PHIN Messaging Standard Request for Intervention
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PHIN Messaging Standard
Request for Intervention
Countermeasure Response Administration Referral
REF^I12
HL7 Version 2.5
Document Version ID: 1.07
June 15, 2005
Centers for Disease Control and Prevention
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Document Version ID: 1.06
June 15, 2005
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TABLE OF CONTENTS
1. INTRODUCTION........................................................................................................................................................................ 5
PHIN
M
ESSAGING
............................................................................................................................................................................ 5
A
UDIENCE
........................................................................................................................................................................................ 6
D
OCUMENT
S
TRUCTURE
................................................................................................................................................................... 6
C
ONTACTS
....................................................................................................................................................................................... 6
2. APPLICATION REQUIREMENTS AND DATA FLOWS............................................................................................................. 7
3. ABSTRACT MESSAGE........................................................................................................................................................... 11
4. SEGMENT AND FIELD DESCRIPTIONS................................................................................................................................ 12
S
EGMENT
A
TTRIBUTE
T
ABLE
A
BBREVIATIONS
.................................................................................................................................... 12
MSH
-
M
ESSAGE
H
EADER
S
EGMENT
............................................................................................................................................... 13
SFT
–
S
OFTWARE
S
EGMENT
........................................................................................................................................................... 16
RF1
–
R
EFERRAL INFORMATION
S
EGMENT
....................................................................................................................................... 17
PID
-
P
ATIENT
I
DENTIFICATION
S
EGMENT
.......................................................................................................................................... 18
DG1-
D
IAGNOSIS
S
EGMENT
............................................................................................................................................................ 22
AL1
-
P
ATIENT
A
LLERGY
I
NFORMATION
S
EGMENT
.............................................................................................................................. 24
OBR
-
O
BSERVATION
R
EQUEST
....................................................................................................................................................... 25
OBX
-
O
BSERVATION
/R
ESULT
S
EGMENT
.......................................................................................................................................... 28
5. DATA TYPES ........................................................................................................................................................................... 31
CE - Coded Element ................................................................................................................................................................ 31
CNN - composite ID number and name simplified ................................................................................................................... 32
CX - Extended Composite ID with Check Digit ........................................................................................................................ 32
DT - Date.................................................................................................................................................................................. 33
DTM - date/time ....................................................................................................................................................................... 33
EI - Entity Identifier................................................................................................................................................................... 33
FN - Family Name .................................................................................................................................................................... 34
HD - Hierarchic Designator ...................................................................................................................................................... 34
ID - Coded Value for HL7 Defined Tables................................................................................................................................. 34
IS - Coded Value for User-Defined Tables................................................................................................................................ 35
MSG – Message Type.............................................................................................................................................................. 35
NDL – Name with Date and Location ....................................................................................................................................... 35
NM - Numeric ........................................................................................................................................................................... 35
PT - Processing Type ............................................................................................................................................................... 36
SAD – Street Address .............................................................................................................................................................. 36
SI - Sequence ID...................................................................................................................................................................... 36
SN – Structured Numeric ......................................................................................................................................................... 37
TS - Time Stamp ...................................................................................................................................................................... 37
TX - Text Data .......................................................................................................................................................................... 37
VID – Version Identifier............................................................................................................................................................. 38
XAD - Extended Address.......................................................................................................................................................... 38
XCN - extended composite ID number and name for persons................................................................................................. 38
XON - Extended Composite Name and Identification Number for Organizations .................................................................... 39
XPN - Extended Person Name................................................................................................................................................. 39
XTN - Extended Telecommunication Number .......................................................................................................................... 40
6. USE OF OBJECT IDENTIFIERS (OIDS)................................................................................................................................. 41
S
TRUCTURE AND
U
SE AT
CDC......................................................................................................................................................... 42
OID
S FOR
W
ELL
K
NOWN
O
BJECTS
.................................................................................................................................................. 42
OID
S FOR
P
UBLIC
H
EALTH
N
AMESPACES
......................................................................................................................................... 42
OID
S FOR
V
OCABULARY
I
TEMS
........................................................................................................................................................ 43
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7. CODE SYSTEMS & VALUE SETS.......................................................................................................................................... 44
PHIN
V
OCABULARY
M
ANAGEMENT
.................................................................................................................................................. 44
8. MISCELLANEOUS .................................................................................................................................................................. 49
HL7
D
EFINITIONS
........................................................................................................................................................................... 49
B
ASIC
M
ESSAGE
C
ONSTRUCTION
R
ULES
......................................................................................................................................... 50
Encoding Rules for Sending..................................................................................................................................................... 50
Encoding Rules for Receiving .................................................................................................................................................. 51
E
XAMPLE
M
ESSAGE
........................................................................................................................................................................ 51
R
EFERENCES
................................................................................................................................................................................. 51
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Revision History
Revision Date By
Description
V1.0 4/5/05
Margaret
Marshburn Update
previous draft to correspond to updated
requirements, and implementation guide template.
V1.01
4/6/05
Mead Walker
Edit for conformance to template and requirements.
V1.01 4/8/05
Margaret
Marshburn
Update/rework
V1.02
4/11/05
Margaret Marshburn
Sent out for review to OM, CRA, PHIN Certification.
V1.03
4/15/05
Margaret Marshburn
Updated per review session today with CRA and OM
representatives.
V1.04
5/23/05
Margaret Marshburn
Updated the code references to the new PHIN-VADS
Preparedness Messaging Vocabulary. Combined the
field descriptions into the Attribute tables for each
segment. Accepted revisions per Mead Walker’s
review.
V1.05 6/6/2005
Margaret
Marshburn
Updated
per OM/CRA review and suggestions.
Added new Vocabulary references and updated the
example to include the OIDs.
Updated the References section.
Inserted the reworked Overview section.
V1.06 6/8/2005
Austin
Kreisler
Updated the Message Flow Diagram.
V1.07
6/15/05
Margaret Marshburn
Removed support for RF1-5 Referral Category after
CRA R&R session today.
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1.
Introduction
This Implementation Guide documents the use of the Health Level 7 (HL7) Version 2.5 Patient Referral
message to support standardized electronic exchange of messages from an outbreak management or
surveillance system to communicate interventions to be managed and followed up by a Countermeasures
Response and Administration application.
The specifications in this supplement are not intended as a tutorial for either HL7 or interfacing in general.
The reader is expected to have a basic understanding of interface concepts, HL7, and the reporting of
laboratory test results. This supplement is based on and conforms to the HL7 Standard, Version 2.5.
PHIN Messaging
The PHIN (Public Health Information Network) initiative is a comprehensive architecture of data and
information systems standards intended to advance the development of efficient, integrated and
interoperable public health information systems. PHIN development, along with the work of related
initiatives such as eHI (e-Health Initiative) is based on the fundamental understanding that exchange of
health-related information between healthcare providers, public health agencies, and the general public is
an essential aspect of public health surveillance and response. As a consequence, messaging – the
electronic exchange of data between computerized information systems – is a key element of the PHIN
architecture.
The development and effective management of data interchange (messaging) requires the use of generally
accepted standards. These standards become more widely used and more effective when they are
developed by a widely based, consensus process, rather than by any single organization. Furthermore,
use of industry standards is a basic tenet of the e-Government initiative which provides direction to CDC as
to other government agents. Since it is generally accepted that Health Level Seven (HL7) standards are
the prevailing industry standards for communicating clinical and laboratory data in the form of electronic
messages, CDC has chosen to work with HL7 as the primary source for interface standards.
The breadth and general applicability of the HL7 standard are advantageous to a wide variety of users but
also present challenges for specific implementations in public health and other contexts. Public health
messaging partners need to define with particularity, the data to be passed, and the circumstances under
which it is passed. In other words, it is necessary to develop message implementation guides based
around specific scenarios or use cases. These guides are necessary because they introduce the level of
specificity required in order to define verifiably compliant messages.
What is an Implementation Guide?
A public health messaging implementation guide is a document that describes:
a)
The circumstances under which messaging takes place.
b)
The data which is passed in a particular message.
c)
Additional specifications and guidance to assist in message implementation.
A wide range of use cases and partners are involved in public health messaging. Despite a multiplicity of
specific message contexts, many of the same partners are involved as message receivers and message
senders. As a result, consistency in both the form and content of message implementation guides can help
establish and maintain a common, standards-based approach to electronic messaging.
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Audience
This guide is designed to be used by analysts who need a better understanding of the contents of PHIN
messages, and by implementers working to develop PHIN compliant applications. In fact, understanding
and using the relevant implementation guide or guides is a key requirement for establishing PHIN
compliance. This flows from the fact that one key aspect of application level PHIN compliance is the ability
to send and receive messages that conform to the requirements of the appropriate implementation guide.
Document Structure
This body of this document contains the following major sections.
•
Application Requirements and Data Flows: describes the context and usage for the messaging.
•
Abstract Message: indicates the segments that comprise the message, and describes their
ordering and repetition.
•
Segment & Field Descriptions: provides details about the segments that make up the message,
and the fields that comprise the segments.
•
Datatypes: defines the datatypes that establish the format and components of fields.
•
Code Systems & Value Sets: includes the list of valid values for coded fields within the message,
and describes how vocabulary items are managed.
•
Use of Object Identifiers: defines the OIDs (object identifiers) that are used to identify a) specific
parties involved in messaging, or in providing data relevant to messaging, and b) the coding
systems and value sets that are used within the message.
•
Miscellaneous: additional material, including sample messages, that will be useful to implementers.
Contacts
For more information on this document, please contact:
PHIN Help Desk
National Center for Public Health Informatics
Phone: 1-800-532-9929 or 770-216-1299
Email:
PHINTech@cdc.gov
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2.
Application Requirements and Data Flows
This guide addresses the data requirements for specifying one of the data flows needed to fully implement
Preparedness & Outbreak Response Messaging. The diagram below outlines the different functional areas
– each of which would normally be supported by a discrete application - that need to cooperate to achieve
the goals of the preparedness messaging process. The diagram also indicates the data flows that are
required in order to support the functional area.
Figure 1: Preparedness & Outbreak Response Messaging Systems and Flows
The list below describes the functional areas, and briefly discusses the transactional information flows. All
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of these functional areas must collaborate to support the overall requirements:
Outbreak Management: OM includes the responsibility for investigating and managing outbreaks,
whether of natural or man-made origin. Outbreak management functions includes identifying individuals
who are affected – cases, referring persons in need of treatment, investigating case contacts, and reporting
on cases that have been detected.
An outbreak management system tracks cases related to an outbreak, and is generally locally deployed for
the management of that outbreak. The outbreak management system supports investigation, monitoring,
management, analysis, and reporting of a public health event or act of bioterrorism. The outbreak
management system aids in the collection and analysis of data to support identifying and containing the
outbreak.
In order to fulfill its responsibilities, an outbreak management system needs to support the following
information flows:
•
The ability to refer patients to a CRA system for management and treatment.
•
The ability to receive information on CRA patient related activities. As shown above, this
includes information on substance administrations (administration of vaccines or other
drugs), treatments (non-pharmaceutical interventions including such activities as isolation
and monitoring), follow-up activities (reviewing the efficacy of drug and other
interventions), and adverse event reports. Outbreak management systems also receive
aggregate statistical reports that summarize the countermeasures that have been
undertaken.
•
The ability to pass investigation/exposure information and outbreak general notifications
from one outbreak management system to another is needed. This function is needed
since multiple outbreak management systems can be deployed to handle an extensive
outbreak, or an outbreak that crosses jurisdictional boundaries.
•
The ability to pass case notifications to an Analysis, Visualization and Reporting (AVR)
system to support reporting and analysis. (In the diagram, the Analysis, Visualization,
and Reporting role is taken by CDC’s National Reporting system.)
•
The ability to send outbreak general notifications to an EED system in order to support
early event detection activities.
•
The ability to receive outbreak general notifications from an EED system as a trigger for
initiating outbreak response.
•
The ability to order tests to be performed by a testing laboratory as part of outbreak
investigation.
•
The ability to receive test results from a laboratory to confirm or rule out the presence of
an investigated condition.
Countermeasure Response Administration (CRA): CRA defines the system responsibilities for
managing specific actions that are taken to prepare for or respond to public health emergencies.
Countermeasures include vaccination and other types of drug prophylaxis, as well as non-drug actions
such as patient follow up activities and isolation and restriction monitoring. The recipients of the
countermeasures may include potential responders from the public and the private sector, identified
exposed individuals, and the general public.
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A countermeasure response system supports preparedness activities, or manages the response to an
outbreak by providing medications and vaccines to affected or potentially affected persons. This includes,
but is not limited to, persons referred by an OM system. It also deploys and manages other services such
as isolation and quarantine.
In order to fulfill its responsibilities, a countermeasure response administration system needs to support the
following information flows:
•
The capability to receive referrals from an outbreak management system in order to initiate
treatment for persons who have been exposed or are at risk of exposure.
•
The ability to provide the OMS system with information on substance administrations and
other treatments provided, follow activities related to persons who have received treatment,
and adverse events experienced as a result of treatment. This information is used to update
the information held by the outbreak management system.
•
The ability to, in order to support reporting and analysis, pass information on substance
administrations and other treatments provided, on follow-up activities related to persons who
have received treatment, and on adverse events experienced as a result of treatment to the
system or systems supporting Analysis, Visualization, and Reporting. It will also provide the
AVR system(s) with information on the amount of drugs and other substances that have
been formulated, and that have been dispensed to patients.
Early Event Detection (EED): EED includes the processes under which data collected by routine means is
collated and analyzed to identify patterns that detect or indicate potential outbreaks that require further
investigation. Typical data analyzed by the EED system includes patient diagnoses, hospital visit chief
complaints, orders, laboratory results and pharmacy prescriptions dispensed.
An early event detection system captures relevant transactional information that is generated in the normal
course of providing healthcare and analyses that information to detect potential cases, and to identify
potential outbreaks for investigation and management.
In order to fulfill its responsibilities, an early event detection system needs to support the following
information flows:
•
The ability to receive transactional information from external applications. For the most part,
these are applications that support healthcare functions in hospitals, doctor’s offices and
pharmacies. The EED system will receive information on patient diagnoses, chief complaints,
lab results, orders, admits discharges and transfers (ADT), and pharmacy drug sales from
these external applications. This data flow provides the EED system with data to analyze.
•
The ability, since laboratory results are a key indicator for many types of outbreak, to receive
information on lab results from clinical testing laboratories.
•
The ability to receive outbreak notifications from an OMS system.
•
The ability, as potential cases are discovered, to pass information to the relevant OMS system.
•
The ability to pass information related to possible cases to the Analysis, Visualization, and
Reporting system, in order to support reporting and analysis.
Analysis Visualization and Reporting (AVR): AVR includes those processes needed to receive reports
from systems involved in any of the other Preparedness & Outbreak Response Messaging functions, to
accumulate the data that has been received, and to make that data useful for analysis through visualization
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and other techniques. Today, CDC is developing such a system to support national requirements. It is
likely that, in the future, other such systems will be implemented.
An Analysis, Visualization, and Reporting system will pull together information from all relevant systems
involved in Preparedness & Outbreak Response Messaging. The data will be managed and stored to
support a wide range of analytic and reporting tasks.
In order to fulfill its responsibilities, an AVR system needs to support the following information flows:
•
The ability to receive information on substance administrations and other treatments provided,
information on follow-up activities related to persons who have received treatment, and
information on adverse events experienced as a result of treatment to CDC’s Analysis,
Visualization, and Reporting system. It will also receive information on the amount of drugs
and other substances that have been formulated, and that have been dispensed to patients.
•
The ability to receive case notifications from outbreak management systems.
•
The ability to receive case notifications from EED systems.
Laboratory: Laboratory processing includes the functions necessary to support testing and results
reporting for samples collected in the process of outbreak management and countermeasure response. It
also includes routine testing and reporting that takes place within the course of providing heath care and
provides important information for early event detection.
A laboratory system manages the processing required for laboratory testing and result reporting.
In order to fulfill its responsibilities, a laboratory system needs to support the following information flows:
•
The ability to receive test orders from an outbreak management or other system, and transmit
relevant lab results to that system.
•
The ability to provide relevant test results to an EED system for analysis.
•
The ability to, when further or specialized testing is needed, pass lab orders onto reference
laboratories, and receive both order confirmations and test results from those laboratories.
External Applications: An external application is one that is not directly involved in Preparedness &
Outbreak Response Messaging but, as a result of its day to day business, generates information that can
be analyzed for EED purposes.
In order to fulfill its preparedness messaging responsibilities, an external system needs to support the
following information flows:
•
The ability to provide transactional information to the EED system. This includes information on
patient diagnoses, chief complaints, lab results, orders, admits discharges and transfers (ADT),
and pharmacy drug sales.
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3.
Abstract Message
The message description below shows how the HL7 Patient Referral specification is constrained for use in
the Preparedness and Response Messaging
Segment
Patient Referral
REF^I12^REF_I12
Usage
HL7 Chapter
MSH Message
Header
Required
and will not repeat
2.15.9
SFT
Software
Required and will not repeat
2.15.17
RF1 Referral
Information
Required
11.6.1
PID
Patient Identification
Required and will not repeat
3.4.2
[{DG1}] Diagnosis
Optional
6.5.2
[{AL1}] Allergy
Information
Optional
3.4.6
[
Observation… begin
{
OBR
Observation Request
[
Results_Notes… begin
Optional and may repeat
7.4.1
{
OBX
Observation/Result
Optional and may repeat
7.4.2
}
]
Results_Notes… end
}
]
Observation...end
•
The AUT and its accompanying CTD (Authorization and Contact) segments are not supported.
•
The PRD and its accompanying CTD (Provider Data and Contact) are not supported.
•
The insurance segments, IN1, IN2 and IN3, are not supported.
•
The ACC - Accident segment is not supported.
•
The DRG – Diagnosis Related Group segment is not supported.
•
The OBR - Observation Request segment - and its accompanying NTE are not used.
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4.
Segment and Field Descriptions
This section contains descriptions of the segments used. Within each segment, the supported fields are
briefly described. For more information on segments and fields, refer to the HL7 Standard.
Segment Attribute Table Abbreviations
The abbreviated terms and their definitions used in the segment table headings are as follows:
ABBREVIATION DEFINITION
HL7 SEQ
The sequence of the elements as they are numbered in the HL7 segment.
HL7 LEN
The HL7 maximum recommended length of the element. Please note that for the
CE data type, the field length for PHIN messaging has been increased to
accommodate OIDs for coding system OIDS.
HL7 DT
The data type of the HL7 element.
HL7 OPT
HL7 standard determination of whether the field is required, optional, or
conditional in a segment.
HL7 RPT/#
Indicates if element repeats. If the number of repetitions is limited, the number of
allowed repetitions is given.
HL7 TBL#
HL7-Specific table reference.
PHIN Value Set
Pre-coordinated tables used in public health messages are accessed via the
Public Health Information Network Vocabulary Access and Distribution Services
at http://www.cdc.gov/PhinVSBrowser/StrutsController.do
HL7 Element
Name
HL7 name of element in the segment.
Description/Com
ments
PHIN context and usage for the element.
Note: Gray = The PHIN Messaging Standard does not support the use of this field.
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MSH - Message Header Segment
This segment is necessary to support the functionality described in the Control/Query chapter of the HL7
standard. MSH is used to define the intent, source, destination, and some specifics of the syntax of a
message.
HL7
Seq.
HL7
Len.
HL7
DT
HL7
Opt
HL7
RPT/#
HL7
Tbl #
PHIN
Value
Set
HL7 Element
Name
Description/Comments
1 1 ST
R
Field Separator
The character to be used as the
field separator for the rest of the
message. The supported value is |,
ASCII (124).
2 4 ST
R
Encoding
Characters
The four characters that always
appear in the same order in this
field are: |^~&|
3 227
HD O 0361
OID
Registry
Sending
Application
This field may be used to uniquely
identify the sending application for
messaging purposes. If populated,
it will contain an OID that represents
the sending application instance.
4 227
HD R 0362
OID
Registry
Sending Facility
This field uniquely identifies the
facility that sends the message.
The sending facility must be part of
the PHIN OID registry.
5 227
HD O 0361
OID
Registry
Receiving
Application
This field may be used to uniquely
identify the receiving application for
messaging purposes. If populated,
it will contain an OID that represents
the receiving application instance.
6 227
HD R 0362
OID
Registry
Receiving Facility
This field uniquely identifies the
facility that is to receive the
message. This unique identifier
must be part of the PHIN OID
registry.
7 26 TS R
Date/Time Of
Message
This field contains the date/time that
the sending system created the
message. The user values the field
only as far as needed. When a
system has only a partial date, e.g.,
month and year, but not day, the
missing values may be interpreted
as zeros. The time zone is
assumed to be that of the sender.
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HL7
Seq.
HL7
Len.
HL7
DT
HL7
Opt
HL7
RPT/#
HL7
Tbl #
PHIN
Value
Set
HL7 Element
Name
Description/Comments
8 40 ST O
Security
This field may be used by the
sender to convey whether
information contained in the
message is sharable or non-
sharable, identified, non-identified,
etc.
9 15
MSG
R
Message Type
This field contains the message
type, trigger event, and the
message structure ID for the
message. For the Adverse Event
message, the value in this field will
always be ORU^R01.
10 20 ST R
Message Control
ID
This field contains a string that
uniquely identifies the message
instance from the sending
application. Typically, this field
contains a timestamp and possibly a
counter.
11 3 PT R
Processing ID
This field may be used to indicate
the intent for processing of the
message, such as “Testing”,
“Development” or “Production”. For
this message, the field will always
contain |P|. Processing mode is
understood to be “Current” if not
explicitly sent in the message.
12 60 VID R
Version ID
This field contains the HL7 version
number that is used to interpret
format and content of the message.
For this message, the version id will
always be 2.5.
13
15
NM
O
Sequence Number Not supported
14
180
ST
O
Continuation
Pointer
Not supported
15
2
ID
O
0155
Accept
Acknowledgment
Type
Not supported
16
2
ID
O
0155
Application
Acknowledgment
Type
Not supported
17 3 ID O 0399
PHVS_C
ountry_F
IPS_10-
4
Country Code
This field may be used to indicate
country of origin of the message.
18
16
ID
O
Y
0211
Character Set
Not supported
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HL7
Seq.
HL7
Len.
HL7
DT
HL7
Opt
HL7
RPT/#
HL7
Tbl #
PHIN
Value
Set
HL7 Element
Name
Description/Comments
19
250
CE
O
Principal
Language Of
Message
Not supported
20
20
ID
O
0356
Alternate
Character Set
Handling Scheme
Not supported
21
427
EI
O
Y
Message Profile
Identifier
Not supported
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SFT – Software Segment
The software segment provides information about the software product being used as the Sending
Application in this message instance. The information will be provided for diagnostic purposes if
necessary on the part of the receiving application.
HL7
Seq.
HL7
Len.
HL7
DT
HL
7
Opt
HL7
RPT/#
HL7
Tbl #
PHIN
Value
Set
HL7 Element Name
Description/Comments
1 567
XON
R
Software
Vendor
Organization
Organization identification
information for the software vendor
that created this transaction. The
Software Vendor Organization field
allows for identification of the
vendor who is responsible for
maintaining the application.
2 15
ST
R
Software
Certified
Version or Release
Number
Software version number assigned
to the instance of the application
being used to send the message.
3 20
ST
R
Software
Product
Name
The name of the software product
that submitted the transaction. This
field is synonymous with the
application name
4 20
ST
R
Software
Binary
ID
Contains the Software Binary ID
issued by the vendor for each
unique software version instance.
Identical IDs in this field indicate
that the software is identical at the
binary level , although configuration
settings may differ.
5
1024 TX
O
Software Product
Information
Not supported.
6 26
TS
O
Software
Install
Date
The date the submitting software
was installed at the sending site.
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RF1 – Referral information Segment
This segment represents information that may be useful when sending referrals from the referring provider
to the referred-to provider.
HL7
Seq.
HL7
Len.
HL7
DT
HL7
Opt
HL7
Rpt#
HL7
Tbl#
PHIN Value
Set
HL7 ELEMENT
NAME
Description/Comments
1 250
CE
O 0283
PHVS_Refer
ralStatus_CD
C_CRA
Referral Status
This field contains the
status of the referral as
defined by referring
provider.
2 250
CE
O 0280
PHVS_Refer
ralPriority_H
L7_2x
Referral Priority
This field contains the
urgency of the referral.
3 250
CE
O 0281
PHVS_Enco
unterPurpos
e|_CDC_CR
A
Referral Type
This field indicates the
intent of the referral.
4 250
CE
O Y
0282
PHVS_Refer
ralDispositio
n_HL7_2x
Referral Disposition
This field contains the
type of response or
action that the referring
provider would like from
the referred-to provider.
5
250
CE
O
0284
Referral Category
Not supported
6 30 EI
R
Originating
Referral
Identifier
This field contains the
unique identifier
generated by the
application doing the
referral. The second
component of this EI
datatype would contain
the OID for the
assigning authority.
7 26
TS
O
Effective
Date This is the requested
date/time of the service
being referred
8
26
TS
O
Expiration Date
Not supported.
9 26
TS
O
Process
Date
This is the date/time of
referral origination.
10 250 CE O Y 0336
PHVS_Refer
ralReason_H
L7_2x
Referral Reason
This field may contain
the specific reason for
referral, if the Referral
Type and Referral
Category were not
considered reasons in
themselves. This field
contains the HL7
recommended values.
11
30
EI
O
Y
External Referral
Identifier
Not supported
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PID - Patient Identification Segment
The PID segment is used as the primary means of conveying patient identification information that is not
likely to change frequently.
HL7
Seq.
HL7
Len.
HL7
DT
HL7
Opt
HL7
RPT/#
HL7
Tbl #
PHIN Value
Set
HL7 Element
Name
Description/Comments
1
4
SI
C
Set ID - PID
This segment sequencing field
does not need to be populated
or could contain a ‘1’, but only
one patient/one PID segment
per message is supported
2
20
CX
B
Patient ID
Not supported
3 250 CX R Y
Patient
Identifier List
This field contains one or more
identifiers used by the sending
application to uniquely identify
a patient. Social security,
account number, and driver’s
license number are sent in this
field as of version 2.3.1 of the
HL7 standard.
4
20
CX
B
Y
Alternate
Patient ID -
PID
Not supported
5 250 XPN R Y PHVS_Name
Type_HL7_2x
PHVS_Degre
eLicenseCerti
ficate_HL7_2
x
Patient Name This field may contain one or
more names of the person who
is the subject of the message.
The name in the first position
is considered the primary or
legal name. Therefore, the
name type code for the first
instance is “L - Legal”. In the
absence of sending a patient
name, some other patient
identifier must be placed in this
field.
6
250
XPN
O
Y
Mother’s
Maiden Name
Not supported
7 26 TS O
Date/Time
of
Birth
This field contains the
patient’s date of birth.
8 1 IS O 0001
PHVS_Admin
istrativeSex_
HL7_2x
Administrativ
e Sex
This field indicates the patient’s
sex.
9
250
XPN
B
Y
Patient Alias
Not supported
10 250 CE O Y 0005
PHVS_Race
Category_CD
C
Race
This field contains one or more
codes that broadly refer to the
patient’s race(s).
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HL7
Seq.
HL7
Len.
HL7
DT
HL7
Opt
HL7
RPT/#
HL7
Tbl #
PHIN Value
Set
HL7 Element
Name
Description/Comments
11 250 XAD O Y PHVS_Addre
ssType_HL7_
2x
PHVS_Count
ry_FIPS_10-4
PHVS_State_
FIPS_5-2
PHVS_Count
y_FIPS_6-4
PHVS_Zipco
de_USPS
Patient
Address
This field contains the
residence address of the
patient. Multiple addresses for
the same person may be sent.
12
4
IS
B
0289
County Code
Not supported – residence
county is part of PID-11
13 250 XTN O Y PHVS_Teleco
mmunication
EquipmentTy
pe_HL7_2x
PHVS_Teleco
mmunication
UseCode_HL
7_2x
Phone
Number -
Home
This field contains a telephone
number of a residence where
the patient may be contacted.
14 250 XTN O Y PHVS_Teleco
mmunication
EquipmentTy
pe_HL7_2x
PHVS_Teleco
mmunication
UseCode_HL
7_2x
Phone
Number -
Business
This field may contain the
patient’s business telephone
number.
15 250 CE O 0296
PHVS_Langu
age_ISO_639
-2
Primary
Language
Language spoken by the
subject of the message.
16 250 CE O 0002
PHVS_Marita
lStatus_HL7_
2x
Marital Status Marital status of the subject of
the message.
17 250 CE O 0006
PHVS_Religi
on_HL7_2x
Religion
Religion of the subject of the
message
18
250
CX
O
Patient
Account
Number
Not supported
19
16
ST
B
SSN Number
- Patient
Not supported. (see PID-3
Patient Identifier list)
20
25
DLN
B
Driver's
License
Number -
Patient
Not supported. (see PID-3
Patient Identifier list)
21
250
CX
O
Y
Mother's
Identifier
Not supported
22 250 CE O Y 0189
PHVS_Ethnic
ityGroup_CD
C
Ethnic Group
This field defines the patient as
either Hispanic or Non-
hispanic.
23 250 ST O
PHVS_Count
ry_FIPS_10-4
Birth Place
Country of Birth of subject of
the message.
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HL7
Seq.
HL7
Len.
HL7
DT
HL7
Opt
HL7
RPT/#
HL7
Tbl #
PHIN Value
Set
HL7 Element
Name
Description/Comments
24
1
ID
O
0136
Multiple Birth
Indicator
Not supported.
25
2
NM
O
Birth Order
Not supported.
26 250 CE O Y 0171
PHVS_Count
ry_FIPS_10-4
Citizenship
Country of Citizenship of
subject of the message.
27
250
CE
O
0172
Veterans
Military
Status
Not supported.
28
250
CE
B
0212
Nationality
Not supported.
29 26 TS O
Patient
Death
Date and
Time
If the patient is known to be
deceased at the time of the
message, the patient death
date/time should be sent in this
field.
30 1 ID O 0136
PHVS_YesNo
_HL7_2x
Patient Death
Indicator
If the patient is known to be
deceased at the time of the
message, the patient death
indicator (Y) would be sent in
this field along with the
deceased date in PID-29
31 1 ID O 0136
PHVS_YesNo
_HL7_2x
Identity
Unknown
Indicator
This field may be populated to
indicate that the treatment
subject’s identity is unknown.
It is a relatively new HL7 field
that simply contains Y or N.
32
20
IS
O
Y
0445
Identity
Reliability
Code
Not supported.
33 26 TS O
Last
Update
Date/Time
This is the date/time of the last
demographics record update.
This field is helpful for patient
reconciliation purposes when
populated by the sending
application.
34
241
HD
O
OID Registry
Last Update
Facility
The application that last
updated the demographics
record. This information is
helpful for patient reconciliation
when populated by the sending
application. An OID should be
passed to identify the facility.
35
250
CE
C
0446
PHVS_Speci
es_CDC_CR
A
Species Code This information may be
necessary for non-human
subjects.
36
250
CE
C
0447
PHVS_Breed
_CDC_CRA
Breed Code
This information is only
relevant if PID-35 Species is
populated.
37
80
ST
O
Strain
This information may be
necessary to further define
non-human living subjects
38 250 CE O 2 0429
PHVS_Produ
ctionClass_H
L7_2x
Production
Class Code
This information may be
necessary for tracking and
identification of non-human
subjects.
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HL7
Seq.
HL7
Len.
HL7
DT
HL7
Opt
HL7
RPT/#
HL7
Tbl #
PHIN Value
Set
HL7 Element
Name
Description/Comments
39
250
CWE
O
Y
0171
Tribal
Citizenship
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DG1- Diagnosis Segment
In the context of referrals, the DG1 may be used to convey diagnoses pertinent to referral. It would be
used when OBR-31 (Reason for Study) does not provide an adequate level of detail to justify the order.
Seq.
Len.
DT
Opt Rpt#
Tbl #
PHIN Value Set
HL7 Element
Name
Comments
1
4
SI
R
Set ID - DG1
This field contains a digit
that identifies the instance
of that segment. For the
first occurrence of the
segment the sequence
number is |1|, for the
second occurrence it is |2|
, etc.
2
2
ID
(B)
R
0053
Diagnosis Coding
Method
Not Supported
3 250 CE
O 0051
PHVS_Administr
ativeDiagnosis_
CDC_ICD-9CM
Diagnosis Code -
DG1
This field contains the
diagnosis code,
description and coding
method for a single
diagnosis.
4
40
ST
B
Diagnosis
Description
Not Supported
5 26 TS O
Diagnosis
Date/Time
This field contains the
date/time that the
diagnosis was identified.
6 2 IS R
0052
PHVS_Diagnosis
Type_HL7_2x
Diagnosis Type
This field identifies the
type of diagnosis being
sent.
7
250
CE
B
0118
Major Diagnostic
Category
Not Supported
8
250
CE
B
0055
Diagnostic Related
Group
Not Supported
9
1
ID
B
0136
DRG Approval
Indicator
Not Supported
10
2
IS
B
0056
DRG Grouper
Review Code
Not Supported
11
250
CE
B
0083
Outlier Type
Not Supported
12
3
NM
B
Outlier Days
Not Supported
13
12
CP
B
Outlier Cost
Not Supported
14
4
ST
B
Grouper Version
And Type
Not Supported
15
2
ID
O
0359
Diagnosis Priority
Not Supported
16
250
XCN
O
Y
Diagnosing
Clinician
Not Supported
17
3
IS
O
0228
Diagnosis
Classification
Not Supported
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Seq.
Len.
DT
Opt Rpt#
Tbl #
PHIN Value Set
HL7 Element
Name
Comments
18
1
ID
O
0136
Confidential
Indicator
Not Supported
19
26
TS
O
Attestation
Date/Time
Not Supported
20
427
EI
C
Diagnosis
Identifier
Not Supported
21
1
ID
C
0206
Diagnosis Action
Code
Not Supported
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AL1 - Patient Allergy Information Segment
The AL1 segment may contain patient allergy information of various types, if the sending system chooses
to populate it. Each AL1 segment instance describes a single patient allergy.
HL7
Seq.
HL7
Len.
HL7
DT
HL7
Opt
HL7
RPT/
#
HL7
Tbl # PHIN Value Set
HL7 Element
Name
Description/Comments
1 4 SI R
Set ID - AL1
This field contains the
segment repeat number. For
the first occurrence of the
segment, the sequence
number is |1|, for the second
allergy occurrence is |2|, etc.
2 250 CE O 0127
PHVS_Allergen
Type_HL7_2x
Allergen Type
Code
This field indicates a general
allergy category (drug, food,
pollen, etc.).
3 250 CE R PHVS_Allergen
_CDC
Allergen Code/
Mnemonic/Descrip
tion
This field uniquely identifies a
particular allergen. The value
set table pulls from the CHI
recommendations for Allergen
codes.
4 250 CE O 0128
PHVS_AllergyS
everity_HL7_2x
Allergy Severity
Code
May indicate the general
severity of the allergy.
5 15 ST O Y
Allergy Reaction
Code
May contain a string of text
that describes the specific
allergic reaction. (The “code”
in t
