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






REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 2 of 52 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 REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 3 of 52 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 REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 4 of 52 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. REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 5 of 52 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. REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 6 of 52 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

REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 7 of 52 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 REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 8 of 52 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. REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 9 of 52 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 REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 10 of 52 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. REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 11 of 52 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. REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 12 of 52 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. REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 13 of 52 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. REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 14 of 52 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 REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 15 of 52 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 REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 16 of 52 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. REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 17 of 52 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 REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 18 of 52 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). REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 19 of 52 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. REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 20 of 52 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. REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 21 of 52 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 REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 22 of 52 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 REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 23 of 52 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 REF^I12 Referral for Intervention Messaging Standard, HL7 v2.5
Document Version ID: 1.06 June 15, 2005 24 of 52 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

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