emsdocs

This document is commercial-in-confidence. The recipient of this document agrees to hold all information presented within as confidential and agree not to use or disclose, or allow to use or disclosure of the said information to unauthorized parties, directly or indirectly, irrespective of the acceptance or rejection of the presentation or at any time before, during or after an agreement has been reached, without prior written consent.

1. EMS Standard Order Comms Messaging

1.1. Document History

Version Date Who Comments
v0.1 - Draft 5th Dec 2017 Lee Dyson First draft
v1.0 - Release 07 June 2021 Robert McNaught Release to customer
v1.1 - Release 28th June 2021 Robert McNaught Consistency updates
v1.2 - Release 30th June 2021 Robert McNaught PD1 consolidation to standard segment doc
v1.3 - Release 16th Jul 2021 Robert McNaught Disclaimer
v1.4 - Release 29th Sept 2021 Robert McNaught Formatting and fixes

1.2. Introduction

EMS supports a traditional Order Comms workflow whereby a placer system (e.g. Sunquest ICE), or EPR system sends EMS an Order for an Endoscopy procedure. Upon receiving the order message, EMS as the filler system will immediately acknowledge receipt of the order message back to the placer system. As the order is accepted, vetted, and further processed in EMS, EMS will send subsequent status update messages back to the placer system. When the endoscopy procedure has been carried out and the Endoscopist’s report has been authorised, EMS will send a final report message back to the placer. This report message includes the clinical report as an embedded binary PDF document.

As with all other EMS interfaces, messages received from another system are mapped into appropriate FHIR message types before being processsed by EMS. HL7 ORM and OMG messages are mapped into FHIR ServiceRequest messages. EMS sends outbound DiagnosticReport FHIR messages which are mapped into HL7 ORU^R01 messages sent back to the placer system

1.3. Message Flow

Message flow diagram

1.4. Message Inbound to EMS

1.4.1. Messages Supported

Message Type Default Action
OMG^O01 Create episode
ORM^O01 Create episode

1.5. Message Structure

[] - Optional

{} - Repeating

1.5.1. ORM

MSH
PID
[PD1]
[PV1]
ORC
OBR
{OBX}
[NTE]

1.5.2. Sample ORM Order Message

MSH|^~\&|Compucare||||20210820100124|EMS|ORM^O01|946254|T|2.4
PID|1||9017308^^^Local^MR~1111111111^^^NHS^NHS||Testing^Tester^^^Mr||19940629000000|M|||The Point, Some Road^^Heresville^^HV6 3QN^^P||01532181248^HOME^PHONE~07113932374^WORK^PHONE~^NET^Internet^testing@Test.com|08102538333^MOBILE^PHONE
PD1|||116 Harley Street^^PGP1|G7123966^A DOCTOR, MP (DR)
PV1|1|D|RTT^^3^KEH|R|||C4108098^Endoscopist^P^^^Mr|G9508136^Clinician^AN^^^Dr|C7040297^Doctor^Ref^^^Mrs|||||G|||||68239
ORC|NW|CC477|||SC||||20210820100500|||C7895671^Doc^Ordering^^^Mr
OBR|1|CC477||COLON^ERCP Fluoroscop20/05/2019||20210820101500|20210908103500|||||||||6104393^BUTT^CHECK^^^MR||Endoscopy|ENDO|||||||||^^^^^ROU
NTE|1|P|VETTED|RE

1.5.3. OMG

MSH
PID
ORC
OBR
{OBX}

1.6. Messages Outbound from EMS

Messages outbound from EMS are normally results (reports) or status messages pertaining to an Order-Comms scenario.

1.7. Order Acknowledgement

1.8. Message Structure

[] - Optional

{} - Repeating

1.8.1. ORR

MSH
PID
ORC
OBR
{OBX}

1.9. Order Status Update

1.10. Message Structure

[] - Optional

{} - Repeating

1.10.1. ORM

MSH
PID
ORC
OBR
{OBX}

1.10.2. Sample ORM Status Message

MSH|^~\&|EMS|NCH|ICE|NCH|20210325112504||ORM^O01^ORM_O01|4ffbea5eaec9e327a757|P|2.4|||AL
PID|||.....REDACTED.....
ORC|SC|MLEMS_106988|||VET|||||||||||||EMS
OBR||MLEMS_106988|MLEMS_106988|OGD^Upper GI endoscopy||||||||||||||||||||||||||||||||||||||N

1.10.3. Final Report

An EMS report is essentially a PDF document containing the clinical report and supporting images from the Endoscopy investigation.

Results or reports from EMS are published as FHIR diagnostic-report bundles. The EMS integration server translates these messages into standard HL7 2.4 messages before forwarding them to recipient systems.

The report is encoded as an ORU^R01 message with the PDF binary content embedded, base-64 encoded, in an OBX segment.

Please Refer to EMS Standard Results Messaging

1.10.4. Outbound ORM Messages

EMS supports outbound ORM messages for order-comms workflows.

1.11. HL7 Segment Definitions

The following segment definitions apply to messages inbound and outbound. If a field is not documented, then it is not considered mandatory or processed by EMS on inbound messages.

1.11.1. MSH

Please Refer to EMS Standard Segment Definitions

1.11.2. MSA

Field Name Required Example Notes
1 Ack Code Y AA AE,AR
2 Msg Control Id Y    
3 Text Message N   Descriptive Error Text

1.11.3. PID

Please Refer to EMS Standard Segment Definitions

Note:

1.11.4. PD1

Please Refer to EMS Standard Segment Definitions

Note:

1.11.5. PV1

The PV1 segment is used both inbound and outbound.

Field Name Required Example Notes
2 Patient Management     see DefaultReferenceData
3 Location Code     Clinic code or location code
3.1 Point of Care   RTT Room local code. Room must be setup in EMS. INBOUND
3.4 Facility   KEH Site local code. Site must be setup in EMS. INBOUND
7 Attending Doctor   C1234567 GMC Number from ODS or ISD list of Endoscopist (performer) being requested. INBOUND
9 Consulting Doctor     GMC code + Name of consultant
14 Admit Source   G Referral source. see DefaultReferenceData INBOUND
18 Patient Type N NHS,PRIVATE see DefaultReferenceData
19 Visit Number N   Round trip data item, not used in EMS but can be returned if requested. INBOUND
44 Admit Date Time     YYYYMMDDhhmmss - Date time of booked endoscopy

Note:

1.11.6. ORC

ORC is used in Order-Comms messages, and results inbound to, and outbound from EMS.

Field Name Required Example Notes
1 Order Controls Y   Used to communicate order status / action
2.1 Placer Order Number Y    
3.1 Filler Order Number N    
5 Order Status Y   Used in conjunction with ORC-1
7 Timing Quantity N   EMS sends appointment booked date/time in this field. For results this is the date/time of the actual examination
9 Transaction DateTime     Date time EMS user ended this result
10 Entered By     Details of PMS users entering details
12 Order Provider     National code of orderer, GP, Consultant
17 Entering Organisation     Specialty of requesting clinician
21 Ordering Facility     ODS hospital code, Consultant code, or GP practice code.

Note: Orders into EMS will contain:-

Results from EMS will contain:-

1.11.7. OBR

OBR is used in Order-Comms messages as well as results inbound to and outbound from EMS.

Field Name Required Example Notes
1 Set Id N 1  
2 Placer’s Order number Y    
3 Filler’s Order number N    
4 Service Id Y code^text The investigation being ordered
7 Date Time N YYYYMMDDHHmm In INBOUND Order messages, indicates the requested procedure / appointment date/time
20 Filler field 1 N   EMS generated key
21 Filer field 2 N   EMS Generated order number
22 Results status changed time N   date / time of result status change (in reports)
27.4 Quantity Timing - Start Time     Date time examination is booked for, or date time examination was performed
27.6 Quantity Timing - Priority   ROU, Emergency Appointment Type see DefaultReferenceData

Notes

1.11.8. OBX

Field Name Required Example Notes
1 Set Id N 1  
2 Value Type   NM,TX,ED e.g. numeric, Encapsulated data, Coded Entry etc.
3 Observation Identifier N   Used for _flags_in order messages
5 Observation value N   Also used for flags in order messages, PDF in report messages
6 Units      
7 Reference range      
8 Abnormal flags   H,L e.g. High, low
11 Observation status Y P,F,C Preliminary, final, changed
14 Observation date/time      
16     code^name of reporting clinician

1.11.9. Binary Attachments

OBX segments in EMS report messages are used to carry binary/PDF document content.

Field Name Required Example Notes
2 Value Type Y ED Encapsulated Data
3 Observation Identifier      
5 Observation Value   DOC^PDF^Base64^zzzzzzzbased 64-content also HL7-encoded for \X0D and \X0A

1.11.10. Cerner OEF segments

Cerner OEF Order Entry Fields are typically encoded as CE type OBX segments. These can be used in inbound messages (i.e. PAS to EMS) to carry site-specific flags which cannot be accommodated elsewhere in the order message

1.11.10.1. Example Cerner flag

OBX|1|TX|URGENT^EMS||YES||||F