy A04 At some sites represents an admission; at some sites needs to be ignored by the interface; at other sites other unusual requirements pertain. A06 Treated as a Patient Admission. A07 Treated as a Patient Discharge. A11 Treated as a discharge. A12 Treated as a transfer. Must contain correct, current location in PV1.3. A13 Treated as an admission. A18 Patient Medical Record Number Change. If the surviving patient does not exist prior to the merge, the interface will change the patient Medical Record number in the patient database. If the surviving patient does exist prior to the merge, no changes will be made and the patient will be added to a merge table accessible in the Hospitality Suite User Interface. 15

19 A21 Patient goes on Leave of Absence: When received, the Not Currently Admitted checkbox (on the patient s general tab) will be checked, and the date/time of processing will be placed in the Reason field. A22 Patient returns from Leave of Absence: The Not Currently Admitted checkbox is cleared, and the Reason field is cleared. A31 Person Update: Hospitality Suite Stores data about patients, not persons (in the same sense that the HL7 standard document uses the word person ), but with that limitation A31 is equivalent to A08. A52 Cancels the effect of A21, i.e., equivalent to A22. A53 Cancels the effect of A52, i.e., equivalent to A21. After processing an A53, the Reason field contains the timestamp for the moment the A53 was processed, not the time of the original A21. A60 Assign/Delete allergy for active patients only. NOTE: Allergies may be communicated via AL1 segments in most ADT messages instead of A60 messages, if desired. Segment Ordering See Section C for the default HL7 grammar (segment ordering). Messages will each consist of the following segments: Message Segment Description A01 (Inpatient Admission) A02 (Transfer) A03 (Discharge) MSH EVN PID Message Header Event Type (optional) NK1 Next of Kin PV1 Patient I.D. Information Patient Visit (optional) PV2 Patient Visit (supp.) (optional) OBX See Section B (optional) AL1 Patient Allergy (optional) DG1 Patient Diagnosis (optional) Z01 See Section A (optional) Z02 See Section A MSH EVN PID PV1 MSH EVN Message Header Event Type Patient I.D. Information Patient Visit Message Header Event Type 16

20 Message Segment Description A03 (Discharge) cont. PID Patient I.D. Information A04 (Patient Registration) A06 (Transfer Outpatient to Inpatient) A07 (Transfer Inpatient to Outpatient) A08 (Update Patient Information) PV1 MSH EVN PID Patient Visit Message Header Event Type (optional) NK1 Next of Kin PV1 Patient I.D. Information Patient Visit (optional) PV2 Patient Visit (supp) (optional) OBX See Section B (optional) AL1 Patient Allergy (optional) DG1 Patient Diagnosis MSH EVN PID PV1 Message Header Event Type Patient I.D. Information Patient Visit (optional) PV2 Patient Visit (supp) (optional) OBX See Section B (optional) AL1 Patient Allergy MSH EVN PID PV1 Message Header Event Type Patient I.D. Information Patient Visit A31 (Update Person Information) MSH Message Header EVN PID Event Type (optional) NK1 Next of Kin PV1 Patient I.D. Information Patient Visit (optional) PV2 Patient Visit (supp) (optional) OBX See Section B (optional) AL1 Patient Allergy (optional) DG1 Patient Diagnosis 17

21 Message Segment Description (optional) Z01 See Section A (optional) Z02 See Section A A11 (Cancel Admit) MSH Message Header EVN Event Type PID Patient I.D. Information PV1 Patient Visit (optional) AL1 Patient Allergy (optional) DG1 Patient Diagnosis A12 (Cancel Transfer) MSH Message Header EVN Event Type PID Patient I.D. Information PV1 Patient Visit (optional) DG1 Patient Diagnosis A13 (Cancel Discharge) MSH Message Header EVN Event Type PID Patient I.D. Information PV1 Patient Visit (optional) OBX See Section B (optional) AL1 Patient Allergy (optional) DG1 Patient Diagnosis A17 (Patient Swap) MSH Message Header EVN Event Type PID Patient I.D. Information PV1 Patient Visit PID Patient I.D. Information A18 (Merge Patient Information) MSH Message Header EVN Event Type PID Patient I.D. Information MRG Merge Information (optional) PV1 Patient Visit A21 (Patient on Leave) MSH Message Header 18

22 Message Segment Description A21 (Patient on Leave) cont. EVN Event Type PID Patient I.D. Information PV1 Patient Visit A22 (Patient returns from Leave) MSH Message Header EVN Event Type PID Patient I.D. Information PV1 Patient Visit A52 (cancel A21) MSH Message Header EVN Event Type PID Patient I.D. Information PV1 Patient Visit A53 (Cancel A22) MSH Message Header EVN Event Type PID Patient I.D. Information PV1 Patient Visit A60 (Patient Allergy) HS 17.7 or later MSH EVN PID PV1 IAM Message Header Event Type Patient I.D. Information Patient Visit Adverse Reaction Information The A60 message is defined by the HL7 standard as a person update, not a patient update. The difference is that a person is not necessarily a patient. Hospitality Suite is interested in knowing about only those persons who require feeding (i.e., patients), so therefore A60 messages are processed somewhat differently than other messages. A60 is processed only if the patient is currently admitted. If not currently admitted the message is silently skipped. 19

23 The following is a listing of those data fields that are significant to the Hospitality Suite system. Not all required fields (i.e., those identified by the HL7 standard document as required) are mentioned in this table. See the HL7 2.1 standard document for details on other fields. Segment Field Element Name Format Max Length Data Type MSH (Message Header) REQUIRED 1 Field Separator See HL7 Standard (version 2.1) 1 2 Encoding Characters See HL7 Standard (version 2.1) Fields not specified here are as specified in the HL7 version 2.1 standard document. 6 Receiving Facility (Note 6) Text string 30 ST 9 Message Type (Note 5) Message Type^Trigger Event Code 7 ID 18.1 Character Encoding (Note 11) ST EVN (Event Type) Fields are as specified in the HL7 version 2.1 standard document. PID (Patient I.D.) REQUIRED 6,3,2 (Note 7) TS REQUIRED 3 Medical Record Number Alphanumeric 20 CK (Note 1) 5 Patient Name Last^first^middle ^^Title 20^15^15^ ^20 PN 7 Date of Birth YYYYMMDD 8 DT 8 Sex M/F 1 ID (Note 8) 20

24 Segment Field Element Name Format Max Length Data Type PID (Patient I.D.) cont. 15 Primary Language Alphanumeric 20 ST 17 Religion Alphanumeric 20 ID 18 Patient ID (Note 1) Alpha/Numeric/P unct 20 CK NK1 (Next of Kin) OPTIONAL All fields are unused. This segment is required according to the HL7 2.1 standard document. MRG (Merge) OPTIONAL 1 Prior Patient s Medical Record Number 3 Prior Patient s Patient ID Alphanumeric 20 CK Alphanumeric 20 CK PV1 (Patient Visit) REQUIRED 2 Patient Class alpha 1 ID 3 Patient location (Note 2) 7 Attending physician (Note 3) Nurse^room^bed 32 ID 18 Patient Type alphanumeric 3 ID 44 Admit date/time (Note 4) 45 Discharge date/time (Note 4) YYYYMMDDHHM MSS YYYYMMDDHHM MSS 19 TS 19 TS 21

25 Segment Field Element Name Format Max Length Data Type PV2 (Patient Visit Supplemental) OPTIONAL 3 Reason for Admission alpha 180 ST Field 3, component 2 (Note 10) 19 Retention Indicator (Note 12) alpha 1 ID 40 Acuity Alphanumeric 20 ST AL1 (Allergy) OPTIONAL/Repeating 2.1 Allergy Type Alphanumeric 250 CE (Note 13) 3 Allergy identifier (Note 9) Flag^allergy code 1^60 CE IAM (Allergy) OPTIONAL/Repeating 2.1 Allergy Type Alphanumeric 250 CE (Note 13) 3.1 Allergy identifier Allergy Identifier 60 CE 6.1 Add/Delete flag alpha 1 CE (Note 14) DG1 (Patient Diagnosis) OPTIONAL 3 Diagnosis Code Alphanumeric 20 CE Items marked (in the table above) with the double-dagger symbol are table-driven in Hospitality Suite. Therefore, the value provided must match the External ID field of an entry in the appropriate Hospitality Suite table. These table values are created by each site to suit their specific needs, so it is important that the IS and Dietary departments have their communications channels open. NOTE that all External ID values are case sensitive. 22

26 Notes: 1. Check-digit fields are ignored by the Hospitality Suite HL7 interface. Hospitality Suite identifies patients only by Medical Record Number (PID.3.1). Optionally, the interface can be configured to use Patient ID (PID.18) as a secondary match. In that case, both Medical Record Number AND Patient ID are required to match before a message will cause a database update. 2. The Patient Location field is filled in with three components consisting of nursing unit, room, and bed. These three items will be concatenated (with all embedded spaces stripped) and used as a location key. This key must match exactly one of the External ID entries in the Room Location table in Hospitality Suite. The length shown above does not include any component separators (because they are not part of the data.) While Hospitality Suite does not require a patient to have a location assigned, once a location has been assigned it is not possible to revert to an unassigned location. 3. The Physician field consists of several components. The first is a doctor code, which is not used by Computrition. Remaining fields are the components of the physician's name in the order of last, first, middle, title/jr./etc. 4. Computrition accepts dates as a 14-digit string, in the form: YYYYMMDDHHMMSS. Timestamps longer than 14 characters are truncated to a length of This field must be two components. For example, a Patient Admit message would contain: ADT^A01 (where the ^ character represents an HL7 component separator ). 6. MSH.6 is used in interface configurations that split one input stream to cause updates to two or more database schemas. The MSH.6 value must be unique to each schema. Configurations that do not split an input stream do not require MSH The EVN fields 6, 3, 2 are examined in that order looking for a valid HL7 timestamp. The first one found containing such a timestamp is used as the event time passed through to the database. If no valid timestamp is found in any of these three fields, a timestamp based on the current system time is constructed. The resulting timestamp may be used in lieu of admit or discharge timestamps, if the message is an admit or discharge message and if it did not contain a suitable value in the correct field of PV1. 8. Must be either M or F. Any other value is ignored and the patient s data remains unchanged. 9. AL1.3 component 1 is a flag valued with either A or C. If A this allergy will be added to the patient s allergy list. If C this allergy will be removed from the patient s allergy list. If neither A nor C, A will be assumed. AL1.3 component 2 is an alphanumeric string identifying the specific allergy desired, and it must match an External ID in the Hospitality Suite LDA table. 10. Reason for Admission (PV2, field 3, component 2) is a free-text field. It is stored in the HS database as received. Each new instance replaces any previous value. There is no saved history. NOTE that this is not a diagnosis, it is a reason for admission. For diagnoses, see DG MSH.18.1, if valued, should contain the identifier of the character set used for certain text fields. If the HL7 interface finds a supported character set identifier there, it will convert certain fields from the message into an appropriate character set for storage in the Computrition database. Fields converted are: PV2.3 (Reason for Admission), PID.5.1, PID.5.2, PID.5.3 (patient name), ODT.3 (special service comment), ODS.4 (diet comment). 12. PV2.19, Retention Indicator may be used in Hospitality Suite to mark a patient as retained. When marked as retained the patient s records will not be purged by the purge discharged 23

27 patients process, and some of the retained information will be available for re-use upon readmission. Permissible values are Y or N, where Y causes the retained indicator to be set. This feature should be used with restraint retaining every patient simply clutters up the database and causes it to grow to unreasonable size. 13. Allergy type can be used by the HL7 interface to block certain types of allergies from being stored in the database. Default behavior is to pass through all allergy types. To allow only certain allergy types to be passed through to the database you will need to let your Interface Specialist know which types you want so that the interface can be configured appropriately. 14. IAM.6.1 is a flag indicating whether this segment assigns an allergy to the patient, or removes the assignment from the patient s records. HL7 requires a value of A to add the assignment, or D to remove the assignment. If this flag is anything other than A or D, the allergy will not be processed, but will be silently skipped. Section A The Computrition Hospitality Suite HL7 Interface understands the following Z-segments. Segment Field Element Name Format Max Length Data Type Z01 (Patient height, weight) OPTIONAL (note 1) 1 height NNN 3 NM (note 2) 2.1 Current weight NNNNN 5 NM (note 5) 2.2 Current weight observation date/time HL7 Timestamp 14 TS (note 2) 9 Normal weight NNNNN 5 NM Notes: 1. Height is in the form of three digits, the first being feet, and the last two being inches. Example: 5 feet eleven inches would be Weight is pounds/ounces; rightmost two digits are always ounces. For example, would be ten pounds seven ounces. Values should be zero-padded on the left to a width of five digits. Z is always stored in Hospitality Suite as the "Current Weight". Z01.9 is always stored in Hospitality Suite as Normal Weight. 24

28 5. If observation date/time is not provided, the interface will assign its own current system date/time to this field. Observation date/time applies only to the Current Weight and is not required for other fields. Best results will occur when the Observation date/time sent to Computrition is the actual date/time the measurement was taken. For every message containing Z01 with a value in Current Weight, if either the weight or the date/time is not the same as the value stored in Hospitality Suite, a new entry is added to the weight history. Therefore, the date/time given should be the actual time the measurement was taken and not the time the message was sent, to avoid adding many redundant entries to the patient weight history. Segment Field Element Name Format Max Length Data Type Z02 (Patient height, weight) (note 1) 1 Height (inches or centimeters) OPTIONAL NNN 3 NM (note 2) 2.1 Current Weight (pounds or kilograms) NNN 6 NM (note 5) 2.2 Current weight observation date/time HL7 Timestamp 14 TS NOTES: (note 4) 4 Metric flag M or E 1 ID (note 2) 5 Normal weight NNN 6 NM 1. Height is in the form of three digits, either inches or centimeters. Z02.4 defines whether metric or English units. Example: 6 feet would be: Weight is pounds or kilograms. See Z02.4. Z is always stored in Hospitality Suite as the Current Weight. Z02.5 is stored in Hospitality Suite as Normal Weight. Example: / 4 lb. would be transmitted as: Flag which defines whether the height and weight (Z02.1, Z02.2 and Z02.5) are in English or metric units. If this field contains an M the height and weight are assumed to be centimeters and kilograms, respectively. Otherwise inches and pounds are assumed. 5. If observation date/time is not provided, the interface will assign its own current system date/time to this field. Observation date/time applies only to the Current Weight and is not required for other fields. 6. Also see the 2 nd paragraph of note 5 in the Z01 discussion above. 25

29 Section B The Computrition Hospitality Suite HL7 Interface provides limited support for OBX segments in certain message types (see tables above), supporting the transmission of patient height and weight information only. The table below describes the fields that are used and the data types/field content that are supported. Segment Field Element Name Format Max Length Data Type OBX OPTIONAL 2 Data Type ST or FT 3 ST (Note 1) 3 Data Identifier ST (Note 2) 3.1 Code ST or FT (Note 3) 3.3 Name of Coding System ST (Note 4) 5 Value ST (Note 5) 6 Value type ST (Note 6) 14 Observation Timestamp 14 TS Notes: 1. OBX field 3 Components 1 and 3 are meaningful. See notes 2 and 3 below. 2. The identifier from the specified coding system that identifies the value being transmitted by this OBX segment. E.g., , which in AS4 represents weight. As of the time of this writing, the following values are supported: Code Coding System Meaning AS4 Height AS4 Weight (See note 7) LOINC Height LOINC Current Weight (See note 7) LOINC Normal Weight (See note 7) 26

30 3. The name (Identifier) of the coding system in use. E.g., AS4 for the AS4 coding system, or LN for LOINC. Note that AS4 and LN are the only supported coding systems in this implementation. 4. The value being passed. E.g., if using AS4 with a code of , you could pass (which if OBX.6 contains lb would represent a patient weight of pounds), or 5.6 (which with an OBX.6 of ft represents 5 feet 6 inches). 5. The type of the data in OBX.5. E.g., could be lb (pounds), oz (ounces), kg (kilograms), gm (grams), in (inches), cm (centimeters), ft (feet). NOTE: Within a single HL7 message all values must be of the same measurement system, either all metric, or all English. 6. An optional timestamp, which represents the date and time when the observation, specifically the weight (AS4) or current weight (LOINC), was made. This is used only if the OBX represents the patient s current weight. Note that if this field is not valued the HL7 interface will make up an observation time based on its current system clock. The observation time is stored in Hospitality Suite in the patient s weight history portion of the screening tab. Computrition recommends that you include the actual timestamp of the time the measurement was taken in your messages, otherwise each time a current weight is received, the current time will be applied as the observation timestamp, causing many entries in the patient weight history for what may in fact have been a single observation that was transmitted multiple times. 7. Normal Weight is stored once in HS. Subsequent values will replace prior ones. Current Weight is kept as a timestamped history of weights. Each Current Weight value transmitted will be added to the weight history, along with its timestamp. (see note 6) Examples: OBX 0001 ST ^WEIGHT^AS LB OBX 0002 ST ^HEIGHT^AS4 60 IN OBX 0001 ST ^WEIGHT^AS4 50 KG OBX 0002 ST ^HEIGHT^AS4 182 CM OBX 0001 ST ^NORMAL WEIGHT^LN 1795 OZ OBX 0002 ST ^HEIGHT^AS4 5.1 FT OBX 0003 ST ^CURRENT WEIGHT^LN 1195 OZ

31 Section C The following tables show the segment ordering (and repetition indicators) for the ADT messages described in this document. Note that this is the default setting of the HL7 ADT Interface, and that it is possible to customize for specialized customer needs. Symbols Meaning [ and ] Optional. Occurs either zero TIMES, or once. { and } Required, optionally repeating. Occurs one or more times. < and > Optional. Occurs zero or more times. ( and ) Occurs exactly once. Type Grammar A01 MSH EVN PID <NK1> PV1 [PV2] <AL1> <OBX> <DG1> [Z01] [Z02] A02 MSH EVN PID <NK1> PV1 [PV2] <AL1> <OBX> [Z01] [Z02] A03 Same as A02 A04 Same as A01 A06 Same as A02 A07 Same as A02 A08 Same as A01 A11 MSH EVN PID PV1 [PV2] <DG1> [Z02] A12 Same as A11 A13 Same as A11 A17 MSH EVN { PID PV1 [PV2] } A18 MSH EVN PID MRG [PV1] A21 MSH EVN PID PV1 A31 Same as A08 A22 MSH EVN PID PV1 A52 MSH EVN PID PV1 A53 MSH EVN PID PV1 A60 MSH EVN PID [PV1] <IAM> 28

32 Appendix B: HL7 Dietary Orders Specifications Introduction This appendix describes the Computrition Hospitality Suite HL7 Dietary Orders Interface, which has been developed to assist hospital Information Systems in providing the dietary departments with up-to-date patient information. This appendix provides specifications for diet orders, nourishments, and special services, as well as allergies, likes and dislikes. This appendix is not a complete definition of the HL7 Diet Orders (or 2.2) standard, but describes the Computrition implementation and is intended to be used as a supplement to the HL7 2.1 and 2.2 standards. References herein have been made to the Health Level Seven Version 2.1 specifications, copyrighted in 1991 by Health Level Seven, Inc., and to the Health Level Seven Version 2.2 copyrighted in 1994 by Health Level Seven, Inc. Prerequisites In order to utilize the Hospitality Suite HL7 Dietary Orders Interface, Hospitality Suite HL7 Patient Information ADT Interface must have been previously (or in parallel) implemented. Procedure 1. The Hospital s Information System extracts the data from the central hospitals information system and formats it per the HL7 formats included in this document. 2. The Hospitality Suite Interface receives the formatted HL7 messages, ACKnowledges their receipt to the HIS sender, stores them in local safe storage, for subsequent update to the Hospitality Suite Database. Hospital Responsibilities: It is the responsibility of the Hospital to provide any additional hardware and/or software required to enable TCP/IP communications between the hospital s interface engine and the Computrition interface. The hospital is completely responsible for the transfer of data in the specified format. Data formats must match EXACTLY as specified. Computrition Responsibilities: Computrition will provide a computer system pre-configured for your hospital network, on which the Hospitality Suite HL7 interface will have been pre-loaded. In the normal course of operation, the interface will receive HL7 messages from HIS and update the patient database accordingly. (NOTE that if you already have purchased and installed the Hospitality Suite HL7 ADT interface you will already have this interface server. In that case the Diet Orders interface resides on the same system as the ADT interface, not on an additional system.) 29

33 Communications All data communication is via TCP/IP utilizing the Berkeley sockets mechanism. The TCP/IP connection is initiated by the HIS system (the client), with the Hospitality Suite HL7 Diet Orders interface monitoring the line for incoming data (the server). The purchase price of the interface does not reflect the purchase or related expenses incurred by the hospital due to the acquisition of any additional hardware and/or software required to achieve the communications goals stated in this document. This includes the installation of data communications lines, as well as the testing of their functionality, all of which is the responsibility of the hospital. The Hospitality Suite HL7 Dietary Orders Interface expects all HL7 messages to be encapsulated within start-stop delimiters as outlined in Appendix C.4 (MINIMAL LOWER LAYER PROTOCOL) in the Health Level Seven Implementation Support Guide. The start of a message is delimited by a Start Block character, 0x0B. The end of a message is delimited by an End Block character, 0x1C, followed by an ASCII carriage return, 0x0D. Example: <Start Block> Data--all segments comprising the message being sent <End Block> <Carriage Return> Note that the HL7 encoding rules require a <cr> (0x0D) character following each message segment. Data Specifications The Hospitality Suite HL7 Dietary Orders Interface is a single-direction interface. All data transfer is from the HIS to Computrition. The only messages originated by Computrition are Acknowledgement messages, confirming receipt of messages from HIS. Computrition's HL7 Dietary Orders Interface follows the HL7 standard, version 2.2, except as flagged with an asterisk (*) or otherwise noted. The grammar for an HL7 Dietary Orders Interface is as follows: ORM MSH PID AL1 PV1 ORC ODS ODT OBX Dietary Order Message Header Patient Identification Allergy (optional, repeating) Patient Visit Common Order Segment Dietary Orders, Supplements, Preferences (optional, repeating) Diet Tray Instructions (optional, repeating) Results (optional) Note:The ORM message consists of the following segments: Message Segment Description ORM (Dietary Order) 30

34 Message Segment Description MSH PID NTE AL1 ORC ODS ODT Message Header Patient I.D. Information Notes and Comments Allergy Code Order Record Dietary Orders, Supplements, and Preferences Diet Tray Instructions The following is a listing of those data fields whose data is significant to the Hospitality Suite system: Segment Field Element Name Format Max Length Data Type MSH (Message Header) Section of the HL7 2.1 Standard REQUIRED 1 Field Separator See Field Descriptions 2 Encoding Characters See Field Descriptions 3-5 Ignored 6 Receiving Facility See Field Descriptions 7,8 Ignored 9 Message Type See Field Descriptions Ignored 18 Character Set See Field Descriptions 1 ST 4 ST 227 HD 3 CM 16 ID PID (Patient I.D.) Section of the HL7 2.1 Standard REQUIRED 31

35 Segment Field Element Name Format Max Length Data Type NTE (Notes and Comments) Section of the HL7 2.2 Standard AL1 (Allergy Code) Section of the HL7 2.2 Standard 1-2 Ignored 3 Medical Record Number (External ID) 4 Ignored See Field Descriptions 5 Patient Name See Field Descriptions 6 Ignored 7 Date of Birth See Field Descriptions 8 Sex See Field Descriptions 9-14 Ignored 15 Primary Language See Field Descriptions 16 Ignored 17 Religion See Field Descriptions 18 Patient ID See Field Descriptions Ignored 1 Ignored OPTIONAL Unused OPTIONAL 2 Allergen Type Code See Field Descriptions 3 Allergy Code/Mnemonic/Descr iption 4-6 Ignored See Field Descriptions 20 CK 50 (20, 15, 15) PN 8 DT 1 ID CE CE 20 CK CE 60 CE 32

36 Note: Items marked with a dagger ( ) in this document are not currently implemented in the Hospitality Suite HL7 Interface. Some or all of them may become available in future versions of Hospitality Suite. At such time this document will be updated to reflect their availability. 33

37 Field Descriptions Field MSH.1 MSH.2 MSH.6 MSH.9 Description Field Separator As defined in of the HL7 2.2 Standard Encoding Characters As defined in of the HL7 2.2 Standard Receiving Facility Identifies the facility/database schema to which this message should be sent. (optional) See Field Descriptions. Message Type Components: <ORM>^<O01> MSH.18 Character Set See Field Descriptions PID.3 PID.5 PID.7 PID.8 PID.15 PID.17 Medical Record Number (External ID) Components: <MRN>^<ignored>^<Ignored>^<Ignored>^<Ignored> Data Descriptions: MRN Max Length 20* *Extra characters truncated PID.3.1 is a required field used to identify patient s records on the Hospitality Suite system. Computrition recommends that the Medical Record Number be used in this field. Patient Name Components: <Last Name>^<First Name>^<Middle Initial or Name>^<Ignored>^<Ignored>^<Ignored> Data Descriptions: Last Name Max Length 20 *Extra characters truncated First Name Max Length 15 *Extra characters truncated Middle Name Max Length 15 *Extra characters truncated Date of Birth Components: <YYYYMMDD>^<Ignored> Data Descriptions: Only the first 8 characters of the date field are used. Sex Data Descriptions: The Sex can contain F/M/O/U as defined in of the HL7 2.2 Standard. If O, U, or any value other than F or M, the Sex field in Hospitality Suite will be left unchanged. Primary Language Components: <language ID>^<ignored>^ A coded value matching an External ID value in Hospitality Suite s language table. Religion Components: <Religion ID>^<ignored>^ A coded value matching an External ID value in Hospitality Suite s religion table. 34

38 Field PID.18 Description Patient Account Number Components: <Patient I.D.>^<Ignored>^Ignored>^<Ignored> Data Descriptions: Patient I.D. Max Length 20 *Extra characters truncated AL1.2 Allergen Type Code Components: <Allergy Type>^<ignored>^ Commonly FA, DA, MA, etc. The interface can be configured to allow only certain values to be processed, thereby skipping undesired allergy types. The default behavior is to allow all types to be processed. This is configured at interface setup time by your interface support specialist. You must inform Computrition which allergy types you want processed if you wish to use this feature. AL1.3 Allergy Code/Mnemonic/Description Components: <Identifier>^<Allergy>^<Ignored>^<Ignored>^<Ignored>^<Ignored> Data Descriptions: Identifier Max Length 1 The Identifier indicates whether the Allergy is to be added or canceled by either a literal "A" or "C". If the field is missing, or contains other than A/C, the Allergy will be added if not already present in the patient record. Allergy Max Length 60 The Allergy field must match exactly an External ID in the user defined Likes/Dislikes/Allergies table. 35

39 ORC.1 Order Control Data Descriptions: The Order Control can contain one of the following: NW New Order CA Cancel a Previous Order DC Discontinue a Previous Order For the purposes of the Hospitality Suite interface, CA and DC are considered equivalent. Any ORC transmitted with data other than NW/CA/DC will be ignored. Notes if ODS.1 consist of "D", Diet Restriction or "C", Diet Abbreviation: On the Hospitality Suite system, diet orders consist of a set of diet restrictions. According to the HL7 2.2 standard, a diet order message must be complete, and contain all restrictions for the assigned diet order. Therefore, in order to provide a comprehensive audit trail, CA and DC transactions will be ignored if ODS.1 is of type "D". The set of restrictions transmitted in a single message results in the automated assignment of Foods (menu items), Nutrient and Exchange Guidelines (for automated menu correcting), and Nourishments. Therefore, whenever ODS.1 is of type Diet Restriction or of type Diet Abbreviation, the transaction set will trigger a diet order change, to be effective immediately upon receipt. Diet order cancellations require that the original order and the cancellation message both contain the same value in ORC.2.1 (Placer Order Number). If there is no Placer Order Number, or if there is a mismatch, cancellation will not occur. For systems running Hospitality Suite or later, refer to Appendix A for additional details regarding diet order cancelation. Starting with Hospitality Suite 18.10, the HL7 interface will only assign a diet order start event to a meal that is assigned both a start time and an External ID in the Hospitality Suite Meals Table. Meals without a start time, end time, and/or an external ID are still allowed in the Meals table, but cannot be assigned a diet order. ORC.2 Placer Order Number ORC.2.1 (field 2, component 1) is stored with the diet portion of the order message. When canceling a diet the cancellation message must contain the same Placer Order Number as did the original order. If there was no Placer Order Number in the original message, if it was not transmitted in the cancel message, or if there is a mismatch, no cancellation will occur. 36