Chapter Chair/Editor: |
Clement
J. McDonald, MD |
Chapter Chair/Editor: |
Hans
Buitendijk |
Chapter Chair/Editor: |
Gunther
Schadow |
Chapter Chair/Editor: |
Helen
Stevens |
The
Order Entry transaction set provides for the transmission of orders or
information about orders between applications that capture the order, by those
that fulfill the order, and other applications as needed. An order is a
request for material or services, usually for a specific patient. These
services include medications from the pharmacy, clinical observations (e.g.,
vitals, I&Os) from the nursing service, tests in the laboratory, food from
dietary, films from radiology, linens from housekeeping, supplies from central
supply, an order to give a medication (as opposed to delivering it to the
ward), etc.
Most orders are associated with a particular patient. However, the Standard
also allows a department to order from another ancillary department without
regard to a patient (e.g., floor stock), as well as orders originating in an
ancillary department (i.e., any application may be the placer of an order or
the filler of an order).
We refer to the person or entity who places the order as the placer. We refer
to the person or entity that carries out the order as the filler (producer in
ASTM terminology). In the case where the person or entity that carries out the
order also requests the order, this person or entity is referred to as the
filler and placer of the order. The filler may also request another
application to assign a filler or placer order number.
This chapter defines the transactions at the seventh level, i.e., the abstract
messages. Various schemes may be used to generate the actual characters that
make up the messages according to the communications environment. The HL7
Encoding Rules will be used where there is not a complete Presentation Layer.
This is described in Chapter 2, Section 2.11, "Message construction rules."
The examples included in this chapter were constructed according to the HL7
Encoding Rules.
This
chapter has been organized into five major sections, General, Diet, Supply,
Pharmacy and Vaccine. Each section contains the trigger events, message
definitions, segments and examples for the specific type of order messages.
Each section about a type of order is organized into background and overview,
message structure, and message segments (that are specific to the order class
in question). Special discussions of the use of fields, segments or messages,
and examples are included. Segments are introduced in order of occurrence in a
message. A list of allowable values for a field is included in the body of the
text, along with the field definition for easier reference.
Section 4.2 outlines the Quantity Timing (TQ) Data Type Definition as
this data type is not defined in chapter 2.
Sections 4.3 to 4.5 `General' includes the triggers and segments for
the clinical observations and diagnostic studies as well as the triggers
and message segments that are common to all of the order entry messages. Orders
for laboratory tests, bedside monitoring, diagnostic imaging,
electrocardiograms, vital signs, etc., are subsumed under this order message
set.
Sections 4.6 to 4.8 `Diet' include all of the usual diet specifications
including snacks and guest trays
Sections 4.9 to 4.11 `Supply' includes order messages for both Stock and
No-stock orders. Supply orders are different in that they often are not
patient-centered (e.g., requests to stock the ward supply room).
Sections 4.12 to 4.15 `Pharmacy / Treatment' includes all pharmacy and
treatment related order messages. These section additionally includes triggers
related to the dispensing, giving and administration of orders. In the
development of the treatment order transaction set , the focus has been on
medication treatments, but the same transaction set works well for total
parenteral nutrition (TPN). There is hope that it is also sufficient for other
kinds of treatment orders, such as those performed by the nursing service. But
it has not yet been exercised in that context and may well need further
development.
Sections 4.16 to 4.18 `Vaccine' includes triggers and segments specific
to vaccination order messages. These sections also include RXA definitions
specific to vaccination messages.
The application responding to, i.e., performing, a request for services (orders) or producing an observation. The filler can also originate requests for services (new orders), add additional services to existing orders, replace existing orders, put an order on hold, discontinue an order, release a held order, or cancel existing orders
An OBX segment defined in Chapter 7.
A request for a service from one application to a second application. The second application may in some cases be the same; i.e., an application is allowed to place orders with itself.
One of several segments that can carry order information. Examples are OBR and RXO. Future ancillary-specific segments may be defined in subsequent releases of the Standard if they become necessary.
The application or individual originating a request for services (order).
A list of associated orders coming from a single location regarding a single patient.
 It is a complex multicomponent field that can have
repeats; i.e., more than one quantity/timing specification, separated by repeat
delimiters, may appear. It is a distinct data type (see Section 2.8.41, "TQ -
timing quantity"). The components of a single quantity/timing specification
are described in Sections 4.3.1, "Quantity component (CQ)," through 4.3.12,
"Total occurrences component (NM)."
Subcomponents:
<quantity (NM) & units (CE)>
Definition: This field specifies the quantity of the service that should be
provided at each service interval. For example, if two blood cultures are to
be obtained every 4 hours, the quantity would be 2. If three units of blood
are to be typed and cross-matched, the quantity would be 3. The default value
is 1. When units are required, they can be added, specified by a subcomponent
delimiter.
Note: The component delimiter in this CQ is demoted to a subcomponent
delimiter.
Subcomponents:
<repeat pattern (IS)> & <explicit time interval (ST)>
Definition: This field determines the interval between repeated services.
The default is one time only, the first subcomponent is the repeat pattern, and
the second subcomponent is the explicit time at which pattern is to be
executed.
Note: The component delimiter in this CQ is demoted to a subcomponent
delimiter.
Definition:
The repeating frequency with which the treatment is to be administered. It is
similar to the frequency and SIG code tables used in order entry systems. The
following is preferred syntax for repeat patterns:
Value |
Description |
|---|---|
Q<integer>S |
every <integer> seconds |
Q<integer>M |
every <integer> minutes |
Q<integer>H |
every <integer> hours |
Q<integer>D |
every <integer> days |
Q<integer>W |
every <integer> weeks |
Q<integer>L |
every <integer> months (Lunar cycle) |
Q<integer>J<day#> |
repeats on a particular day of the week, from the French jour (day). If <integer> is missing, the repeat rate is assumed to be 1. Day numbers are counted from 1=Monday to 7=Sunday. So Q2J2 means every second Tuesday; Q1J6 means every Saturday. |
BID |
twice a day at institution-specified times (e.g., 9AM-4PM) |
TID |
three times a day at institution-specified times (e.g., 9AM-4PM-9PM) |
QID |
four times a day at institution-specified times (e.g., 9AM-11AM-4PM-9PM) |
xID |
"X" times per day at institution-specified times, where X is a numeral 5 or greater. E.g., 5ID=five times per day; 8ID=8 times per day |
QAM |
in the morning at institution-specified time |
QSHIFT |
during each of three eight-hour shifts at institution-specified times |
QOD |
every other day (same as Q2D) |
QHS |
every day before the hour of sleep |
QPM |
in the evening at institution-specified time |
C |
service is provided continuously between start time and stop time |
U <spec> |
for future use, where <spec> is an interval specification as defined by the UNIX cron specification. |
PRN |
given as needed |
PRNxxx |
where xxx is some frequency code (e.g., PRNQ6H); given as needed over the frequency period. |
Once |
one time only. This is also the default when this component is null. |
Meal Related Timings |
<timing>C ("cum")<meal> |
A |
Ante (before) |
P |
Post (after) |
I |
Inter (e.g., between this meal and the next, between dinner and sleep |
M |
Cibus Matutinus (breakfast) |
D |
Cibus Diurnus (lunch) |
V |
Cibus Vespertinus (dinner) |
The
first subcomponent may repeat, with repeat values separated by a space. The
repeats are interpreted as connected by logical ANDs. E.g.,
Twice per day, every other day: BID QOD
Three times per day, Monday Wednesday and Friday: TID QJ135
Because of this syntax, repeat values should never contain blanks. If a free
text frequency, such as "Twice a day, every other day" is to be sent, use the
text component (component 8).
Definition:
This field explicitly lists the actual times referenced by the code in the
first subcomponent, in the following format: HHMM,HHMM,HHMM,.... This second
subcomponent will be used to clarify the first subcomponent in cases where the
actual administration times vary within an institution. If the time of the
order spans more than a single day, this new subcomponent is only practical if
the same times of administration occur for each day of the order. If the
actual start time of the order (as given by the fourth subcomponent of the
quantity/timing field) is after the first explicit time, the first
administration is taken to be the first explicit time after the start time. In
the case where the patient moves to a location having a different set of
explicit times, the existing order may be updated with a new quantity/timing
field showing the changed explicit times.
Ex: 2nd component of quantity/timing field:
...^QID&0230,0830,1430,2030^...
Definition:
This field indicates how long the service should continue after it is started.
The default is INDEF (do indefinitely). This component is coded as follows:
S<integer> |
= |
<integer> seconds |
M<integer> |
= |
<integer> minutes |
H<integer> |
= |
<integer> hours |
D<integer> |
= |
<integer> days |
W<integer> |
= |
<integer> weeks |
L<integer> |
= |
<integer> months |
X<integer> |
= |
<integer> times at interval specified in the order. A request for 2 blood cultures Q2H X3 would imply obtaining 2 blood cultures 3 different times at 2-hour intervals for a total of 6 blood cultures. |
T<integer> |
= |
at the interval and amount stated until a total of <integer> "DOSAGE" is accumulated. Units would be assumed to be the same as in the QUANTITY field. |
INDEF |
= |
do indefinitely - also the default |
Definition:
This field may be specified by the orderer, in which case it indicates the
earliest date/time at which the services should be started. In many cases,
however, the start date/time will be implied or will be defined by other fields
in the order record (e.g., urgency - STAT). In such a case, this field will be
empty.
The filling service will often record a value in this field after receipt of
the order, however, and compute an end time on the basis of the start date/time
for the filling service's internal use.
Definition:
When filled in by the requester of the service, this field should contain the
latest date/time that the service should be performed. If it has not been
performed by the specified time, it should not be performed at all. The
requester may not always fill in this value, yet the filling service may fill
it in on the basis of the instruction it receives and the actual start time.
Regardless of the value of the end date/time, the service should be stopped at
the earliest of the date/times specified by either the duration or the end
date/time.
Definition:
This field describes the urgency of the request. The following values are
suggested (the default for Priority is R):
S |
= |
Stat |
With highest priority |
A |
= |
ASAP |
Fill after S orders |
R |
= |
Routine |
Default |
P |
= |
Preop |
|
C |
= |
Callback |
|
T |
= |
Timing critical |
A request implying that it is critical to come as close as possible to the requested time, e.g., for a trough antimicrobial level. |
PRN |
= |
As needed |
If
using the value "T" (timing critical), the degree of criticality can be
specified thus:
Format:
TS<integer> |
= |
timing critical within <integer> seconds |
TM<integer> |
= |
timing critical within <integer> minutes |
TH<integer> |
= |
timing critical within <integer> hours |
TD<integer> |
= |
timing critical within <integer> days |
TW<integer> |
= |
timing critical within <integer> weeks |
TL<integer> |
= |
timing critical within <integer> months |
For
the sequential orders specification, these values specify the time criticality
with which the predecessor order must be followed by the given order.
The priority component may repeat; separate repeating values with a space.
Definition: This is a free text field that describes the conditions under which the drug is to be given. For example, PRN pain, or to keep blood pressure below 110. The presence of text in this field should be taken to mean that human review is needed to determine the how and/or when this drug should be given.
Definition: This field is a full text version of the instruction (optional).
Definition:
This non-null component indicates that a second timing specification is to
follow using the repeat delimiter. This field can take three values as shown
in HL7 table 0472
-
TQ Conjunction ID.
Value |
Description |
|---|---|
S |
Synchronous.
Do the next specification after this one (unless otherwise constrained by the
following components: ORC-7^4-start date/time and ORC-7^5-end
date/time). |
A |
Asynchronous
|
C |
This
is an actuation time |
Definition:
There are many situations, such as the creation of an order for a group of
intravenous (IV) solutions, where the sequence of the individual intravenous
solutions (each a service in itself) needs to be specified, e.g.,
hyperalimentation with multi-vitamins in every third bottle.
There are other situations where part of the order's instructions contains a
results condition of some type, such as "PRN pain." There is currently a free
text "condition" component of ORC-7-quantity/timing which allows any
condition to be specified. However, to support a fully encoded version of
order sequencing, or results condition, we have defined in the following
paragraphs a 10th component of ORC-7-quantity/timing.
The sequencing conditions supported by this 10th component are based on the
completion of a predecessor service.
To
define a sequence condition, the 10th component of the quantity/timing field
component is divided into the subcomponents described in Figure 4-1.
Subcomponent |
Contains |
Notes |
|---|---|---|
1 |
Sequence/Results Flag |
S for sequence conditions; C for cyclical; R is reserved for possible future use. The C will be used for indicating a repeating cycle of orders; for example, individual intravenous solutions used in a cyclical sequence (a.k.a. "Alternating IVs"). This value would be compatible with linking separate orders or with having all cyclical order components in a single order. Likewise, the value would be compatible with either Parent-Child messages or a single order message to communicate the orders' sequencing |
2, 3 |
Placer
Order Number, |
Required/Optional: Contains the first two components of the placer order number: entity identifier (ST) and namespace ID (IS) (respectively). Uses two subcomponents since the placer order number is an EI data type. We have not defined sub-subcomponents in HL7. |
4, 5 |
Filler
Order Number, |
Required/Optional: Contains the first two components of the filler order number: entity identifier (ST) and namespace ID (IS) (respectively). Uses two subcomponents since the filler order number is an EI data type. We have not defined sub-subcomponents in HL7. |
6 |
Sequence Condition Value |
The acceptable condition values have the form commonly used in project planning methodologies: |
<one of "SS", "EE", "SE", or "ES"> +/- <time> |
||
The first letter stands for start (S) or end (E) of predecessor order, where the predecessor is defined by the placer or filler order number in subcomponents 1,2 or subcomponents 3,4. |
||
The second letter stands for the start (S) or end (E) of the successor order, where the successor order is the order containing this quantity/timing specification. |
||
The time specifies the interval between the predecessor and successor starts or ends (see following examples). |
||
Where
<time> is defined as: |
||
7 |
Maximum Number of Repeats |
The maximum number of repeats to be used only on cyclic groups. The total number of repeats is constrained by the end date/time of the last repeat or the end date/time of the parent, whichever is first. |
8, 9 |
Placer
Order Number, |
Required/Optional: Contains the last two components of the placer order number: universal ID (ST) and universal ID type (ID) (respectively). Uses two subcomponents since the placer order number is an EI data type. We have not defined sub-subcomponents in HL7. |
10, 11 |
Filler
Order Number, |
Required/Optional: Contains the last two components of the filler order number: universal ID (ST) and universal ID type (ID) (respectively). Uses two subcomponents since the filler order number is an EI data type. We have not defined sub-subcomponents in HL7. |
Use
notes:
Suppose the following:
The predecessor order is defined by the OE1000&OrdEnt as the placer order
number, in subcomponents 2 and 3 of component 10 of
ORC-7-quantity/timing.
The successor order, this order, has the placer order number OE1001^OrdEnt in
the ORC segment.
The following sequence condition values have the following meanings:
ES + 10M |
The finish time of OE1000&OrdEnt (predecessor) plus 10 minutes defines the start time of the successor, OE1001^OrdEnt (this order); i.e., start this order 10 minutes after the completion of its predecessor. |
SS - 10M |
The start time of the predecessor minus 10 minutes defines the start time of this order; i.e., start this order 10 minutes before its predecessor. |
For
the special case where there is a cycle of orders that must be repeated, the
first order to be executed will have a "sequence condition value" whose first
character must be an asterisk (*). The last order to be executed may have a
"sequence condition value" whose first character must be a pound sign (#).
Example:
*FS+10M |
translates to: execute this order the first time without evaluating the condition specified in the 10th component; but repeat only its execution when the specified external order's start or finish date/time has met this condition. This specification generates a repetition of the order for each iteration of the cycle. |
Note:
This requires that the ordering application be able to specify the placer order
number of the last order in the cycle in the first order's quantity/timing
specification.
To implement a cyclic group of four IV orders using the parent/child paradigm,
the parent specifies a custom group of IVs, and the following occurs:
ORC-7-quantity/timing of the second child order specifies that it
follows the first child order.
ORC-7-quantity/timing of the third child order specifies that it follows
the second child order.
ORC-7-quantity/timing of the fourth child order specifies that it
follows the third order.
To repeat the group of four child orders in a cyclic manner, the following
occurs:
ORC-7-quantity/timing of the first child order specifies that it is to
be executed once without any dependence on the completion of other orders.
Its second execution follows the completion of the fourth order. See example
in Section 4.15.2, "RXO segment field examples
This scheme allows the following to be tracked:
The status of the whole group of orders to be reported back at the level of the
parent order.
The status for each individual IV order by following the status of the
corresponding child order.
Separate Orders example:
The same group of orders can be sent as a group of four orders (without a
common parent), linked only by the data in their quantity/timing fields. In
this case, there is no convenient HL7 method of transmitting the order status
of the group as a whole without transmitting the status of each of the four
separate orders.
Cancellation/discontinuation/hold
order control events:
This logic implies the normal execution of the referenced predecessor order.
Thus a cancel (or discontinuation or hold) of a predecessor order implies the
cancellation (or discontinuation or hold) of all subsequent orders in the
chain.
If the referenced order has been canceled (or discontinued or held), the
current order inherits that same status.
In the case of hold, the removal of the hold of the predecessor implies a
removal of the hold for the given order (which can then be executed according
to the specification in the 10th component).
Subcomponents:
<identifier (ST)> & <text (ST)> & <name of coding system
(IS)> & <alternate identifier (ST)> & <alternate text
(ST)> & <name of alternate coding system>
Definition: This field contains the duration for a single performance of a
service, e.g., whirlpool twenty minutes three times per day for three days. It
is optional within TQ and does not repeat.
Note: The component delimiter in this CQ is demoted to a subcomponent
delimiter.
Definition: This field contains the total number of occurrences of a service that should result from this order. It is optional within TQ and does not repeat. If both the end date/time and the total occurrences are valued and the occurrences would extend beyond the end date/time, then the end date/time takes precedence. Otherwise the number of occurrences takes precedence.
3^Once
Perform the service at one point in time, e.g., order 3 units of blood to be
given once.
1^QHS^X2
Perform the service twice at bedtime, e.g., give a unit of blood at bedtime on
two sequential nights.
1^C^D3
Do a service continuously for 3 days.
1^Q1H^X4^^^^PVCs>10/min
Perform an EKG every hour up to a maximum of 4 EKGs, if patient is having more
than 10 PVCs per minute.
1^Q1J2^^200005231432
Perform a service every Tuesday at 2:32 p.m. starting on 05/23/2000.
1^^^^198911210800
Perform a test before 11/21/89 0800, e.g., some preop laboratory tests.
1^Q1H^X5^198911051030
Perform a service every hour for 5 hours starting at 10:30 a.m. 11/5/89, e.g.,
draw a blood glucose.
1^QAM^X3^^^^^^S~1^QOD^D4^^^^if K+>5.5
Perform a service every morning for 3 days and then do it every other day for 4
days (i.e., max twice) if the serum potassium is greater than 5.5.
^^^198812120800^^T^^Trough specimen for MIC^C~^^^^^R
The first repeat instructs to draw a blood specimen exactly at 8:00 a.m. on
12/12/1988. The second repeat specifies to report results routinely.
1^QD^D7^^^^^^^^M20
Whirlpool ankle for twenty minutes once a day for one week.
1^^^19990301^19990331^^^^^^H1^3
Three one hour home health nursing visits within the next month.
This section includes trigger events and message definitions that are general to all orders in addition to the Observation and Diagnostic Study.
Left
for backward compatibility only. It is recommended that the trigger
events OMG, OML, OMD, OMS OMN and OMP be used instead when communicating orders
and order related events.
The function of this message is to initiate the transmission of information
about an order. This includes placing new orders, cancellation of existing
orders, discontinuation, holding, etc. ORM messages can originate also with a
placer, filler, or an interested third party.
The trigger event for this message is any change to an order. Such changes
include submission of new orders, cancellations, updates, patient and
non-patient specific orders, etc.
The CTD segment in this trigger is used to transmit temporary patient contact
details specific to this order.
ORM^O01^ORM_O01 |
General Order Message |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
[{NTE}] |
Notes and Comments (for Header) |
2 |
[ |
||
PID |
Patient Identification |
3 |
[PD1] |
Additional Demographics |
3 |
[{NTE}] |
Notes and Comments (for Patient ID) |
2 |
[ |
||
PV1 |
Patient Visit |
3 |
[PV2]] |
Patient Visit- Additional Info |
3 |
[{IN1 |
Insurance |
6 |
[IN2] |
Insurance Additional Info |
6 |
[IN3] |
Insurance Add'l Info - Cert. |
6 |
}] |
||
[GT1] |
Guarantor |
6 |
[{AL1}] |
Allergy Information |
3 |
] |
||
{ |
||
ORC |
Common Order |
4 |
[ |
||
<OBR| |
Order Detail Segment OBR, etc. |
4 |
RQD| |
||
RQ1| |
||
RXO| |
||
ODS| |
||
ODT> |
||
[{NTE}] |
Notes and Comments (for Detail) |
2 |
[CTD] |
Contact Data |
11 |
[{DG1}] |
Diagnosis |
6 |
[{ |
||
OBX |
Observation/Result |
7 |
[{NTE}] |
Notes and Comments (for Results) |
2 |
}] |
||
] |
||
[{FT1}] |
Financial Transaction |
6 |
[{CTI}] |
Clinical Trial Identification |
7 |
[BLG] |
Billing Segment |
4 |
} |
a)
The abstract message syntax for some order segments vary slightly. Please
refer to the appropriate sections for specific examples: for supply orders
(RQ), see Section
4.10
"Supply Trigger Events & Messages" for pharmacy, see Section 4.13
"Pharmacy/Treatment Trigger Events & Messages"; and for dietary orders, see
Section 4.7, "Diet Trigger Events & Message Definitions".
b) The segment named "Order Detail Segment" represents whichever of these order
detail segment(s) is appropriate to the message, currently OBR, RQD, RQ1, RXO,
ODS, ODT.
c) The NTE segment(s) can be included in the ORM message in four places; in
each place the NTE refers to the segment which it follows. In particular, the
NTEs following the MSH refer only to the message header, the NTEs following the
order detail segment apply to the service defined by that ORC and order detail
segment.
d) The PID segment is required if and only if new orders are being entered and
they are related to a particular patient. For nonpatient-related orders the
PID segment is never included.
e) The optional PV1 segment is present mainly to permit transmission of patient
visit information such as current location with an order.
f) The order detail segments are not required when a simple control message is
being sent. For example, a hold message (ORC-1-order control = HD) does
not require that an order segment follow it.
g) ORC-1-order control is critical to the operation of both ORM and ORR
messages. For example, to request cancellation of an order, one would transmit
a CA in ORC-1-order control of the appropriate ORC. (See the definition
of ORC-1-order control.)
h) A method to inquire for order status in the display format is provided in
Chapter 2, and uses the record format provided in Chapter 7.
i) Each order message that defines any type of new order (ORC-1-order
control = NW, CH, RO, or SN) requires an ORC/OBR pair to define each order
to the receiving application. This also applies to any other types of orders,
with the OBR being replaced by the appropriate order detail segment, as defined
below. Thus two consecutive ORCs could occur if a cancel order request
(needing only the order numbers) were followed by a second cancel order
request. Many other examples are possible.
j) The insurance segments (IN1, IN2, and GT1) are typically used for external
fillers, e.g., reference labs, where formal ADT transactions are overly complex
or not needed.
The
function of this message is to respond to an ORM message. An ORR message is
the application acknowledgment to an ORM message. See Chapter 2 for a
description of the acknowledgment paradigm.
In ORR the PID and ORC segments are optional, particularly in case of an error
response. However, ORC segments are always required in ORR when an order
detail segment is present. For example, a response ORR might include only the
MSH and MSA, but if a RQ1 is present, it must be preceded by an ORC.
The function (e.g., cancel, new order) of both ORM and ORR messages is
determined by the value in ORC-1-order control. (See the table of order
control values for a complete list.)
ORR^O02^ORR_O02 |
General Order Acknowledgment Message |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
MSA |
Message Acknowledgment |
2 |
[ERR] |
Error |
2 |
[{NTE}] |
Notes and Comments (for Header) |
2 |
[ |
||
[PID |
Patient Identification |
3 |
[{NTE}]] |
Notes and Comments (for Patient ID) |
2 |
{ |
||
O RC |
Common Order |
4 |
<OBR| |
[Order Detail Segment] OBR, etc. |
4 |
RQD| |
||
RQ1| |
||
RXO| |
||
ODS| |
||
ODT> |
||
[{NTE}] |
Notes and Comments (for Detail) |
2 |
[{CTI}] |
Clinical Trial Identification |
7 |
} |
||
] |
OSQ^Q06 |
Order Status Query |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
QRD |
Query Definition |
2 |
[ QRF ] |
Query Filter |
2 |
[ DSC ] |
Continuation Pointer |
2 |
OSR^Q06 |
Order Status Response |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
MSA |
Message Acknowledgment |
2 |
[ERR] |
Error |
2 |
[{NTE}] |
Notes and Comments (for Header) |
2 |
QRD |
Query Definition |
2 |
[QRF] |
Query Filter |
2 |
[ |
||
[PID |
Patient Identification |
3 |
[{NTE}] |
Notes and Comments (for Patient ID) |
2 |
] |
||
{ |
||
ORC |
Common Order |
4 |
<OBR|RQD|RQ1| RXO|ODS|ODT> |
[Order Detail Segment] OBR, etc. |
4 |
[{NTE}] |
Notes and Comments (for Detail) |
2 |
[{CTI}] |
Clinical Trial Identification |
7 |
} |
||
] |
||
[DSC] |
Continuation Pointer |
2 |
The
QRD and QRF segments are defined in Chapter 2, Section 2.16, "Message Control
Segments."
The subject filters contained in the QRD and QRF segments describe the kind of
information that is required to satisfy the request. They are defined by local
agreement between the inquiring system and the ancillary system. See the
Implementation Guide for detailed examples of the use of query filter
fields.
The Set ID fields in the various segments (including PID) are used to count the
number of segments of one kind transmitted at one level of the hierarchy.
The Query Result Level field of the QRD determines the amount of data
requested. See Chapter 5, Section <IP_ADDRESS>, "QRD - original style query
definition segment."
The OSQ message is a record-oriented query that has the structure as the
regular QRY message. OSQ is included here for the convenience of implementers.
The
function of this message is to initiate the transmission of information about a
general clinical order that uses the OBR segment. Messages using the ORM
message with the OBR segment are supported for backward compatibility. This
includes placing new orders, cancellation of existing orders, discontinuation,
holding, etc. OMG messages can originate also with a placer, filler, or an
interested third party.
The trigger event for this message is any change to a general clinical order.
Such changes include submission of new orders, cancellations, updates, patient
and non-patient-specific orders, etc.
This trigger includes segments identified as being for `previous results'.
These segments allow the sending system to include demographic and/or result
information from previous result reports when they are related to the current
order.
For example:
* Diagnostic laboratories referring tests to another lab for either
confirmation of results (HIV, etc.) or due to not being equipped to do the
tests (genetic testing, etc.).
* Diagnostic laboratories sending test results to Knowledge Bases for the
automated generation of diagnostic comments for inclusion into the lab
report.
The CTD segment in this trigger is used to transmit temporary patient contact
details specific to this order.
OMG^O19^OMG_O19 |
General Clinical Order Message |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
[{NTE}] |
Notes and Comments (for Header) |
2 |
[ |
||
PID |
Patient Identification |
3 |
[PD1] |
Additional Demographics |
3 |
[{NTE}] |
Notes and Comments (for Patient ID) |
2 |
[ |
||
PV1 |
Patient Visit |
3 |
[PV2] |
Patient Visit- Additional Info |
3 |
] |
|
|
[{IN1 |
Insurance |
6 |
[IN2] |
Insurance Additional Info |
6 |
[IN3] |
Insurance Add'l Info - Cert. |
6 |
}] |
||
[GT1] |
Guarantor |
6 |
[{AL1}] |
Allergy Information |
3 |
] |
||
{ |
||
ORC |
Common Order |
4 |
OBR |
Observation |
4 |
[{NTE}] |
Notes and Comments (for Detail) |
2 |
[CTD] |
Contact Data |
11 |
[{DG1}] |
Diagnosis |
6 |
[{ |
||
OBX |
Observation/Result |
7 |
[{NTE}] |
Notes and Comments (for Results) |
2 |
}] |
||
{[ |
||
[ |
||
PID |
Patient Identification - previous result |
3 |
[PD1] |
Additional Demographics - previous result |
3 |
] |
||
[ |
||
PV1 |
Patient Visit - previous result |
3 |
[PV2] |
Patient Visit Add. Info - previous result |
3 |
] |
||
[{AL1}] |
Allergy Information - previous result |
3 |
{ |
||
[ORC] |
Common Order - previous result |
4 |
OBR |
Order Detail - previous result |
4 |
{[NTE]} |
Notes and Comments - previous result |
2 |
[CTD] |
Contact Data - previous result |
10 |
{ |
||
OBX |
Observation/Result - previous result |
7 |
[{NTE}] |
Notes and Comments - previous result |
2 |
} |
||
} |
||
}] |
||
[{FT1}] |
Financial Transaction |
6 |
[{CTI}] |
Clinical Trial Identification |
7 |
[BLG] |
Billing Segment |
4 |
} |
The
function of this message is to respond to an OMG message. An ORG message is
the application acknowledgment to an OMG message. See Chapter 2 for a
description of the acknowledgment paradigm.
In ORG the PID and ORC segments are optional, particularly in case of an error
response. However, ORC segments are always required in ORG when the OBR is
present. For example, a response ORG might include only the MSH and MSA.
The function (e.g., cancel, new order) of both OMG and ORG messages is
determined by the value in ORC-1-order control. (See the table of order
control values for a complete list.)
ORG^O20^ORG_O20 |
General Clinical Order Acknowledgment Message |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
MSA |
Message Acknowledgment |
2 |
[ERR] |
Error |
2 |
[{NTE}] |
Notes and Comments (for Header) |
2 |
[ |
||
[PID |
Patient Identification |
3 |
[{NTE}] |
Notes and Comments (for Patient ID) |
2 |
] |
||
{ |
||
ORC |
Common Order |
4 |
[OBR] |
Observation |
4 |
[{NTE}] |
Notes and Comments (for Detail) |
2 |
[{CTI}] |
Clinical Trial Identification |
7 |
} |
||
] |
The
following message structure may be used for the communication of laboratory and
other order messages and must be used for lab automation messages. While the
ORM message with the OBR segment can be used for backwards compatibility for
general lab messages, only the OML message should be used to take advantage of
the specimen and container extensions required in laboratory automation.
Note: The additional patient information (the segments PID, PD1, PV1, PV2, etc,
which are sent after the OBR with the current order - indicated below with
words "previous result"), could have been transferred with the previous result,
because the patient demographics related to the previous result can differ from
the demographics related to the current order. The current intent is to only
allow references to the same patient as in the header PID.
The SAC segments included in the message allow the transfer of, e.g.: a
laboratory order with multiple containers and multiple test orders related to
each container, or laboratory orders with test order requiring multiple
containers.
Refer to Chapter 13 Laboratory Automation for examples of usage,
particularly to clarify the use of two references to SAC segments in this one
message.
The CTD segment in this trigger is used to transmit temporary patient contact
details specific to this order.
OML^O21^OML_O21 |
Laboratory Order Message |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
[{NTE}] |
Notes and Comments (for Header) |
2 |
[ |
||
PID |
Patient Identification |
3 |
[PD1] |
Additional Demographics |
3 |
[{NTE}] |
Notes and Comments (for Patient ID) |
2 |
[PV1 |
Patient Visit |
3 |
[PV2]] |
Patient Visit- Additional Info |
3 |
[{IN1 |
Insurance |
6 |
[IN2] |
Insurance Additional Info |
6 |
[IN3] |
Insurance Add'l Info - Cert. |
6 |
}] |
||
[GT1] |
Guarantor |
6 |
[{AL1}] |
Allergy Information |
3 |
] |
||
{ |
||
[ |
||
SAC |
Specimen Container Details |
13 |
[{OBX}] |
Additional Specimen Characteristics |
7 |
] |
||
{ |
||
ORC |
Common Order |
4 |
[ |
||
OBR |
Observation Request |
4 |
[{ |
||
SAC |
Specimen Container Details |
13 |
[{OBX}] |
Additional Specimen Characteristics |
7 |
}] |
||
[TCD] |
Test Code Details |
13 |
[{NTE}] |
Notes and Comments (for Detail) |
2 |
[{DG1}] |
Diagnosis |
6 |
[{ |
||
OBX |
Observation/Result |
7 |
[TCD] |
Test Code Detail |
13 |
[{NTE}] |
Notes and Comments (for Results) |
2 |
}] |
||
[{ |
||
[PID |
Patient Identification - previous result |
3 |
[PD1]] |
Additional Demographics - previous result |
3 |
[PV1 |
Patient Visit - previous result |
3 |
[PV2]] |
Patient Visit Add. Info - previous result |
3 |
[{AL1}] |
Allergy Information - previous result |
3 |
{ |
||
[ORC] |
Common Order - previous result |
4 |
OBR |
Order Detail - previous result |
4 |
{[NTE]} |
Notes and Comments - previous result |
2 |
{ |
||
OBX |
Observation/Result - previous result |
7 |
[{NTE}] |
Notes and Comments - previous result |
2 |
} |
||
} |
||
}] |
||
] |
||
[{FT1}] |
Financial Transaction |
6 |
[{CTI}] |
Clinical Trial Identification |
7 |
[BLG] |
Billing Segment |
4 |
} |
||
] |
The
function of this message is to respond to an OML message. An ORL message is
the application acknowledgment to an OML message. See Chapter 2 for a
description of the acknowledgment paradigm.
ORL^O22^ORL_O22 |
General Laboratory Order Acknowledgment Message |
Chapter |
|---|---|---|
MSH |
Message Header |
2 |
MSA |
Message Acknowledgment |
2 |
[ERR] |
Error |
2 |
[{NTE}] |
Notes and Comments (for Header) |
2 |
[ |
||
[PID |
Patient Identification |
3 |
{ |
||
[SAC |
Specimen Container Details |
13 |
[{OBX}] |
Additional Specimen Characteristics |
7 |
] |
||
[{ |
||
ORC |
Common Order |
4 |
[OBR |
Observation Request |
4 |
[{SAC}] |
Specimen Container Details |
13 |
] |
||
}] |
||
} |
||
] |
||
] |
The following segments (ORC and BLG) are common to many order messages.
The
Common Order segment (ORC) is used to transmit fields that are common to all
orders (all types of services that are requested). The ORC segment is required
in the Order (ORM) message. ORC is mandatory in Order Acknowledgment (ORR)
messages if an order detail segment is present, but is not required
otherwise.
If details are needed for a particular type of order segment (e.g., Pharmacy,
Dietary), the ORC must precede any order detail segment (e.g., RXO, ODS). In
some cases, the ORC may be as simple as the string ORC|OK|<placer order
number>|<filler order number>|<cr>.
If details are not needed for the order, the order detail segment may be
omitted. For example, to place an order on hold, one would transmit an ORC
with the following fields completed: ORC-1-order control with a value of
HD, ORC-2-placer order number, and ORC-3-filler order number.
There is some overlap between fields of the ORC and those in the order detail
segments. These are described in the succeeding sections.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
2 |
ID |
R |
N |
0119 |
00215 |
Order Control |
2 |
22 |
EI |
C |
00216 |
Placer Order Number |
||
3 |
22 |
EI |
C |
00217 |
Filler Order Number |
||
4 |
22 |
EI |
O |
00218 |
Placer Group Number |
||
5 |
2 |
ID |
O |
N |
0038 |
00219 |
Order Status |
6 |
1 |
ID |
O |
0121 |
00220 |
Response Flag |
|
7 |
200 |
TQ |
O |
Y |
00221 |
Quantity/Timing |
|
8 |
200 |
CM |
O |
00222 |
Parent |
||
9 |
26 |
TS |
O |
00223 |
Date/Time of Transaction |
||
10 |
250 |
XCN |
O |
Y |
00224 |
Entered By |
|
11 |
250 |
XCN |
O |
Y |
00225 |
Verified By |
|
12 |
250 |
XCN |
O |
Y |
00226 |
Ordering Provider |
|
13 |
80 |
PL |
O |
00227 |
Enterer's Location |
||
14 |
250 |
XTN |
O |
Y/2 |
00228 |
Call Back Phone Number |
|
15 |
26 |
TS |
O |
00229 |
Order Effective Date/Time |
||
16 |
250 |
CE |
O |
00230 |
Order Control Code Reason |
||
17 |
250 |
CE |
O |
00231 |
Entering Organization |
||
18 |
250 |
CE |
O |
00232 |
Entering Device |
||
19 |
250 |
XCN |
O |
Y |
00233 |
Action By |
|
20 |
250 |
CE |
O |
0339 |
01310 |
Advanced Beneficiary Notice Code |
|
21 |
250 |
XON |
O |
Y |
01311 |
Ordering Facility Name |
|
22 |
250 |
XAD |
O |
Y |
01312 |
Ordering Facility Address |
|
23 |
250 |
XTN |
O |
Y |
01313 |
Ordering Facility Phone Number |
|
24 |
250 |
XAD |
O |
Y |
01314 |
Ordering Provider Address |
|
25 |
250 |
CWE |
O |
N |
01473 |
Order Status Modifier |
ORC
use notes
a) placer order groups
The Standard supports a mechanism to collect several orders together in a
group. Most often this is used to represent an "ordering session" for a single
patient.
An order group is a list of orders (ORCs) associated with an ORC-4-placer
group number. A group is established when the placer supplies a placer
group number with the original order. The order group consists of all the ORCs
and order detail segments that have the same placer group number. Orders can
be removed from the group using cancel, or added using the replacement or
parent-child mechanisms. New orders cannot otherwise be added to the group.
b) duplicate fields
The ORC is intended to uniformly define the fields that are common to all
orders (i.e., requested services). Some ORC fields are duplicated in some
order detail segments (e.g., OBR, RXO). For example, ORC-2-placer order
number has the same meaning and purpose as OBR-2-placer order number
field. This promotes upward compatibility with past versions and ASTM.
The rule for using these fields is that the value must appear in the order
detail segment if it does not appear in the ORC. However, it is recommended to
transmit the field value in both places to avoid confusion.
c) parent/child - cancel, hold, discontinue
During transmission of a request to cancel, hold, or discontinue a parent
order, the request is intended to apply recursively to the parent order and all
associated child orders.
For example:
1) An EKG application receives an order for three EKGs on successive
mornings.
2) The EKG application creates three child orders, one for each requested
EKG.
3) The first daily EKG has already been performed when a request is received to
cancel the original parent order. (The parent is beyond the point of
cancellation.)
4) The remaining, unperformed, children are canceled as a result of the request.
Definition:
Determines the function of the order segment. Refer to
HL7
Table
0119 - O
rder
co
ntrol
codes and their meaning for valid entries. Depending on the message,
the action of the control code may refer to an order or an individual service.
For example, the code CA in an OMP message cancels the order. The same code in
an RDS message, cancels the dispense. Very detailed explanatory notes are
given at the end of this section.
This field may be considered the "trigger event" identifier for orders. The
codes fall roughly into the following three categories:
a) event request
Codes like "NW" (new order) and "CA" (cancel order request) are used to
initiate an event.
b) event acknowledgment
Codes like "OK" (order accepted) and "CR" (canceled as requested) are used to
reply to the event request.
c) event notification
Codes like "OC" (order canceled) and "OD" (order discontinued) are used to
notify other applications that an event has occurred. No application reply is
necessary.
Event request codes are intended to initiate an event. Event acknowledgment
codes are intended to reply to an application that requested an event. Event
notification codes are intended to notify another application that, e.g., the
filler has performed some action on an order that the other application, e.g.,
the placer, needs to know.
Fillers, placers, and other applications can use event requests, event
acknowledgments, and event - notification-type trigger events interchangeably.
However, certain order control codes can originate only from the filler (e.g.,
CR) and others can only originate from the placer (e.g., CA).
Refer to section 4.19.1 for the contents of HL7
Table
0119
- Order control codes.
a)
CA
A cancellation is a request not to do a previously ordered service.
Confirmation of the cancellation request is provided by the filler, e.g., a
message with an ORC-1-order control value of CR.
b) UC
An unable-to-cancel code is used when the ordered service is at a point that it
cannot be canceled by the filler or when local rules prevent cancellation by
the filler. The use of this code is dependent on the value of
ORC-6-response flag.
c) DC
A discontinue request code is used to stop an ongoing ordered service. It is
not the same as a cancellation request, which is used in an attempt to prevent
an order from happening.
d) RP, RQ, RU, RO
A replacement is the substitution of one or more orders for one or more
previously ordered services.
The replaced orders are treated as though they were canceled. If and when an
ordered service can be replaced are local site-specific determinations.
Use the parent/child order control codes if the site specifies that the
original order must remain intact. Do not use the replacement codes under this
circumstance.
For each order to be replaced, use an ORC-1-order control value of RP
(request for a replacement going to a filler) or RU (an unsolicited replacement
created by the filler) used by the filler to notify the placer and/or other
systems). By local agreement, the ORC segment (with RP or RU) may be followed
by its original order detail segment. The ORC segments (with RP or RU) must be
followed by an ORC segment with an ORC-1-order control value of RO
(indicating the replacement order). By local agreement, the ORC with the RO
value may be followed by an order detail segment.
For example, suppose that an ancillary application were replacing two OBR
orders with three different orders. The sequence of segments would be as
follows:
Segment |
Order Control |
Comment |
|---|---|---|
ORC |
RU |
1st replaced ORC |
OBR |
1st replaced order's detail segment |
|
ORC |
RU |
2nd replaced ORC |
OBR |
2nd replaced order's detail segment |
|
ORC |
RO |
1st replacement ORC |
OBR |
1st replacement order's detail segment |
|
ORC |
RO |
2nd replacement ORC |
OBR |
2nd replacement order's detail segment |
|
ORC |
RO |
3rd replacement ORC |
OBR |
3rd replacement order's detail segment |
Whether
the OBR segments must be present is determined by the value of
ORC-6-response flag.
The described replacement method will handle all possible cases of replacement:
one-into-one, many-into-one, one-into-many, and many-into-many. If the placer
sent this request to the filler with two RPs, and this was a response back from
the filler to the placer, the two RUs (replaced unsolicited) would be two RQs
(replaced as requested).
Segment |
Order Control |
Comment |
|---|---|---|
ORC |
RQ |
1st replaced ORC |
OBR |
1st replaced order's detail segment |
|
ORC |
RQ |
2nd replaced ORC |
OBR |
2nd replaced order's detail segment |
|
ORC |
RO |
1st replacement ORC |
OBR |
1st replacement order's detail segment |
|
ORC |
RO |
2nd replacement ORC |
OBR |
2nd replacement order's detail segment |
|
ORC |
RO |
3rd replacement ORC |
OBR |
3rd replacement order's detail segment |
e)
RP, RQ
The order replace request code permits the order filler to replace one or more
new orders with one or more new orders, at the request of the placer
application.
f) RU
The unsolicited replacement code permits the filler application to notify
another application without being requested from the placer application.
g) RO, RQ
The replacement order code is sent by the filler application to another
application indicating the exact replacement ordered service. It is used with
the RP and RU order control codes as described above.
h) RP, RQ, RU, RO
The rules for the order numbers in ORC segments with an order control value of
RO are determined by the replacement type (RP or RU).
In the case of the RU type (i.e., unsolicited replacement by the filler), the
filler order number is generated as usual by the filler application. The
placer order number is identical to the placer order number of the first
transmitted ORC with an order control value of RU.
In the case of the RP type (i.e., a replacement request from another
application to the filler), the placer order number is generated by the placer
application using the procedure for new orders. The filler order number is
generated by the filler application using the procedure identical for new
orders.
If a replacement sequence is used in an ORU message (i.e., during results
reporting), the following are the recommended segments to be used for the
replacement orders:
1) ORC with an order control value of RO
2) Any OBR segments (can be replaced by any order detail segments)
3) Optionally followed by observation result segments (OBX)
4) NTE segments can appear after the OBR (or any order detail segment) or after
an OBX segment as in a regular ORU message
i) PA, CH
The parent (PA) and child (CH) order control codes allow the spawning of
"child" orders from a "parent" order without changing the parent (original
order). One or more ORC segments with an ORC-1-order control value of
PA are followed by one or more ORC segments with an ORC-1-order control
value of CH. Whether OBR segments must be present is determined by the value
of ORC-6-response flag.
For example, suppose that a microbiology culture produced two organisms and
corresponding susceptibility reports. Then the sequence of segments would be
as follows:
Segment |
Order Control |
Comment |
|---|---|---|
ORC |
PA |
1st parent ORC |
ORC |
CH |
1st child ORC |
OBR |
1st child order |
|
ORC |
CH |
2nd child ORC |
OBR |
2nd child order |
The
assignment of placer order numbers in the parent-child paradigm depends on
whether the placer or filler creates the child order and in the latter case, on
whether the placer supports the SN/NA transaction. If the placer creates the
child orders it will assign their placer order numbers according to its usual
procedures. If the filler creates the child orders there are two possibilities:
each child will inherit the placer order number of its parent, or the filler
will use the SN/NA transaction to request that the placer assign a placer order
number. In either case, the filler application creates the filler order
numbers of the children according to its usual procedures.
Whenever a child order is transmitted in a message the ORC segment's
ORC-8-parent is valued with the parent's filler order number (if
originating from the filler) and with the parent's placer order number (if
originating from the filler or if originating from the placer).
The parent-child mechanism can be used to "expand" a parent order (e.g., an
order for three EKGs on successive mornings).
j) RE
The observations-to-follow code is used to transmit patient-specific
information with an order. An order detail segment (e.g., OBR) can be followed
by one or more observation segments (OBX). Any observation that can be
transmitted in an ORU message can be transmitted with this mechanism. When
results are transmitted with an order, the results should immediately follow
the order or orders that they support.
The following example shows the sequence of segments for three Pharmacy orders.
It illustrates the use of the RE code:
Segment |
Order Control |
Comment |
|---|---|---|
MSH |
||
PID |
||
ORC |
NW |
First new order |
RXO |
First order segment |
|
ORC |
NW |
2nd new order |
RXO |
2nd order segment |
|
[ORC |
RE |
Patient-specific observation, optional in V 2.2 |
OBR] |
Observation OBR, optional in V 2.2 |
|
OBX |
An observation segment |
|
OBX |
Another observation segment |
|
OBX |
Another observation segment |
|
OBX |
Another observation segment |
|
ORC |
NW |
3rd order |
RXO |
3rd order segment |
In
this version of HL7, results can be transmitted with an order as one or more
OBX segments without the necessity of including the ORC and OBR segments.
Observations can be transmitted in an ORU message without using an ORC. There
are times when it is necessary to transmit information not included in the OBR
segments of the ORU message. In this case, it is recommended that the ORC be
included in the ORU message.
The order control value of RE is required only in ORM messages to indicate that
an order is followed by observation results (OBX). The RE code is not
necessary in the ORU message because it is expected that the OBR segments can
be followed by observation results (OBX).
k) RR
Left in for backward compatibility. In the current version it is
equivalent to an accept acknowledgment. The request-received code indicates
that an order message has been received and will be processed later. The order
has not yet undergone the processing that would permit a more exact
response.
l) SN, NA, NW
There are three circumstances that involve requesting an order number
(ORC-2-placer order number or ORC-3-filler order
number):
1) When the filler application needs to request an ORC-3-filler order
number from a centralized application (e.g., HIS)
2) When the filler application needs to request an ORC-2-placer order
number from some other application (e.g., Order Entry)
3) When an application (not the filler application) wants to assign an
ORC-3-filler order number for a new order
1) The filler application needs a centralized filler order number
SN - The send order number code provides a mechanism for the filler to
request an ORC-3-filler order number from some centralized application
(called "other" in the table below), such as a central HIS, by sending an ORM
message containing an ORC-1-order control value of SN. This ORC has a
null ORC-3-filler order number and an ORC-2-placer order number
created by the filler application when the filler originates the order.
The ORM (SN type) message can be acknowledged by two methods:
i) By an ORR message containing an ORC-1-order control value of OK. An
unsolicited ORM message can be sent at a future time, containing an ORC with
ORC-1-order control value of NA.
ii) By an ORR message containing an ORC-1-order control value of NA as
described below.
NA - The number assigned code allows the "other" application to notify
the filler application of the newly-assigned filler order number.
ORC-1-order control contains value of NA, ORC-2-placer order
number (from the ORC with the SN value), and the newly-assigned filler
order number.
Note: Both the placer order number and the filler order number have the
filler's application ID.
Code |
From |
ORC-2-Placer Order Number |
ORC-3-Filler Order Number |
SN |
filler application |
placer order number^filler application ID |
null |
NA |
other application |
placer order number^filler application ID |
filler order number^filler application ID |
2)
The filler application needs a placer order number
SN - The send order number code provides a mechanism for the filler
application to request an ORC-2-placer order number from another
application (called "other" in the table below) by sending an ORM message
containing an ORC-1-order control value of SN. This ORC has a null
ORC-2-placer order number and an ORC-3-filler order number
created by the filler application when the filler originates the order.
The ORM (SN type) message can be acknowledged by two methods:
i) By an ORR message containing an ORC-1-order control value of OK. An
unsolicited ORM message can be sent at a future time, containing an
ORC-1-order control value of NA.
ii) By an ORR message containing an ORC-1-order control value of NA as
described below.
NA - The number assigned code allows the "other" application to notify
the filler application of the newly-assigned ORC-2-placer order number.
The ORC contains an ORC-1-order control value of NA, the newly-assigned
ORC-2-placer order number, and the ORC-3-filler order number
(from the ORC with the SN value).
Note: The new ORC-2-placer order number has the placer's
application ID.
Code |
From |
ORC-2-Placer Order Number |
ORC-3-Filler Order Number |
SN |
filler application |
null |
filler order number^filler application ID |
NA |
other application |
placer order number^placer application ID |
filler order number^filler application ID |
3) An application wants to assign a filler order number
NW - When the application creating an order (not the filler
application) wants to assign a filler order number for a new order
or
RO - (RO following an RP). In this case, the "other" application
completes ORC-3-filler order number, using the filler application ID as
the second component of the filler order number.
Code |
From |
ORC-2-Placer Order Number |
ORC-3-Filler Order Number |
NW or RO |
other application to the filler |
placer order number^placer application ID |
filler order number^filler application ID |
m)
CN
The combined result code provides a mechanism to transmit results that are
associated with two or more orders. This situation occurs commonly in
radiology reports when the radiologist dictates a single report for two or more
exams represented as two or more orders. For example, knee and hand films for
a rheumatoid arthritis patient might generate a single dictation on the part of
the radiologist.
When such results are reported the CN code replaces the RE code in all but the
last ORC, and the results follow the last ORC and its OBR. An example follows
of a single report following three ORCs:
MSH|...<cr>
PID|...<cr>
ORC|CN|...<cr>
OBR|1|A4461XA^HIS|81641^RAD|73666^Bilateral Feet|...<cr>
ORC|CN|...<cr>
OBR|2|A4461XB^HIS|81642^RAD|73642^Bilateral Hand PA|...<cr>
ORC|RE|...<cr>
OBR|3|A4461XC^HIS|81643^RAD|73916^Bilateral Knees|...<cr>
OBX|1|CE|73916&IMP|1|Radiologist's Impression|...<cr>
OBX|2|CE|73642&IMP|1|Radiologist's Impression|...<cr>
OBX|3|FT|73642&GDT|1|Description|...<cr>
n) UA
An unable-to-accept code is used when a new order cannot be accepted by the
filler. Possible reasons include requesting a prescription for a drug which
the patient is allergic to or for an order which requires certain equipment
resources which are not available such that the order cannot be filled. Note
that this is different from the communication level acceptance as defined
within the MSA segment.
o) RF
RF accommodates requests by both the filler or the placer. The filler may be
requesting refill authorization from the placer. A placer system may be
requesting a refill to be done by the filler system.
p) AF
AF is a response back from the placer authorizing a refill or quantity of
refills.
q) DF
DF indicates that the placer will not authorize refills for the order. The
order control code reason may be used to indicate the reason for the request
denial. Some suggested values include:
AA |
Patient unknown to the provider |
AB |
Patient never under provider care |
AC |
Patient no longer under provider care |
AD |
Patient has requested refill too soon |
AE |
Medication never prescribed for the patient |
AF |
Patient should contact provider first |
AG |
Refill not appropriate |
Note
that these values originate from the NCPDP SCRIPT Response Segment Code List
Qualifiers.
r) FU
FU notifies the placer that the filler issued a refill for the order at the
patient's request.
s) OF
OF directly responds to the placer system's request for a refill
t) UF
UF indicates an application level denial by the filler system to an authorized
refill request.
u) LI, UN
Use only with Patient Care problems or goals, Chapter 12.
v) PR
PR indicates that this ORC is part of an ORU structure containing previous
observation, which is embedded in the order.
At least two main use cases require that the complete results of the
previous observations be transmitted with the order.
* Diagnostic laboratories referring tests to another lab for either
confirmation of results (HIV, etc.) or due to not being equipped to do the
tests (genetic testing, etc.).
* Diagnostic laboratories sending test results to Knowledge Bases for the
automated generation of diagnostic comments for inclusion into the lab report.
Components:
<entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID
(ST)> ^ <universal ID type (ID)>
Definition: This field is the placer application's order number.
This field is a case of the Entity Identifier data type (See Section 2.8.13,
"EI - Entity Identifier"). The first component is a string that identifies an
individual order (e.g., OBR). A limit of fifteen (15) characters is suggested
but not required. An implementation is HL7 compliant when the number of
characters for this field is increased to accommodate applications that require
a greater number of characters for the Placer order number. It is assigned by
the placer (ordering application). It identifies an order uniquely among all
orders from a particular ordering application. The second through fourth
components contain the application ID of the placing application in the same
form as the HD data type (Section 2.8.18, "HD - Hierarchic designator"). The
second component, namespace ID, is a user-defined coded value that will be
uniquely associated with an application. A limit of six (6) characters is
suggested but not required. A given institution or group of intercommunicating
institutions should establish a unique list of applications that may be
potential placers and fillers and assign unique application IDs. The
components are separated by component delimiters.
There are three situations in which the true placer is somewhat arbitrary (and
thus not unique):
a) in ORC-1-order control value of RO, following an RU replacement;
b) in ORC-1-order control value of CH (child orders); and
c) in ORC-1-order control value of SN (send number).
See the Table Notes under ORC-1-order control for the details of how the
ORC-2-placer order number is assigned in these cases.
The application ID list becomes one of the institution's master dictionary
lists that is documented in Chapter 8. Since third-party applications (those
other than the placer and filler of an order) can send and receive ORM and ORR
messages, the placer application ID in this field may not be the same as any
sending and receiving application on the network (as identified in the MSH
segment).
ORC-2-placer order number is the same as OBR-2-placer order
number. If the placer order number is not present in the ORC, it must be
present in the associated OBR and vice versa. If both fields, ORC-2-placer
order number and OBR-2-placer order number are valued, they must
contain the same value. When results are transmitted in an ORU message, an ORC
is not required, and the identifying placer order number must be present
in the OBR segments.
These rules apply to the few other fields that are present in both ORC and OBR
for upward compatibility (e.g., quantity/timing, parent numbers, ordering
provider, and ordering call back numbers).
Components:
<entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID
(ST)> ^ <universal ID type (ID)>
Definition: This field is the order number associated with the filling
application. It is a case of the Entity Identifier data type (Section 2.8.13).
Its first component is a string that identifies an order detail segment (e.g.,
OBR). A limit of fifteen (15) characters is suggested but not required. An
implementation is HL7 compliant when the number of characters for this field is
increased to accommodate applications that require a greater number of
characters for the Filler order number. It is assigned by the order filler
(receiving) application. This string must uniquely identify the order (as
specified in the order detail segment) from other orders in a particular
filling application (e.g., clinical laboratory). This uniqueness must persist
over time.
The second through fourth components contain the filler application ID, in the
form of the HD data type (see Section 2.8.18, "HD - hierarchic designator").
The second component is a user-defined coded value that uniquely defines the
application from other applications on the network. A limit of six (6)
characters is suggested but not required. The second component of the filler
order number always identifies the actual filler of an order.
A given institution or group of intercommunicating institutions should
establish a list of applications that may be potential placers and fillers of
orders and assign each a unique application ID. The application ID list
becomes one of the institution's master dictionary lists that is documented in
Chapter 8. Since third- party applications (those other than the placer and
filler of an order) can send and receive ORM and ORR messages, the filler
application ID in this field may not be the same as any sending and receiving
application on the network (as identified in the MSH segment).
ORC-3-filler order number is the same as OBR-3-filler order
number. If the filler order number is not present in the ORC, it must be
present in the associated OBR. (This rule is the same for other identical
fields in the ORC and OBR and promotes upward and ASTM compatibility.) This is
particularly important when results are transmitted in an ORU message. In this
case, the ORC is not required and the identifying filler order number must be
present in the OBR segments.
The filler order number (OBR-3 or ORC-3) also uniquely identifies an
order and its associated observations. For example, suppose that an
institution collects observations from several ancillary applications into a
common database and this common database is queried by yet another application
for observations. In this case, the filler order number and placer order
number transmitted by the common database application would be that of the
original filler and placer, respectively, rather than a new one assigned by the
common database application.
Similarly, if a third-party application, not the filler or placer, of an order
were authorized to modify the status of an order (say, cancel it), the
third-party application would send the filler an ORM message containing an ORC
segment with ORC-1-order control equal to "CA" and containing the
original placer order number and filler order number, rather than assign either
itself.
Components:
<entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID
(ST)> ^ <universal ID type (ID)>
Definition: This field allows an order placing application to group sets of
orders together and subsequently identify them. It is a case of an Entity
Identifier data type (2.8.13).
The first component is a string that uniquely identifies all order groups from
the given placer application. A limit of fifteen (15) characters is suggested
but not required. It is assigned by the placer application and may come from
the same series as the placer order number of the ORC, but this is not
required.
The second through fourth components constitute a placer application ID
identical to the analogous components of ORC-2-placer order number.
Order groups and how to use them are described in detail in Section 4.5.1, "PRC
- common order segment."
Definition:
This field specifies the status of an order. Refer to HL7 Table 0038 -
Order status for valid entries. The purpose of this field is to report
the status of an order either upon request (solicited), or when the status
changes (unsolicited). It does not initiate action. It is assumed that the
order status always reflects the status as it is known to the sending
application at the time that the message is sent. Only the filler can
originate the value of this field.
Although HL7 Table 0038 - Order status contains many of the same
values contained in HL7 Table 0119 - Order control codes and their
meaning, the purpose is different. Order status may typically be used
in a message with an ORC-1-order control value of SR or SC to report the
status of the order on request or to any interested party at any time.
Value |
Description |
|---|---|
A |
Some, but not all, results available |
CA |
Order was canceled |
CM |
Order is completed |
DC |
Order was discontinued |
ER |
Error, order not found |
HD |
Order is on hold |
IP |
In process, unspecified |
RP |
Order has been replaced |
SC |
In process, scheduled |
Definition:
This field allows the placer (sending) application to determine the amount of
information to be returned from the filler. Sometimes the requested level of
response may not be possible immediately, but when it is possible, the filler
(receiving) application must send the information. When the field is null, D
is the default value of the field. Refer to HL7 Table 0121 - Response
flag for valid entries.
Value |
Description |
|---|---|
E |
Report exceptions only |
R |
Same as E, also Replacement and Parent-Child |
D |
Same as R, also other associated segments |
F |
Same as D, plus confirmations explicitly |
N |
Only the MSA segment is returned |
Components:
<quantity (CQ)> ^ <interval (CM)> ^ <duration (ST)> ^
<start date/time (TS)> ^ <end date/time (TS)> ^ <priority
(ST)> ^ <condition (ST)> ^ <text (TX)> ^ <conjunction
(ID)> ^ <order sequencing (CM)> ^ <occurrence duration (CE)> ^
<total occurrences (NM)>
Definition: This field determines the priority, quantity, frequency, and
timing of an atomic service. Order segments should be thought of as describing
an atomic service. It is a composite field that is defined in detail in
Section 4.3, "Quantity/Timing (TQ) Definition."
For example, if an OBR segment describes a unit of blood, this field might
request that three (3) such units be given on successive mornings. In this
case ORC-7-quantity/timing would be "1^QAM^X3".
ORC-7-quantity/timing is the same as OBR-27-quantity/timing.
To send information about "collection time", use the `text' component of the TQ
data type in either the ORC-7 or OBR-27.
ORC-7-quantity/timing is the same as OBR-27-quantity/timing. If
the ORC-7 and OBR-27 are both valued, then both should be valued exactly the
same. If the quantity/timing is not present in the ORC, it must be present in
the associated OBR. (This rule is the same for other identical fields in the
ORC and OBR and promotes upward and ASTM compatibility.) This is particularly
important when results are transmitted in an ORU message. In this case, the
ORC is not required and the identifying filler order number must be present in
the OBR segments.
Components:
<parent's placer order number (EI)> ^ <parent's filler order number
(EI)>
Subcomponents of parent's placer order number: <entity identifier
(ST)> & <namespace ID (IS) & <universal ID (ST)> &
<universal ID type (IS)>
Subcomponents of parent's filler order number: <entity identifier
(ST)> & <namespace ID (IS)> & <universal ID (ST)> &
<universal ID type (IS)>
Definition: This field relates a child to its parent when a parent-child
relationship exists. The parent-child mechanism is described under
ORC-1-order control notes.
The first component has the same format as ORC-2-placer order number
(Section <IP_ADDRESS>, "Placer order number (EI) 00216)." The second component
has the same format as ORC-3-filler order number (Section <IP_ADDRESS>,
"Filler order number (EI) 00217)" . The components of the placer order
number and the filler order number are transmitted in sub-components of the two
components of this field.
ORC-8-parent is the same as OBR-29-parent. If the parent is not
present in the ORC, it must be present in the associated OBR. (This rule is
the same for other identical fields in the ORC and OBR and promotes upward and
ASTM compatibility.) This is particularly important when results are
transmitted in an ORU message. In this case, the ORC is not required and the
identifying filler order number must be present in the OBR segments.
Definition: This field contains the date and time of the event that initiated the current transaction as reflected in ORC-1 Order Control Code. This field is not equivalent to MSH-7 Date and Time of Message which reflects the date/time of the physical message.
Components:
In Version 2.3 and later, use instead of the CN data type. <ID number
(ST)> ^ <family name (FN)> ^ <given name (ST)> ^ <second or
further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III)
(ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^
<source table (IS)> ^ <assigning authority (HD)> ^ <name type
code (ID)> ^ <identifier check digit (ST)> ^ <code identifying the
check digit scheme employed (ID)> ^ <identifier type code (IS)> ^
<assigning facility (HD)> ^ <name representation code (ID)> ^
<name context (CE)> ^ <name validity range (DR)> ^ < name
assembly order (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the identity of the person who actually keyed
the request into the application. Note that this refers to the current
transaction as reflected in ORC-1 Order Control Code. It provides an
audit trail in case the request is entered incorrectly and the ancillary
department needs to clarify the request. By local agreement, either the ID
number or name component may be omitted.
Components:
In Version 2.3 and later, use instead of the CN data type. <ID number
(ST)> ^ <family name (FN)> ^ <given name (ST)> ^ <second or
further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III)
(ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^
<source table (IS)> ^ <assigning authority (HD)> ^ <name type
code (ID)> ^ <identifier check digit (ST)> ^ <code identifying the
check digit scheme employed (ID)> ^ <identifier type code (IS)> ^
<assigning facility (HD)> ^ <name representation code (ID)> ^
<name context (CE)> ^ <name validity range (DR)> ^ < name
assembly order (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the identity of the person who verified the
accuracy of the entered request. Note that this refers to the current
transaction as reflected in ORC-1 Order Control Code. It is used in
cases where the request is entered by a technician and needs to be verified by
a higher authority (e.g., a nurse). By local agreement, either the ID number
or name component may be omitted.
Components:
In Version 2.3 and later, use instead of the CN data type. <ID number
(ST)> ^ <family name (FN)> ^ <given name (ST)> ^ <second or
further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III)
(ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^
<source table (IS)> ^ <assigning authority (HD)> ^ <name type
code (ID)> ^ <identifier check digit (ST)> ^ <code identifying the
check digit scheme employed (ID)> ^ <identifier type code (IS)> ^
<assigning facility (HD)> ^ <name representation code (ID)> ^
<name context (CE)> ^ <name validity range (DR)> ^ < name
assembly order (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the identity of the person who is responsible
for creating the request (i.e., ordering physician).
ORC-12-ordering provider is the same as OBR-16-ordering provider.
If the ordering provider is not present in the ORC, it must be present in the
associated OBR. (This rule is the same for other identical fields in the ORC
and OBR and promotes upward and ASTM compatibility.) This is particularly
important when results are transmitted in an ORU message. In this case, the
ORC is not required and the identifying filler order number must be present in
the OBR segments.
Components:
<point of care (IS)> ^ <room (IS)> ^ <bed (IS)> ^
<facility (HD)> ^ <location status (IS)> ^ <person location
type (IS)> ^ <building (IS)> ^ <floor (IS)> ^ <location
description (ST)>
Subcomponents of facility: <namespace ID (IS)> & <universal
ID (ST)> & <universal ID type (ID)
Definition: This field specifies the location (e.g., nurse station, ancillary
service location, clinic, floor) where the person who entered the request was
physically located when the order was entered. Note that this refers to the
current transaction as reflected in ORC-1 Order Control Code. Only
those subcomponents relevant to enterer's location should be valued (commonly
nursing unit; facility; building; floor). The person who entered the request is
defined in ORC-10-entered by.
Components:
[NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^
<telecommunication use code (ID)> ^ <telecommunication equipment type
(ID)> ^ <email address (ST)> ^ <country code (NM)> ^
<area/city code (NM)> ^ <phone number (NM)> ^ <extension
(NM)> ^ <any text (ST)>
Definition: This field contains the telephone number to call for clarification
of a request or other information regarding the order. ORC-14-call back
phone number is the same as OBR-17-order callback phone number.
Definition:
This field contains the date/time that the changes to the request took effect
or are supposed to take effect.
If ORC-9-date/time of transaction is after or equal to ORC-15-order
effective date/time, the data values in the ORC and its subordinate
segments took effect on the order effective date/time.
If ORC-9-date/time of transaction is before the time specified in
ORC-15-order effective date/time, the data values in ORC and its
subordinate segments are planned to take effect on the order effective
date/time.
If ORC-15-order effective date/time is left blank, its value is assumed
to be equal to that specified in ORC-9-date/time of transaction or
MSH-7-date/time of message if the transaction date/time is blank.
In the case where the time specified in ORC-15-order effective date/time
(for the order control code event in the same ORC segment) is different from
the corresponding date/time in ORC-7-quantity/timing, the time specified
in ORC-15-order effective date/time takes precedence. Thus if the ORC
event is a discontinue request to the filler for a continuing order, and the
order-effective date/time is prior to the end date/time of
ORC-7-quantity/timing, the order effective date/time should take
precedence. If the order identified in the ORC has children, the children
which have not started should be canceled; if there is a child in process, it
should be discontinued; if a child has progressed beyond the point where it can
be discontinued, its status is unaffected.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the explanation (either in coded or text form)
of the reason for the order event described by the order control code
(HL7 Table 0119). Whereas an NTE after the order-specific segment
(e.g., RXO, ORO, OBR) would provide a comment for that specific segment, the
purpose of the order control code reason is only to expand on the reason for
the order event.
ORC-16-order control code reason is typically not valued when
ORC-1-order control is NW, although it could be. In the case of a
canceled order, for example, this field is commonly used to explain the
cancellation. A Pharmacy system that canceled a drug order from a physician
because of a well documented allergy would likely report the fact of the
allergy in this field.
If it canceled the order because of a drug interaction this field might contain
at least the names (and codes, if needed) of the interacting substances, the
text describing the interaction, and the level of severity of the interaction.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field identifies the organization that the enterer belonged
to at the time he/she enters/maintains the order, such as medical group or
department. The person who entered the request is defined in ORC-10
-entered by.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field identifies the physical device (terminal, PC) used to
enter the order.
Components:
In Version 2.3 and later, use instead of the CN data type. <ID number
(ST)> ^ <family name (FN)> ^ <given name (ST)> ^ <second or
further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III)
(ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^
<source table (IS)> ^ <assigning authority (HD)> ^ <name type
code (ID)> ^ <identifier check digit (ST)> ^ <code identifying the
check digit scheme employed (ID)> ^ <identifier type code (IS)> ^
<assigning facility (HD)> ^ <name representation code (ID)> ^
<name context (CE)> ^ <name validity range (DR)> ^ < name
assembly order (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the identity of the person who initiated the
event represented by the corresponding order control code. For example, if the
order control code is CA (cancel order request), this field represents the
person who requested the order cancellation. This person is typically a care
provider but may not always be the same as ORC-12 ordering provider.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field indicates the status of the patient's or the patient's
representative's consent for responsibility to pay for potentially uninsured
services. This element is introduced to satisfy HCFA Medical Necessity
requirements for outpatient services. This element indicates (a) whether the
associated diagnosis codes for the service are subject to medical necessity
procedures, (b) whether, for this type of service, the patient has been
informed that they may be responsible for payment for the service, and (c)
whether the patient agrees to be billed for this service. The values for this
field are drawn from User-defined Table 0339 - Advanced
beneficiary notice code.
Value |
Description |
|---|---|
1 |
Service is subject to medical necessity procedures |
2 |
Patient has been informed of responsibility, and agrees to pay for service |
3 |
Patient has been informed of responsibility, and asks that the payer be billed |
4 |
Advanced Beneficiary Notice has not been signed |
Components:
<organization name (ST)> ^ <organization name type code (IS)> ^
<ID Number (NM)> ^ <check digit (NM)> ^ <code identifying the
check digit scheme employed (ID)> ^ <assigning authority (HD)> ^
<identifier type code (IS)> ^ <assigning facility ID (HD)> ^
<name representation code (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)>
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)>
Definition: This field contains the name of the facility placing the order.
Components:
In Version 2.3 and later, replaces the AD data type. <street address
(SAD)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or
province (ST)> ^ <zip or postal code (ST)> ^ <country (ID)> ^
< address type (ID)> ^ <other geographic designation (ST)>
^ <county/parish code (IS)> ^ <census tract (IS)> ^
<address representation code (ID)> ^ <address validity range
(DR)>
Definition: This field contains the address of the facility placing the order.
Components:
[NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^
<telecommunication use code (ID)> ^ <telecommunication equipment type
(ID)> ^ <email address (ST)> ^ <country code (NM)> ^
<area/city code (NM)> ^ <phone number (NM)> ^ <extension
(NM)> ^ <any text (ST)>
Definition: This field contains the telephone number of the facility placing
the order.
Components:
In Version 2.3 and later, replaces the AD data type. <street address
(SAD)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or
province (ST)> ^ <zip or postal code (ST)> ^ <country (ID)> ^
< address type (ID)> ^ <other geographic designation (ST)>
^ <county/parish code (IS)> ^ <census tract (IS)> ^
<address representation code (ID)> ^ <address validity range
(DR)>
Definition: This field contains the address of the care provider requesting
the order.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)> ^ <coding system version ID
(ST)> ^ alternate coding system version ID (ST)> ^ <original text
(ST)>
Definition: This field is a modifier or refiner of the ORC-5-Order status
field. This field may be used to provide additional levels of specificity
or additional information for the defined order status codes. Unlike the Order
Status field, which is controlled by an HL7 defined table, this field is a CE
data type allowing applications to support an unlimited library of Order Status
Modifier codes.
Usage Rule: This field may only be populated if the ORC-5-Order Status field is
valued.
Examples: An LIS is processing an order with an order status of IP may send an
update using the order status modifier to indicate the progress of the order
through the laboratory or to indicate that the order has been sent to an
external laboratory. Another example using the non-medical orders would be
where a phone has been ordered delivered to a patient's room, but has been
disconnected temporarily. The ORC-5-Order status indicates IP and the
ORC-25-Order status modifier would indicate a disconnected status. A
third example involves pharmacy dispenses. It is sometimes not enough to know
the prescription is being dispensed. The ORC-25-Order status modifier
would indicate if a label had been printed, the prescription filled, or the
prescription sold.
The
BLG segment is used to provide billing information, on the ordered service, to
the filling application.
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
40 |
CM |
O |
0100 |
00234 |
When to Charge |
|
2 |
50 |
ID |
O |
0122 |
00235 |
Charge Type |
|
3 |
100 |
CX |
O |
00236 |
Account ID |
Components:
<when to charge code (ID)> ^ <date/time (TS)>
Definition: This field specifies when to charge for the ordered service. The
first component contains a value defined in HL7 Table 0100 - When to
charge. The second component is used to express the exact time to
charge for the ordered service; it is used only when the when to
charge value is T. When used, it is expressed as a TS data type.
Value |
Description |
|---|---|
D |
On discharge |
O |
On receipt of order |
R |
At time service is completed |
S |
At time service is started |
T |
At a designated date/time |
Definition:
This field identifies someone or something other than the patient to be billed
for this service. It is used in conjunction with BLG-3-account ID.
Refer to HL7 Table 0122 - Charge type for valid values.
Value |
Description |
|---|---|
CH |
Charge |
CO |
Contract |
CR |
Credit |
DP |
Department |
GR |
Grant |
NC |
No Charge |
PC |
Professional |
RS |
Research |
Components:
<ID (ST)> ^ <check digit (ST)> ^ <code identifying the check
digit scheme employed (ID)> ^ < assigning authority (HD)> ^
<identifier type code (ID)> ^ < assigning facility (HD) ^
<effective date (DT)> ^ <expiration date (DT)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field identifies the account to be billed. It is used in
conjunction with BLG-2-charge type. Refer to HL7 table 0061 -
Check digit scheme in Chapter 2.
General
(taken from ASTM E1238)
The Observation Request (OBR) segment is used to transmit information specific
to an order for a diagnostic study or observation, physical exam, or
assessment.
The Observation Request segment defines the attributes of a particular request
for diagnostic services (e.g., laboratory, EKG) or clinical observations (e.g.,
vital signs or physical exam). When a placer requests a given set of
observations, always include an order segment. For lab tests, the information
in the order segment usually applies to a single specimen. However, there is
not a one-to-one relationship between specimen and tests ordered. Different
test batteries will usually require their own order segments even when they can
be performed on a single specimen. In this case, the specimen information must
be duplicated in each of the order segments that employ that specimen. For
other diagnostic studies, e.g., chest X-ray, a separate order segment will
usually be generated for each diagnostic study.
Though multiple observation batteries can be ordered on a single order segment,
the observation filler shall generate a separate order segment for each battery
that it processes independently, e.g., electrolyte, CBC, vital signs. When
reporting the observations, the filling service shall copy the appropriate
order (specimen) information from the original order segment into each of the
new order segments so that a separate "order" segment is returned to the placer
as a "header" for each separate battery of observations.
In the event that an ordered battery of observations cannot be performed, e.g.,
because of hemolysis on a blood sample, an order segment will be returned to
the placer with OBR-25-result status equal to X (to indicate that the
study was not performed). In this case, no observation segments will be
transmitted.
When observations are successfully completed, the message returned to the
placer will include the order segment (OBR) followed by observation (OBX)
segments for each distinct observation generated by the order (see Chapter 7).
The number of such observation segments will depend upon the number of
individual measurements performed in the process.
OBX segments can be sent by the placer along with an order to provide the
filling service with clinical data needed to interpret the results. (See
Chapter 7 for OBX details.)
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM # |
ELEMENT NAME |
|---|---|---|---|---|---|---|---|
1 |
4 |
SI |
O |
00237 |
Set ID - OBR |
||
2 |
22 |
EI |
C |
00216 |
Placer Order Number |
||
3 |
22 |
EI |
C |
00217 |
Filler Order Number |
||
4 |
250 |
CE |
R |
00238 |
Universal Service Identifier |
||
5 |
2 |
ID |
B |
00239 |
Priority - OBR |
||
6 |
26 |
TS |
B |
00240 |
Requested Date/Time |
||
7 |
26 |
TS |
C |
00241 |
Observation Date/Time # |
||
8 |
26 |
TS |
O |
00242 |
Observation End Date/Time # |
||
9 |
20 |
CQ |
O |
00243 |
Collection Volume * |
||
10 |
250 |
XCN |
O |
Y |
00244 |
Collector Identifier * |
|
11 |
1 |
ID |
O |
0065 |
00245 |
Specimen Action Code * |
|
12 |
250 |
CE |
O |
00246 |
Danger Code |
||
13 |
300 |
ST |
O |
00247 |
Relevant Clinical Information |
||
14 |
26 |
TS |
C |
00248 |
Specimen Received Date/Time * |
||
15 |
300 |
CM |
O |
0070/ 0163/ 0 369 |
00249 |
Specimen Source |
|
16 |
250 |
XCN |
O |
Y |
00226 |
Ordering Provider |
|
17 |
250 |
XTN |
O |
Y/2 |
00250 |
Order Callback Phone Number |
|
18 |
60 |
ST |
O |
00251 |
Placer Field 1 |
||
19 |
60 |
ST |
O |
00252 |
Placer Field 2 |
||
20 |
60 |
ST |
O |
00253 |
Filler Field 1 + |
||
21 |
60 |
ST |
O |
00254 |
Filler Field 2 + |
||
22 |
26 |
TS |
C |
00255 |
Results Rpt/Status Chng - Date/Time + |
||
23 |
40 |
CM |
O |
00256 |
Charge to Practice + |
||
24 |
10 |
ID |
O |
0074 |
00257 |
Diagnostic Serv Sect ID |
|
25 |
1 |
ID |
C |
0123 |
00258 |
Result Status + |
|
26 |
400 |
CM |
O |
00259 |
Parent Result + |
||
27 |
200 |
TQ |
O |
Y |
00221 |
Quantity/Timing |
|
28 |
250 |
XCN |
O |
Y/5 |
00260 |
Result Copies To |
|
29 |
200 |
CM |
O |
00222 |
Parent |
||
30 |
20 |
ID |
O |
0124 |
00262 |
Transportation Mode |
|
31 |
250 |
CE |
O |
Y |
00263 |
Reason for Study |
|
32 |
200 |
CM |
O |
00264 |
Principal Result Interpreter + |
||
33 |
200 |
CM |
O |
Y |
00265 |
Assistant Result Interpreter + |
|
34 |
200 |
CM |
O |
Y |
00266 |
Technician + |
|
35 |
200 |
CM |
O |
Y |
00267 |
Transcriptionist + |
|
36 |
26 |
TS |
O |
00268 |
Scheduled Date/Time + |
||
37 |
4 |
NM |
O |
01028 |
Number of Sample Containers * |
||
38 |
250 |
CE |
O |
Y |
01029 |
Transport Logistics of Collected Sample * |
|
39 |
250 |
CE |
O |
Y |
01030 |
Collector's Comment * |
|
40 |
250 |
CE |
O |
01031 |
Transport Arrangement Responsibility |
||
41 |
30 |
ID |
O |
0224 |
01032 |
Transport Arranged |
|
42 |
1 |
ID |
O |
0225 |
01033 |
Escort Required |
|
43 |
250 |
CE |
O |
Y |
01034 |
Planned Patient Transport Comment |
|
44 |
250 |
CE |
O |
0088 |
00393 |
Procedure Code |
|
45 |
250 |
CE |
O |
Y |
0340 |
01316 |
Procedure Code Modifier |
46 |
250 |
CE |
O |
Y |
0411 |
01474 |
Placer Supplemental Service Information |
47 |
250 |
CE |
O |
Y |
0411 |
01475 |
Filler Supplemental Service Information |
The
daggered (+) items in this segment are known to the filler, not the placer.
They are valued by the filler as needed when the OBR segment is returned as
part of a report.
The starred (*) fields are only relevant when an observation is associated with
a specimen. These are completed by the placer when the placer obtains the
specimen. They are completed by the filler when the filler obtains the
specimen.
OBR-7-observation date/time and OBR-8-observation end date/time
(flagged with #) are the physiologically relevant times. In the case of an
observation on a specimen, they represent the start and end of the specimen
collector. In the case of an observation obtained directly from a subject
(e.g., BP, Chest X-ray), they represent the start and end time of the
observation.
Definition: For the first order transmitted, the sequence number shall be 1; for the second order, it shall be 2; and so on.
Components:
<entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID
(ST)> ^ <universal ID type (ID)>
Definition: This field is identical to ORC-2-placer order number.
This field is a special case of the Entity Identifier data type (Section
2.8.13). The first component is a string that identifies an individual order
(e.g., OBR). A limit of fifteen (15) characters is suggested but not required.
It is assigned by the placer (ordering application). An implementation is HL7
compliant when the number of characters for this field is increased to
accommodate applications that require a greater number of characters for the
Placer order number. It identifies an order uniquely among all orders from a
particular ordering application. The second through fourth components contain
the application ID of the placing application in the same form as the HD data
type (Section 2.8.18, "HD - Hierarchic designator"). The second component,
namespace ID, is a user-defined coded value that will be uniquely associated
with an application. A limit of six (6) characters is suggested but not
required. A given institution or group of intercommunicating institutions
should establish a unique list of applications that may be potential placers
and fillers and assign unique application IDs. The components are separated by
component delimiters.
See ORC-2-placer order number (Section <IP_ADDRESS>) for information on when
this field must be valued.
Components:
<entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID
(ST)> ^ <universal ID type (ID)>
Definition: This is a permanent identifier for an order and its associated
observations. It is a special case of the Entity Identifier data type (see
Chapter 2, Section 2.9.17, "EI - entity identifier").
The first component is a string that identifies an individual order segment
(e.g., OBR). It is assigned by the order filling (receiving) application. It
identifies an order uniquely among all orders from a particular filling
application (e.g., clinical laboratory). A limit of fifteen (15) characters is
suggested but not required.
The second through fourth components contain the filler application ID, in the
form of the HD data type (see Section 2.8.18, "HD - hierarchic designator").
The second component is a user-defined coded value that uniquely defines the
application from other applications on the network. A limit of six (6)
characters is suggested but not required. The second component of the filler
order number always identifies the actual filler of an order.
A limit of fifteen (15) characters is suggested but not required. An
implementation is HL7 compliant when the number of characters for this field is
increased to accommodate applications that require a greater number of
characters for the Filler order number.
See ORC-3-filler order number for information on when this field must be
valued.
OBR-3-filler order number is identical to ORC-3-filler order
number.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the identifier code for the requested
observation/test/battery. This can be based on local and/or "universal" codes.
We recommend the "universal" procedure identifier. The structure of this CE
data type is described in the control section.
Definition: This field has been retained for backward compatibility only. It is not used. Previously priority (e.g., STAT, ASAP), but this information is carried as the sixth component of OBR-27-quantity/timing.
Definition: This field has been retained for backward compatibility only. It is not used. Previously requested date/time. This information is now carried in the fourth component of the OBR-27-quantity/timing.
Definition: This field is the clinically relevant date/time of the observation. In the case of observations taken directly from a subject, it is the actual date and time the observation was obtained. In the case of a specimen-associated study, this field shall represent the date and time the specimen was collected or obtained. (This is a results-only field except when the placer or a third party has already drawn the specimen.) This field is conditionally required. When the OBR is transmitted as part of a report message, the field must be filled in. If it is transmitted as part of a request and a sample has been sent along as part of the request, this field must be filled in because this specimen time is the physiologically relevant date/time of the observation.
Definition: This field contains the end date and time of a study or timed specimen collection. If an observation takes place over a substantial period of time, it will indicate when the observation period ended. For observations made at a point in time, it will be null. This is a results field except when the placer or a party other than the filler has already drawn the specimen.
Components:
<quantity (NM)> ^ <units (CE)>
Subcomponents of units: <identifier (ST)> & <text (ST)>
& <name of coding system (IS)> & <alternate identifier
(ST)> & <alternate text (ST)> & <name of alternate coding
system (IS)>
Definition: For laboratory tests, the collection volume is the volume of a
specimen. The default unit is ML. Specifically, units should be expressed in
the ISO Standard unit abbreviations (ISO-2955, 1977). This is a results-only
field except when the placer or a party has already drawn the specimen. (See
Chapter 7 for full details about units.)
Components:
In Version 2.3 and later, use instead of the CN data type. <ID number
(ST)> ^ <family name (FN)> ^ <given name (ST)> ^ <second or
further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III)
(ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^
<source table (IS)> ^ <assigning authority (HD)> ^ <name type
code (ID)> ^ <identifier check digit (ST)> ^ <code identifying the
check digit scheme employed (ID)> ^ <identifier type code (IS)> ^
<assigning facility (HD)> ^ <name representation code (ID)> ^
<name context (CE)> ^ <name validity range (DR)> ^ < name
assembly order (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: When a specimen is required for the study, this field will
identify the person, department, or facility that collected the specimen.
Either name or ID code, or both, may be present.
Definition:
This field identifies the action to be taken with respect to the specimens
that accompany or precede this order. The purpose of this field is to further
qualify (when appropriate) the general action indicated by the order control
code contained in the accompanying ORC segment. For example, when a new order
(ORC - "NW") is sent to the lab, this field would be used to tell the lab
whether or not to collect the specimen ("L" or "O"). Refer to HL7 Table
0065 - Specimen action code for valid values.
Value |
Description |
|---|---|
A |
Add ordered tests to the existing specimen |
G |
Generated order; reflex order |
L |
Lab to obtain specimen from patient |
O |
Specimen obtained by service other than Lab |
P |
Pending specimen; Order sent prior to delivery |
R |
Revised order |
S |
Schedule the tests specified below |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the code and/or text indicating any known or
suspected patient or specimen hazards, e.g., patient with active tuberculosis
or blood from a hepatitis patient. Either code and/or text may be absent.
However, the code is always placed in the first component position and any free
text in the second component. Thus, free text without a code must be preceded
by a component delimiter.
Definition: This field contains the additional clinical information about the patient or specimen. This field is used to report the suspected diagnosis and clinical findings on requests for interpreted diagnostic studies. Examples include reporting the amount of inspired carbon dioxide for blood gasses, the point in the menstrual cycle for cervical pap tests, and other conditions that influence test interpretations. For some orders this information may be sent on a more structured form as a series of OBX segments (see Chapter 7) that immediately follow the order segment.
Definition: For observations requiring a specimen, the specimen received date/time is the actual login time at the diagnostic service. This field must contain a value when the order is accompanied by a specimen, or when the observation required a specimen and the message is a report.
Components:
<specimen source name or code (CE)> ^ <additives (TX)> ^
<freetext (TX)> ^ <body site (CE)> ^ <site modifier (CE)> ^
<collection method modifier code (CE)> ^ <specimen role
(CE)>
Subcomponents of specimen source name or role: <identifier (ST)>
& <test (ST)> & <name of coding system (IS)> &
<alternate identifier (ST)> & <alternate text (ST)> &
<name of alternate coding system (ST)>
Subcomponents of body site: <identifier (ST)> & <test (ST)>
& <name of coding system (IS)> & <alternate identifier
(ST)> & <alternate text (ST)> & <name of alternate coding
system (ST)>
Subcomponents of site modifier: <identifier (ST)> & <test
(ST)> & <name of coding system (IS)> & <alternate
identifier (ST)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Subcomponents of collection method modifier code: <identifier (ST)>
& <test (ST)> & <name of coding system (IS)> &
<alternate identifier (ST)> & <alternate text (ST)> &
<name of alternate coding system (ST)>
Subcomponents of specimen role: <identifier (ST)> & <test
(ST)> & <name of coding system (IS)> & <alternate
identifier (ST)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field identifies the site where the specimen should be
obtained or where the service should be performed.
The first component contains the specimen source name or code (as a CE data
type component). (Even in the case of observations whose name implies the
source, a source may be required, e.g., blood culture-heart blood.) Refer
to HL7 Table 0070 - Specimen source codes for valid
entries.
The second component should include free text additives to the specimen such as
Heparin, EDTA, or Oxlate, when applicable.
The third is a free text component describing the method of collection when
that information is a part of the order. When the method of collection is
logically an observation result, it should be included as a result segment.
The fourth component specifies the body site from which the specimen was
obtained, and the fifth is the site modifier. For example, the site could be
antecubital fossa, and the site modifier "right." The components of the CE
fields become subcomponents. Refer to HL7 Table 0163 - Body site
for valid entries.
Value |
Description |
|---|---|
BE |
Bilateral Ears |
OU |
Bilateral Eyes |
BN |
Bilateral Nares |
BU |
Buttock |
CT |
Chest Tube |
LA |
Left Arm |
LAC |
Left Anterior Chest |
LACF |
Left Antecubital Fossa |
LD |
Left Deltoid |
LE |
Left Ear |
LEJ |
Left External Jugular |
OS |
Left Eye |
LF |
Left Foot |
LG |
Left Gluteus Medius |
LH |
Left Hand |
LIJ |
Left Internal Jugular |
LLAQ |
Left Lower Abd Quadrant |
LLFA |
Left Lower Forearm |
LMFA |
Left Mid Forearm |
LN |
Left Naris |
LPC |
Left Posterior Chest |
LSC |
Left Subclavian |
LT |
Left Thigh |
LUA |
Left Upper Arm |
LUAQ |
Left Upper Abd Quadrant |
LUFA |
Left Upper Forearm |
LVG |
Left Ventragluteal |
LVL |
Left Vastus Lateralis |
NB |
Nebulized |
PA |
Perianal |
PERIN |
Perineal |
RA |
Right Arm |
RAC |
Right Anterior Chest |
RACF |
Right Antecubital Fossa |
RD |
Right Deltoid |
RE |
Right Ear |
REJ |
Right External Jugular |
OD |
Right Eye |
RF |
Right Foot |
RG |
Right Gluteus Medius |
RH |
Right Hand |
RIJ |
Right Internal Jugular |
RLAQ |
Rt Lower Abd Quadrant |
RLFA |
Right Lower Forearm |
RMFA |
Right Mid Forearm |
RN |
Right Naris |
RPC |
Right Posterior Chest |
RSC |
Right Subclavian |
RT |
Right Thigh |
RUA |
Right Upper Arm |
RUAQ |
Right Upper Abd Quadrant |
RUFA |
Right Upper Forearm |
RVL |
Right Vastus Lateralis |
RVG |
Right Ventragluteal |
The
fifth component indicates whether the specimen is frozen as part of the
collection method. Suggested values are F (Frozen); R (Refrigerated). If the
component is blank, the specimen is assumed to be at room temperature.
Refer to section 4.19.2 for the contents of the HL7 Table 0070 Specimen
source codes
The 7th component indicates the role of the sample. Refer to
User-defined Table
0369
- Specime
n
Role for suggested values. Each of these values is normally
identifiable by the systems and its components and can influence processing and
data management related to the specimen.
This is a user-defined table with following recommended values. If the value
is blank, it is assumed to be a patient specimen.
Value |
Description |
P |
Patient (default if blank component value) |
Q |
Control specimen |
C |
Calibrator |
B |
Blind Sample |
R |
Replicate (of patient sample as a control) |
Components:
In Version 2.3 and later, use instead of the CN data type. <ID number
(ST)> ^ <family name (FN)> ^ <given name (ST)> ^ <second or
further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III)
(ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^
<source table (IS)> ^ <assigning authority (HD)> ^ <name type
code (ID)> ^ <identifier check digit (ST)> ^ <code identifying the
check digit scheme employed (ID)> ^ <identifier type code (IS)> ^
<assigning facility (HD)> ^ <name representation code (ID)> ^
<name context (CE)> ^ <name validity range (DR)> ^ < name
assembly order (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field identifies the provider who ordered the test. Either
the ID code or the name, or both, may be present. This is the same as
ORC-12-ordering provider.
Components:
[NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^
<telecommunication use code (ID)> ^ <telecommunication equipment type
(ID)> ^ <email address (ST)> ^ <country code (NM)> ^
<area/city code (NM)> ^ <phone number (NM)> ^ <extension
(NM)> ^ <any text (ST)>
Definition: This field contains the telephone number for reporting a status or
a result using the standard format with extension and/or beeper number when
applicable.
Definition: This field is user field #1. Text sent by the placer will be returned with the results.
Definition: This field is similar to placer field #1.
Definition: This field is definable for any use by the filler (diagnostic service).
Definition: This field is similar to filler field #1.
Definition: This field specifies the date/time when the results were reported or status changed. This field is used to indicate the date and time that the results are composed into a report and released, or that a status, as defined in ORC-5 order status, is entered or changed. (This is a results field only.) When other applications (such as office or clinical database applications) query the laboratory application for untransmitted results, the information in this field may be used to control processing on the communications link. Usually, the ordering service would want only those results for which the reporting date/time is greater than the date/time the inquiring application last received results.
Components:
<dollar amount (MO)> ^ <charge code (CE)>
Subcomponents of dollar amount: <quantity (NM)> &
<denomination (ID)>
Subcomponents of charge code: <identifier (ST)> & <test
(ST)> & <name of coding system (IS)> & <alternate
identifier (ST)> & <alternate text (ST)> & <name of
alternate coding system (ST)>
Definition: This field is the charge to the ordering entity for the studies
performed when applicable. The first component is a dollar amount when known by
the filler. The second is a charge code when known by the filler (results
only).
Definition:
This field is the section of the diagnostic service where the observation was
performed. If the study was performed by an outside service, the
identification of that service should be recorded here. Refer to
HL7
Table 0074 - Diagnostic service section ID for valid entries.
Value |
Description |
Value |
Description |
|---|---|---|---|
AU |
Audiology |
OUS |
OB Ultrasound |
BG |
Blood Gases |
OT |
Occupational Therapy |
BLB |
Blood Bank |
OTH |
Other |
CUS |
Cardiac Ultrasound |
OSL |
Outside Lab |
CTH |
Cardiac Catheterization |
PHR |
Pharmacy |
CT |
CAT Scan |
PT |
Physical Therapy |
CH |
Chemistry |
PHY |
Physician (Hx. Dx, admission note, etc.) |
CP |
Cytopathology |
PF |
Pulmonary Function |
EC |
Electrocardiac (e.g., EKG, EEC, Holter) |
RAD |
Radiology |
EN |
Electroneuro (EEG, EMG,EP,PSG) |
RX |
Radiograph |
HM |
Hematology |
RUS |
Radiology Ultrasound |
ICU |
Bedside ICU Monitoring |
RC |
Respiratory Care (therapy) |
IMM |
Immunology |
RT |
Radiation Therapy |
LAB |
Laboratory |
SR |
Serology |
MB |
Microbiology |
SP |
Surgical Pathology |
MCB |
Mycobacteriology |
TX |
Toxicology |
MYC |
Mycology |
VUS |
Vascular Ultrasound |
NMS |
Nuclear Medicine Scan |
VR |
Virology |
NMR |
Nuclear Magnetic Resonance |
XRC |
Cineradiograph |
NRS |
Nursing Service Measures |
Definition:
This field contains the status of results for this order. This conditional
field is required whenever the OBR is contained in a report message. It is not
required as part of an initial order.
There are two methods of sending status information. If the status is that of
the entire order, use ORC-15-order effective date/time and
ORC-5-order status. If the status pertains to the order detail segment,
use OBR-25-result status and OBR-22-results rpt/status chng -
date/time. If both are present, the OBR values override the ORC values.
This field would typically be used in a response to an order status query where
the level of detail requested does not include the OBX segments. When the
individual status of each result is necessary, OBX-11-observ result
status may be used. Refer to HL7 table 0123 - Result status
for valid entries.
Value |
Description |
Value |
Description |
|---|---|---|---|
O |
Order received; specimen not yet received |
R |
Results stored; not yet verified |
I |
No results available; specimen received, procedure incomplete |
F |
Final results; results stored and verified. Can only be changed with a corrected result. |
S |
No results available; procedure scheduled, but not done |
X |
No results available; Order canceled. |
A |
Some, but not all, results available |
Y |
No order on record for this test. (Used only on queries) |
P |
Preliminary: A verified early result is available, final results not yet obtained |
Z |
No record of this patient. (Used only on queries) |
C |
Correction to results |
Components:
<OBX-3-observation identifier of parent result (CE)> ^ <OBX-4-sub-ID
of parent result (ST)> ^ <part of OBX-5 observation result from parent
(TX)see discussion>
Subcomponents of OBX-3-observation identifier of parent result:
<identifier (ST)> & <test (ST)> & <name of coding system
(IS)> & <alternate identifier (ST)> & <alternate text
(ST)> & <name of alternate coding system (ST)>
Definition: This field is defined to make it available for other types of
linkages (e.g., toxicology). This important information, together with the
information in OBR-29-parent, uniquely identifies the parent result's
OBX segment related to this order. The value of this OBX segment in the parent
result is the organism or chemical species about which this battery reports.
For example, if the current battery is an antimicrobial susceptibility, the
parent results identified OBX contains a result which identifies the organism
on which the susceptibility was run. This indirect linkage is preferred
because the name of the organism in the parent result may undergo several
preliminary values prior to finalization.
The third component may be used to record the name of the microorganism
identified by the parent result directly. The organism in this case should be
identified exactly as it is in the parent culture.
We emphasize that this field does not take the entire result field from the
parent. It is meant only for the text name of the organism or chemical
subspecies identified. This field is included only to provide a method for
linking back to the parent result for those systems that could not generate
unambiguous Observation IDs and sub-IDs.
This field is present only when the parent result is identified by
OBR-29-parent and the parent spawns child orders for each of many
results. (See Chapter 7 for more details about this linkage.)
A second mode of conveying this information is to use a standard observation
result segment (OBX). If more than one organism is present,
OBX-4-observation sub-ID is used to distinguish them. In this case, the
first OBX with subID N will contain a value identifying the Nth microorganism,
and each additional OBX with subID N will contain susceptibility values for a
given antimicrobial test on this organism.
 See Section 4.3, "Quantity/Timing (TQ) Data Type D."
Components:
In Version 2.3 and later, use instead of the CN data type. <ID number
(ST)> ^ <family name (FN)> ^ <given name (ST)> ^ <second or
further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III)
(ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^
<source table (IS)> ^ <assigning authority (HD)> ^ <name type
code (ID)> ^ <identifier check digit (ST)> ^ <code identifying the
check digit scheme employed (ID)> ^ <identifier type code (IS)> ^
<assigning facility (HD)> ^ <name representation code (ID)> ^
<name context (CE)> ^ <name validity range (DR)> ^ < name
assembly order (ID)>
Subcomponents of assigning authority: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> &
<universal ID (ST)> & <universal ID type (ID)
Definition: This field identifies the people who are to receive copies of the
results. By local convention, either the ID number or the name may be absent.
Components:
<parent's placer order number (EI)> ^ <parent's filler order number
(EI)>
Subcomponents of parent's placer order number: <entity identifier
(ST)> & <namespace ID (IS)> & <universal ID (ST)> &
<universal ID type (IS)>
Subcomponents of parent's filler order number: <entity identifier
(ST)> & <namespace ID (IS)> & <universal ID (ST)> &
<universal ID type (IS)>
Definition: This field is identical to ORC-8-parent. This field
relates a child to its parent when a parent-child relationship exists. For
example, observations that are spawned by previous observations, e.g.,
antimicrobial susceptibilities spawned by blood cultures, need to record the
parent (blood culture) filler order number here. The parent-child mechanism is
described under the order control field notes (see Section <IP_ADDRESS>.1, "Table
notes for order control codes of ORC"). It is required when the order is a
child.
Parent is a two-component field. The components of the placer order number and
the filler order number are transmitted in subcomponents of the two components
of this field.
Definition:
This field identifies how (or whether) to transport a patient, when
applicable. Refer to HL7 Table 0124 - Transportation mode for
valid codes.
Value |
Description |
|---|---|
CART |
Cart - patient travels on cart or gurney |
PORT |
The examining device goes to patient's location |
WALK |
Patient walks to diagnostic service |
WHLC |
Wheelchair |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field is the code or text using the conventions for coded
fields given in the Control chapter (Chapter 2). This is required for some
studies to obtain proper reimbursement.
Components:
<name (CN)> ^ <start date/time (TS)> ^ <end date/time (TS)> ^
<point of care (IS)> ^ <room (IS)> ^ <bed (IS)> ^
<facility (HD)> ^ <location status (IS)> ^ <patient location
type (IS)> ^ <building (IS)> ^ <floor (IS)>
Subcomponents of name: <ID number (ST)> & <family name
(ST)> & <given name (ST)> & <middle initial or name
(ST)> & <suffix (e.g., JR or III) (ST)> & <prefix (e.g.,
DR) (ST)> & <degree (e.g., MD (ST)> & <source table
(IS)> & <assigning authority (HD)>
Subcomponents of facility: <namespace ID (IS)> & <universal
ID (ST)> & <universal ID type (ID)>
Definition: This field identifies the physician or other clinician who
interpreted the observation and is responsible for the report content.
Components:
<name (CN)> ^ <start date/time (TS)> ^ <end date/time (TS)> ^
<point of care (IS)> ^ <room (IS)> ^ <bed (IS)> ^
<facility (HD)> ^ <location status (IS)> ^ <patient location
type (IS)> ^ <building (IS)> ^ <floor (IS)>
Subcomponents of name: <identifier(ST)> & <test (ST)>
& <name of coding system (IS)> & <alternate identifier
(ST)> & <alternate text (ST)> & <name of alternate coding
system (ST)>
Subcomponents of facility: <namespace ID (IS)> & <universal
ID (ST)> & <universal ID type (ID)>
Definition: This field identifies the clinical observer who assisted with the
interpretation of this study.
Components:
<name (CN)> ^ <start date/time (TS)> ^ <end date/time (TS)> ^
<point of care (IS)> ^ <room (IS)> ^ <bed (IS)> ^
<facility (HD)> ^ <location status (IS)> ^ <patient location
type (IS)> ^ <building (IS)> ^ <floor (IS)>
Subcomponents of name: <identifier(ST)> & <test (ST)>
& <name of coding system (IS)> & <alternate identifier
(ST)> & <alternate text (ST)> & <name of alternate coding
system (ST)>
Subcomponents of facility: <namespace ID (IS)> & <universal
ID (ST)> & <universal ID type (ID)>
Definition: This field identifies the performing technician.
Components:
<name (CN)> ^ <start date/time (TS)> ^ <end date/time (TS)> ^
<point of care (IS)> ^ <room (IS)> ^ <bed (IS)> ^
<facility (HD)> ^ <location status (IS)> ^ <patient location
type (IS)> ^ <building (IS)> ^ <floor (IS)>
Subcomponents of name: <identifier(ST)> & <test (ST)>
& <name of coding system (IS)> & <alternate identifier
(ST)> & <alternate text (ST)> & <name of alternate coding
system (ST)>
Subcomponents of facility: <namespace ID (IS)> & <universal
ID (ST)> & <universal ID type (ID)>
Definition: This field identifies the report transcriber.
Definition: This field is the date/time the filler scheduled an observation, when applicable (e.g., action code in OBR-11-specimen action code = "S"). This is a result of a request to schedule a particular test and provides a way to inform the placer of the date/time a study is scheduled (result only).
Definition: This field identifies the number of containers for a given sample. For sample receipt verification purposes; may be different from the total number of samples which accompany the order.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field is the means by which a sample reaches the diagnostic
service provider. This information is to aid the lab in scheduling or
interpretation of results. Possible answers: routine transport van, public
postal service, etc. If coded, requires a user-defined table.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field is for reporting additional comments related to the
sample. If coded, requires a user-defined table. If only free text is
reported, it is placed in the second component with a null in the first
component, e.g., ""^difficult clotting after venipuncture and
ecchymosis.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field is an indicator of who is responsible for arranging
transport to the planned diagnostic service. Examples: Requester, Provider,
Patient. If coded, requires a user-defined table.
Definition:
This field is an indicator of whether transport arrangements are known to have
been made. Refer to HL7 Table 0224 - Transport arranged
for valid codes.
Value |
Description |
|---|---|
A |
Arranged |
N |
Not Arranged |
U |
Unknown |
Definition:
This field is an indicator that the patient needs to be escorted to the
diagnostic service department. Note: The nature of the escort requirements
should be stated in OBR-43-planned patient transport
comment. See HL7 Table 0225 - Escort required for valid values.
Value |
Description |
|---|---|
R |
Required |
N |
Not Required |
U |
Unknown |
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field is the code or free text comments on special
requirements for the transport of the patient to the diagnostic service
department. If coded, requires a user-defined table.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains a unique identifier assigned to the procedure,
if any, associated with the Universal Service ID reported in field 4.
User-defined table 0088 - Procedure code is used as the HL7 identifier for
the user-defined table of values for this field. This field is a CE data
type for compatibility with clinical and ancillary systems. This field will
contain the HCPCS code associated with the order.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains the procedure code modifier to the procedure
code reported in field 44, when applicable. Procedure code modifiers are
defined by regulatory agencies such as HCFA and the AMA. Multiple modifiers
may be reported. Refer to user-defined table 0340 - Procedure code
modifier for suggested values.
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains supplemental service information sent from the
placer system to the filler system for the universal procedure code reported in
OBR-4 Universal Service ID. This field will be used to provide ordering
information detail that is not available in other, specific fields in the OBR
segment. Multiple supplemental service information elements may be reported.
Refer to User-defined Table 0411 - Supplemental service information
values.
This field can be used to describe details such as whether study is to be done
on the right or left, for example where the study is of the arm and the order
master file does not distinguish right from left or whether the study is to be
done with or without contrast (when the order master file does not make such
distinctions).
Components:
<identifier (ST)> ^ <text (ST)> ^ <name of coding system
(IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field contains supplemental service information sent from the
filler system to the placer system for the procedure code reported in OBR-4
Universal Service ID. This field will be used to report ordering
information details that is not available in other, specific fields in the OBR
segment. Typically it will reflect the same information as was sent to the
filler system in OBR-46-Placer supplemental information unless the
order was modified in which case the filler system will report what was
actually performed using this field. Multiple supplemental service information
elements may be reported. Refer to User-defined Table 0411 -
Supplemental service information values.
This field can be used to describe details such as whether study is to be done
on the right or left, for example where the study is of the arm and the order
master file does not distinguish right from left or whether the study is to be
done with or without contrast (when the order master file does not make such
distinctions).
Value |
Description |
|---|---|
No
suggested values |
The purpose of this section is to show how certain specific situations would be handled using the order entry protocol. The ellipses represent uncompleted details. The symbol // precedes comments for clarification.
Suppose
that an application called "PC" is sending an order to the EKG application for
three EKGs to be done on successive days.
The order might be placed as follows:
ORM message:
MSH|...<cr>
PID|...<cr>
ORC|NW|A226677^PC||946281^PC||N|3^QAM||198801121132|P123^AQITANE^ELLINORE^""^""^""^MD|||4EAST|...<cr>
// EKG order
OBR|1|||8601-7^EKG
IMPRESSION^LN||||||||||||P030^SMITH^MARTIN^""^""^""^MD|||||||||||3^QAM|...<cr>
BLG|...<cr>
ORC|NW|...<cr>
// Another order yet others may follow
There is a group number first component indicating that an order group is being
created.
Responses: Because the EKG application must turn the single order above into
three orders for three separate EKGs (services), the results of each will be
reported under its own OBR segment. Several response levels are possible
depending on the Response Flag:
a) If the Response Flag is N (as it is), then the filler EKG application only
responds "I got the order."
MSH|...<cr>
MSA|...<cr>
The only implication of this response is that the order was received.